strategies to promote critical thinking in nursing

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What Is Critical Thinking In Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples

Last updated on August 19th, 2023

Nurses play a critical role in making critical decisions that directly impact patient outcomes in the dynamic field of healthcare. Developing strong critical thinking skills is essential for success in this role.

In this article, we present a comprehensive list of 23 nursing-specific strategies aimed at improving critical thinking and improve the quality of patient care.

24 Strategies to improve critical thinking skills in nursing

You may also want to check out: 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

1. Reflective Journaling: Delving into Deeper Understanding

Reflective journaling is a potent tool for nurses to explore their experiences, actions, and decisions.

By regularly pondering over situations and analyzing their thought processes, nurses can identify strengths and areas for improvement.

This practice encourages the conscious development of critical thinking by comparing past experiences with current knowledge and exploring alternative solutions.

After a particularly challenging case, a nurse reflects on their decision-making process, exploring what worked well and what could have been done differently.

2. Meeting with Colleagues: Collaborative Learning for Critical Thinking

Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills .

Colleagues’ insights can challenge assumptions and broaden perspectives, ultimately leading to more well-rounded clinical judgments.

A nursing team gathers to discuss a recent complex case, sharing their perspectives, insights, and lessons learned to collectively improve patient care strategies.

3. Concept Mapping: Visualizing Complexity

Concept mapping is an excellent technique to synthesize intricate patient information. By creating visual representations of patient problems and interventions, nurses can identify relationships and patterns that might not be apparent otherwise.

This strategy aids in comprehensive care planning and encourages nurses to think holistically about patient care.

Creating a concept map to connect patient symptoms, diagnostics, and interventions reveals patterns that help the nurse formulate a comprehensive care plan.

4. Socratic Questioning: Digging Deeper into Situations

The art of Socratic questioning involves asking probing questions that lead to deeper understanding.

Applying this technique allows nurses to uncover assumptions, examine inconsistencies, and explore multiple viewpoints.

This approach is especially valuable when reviewing patient history, discussing conditions, and planning care strategies.

When assessing a patient’s deteriorating condition, a nurse asks probing questions to uncover potential underlying causes and prioritize appropriate interventions.

5. Inductive and Deductive Reasoning: From Specifics to Generalizations

Developing skills in both inductive and deductive reasoning equips nurses to analyze situations from different angles.

Inductive reasoning involves drawing conclusions from specific observations, while deductive reasoning starts with general premises to arrive at specific conclusions.

Proficient use of these methods enhances nurses’ ability to make accurate clinical judgments.

When encountering a series of patients with similar symptoms, a nurse uses inductive reasoning to identify a common pattern and deduce potential causes.

6. Distinguishing Statements: Fact, Inference, Judgment, and Opinion

Clear thinking demands the ability to differentiate between statements of fact, inference, judgment, and opinion.

Nurses must critically evaluate information sources, ensuring they rely on evidence-based practice.

This skill safeguards against misinformation and supports informed decision-making.

While reviewing a patient’s history, a nurse differentiates factual medical information from inferences and subjective judgments made by different healthcare professionals.

7. Clarifying Assumptions: Promoting Effective Communication

Recognizing assumptions and clarifying their underlying principles is vital for effective communication. Nurses often hold differing assumptions, which can impact patient care.

By acknowledging these assumptions and encouraging open discussions, nursing teams can collaboratively create care plans that align with patients’ best interests.

Before suggesting a treatment plan, a nurse engages in a conversation with a patient to understand their cultural beliefs and preferences, ensuring assumptions are not made.

8. Clinical Simulations: Learning through Virtual Scenarios

Clinical simulations provide nurses with a risk-free environment to practice decision-making and problem-solving skills.

These virtual scenarios mimic real-life patient situations and allow nurses to test different approaches, assess outcomes, and reflect on their choices.

By engaging in simulations, nurses can refine their critical thinking abilities, learn from mistakes, and gain confidence in their clinical judgment.

Engaging in a simulated scenario where a patient’s condition rapidly changes challenges a nurse’s decision-making skills in a controlled environment.

9. Case Studies and Grand Rounds: Analyzing Complex Cases

Engaging in case studies and participating in grand rounds exposes nurses to complex patient cases that require in-depth analysis.

Working through these scenarios encourages nurses to consider various factors, potential interventions, and their rationale.

Discussing these cases with colleagues and experts fosters collaborative critical thinking and widens the spectrum of possible solutions.

Nurses participate in grand rounds, discussing a challenging case involving multiple medical specialties, encouraging a holistic approach to patient care.

10. Continuing Education and Lifelong Learning: Expanding Knowledge

Staying up-to-date with the latest advancements in nursing and healthcare is crucial for effective critical thinking.

Pursuing continuing education opportunities, attending conferences, and engaging in self-directed learning keeps nurses informed about new research, technologies, and best practices.

This continuous learning enriches their knowledge base, enabling them to approach patient care with a well-rounded perspective.

Attending a nursing conference on the latest advancements in wound care equips a nurse with evidence-based techniques to improve patient outcomes.

11. Debates and Discussions: Encouraging Thoughtful Dialogue

Organizing debates or participating in structured discussions on healthcare topics stimulates critical thinking.

Engaging in debates requires researching and presenting evidence-based arguments, promoting the evaluation of different perspectives.

Nurses can exchange insights, challenge assumptions, and refine their ability to defend their viewpoints logically.

Engaging in a debate on the pros and cons of a new treatment method encourages nurses to critically analyze different viewpoints and strengthen their own understanding.

12. Multidisciplinary Collaboration: Gaining Insights from Various Disciplines

Collaborating with professionals from diverse healthcare disciplines enriches nurses’ critical thinking.

Interacting with doctors, pharmacists, therapists, and other experts allows nurses to benefit from different viewpoints and approaches.

This cross-disciplinary collaboration broadens their understanding and encourages innovative problem-solving.

Collaborating with physical therapists, nutritionists, and pharmacists helps a nurse develop a holistic care plan that addresses all aspects of a patient’s recovery.

13. Ethical Dilemma Analysis: Balancing Patient Autonomy and Best Practice

Ethical dilemmas are common in nursing practice. Analyzing these situations requires nurses to weigh the principles of beneficence, non-maleficence, autonomy, and justice.

By critically examining ethical scenarios, nurses develop the capacity to navigate morally complex situations, prioritize patient welfare, and make ethically sound decisions.

When faced with a patient’s refusal of treatment due to religious beliefs, a nurse evaluates the ethical considerations, respects autonomy, and seeks alternatives.

14. Root Cause Analysis: Investigating Adverse Events

When adverse events occur, performing a root cause analysis helps identify the underlying causes and contributing factors.

Nurses engage in a systematic process of analyzing events, exploring the “5 Whys” technique , and developing strategies to prevent similar occurrences in the future.

This approach cultivates a thorough and analytical approach to problem-solving.

After a medication error, a nurse leads a root cause analysis to identify system failures and implement preventive measures to enhance patient safety.

15. Creative Thinking Exercises: Expanding Solution Repertoire

Encouraging creative thinking through brainstorming sessions or scenario-based exercises widens the range of possible solutions nurses consider.

By thinking outside the box and exploring innovative approaches, nurses develop adaptable problem-solving skills that can be applied to complex patient care challenges.

Brainstorming creative approaches to comfort a distressed pediatric patient empowers a nurse to find innovative methods beyond routine interventions.

16. Journal Clubs: Fostering Evidence-Based Discussion

Participating in journal clubs involves healthcare professionals coming together to dissect recent research articles.

This practice ignites critical thinking by allowing nurses to evaluate study methodologies, scrutinize findings, and consider the implications for their practice.

Engaging in evidence-based discussions not only cultivates a culture of critical inquiry but also reinforces continuous learning.

At the monthly journal club meeting, Nurse Mark engages in a discussion on a recent research article focusing on pain management strategies for post-operative patients.

The group analyzes the study design, scrutinizes the findings, and considers the potential implications for their practice.

During the discussion, Mark raises thought-provoking questions about the study’s methodology and suggests potential applications in their hospital’s patient care protocols.

This active participation in journal clubs not only refines Mark’s critical thinking but also instills evidence-based practices into his nursing approach.

17. Critical Reflection Groups: Collaborative Learning and Analysis

Similarly, establishing critical reflection groups, where nurses meet regularly to discuss experiences, cases, and challenges, fosters collective learning.

These sessions encourage the exchange of diverse perspectives, enriching the analysis process and ultimately enhancing patient care strategies.

Through shared insights and discussions, nurses can refine their clinical reasoning and broaden their problem-solving capabilities.

Nurse Emma actively participates in critical reflection groups in order to broaden her clinical knowledge. During a recent meeting, the group tackled a difficult patient case with complicated symptomatology.

Emma suggests alternative diagnostic pathways based on her own experiences. Emma’s critical thinking skills are honed as a result of the group’s dynamic interaction, which also emphasizes the importance of collaborative decision-making in complex scenarios.

18. Mindfulness and Reflection Practices: Enhancing Self-Awareness

Mindfulness techniques, such as meditation and deep breathing, encourage self-awareness and a clear mind.

Engaging in these practices helps nurses become more attuned to their thoughts and emotions, leading to better self-regulation and improved decision-making during high-pressure situations.

Engaging in mindfulness exercises before a demanding shift helps a nurse maintain focus, manage stress, and make clear-headed decisions.

19. Problem-Based Learning: Applying Knowledge in Real Scenarios

Problem-based learning involves presenting nurses with real-world patient cases and encouraging them to collaboratively solve the problems.

This approach bridges the gap between theoretical knowledge and practical application, fostering critical thinking through active problem-solving.

Working through a simulated patient case challenges nurses to apply theoretical knowledge to practical situations, refining their clinical reasoning.

20. Self-Assessment and Feedback: Evaluating Decision-Making Skills

Regularly assessing one’s own decision-making process and seeking feedback from peers and mentors is essential for improvement.

Reflecting on past decisions, considering alternative approaches, and understanding the rationale behind them contribute to the refinement of critical thinking skills.

A nurse evaluates their performance after a patient’s unexpected complication, seeking feedback from peers and mentors to identify areas for improvement.

21. Cultural Competence Training: Navigating Diverse Perspectives

Cultural competence training enhances critical thinking by enabling nurses to understand the diverse cultural beliefs and practices of patients.

This knowledge is vital for providing patient-centered care, as it encourages nurses to think critically about the unique needs of each individual.

A nurse attends cultural competence training to understand the dietary preferences of a diverse patient population, ensuring respectful and patient-centered care.

22. Active Listening and Empathetic Communication: Gathering Insights

Active listening and empathetic communication with patients and their families enable nurses to gather comprehensive information about their conditions, concerns, and preferences.

This data forms the basis for critical analysis and informed decision-making in patient care.

Through attentive listening, a nurse uncovers a patient’s underlying concerns, leading to an informed care plan that addresses both medical needs and emotional well-being.

23. Mentorship and Preceptorship: Learning from Experienced Professionals

Having a mentor or preceptor provides novice nurses with the opportunity to learn from experienced professionals.

Mentors guide critical thinking by sharing their insights, challenging assumptions, and offering guidance in complex situations. This relationship fosters growth and expertise development.

A novice nurse gains valuable insight from a mentor, who guides them through complex cases, offering real-world wisdom and refining critical thinking skills.

24. Self-Assessment and Feedback: Evaluating Decision-Making Skills

Reflecting on past decisions, considering alternative approaches, and understanding the rationale behind them contribute to the refinement of critical thinking skills .

Nurse Sarah regularly takes time to assess her decision-making skills by reviewing past patient cases. After a challenging case involving conflicting symptoms, she reflects on her initial approach, the outcomes, and what she could have done differently.

She seeks feedback from her senior colleague, who provides insights on alternative diagnostic paths. Sarah’s self-assessment and feedback-seeking process enable her to identify areas for improvement and refine her critical thinking in similar situations.

• Clinical Reasoning In Nursing (Explained W/ Example)
• 8 Stages Of The Clinical Reasoning Cycle
• What is Critical Thinking in Nursing? (Explained W/ Examples)

Enhancing critical thinking skills is an ongoing journey that transforms nursing practice.

Reflective journaling, collaborative learning, concept mapping, Socratic questioning , reasoning techniques, distinguishing statements, and clarifying assumptions all play integral roles in nurturing these skills.

By incorporating these strategies into their daily routines, nurses can improve their critical thinking skills.

Additionally, this will help nurses in navigating the complexities of the healthcare field with confidence, expertise, and the ability to make well-informed decisions that improve patient outcomes.

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The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

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Why Critical Thinking Skills in Nursing Are Essential

Written by: university of tulsa   •  feb 29, 2024.

Why Critical Thinking Skills in Nursing Are Essential ¶

Working in health care requires quick thinking and confident decision-making to care for patients. While nurses use a broad range of technical skills to provide quality care, an essential skill that’s easy to overlook is critical thinking. Nursing professionals should explore the benefits of critical thinking skills in nursing, how to apply them, and the ways that advanced education can sharpen their ability to make precise decisions.

Critical Thinking Skills: A Definition ¶

Critical thinking is the process of evaluating facts, interpreting information, and analyzing situations to make informed decisions in various situations. Finding the correct answer to a complex problem isn’t easy. When situations don’t have clear answers and many factors to consider, critical thinking can help individuals move forward and make decisions.

Critical thinking competencies can be applied to a wide range of workplaces and personal situations. In nursing, critical thinking skills can help deliver effective care, handle a patient crisis, and assess the efficacy of treatment plans.

The Importance of Critical Thinking Skills in Nursing ¶

The fast-paced nursing environment requires prompt, data-driven decisions. Nurses use critical thinking daily, reviewing information and making decisions to promote quality care for patients. The following benefits of critical thinking highlight the importance of this skill in nursing careers:

Improves decision-making speed. A critical thinking mindset can help nurses make timely, effective decisions in difficult situations. A systematic method to evaluate decisions and move forward is a powerful tool for nurses.

Refines communication. Improving professional communication allows for factual, efficient, and empathetic conversations with patients and other health care professionals.

Promotes open-mindedness. It’s easy to overlook certain opinions or viewpoints in a high-pressure situation. Thankfully, critical thinking promotes open-mindedness in exploring solutions.

Combats bias. A critical look at different behaviors, contexts, and viewpoints can be helpful for identifying and addressing bias. Nurses must actively seek out ways to confront and remove bias in the workplace.

Critical Thinking in the Nursing Process ¶

There are many ways to apply critical thinking skills to nursing situations. The nursing process is a five-step process to assist nurses in applying critical thinking skills to their daily duties. Experienced nurses and professionals considering a career change to nursing should review the steps as part of their critical thinking process.

Step 1: Assessment ¶

Assessing a patient means far more than taking their vital signs. It also includes collecting sociocultural and psychological data. Lifestyle factors and experiences can affect the treatment process and approach, so skilled nurses review these areas before moving toward the next step, diagnosis.

For example, if a patient reports dizziness or shortness of breath, a nurse should not only check the patient’s temperature, blood pressure, and heart rate but also ask about their family history and recent events.

Step 2: Diagnosis ¶

During the second step, a nurse’s assessment and critical thinking skills produce a clinical judgment. Nurses need to carefully consider all the factors included in the first step. When necessary, consult with other health care professionals before reaching a diagnosis or communicating that diagnosis with the patient.

Discussing a patient’s assessment with other health care professionals requires critical thinking, as the information provided about vital signs, recent events, and family history are key components of this step.

Step 3: Planning ¶

A nurse may be responsible for setting goals and planning a treatment plan for patients. The third step can include setting measurable, achievable goals. Nurses also coordinate care with other health care professionals.

Goals can be simple or complex, depending on the assessment and diagnosis. For example, one patient’s goals may include eating three meals a day, while another’s may include having multiple medications, specialist visits, and physical therapy activities as part of their treatment plan.

Step 4: Implementation ¶

Critical thinking is needed to implement the nursing process, finding ways to carry out the plan with empathy. It’s also important for nurses to document care throughout the fourth step of the process.

For example, nurses should review patient history and consider symptoms before administering medication. Nursing professionals should also think critically about which patients to see first and how to prioritize patients who may need critical attention.

Step 5: Evaluation ¶

Nurses need to continue to evaluate and review the patient’s condition using critical thinking. Evaluation allows nursing professionals to review patient conditions, recommend care plan modification, and consider overall patient status.

For example, identifying whether patients may be ready for a care plan modification or another change in care requires critical thinking and a clear, focused evaluation of multiple patient factors.

How to Foster Critical Thinking Through Nursing Education ¶

Critical thinking is integral to success in the health care field. Thankfully, many ways are available for nurses to improve their critical thinking skills. Below are training, mentoring, and education options for fostering critical thinking.

On-the-Job Training ¶

Because critical thinking is so critical to the daily duties of nurses, experience in the field can improve their ability to evaluate situations and make data-driven decisions. Working firsthand with patients and alongside skilled professionals is a powerful way to see and apply critical thinking in real-world scenarios.

Mentoring Opportunities ¶

Nurses should seek mentorship opportunities for personalized, side-by-side instruction and inspiration from fellow professionals. Mentorships can be either formal or informal opportunities to learn from skilled nurses and health care professionals to promote critical thinking.

Further Education ¶

Many continuing education opportunities are available for nurses. Professionals looking to improve their critical thinking skills should consider enrolling in a course that promotes reflection, evaluation, and analytical thinking.

Review Critical Thinking Skills With The University of Tulsa ¶

Expand your critical thinking skills in nursing by enrolling in a program to earn a degree in the field. The University of Tulsa offers an accelerated online RN to Bachelor of Science in Nursing (RN to BSN) program for students to earn their BSN in as little as 12 months. Take 30 credits of online courses to expand your medical knowledge, general education, and critical thinking abilities. Review the features of this online opportunity to see if it’s the right decision for your career.

Recommended Readings:

The Benefits of Nurse Mentoring

Hospice Nurse: Job Description and Salary

Work-From-Home Safety Checklist: Securing Your Virtual Workspace

American Nurses Association, The Nursing Process

American Nurses Association, What Are the Qualities of a Good Nurse?

Forbes , “The Power of Critical Thinking: Enhancing Decision-Making and Problem-Solving”

Indeed, “Critical Thinking in Nursing (Definition and Vital Tips)”

Indeed, “Critical Thinking Skills in Nursing: Definition and Improvement Tips”

Indeed, “15 Essential Nursing Skills to Include on Your Resume”

StatPearls, “Nursing Process”

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Strategies to promote critical thinking and active learning

15 Strategies to promote critical thinking and active learning Connie J. Rowles, DSN, RN Nursing faculty spend a considerable amount of their time planning experiences to facilitate student learning. The selection of teaching strategies and learning experiences traditionally has been governed by behavioral objectives. However, nursing education has been undergoing a major revolution, with attention focused on how to teach students to think critically. Therefore nurse educators are continually reexamining the “best” way to teach and to empower students for learning. The purpose of this chapter is to identify strategies that students and faculty can use to promote learning. The chapter begins with a discussion of critical thinking as the basis for any teaching strategy. Developing effective learning experiences comes next. A variety of teaching strategies are then presented with a discussion of their use, advantages, disadvantages, and tips for making the learning experience interactive and meaningful. Critical thinking and active learning Thinking, reflective thinking, and critical thinking have been topics of discussion among educators for many years ( Bandman & Bandman, 1995; Brookfield , 1987, 1995; Dewey , 1933; Facione , 1990; Halpern et al., 1994; Hunkins , 1985; Kurfiss , 1988; McPeck , 1981; Norris & Ennis, 1989; Paul , 1995; Perry , 1970; Siegel , 1980; Watson & Glaser, 1984). A recent search in the Cumulative Index to Nursing and Allied Health (CINAHL) located 58 articles about critical thinking even when the search was limited to full-length articles in English in the time frame of July 2009 through July 2010. One excellent source from the search is Romeo (2010). She reviewed the critical thinking literature and found issues related to the definition of critical thinking as well as issues in the use of instruments to measure critical thinking. She also cited the lack of findings that show a clear-cut correlation with factors that interest nurse educators, such as licensing exam pass rates and changes in critical thinking over time in the program. So, while there is still a lot in the literature about critical thinking, there are some who recommend a change in the dialogue about thinking in nursing. A brief discussion of some of the newer terms found in the literature follows. A common thread with the newer ideas is that they all build on a foundation of critical thinking. Clinical reasoning Clinical reasoning is the ability of the nurse to use critical thinking skills in the ever-changing clinical environment. It should include the “. . . context and concerns of the patient and family” ( Benner , Sutphen, Leonard, & Day, 2010, p. 85). Clinical imagination and reflection are also part of clinical reasoning ( Benner et al., 2010). The thought is that critical thinking is more a snapshot in time while clinical reasoning can accommodate the changing nature in clinical settings. Clinical judgment Clinical judgment can be defined as “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response” ( Tanner , 2006, p. 204). Tanner acknowledges that problem solving, critical thinking, decision making, and clinical judgment are often used in the literature to mean the same thing. Metacognition Metacognition is the “self-communication process in which a person engages before, during and after performing a task” ( Beitz , 1996, p. 23) and more commonly thought of as thinking about thinking. It is an active process of monitoring your own thinking. Kuiper and Pesut (2004) contend that it is the combination of metacognition (reflective thinking) and critical thinking that better describes the thinking necessary in nursing. Clinical reasoning, clinical judgment, and metacognition are all important in nursing. However, the basis of all of these is critical thinking. This chapter focuses on critical thinking, the ideal critical thinker, and the related cognitive skills. The ideal critical thinker defined Most experts agree that if an individual is a critical thinker, he or she not only has well-developed critical thinking skills but also exhibits what are variously described as the disposition, attitude, or traits of a critical thinker ( Baron & Sternberg, 1986; Facione , Facione, & Sanchez, 1994; Ford & Profetto-McGrath, 1994; Kataoka-Yahiro & Saylor, 1994; Paul , 1995; Pless & Clayton, 1993; Turner , 2005; Watson & Glaser, 1984). This chapter uses Facione’s (1990) definition of an ideal critical thinker. This description was derived by a consensus of experts in critical thinking who participated in a Delphi study. The panel of experts included “46 scholars, educators and leading figures in critical thinking theory and critical thinking assessment research” (p. 34). The experts essentially agreed that The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit. (p. 3) Facione et al. (1994) suggest that the Delphi study description of an ideal critical thinker describes a nurse with ideal clinical judgment. Cognitive skills (subskills) of critical thinking were also delineated in Facione’s (1990) Delphi study. These include the cognitive skills and subskills of analysis (examining ideas, identifying arguments, analyzing arguments), evaluation (assessing claims, assessing arguments), inference (querying evidence, conjecturing alternatives, drawing conclusions), interpretation (categorizing, decoding significance, clarifying meaning), explanation (stating results, justifying procedures, presenting arguments), and self-regulation (self-examination and self-correction) ( Facione , 1990). Critical thinking in nursing and nursing education Nurses need a high level of critical thinking skills and a critical thinking disposition because nurses encounter multiple patients with the same health care needs. However, each patient responds to those needs differently. Therefore nurses are required to use their holistic nursing knowledge base to think through each situation to provide individualized, effective (evidence-based) care rather than simply to follow routine procedures. Jones and Brown (1993) believe that nursing is practiced in complex environments with humans, who are complex beings. Technological advances and a knowledge explosion have also changed the face of health care. Thinking skills of the nurse become more important than the ability to perform the associated psychomotor skills. Case (1994) discussed the changing arenas for decision making as being not only at the bedside but also in quality assurance processes, delegation activities, shared governance, and management and executive roles. As health care reform extends patient care from the predominantly structured inpatient arena to the more unstructured outpatient or community arenas, critical thinking skills and empowerment become even more important. Carlson-Catalano (1992), in discussing empowering nurses, believed that traditional curricula encourage students to be obedient, dependent, and fearful in caring for patients. She suggests that nurses in professional practice should be empowered and that students need to be treated as valued members of the profession. She offers analytic nursing, change activities, collegiality, and sponsorship as strategies for empowering nurses. These strategies would be addressed if nursing faculty adopted the principles of critical thinking as the foundation for practice. Students must develop higher-order thinking skills. Brigham (1993) contends that faculty need to assist students to recognize how systems respond to specific health problems. Students need to know what nursing measures will be needed when they read laboratory reports with abnormal results; they do not need to memorize normal laboratory values. Jones and Brown (1991) argue that nurse educators can no longer convey facts to nursing students. “There are far too many facts, but there are far too many facts that become erroneous over time” ( Jones & Brown, 1991, p. 533). Miller (1992) concurs: More emphasis should be given to the mental processes students engage in as they solve nursing problems and less given to simply identifying the correct answer. Focusing on making clinical inferences from given data, recognizing unstated assumptions, deductive reasoning, weighing of evidence and distinguishing between weak and strong arguments emphasizes the importance of the processes of thinking. (p. 1406) Scheffer and Rubenfeld (2000) conducted a Delphi study to develop a consensus statement about critical thinking in nursing education. A panel of 55 experts from 9 countries determined that Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice [possess] the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. (p. 357) In summary, Jackson (1995) states, “Every patient deserves caregivers who think critically . . . . The ability to think critically can be empowering. Practitioners must commit to a struggle of balancing an explosion of objective and intuitive information in an explosive health care environment” (p. 187). Therefore nurse educators are challenged to help students develop necessary critical thinking skills as the students progress through the curriculum. Roles of faculty and students in developing critical thinking skills The development of students’ critical thinking skills and dispositions requires faculty to reconsider their philosophy of teaching. The faculty-dominated classroom is not conducive to development of critical thinking. It is the responsibility of faculty to think about the roles of the teacher and student, as well as to create an environment that empowers students. Transmitting information through rote lecture to students does not guarantee learning. Students must be actively engaged with the information for it to be transformed into knowledge. Lesson plans must be designed to foster the development of critical thinking skills (cognitive) and a critical thinking disposition (affective) as students engage with the theoretical, affective, and psychomotor content that is nursing. Students must become empathetic, empowered, and able to critically think about every situation if they are to succeed in nursing ( Bevis , 1993; Ford & Profetto-McGrath, 1994). Faculty roles Faculty must become facilitators of learning rather than teachers of content ( Bevis , 1993; Brigham , 1993; Brookfield , 1995; Creedy , Horsfall, & Hand, 1992; Jones & Brown , 1993). Ford and Profetto-McGrath (1994) believe that the teacher–student relationship must become a “working with” relationship—an egalitarian relationship. Burns and Egan (1994) suggest that faculty should demonstrate critical thinking as content is presented. For example, when teaching content such as medical acidosis and alkalosis, faculty could demonstrate their own problem-solving skills by thinking aloud as they discuss a relevant case study. Students should think aloud while interacting with the content so that faculty can identify inappropriate thinking processes and provide immediate constructive feedback. Creedy et al. (1992) propose that faculty can empower students by valuing their contributions, encouraging expression of their opinions, exploring mistakes objectively without demeaning the students, and promoting risk taking. Brookfield (1987) cites the following principles that will facilitate students to think critically: •  Affirm the critical thinkers’ self-worth ( p. 72 ). •  Listen attentively to critical thinkers ( p. 73 ). •  Show that you support critical thinkers’ efforts ( p. 74 ). •  Reflect and mirror critical thinkers’ ideas and actions ( p. 75 ). •  Motivate people to think critically ( p. 76 ). •  Regularly evaluate progress ( p. 78 ). •  Help critical thinkers create networks ( p. 79 ). •  Be critical teachers ( p. 80 ). •  Model critical thinking ( p. 85 ). Thus according to Brookfield (1987), the facilitator of learning must enter into an egalitarian relationship to support the learners’ attempts to engage in critical thinking. Faculty can only provide learning experiences for students; faculty cannot teach (impart knowledge); they can only share their knowledge. Students must transform the content into their own knowledge. Student roles Learning to think critically requires active student participation ( Meyers , 1986); students must become active creators of their own knowledge ( Creedy et al., 1992). At this time, it can be assumed most students have come from faculty-dominated classrooms in which the students have been the recipients of endless amounts of facts to be memorized and recalled for examinations ( Valiga , 1983). Students have probably not been asked to apply those facts to real-life situations. Therefore students will have to be assisted with the transition from the passive to active learner role. Faculty need to create a risk-free environment that is conducive to active student participation. The discussion later in this chapter related to creation of an anticipatory set serves as an example of helping students to make the transition from passive to active learners. Repeated encounters with active learning situations are needed before students can become comfortable with the active learner role. Active learners must come to class prepared. They cannot rely on the faculty to tell them what they need to know. “Preclass written assignments, study guides, quizzes and short in-class writings” ( Brigham , 1993, p. 52) are effective in stimulating students to come to class prepared to engage with the content while interacting with faculty and fellow students in planned learning activities. Classroom environment for the development of critical thinking skills The classroom environment changes when the principles of critical thinking are adopted. Active learning can be a very threatening situation. Faculty must create a risk-free environment that allows students to explore the content, make mistakes, reflect on the content, associate the content with experience, and transform the content into knowledge ( McCabe , 1992). Brigham (1993) suggests that faculty set the stage by sharing that their philosophy of teaching is to enhance critical thinking. This should be done when students are being introduced to the course. Students need to know that learning experiences have been designed for them to actively engage with the information and with each other while faculty facilitate the activities and learning process. Students must understand that, through the interactions, information will be converted into knowledge ( Bevis , 1993). Classroom environments should establish a sense of connection between faculty and students and among students themselves. Students should understand that neither faculty nor students have all of the answers and that no one answer is correct in all situations. Open discussion and student willingness to take risks should be supported while faculty guide the group toward the preestablished learning outcome. Students need to be aware that there are conflicting ideas about some concepts. Faculty at some schools of nursing do not adopt a specific textbook for their courses; rather, the bookstore stocks appropriate textbooks by different authors and students select the textbook they would like to use. This particular idea is intriguing because it certainly provides a basis for discussion of information from multiple points of view. When contradictions are found, it helps students recognize that the written word should be questioned. The physical component of the classroom is important; however, any classroom can be conducive to active student learning. Students should be able to make eye contact with each other and with faculty. MacIntosh (1995) suggests rearranging chairs into small or large circles. Faculty can be creative in modifying the physical characteristics of the classroom. For example, in classrooms where desks are bolted down, students could sit on the tops of the desks to be able to face others in the group. Student responses to active learning Beck (1995) conducted a study using a cooperative learning model based on feminist pedagogy that resulted in positive teacher–student and student–student interactions and satisfactory learning. Hezekiah (1993) cites the five basic feminist goals for the classroom—“atmosphere of mutual respect, trust and community, shared leadership, cooperative structure, integration of cognitive and affective learning, and action oriented field work” (pp. 55–56)—that would establish an environment for the development of critical thinking skills as the learner transforms information to knowledge. Wake , Coleman, and Kneeland (1992) discuss shared governance in the classroom. They note that shared governance in nursing education produces professional nurses who will be prepared to practice in an ever-changing health care environment. Price (1991) found that “interaction between the student and teacher ranked high as a positive contributor to learning” ( p. 170 ). Price cited the following student responses to the benefits of an interactive classroom: What’s good is your understanding of conflicts we may be facing as new students, your continual encouragement, and the fact that you’re always available to answer questions . . . I don’t function well, never have, when the question is memorizing. . . . I tend to learn very abstractly and not sequentially; my learning is not textbook learning. . . . I really find that I learn the most when I can apply it to myself and to someone else; that’s the thing I can underline and say, “Yes, I learned that very well.” . . . It’s practical application, where it’s applied to life, where your pattern of behavior is changed, something you can apply in your relationship with another human being. (pp. 170–171) Summary Nurses must possess a high level of critical thinking skills and a critical thinking disposition. Faculty must create opportunities for students to develop critical thinking as they progress through the curriculum. Faculty must become facilitators of learning and students must become active learners. Critical thinking should be at the forefront of planning learning experiences for nursing students. If educators believe that “students can and should think their way through the content of their courses, . . . gain some grasp of the logic of what they study, . . . develop explicit intellectual standards, then they can find many ways to move instruction in this direction” ( Barnes , 1992, p. 22). Faculty must create an environment that develops the traits of an ideal critical thinker and plan learning experiences that include strategies to develop the cognitive skills and subskills of critical thinking. Planning learning experiences Planning challenging encounters that will entice students to learn and develop critical thinking skills is a major task for any faculty member. Effective planning of any kind requires much time and effort; planning learning experiences is no exception. Careful planning of each learning experience gives teachers more self-confidence and aids in formative and summative evaluation of teaching. At least six steps are used in designing learning experiences: 1.  Determine the learning outcomes for the specific class period. 2.  Create an anticipatory set. 3.  Select teaching and learning strategies. 4.  Consider implementation issues. 5.  Design closure to the learning experience. 6.  Design formative and summative evaluation strategies. Each of the stages is discussed in detail. All steps can be planned by both students and faculty. Novice faculty may find it helpful to design learning experiences in great detail ( Table 15-1 ), whereas more experienced faculty may use only a more general outline form. Table 15-1 Sample Plan for a Learning Experience: Ethics in Leadership 1.  Outcomes: Identify ethical theory used for own decision making. Discuss implications of use of ethical theories in the workplace. Activity Content Time Strategies 2.  Anticipatory set a.  Preclass assignment b.  In-class exercise a.  Ethical theories b.  Ethical case examples c.  Ethical situations a.  2 hr b.  10 min a.  Text reading b.  Ethical survey c.  Individual reflection to identify the most difficult question on the survey and write how and why answered 3.  Implementation tools a.  Projector b.  PowerPoint slides a.  Three ethical theories from text b.  Application (1)  Identify own theory used. (2)  Apply to familiar situation. (3)  Apply to new situation. (4)  Apply to workplace decision making. a.  40 min b.  30 min a.  Large group discussion (1)  Slides of the theories’ main points (2)  At each main point ask, “What does this mean to you?” and “Give an example of how the point would be seen in practice.” b.  Small group discussion (1)  “Which theory do you use?” (2)  “Give example of how you used the theory.” (3)  “How would a nurse administrator use the theory to make ethical decisions?” (4)  “How could use of the theories lead to conflict in the workplace?” 4.  Closure Emphasize class outcomes. 20 min a.  Small group reports b.  Overall summary Determining the learning outcomes The first step is to determine the learning outcomes of the class. Several activities must be carried out before specific outcomes for any class period are developed. The first activity is assessment of the overall curriculum outcomes and the placement of the specific course in meeting these outcomes. Typically, general curriculum outcomes are stated in very broad terms and will likely not give the teacher any information about what to include in a specific class period. However, a thorough understanding of the broad curriculum goals is necessary so teachers can “connect” the specifics for the day to the broad curriculum outcomes. Course objectives and outcomes need to be reviewed to ascertain how the particular course “fits” within the curriculum ( Ayer , 1986; Torres & Stanton, 1982). See Chapters 8 to 11 for additional information. Teachers tend to design learning experiences within their own belief and value systems. Their own philosophies about teaching, learning, the curriculum, the ability of students, and how and what a nurse educator “should” do all influence the development of activities for a specific class period. Teachers need to be aware of these value systems and recognize the influence of them on their teaching and selection of teaching strategies ( Creedy et al., 1992). With these activities in mind, outcomes for a given experience can be established. There are several ways to identify outcomes. One way is to use behavioral objectives (see Chapters 9 and 10 ). For many, however, behavioral objectives imply rigid lists of specific content, faculty-dominated classrooms, and only one right answer to each examination question. Some believe that specific behavioral objectives need to be abandoned, given the important issue of development of critical thinking abilities in students ( Bevis , 1993). In another approach, general outcomes or competencies are identified, and the path to achieving them is left open. How they are written depends on individual school requirements, the overall curriculum design, the content of the course, and the beliefs or values of the individual faculty member. Creating an anticipatory set The second major step in planning a learning experience is to create an environment that invites all students to become interested in the content and to participate in the learning process. This activity is referred to as creating an anticipatory set ( Ayer , 1986; deTornyay & Thompson, 1982; Maas , 1990). The activity typically takes little in-class time and merely sets the stage for active involvement in the learning process. Maas (1990) includes three elements in an anticipatory set: active participation, relevance to the students, and relevance to the class period. Preclass readings; active, thought-provoking questions; and a class exercise that emphasizes students’ prior knowledge are examples of activities that can be used as an anticipatory set. The anticipatory set prepares students for the main activity or content of the class period. Selecting a teaching strategy Selecting the particular teaching strategy is the third step in lesson planning. Faculty must consider multiple factors as they select a particular strategy. The first factor is the content itself. For example, teaching abstract concepts is probably better accomplished through mind mapping ( Rooda , 1994), whereas psychomotor skills are better taught through demonstration ( Kelly , 1992). The philosophy underlying the broad curriculum outcomes also influences the selection of teaching strategies. In a school that has adopted the principles of critical thinking, the traditional lecture would seldom be used as a strategy. Last, faculty must consider teaching strategies that are feasible. Questions to consider may include the amount of time available, room size, distance learning delivery system being used, the availability of equipment, the number of students, time and money costs for both the teacher and the student, and learning styles of the students. With these factors in mind, many different teaching strategies would be appropriate for any student group and class content. Throughout the course it is important to vary the strategies. Using the same type of anticipatory set followed by lecture and then the same closure can be very boring for students. For example, faculty may create interest for the students by using lecture some of the time and role play, demonstration, and reflection at other times. Varying the strategies also has the advantage of appealing to all types of learners (see Chapter 2 ). Few of the teaching strategies are equally stimulating to all types of learners. It is not particularly important that teachers use strategies that appeal to all learners in every class, but it is important for them to use strategies that appeal to all types of learners throughout the course. Questioning is a teaching strategy that should be used consistently; it can even be used in every class ( Paul , 1995). “Helping students to ask their own questions should perfect their ability to think critically about information and how to process it” ( Hunkins , 1985, p. 296). Strategies that appeal to one type of learner can also be used for the preclass assignments or activities, and strategies for other types of learners can be used for the classroom experience. Teaching strategies and critical thinking The actual steps in designing learning experiences do not change when critical thinking concepts are applied to the curriculum. Teaching strategies should be selected for the development of critical thinking skills. Development of these skills in students should be a planned activity throughout all stages of the curriculum. Any strategy selected should be selected for a particular reason, and all strategies should lead to the development of advancing levels of critical thinking. Cognitive levels Cognitive levels must be considered during lesson planning. Several theorists have written about the various cognitive levels of students. Perry (1970) identifies four levels including nine stages of intellectual development. Belenky , Clinchy, Goldberger, and Tarule (1986) have demonstrated that women and men differ in intellectual development in several major areas. One example is that women typically have a silent stage of cognitive development, which is the first level. This stage is characterized by a powerless, dependent fear of authority figures. Men typically do not go through the silent stage. Hickman (1993) examined the theories of Perry (1970), Belenky et al. (1986), and others and integrated their thinking on cognitive levels with Benner’s (1984) levels of skill acquisition. Hickman’s (1993) thoughts are related directly to the licensed nurse, but her ideas can also be applied to the undergraduate nursing student. The beginning nursing student is a novice in critical thinking. Thinking is characterized as dualistic (everything is black or white). Little or no critical thinking is used. The novice depends on authority for knowledge and is usually silent. The next cognitive level is the advanced beginner. In this stage, thinking at the multiplicity level occurs. Students use subjective knowledge to begin seeing recurring themes, but they fail to differentiate important cues. Students at this level require assistance in establishing priorities. The next stage is the competent student nurse. At this stage, students continue to use subjective knowledge, but they do so consciously and they use the subjective knowledge in deliberate planning activities. The last cognitive level is the proficient student nurse, who is at the relativistic level of intellectual development. Relativism is the recognition that opinions differ in quality and require supporting evidence to be valid. Relativism is equated with procedural knowledge, connected knowledge, or both. Students no longer see information as only black and white; they begin to see how things “fit” together and notice where information is missing. They begin to think critically. It would be hoped that students completing a basic nursing education program would have attained the relativism level of cognitive development. Most undergraduate students will not have attained the final level, which is commitment in relativism. Commitment in relativism describes the expert nurse who integrates knowledge with experience and uses personal reflection to derive constructed knowledge ( Hickman , 1993). Many graduate students will have already moved to this level. Undergraduate nursing students will likely move to the final level of cognitive development after they are licensed and have many more real-life nursing experiences and the time to reflect on and integrate those experiences. The cognitive level of students must be addressed when learning experiences are designed. Moving students from the cognitive level of dualism to the level of relativism should be a major goal of nursing education. The level of cognitive development also influences the selection of teaching strategies. Bowers and McCarthy (1993) suggest that students who exhibit thinking at the informed commitment (relativistic) level would probably feel frustrated if they were expected to think at a dualistic level. For example, proficient student nurses would rather discuss implications of abnormal blood gas values (relativistic thinking) than respond to questions about normal findings (dualistic thinking). Implementation issues The fourth stage of lesson planning is implementation of the learning experience. In this stage, two major activities are considered. The first is the timing. How much time will be spent on the strategies selected to develop the anticipatory set? What backup plans are made to account for a lesson that takes much less or more time than anticipated? What can be cut or what can be added? What are the most crucial concepts to be covered if time is short? The sample plan (see Table 15-1 ) contains estimated times, with more detail included in a more extensive version of the plan. The second activity in this stage is to plan for the tools needed to implement the class. In this case, tools can refer to many things. Tools can be instructional media and equipment such as a projector, computer, or video information system (see Table 15-1 ). Tools can also refer to the information technology tools used to establish the learning community, such as computer conferencing or video conferencing. Plan to check the equipment for correct working order. Nothing can ruin a well-planned learning experience quite as effectively as instructional media that do not work! Tools could also be the classroom itself. How should the chairs be arranged? Do you want to use a podium? Does the screen for the projector or computer work? The last set of tools is the paper products. What handouts does the faculty member need? How much lead time is needed for typing and copying the handouts? Are the computer slides or transparencies ready? Are there items that need to have copyrights cleared? Who does that and how much time does it take? Assessing and planning for the amount of time and the tools necessary for implementation of the teaching strategy are activities that should not be left to the last minute. Designing closure The last step in designing the learning experience is planning for closure. Closure may be as simple as a few sentences that summarize the major concepts. In this case, the time allowed for closure would be very short. However, closure can take a large amount of class time, especially when dealing with sensitive or emotional content. Applying major concepts to similar or new areas of interest is another example of a closure technique ( deTornyay & Thompson, 1987). This time may also be used to create the anticipatory set for the next class period by discussing how the content of the class relates to the content of the next class period. Designing formative and summative evaluation strategies During the lesson planning phase, both formative and summative evaluation need to be considered ( Ayer , 1986). Chapter 16 contains information about classroom assessment, and Chapters 24 to 26 contain information about assessment of learning outcomes. These chapters should assist in this stage of planning. Evaluation activities should occur throughout the learning experience. Many formative evaluation techniques are available (see Chapter 16 ). Frequent formative evaluation is important for assessment of students’ understanding of content. Varying the types of formative evaluation used is important. For example, sometimes the objectives can be evaluated and at other times the teaching strategy used can be evaluated. Frequent self-evaluation is critical. Faculty should ask whether the time, tools, strategy, and content were organized and planned effectively and what could have been done differently to enhance student learning. Summary Designing effective learning experiences involves at least six distinct stages. A well-designed experience that enhances student learning cannot be done in a haphazard manner or at the last minute. Enhanced student learning and the development of critical thinking skills are the outcomes of well-planned learning experiences. Teaching strategies There are many different teaching strategies. Those with the most application to nursing education are presented throughout the rest of the chapter. Each strategy is described with its advantages and disadvantages, teaching tips, and additional references where the reader may find a more detailed description of the strategy. Simulation is a teaching strategy that is growing in use in nursing education; it is discussed in detail in Chapter 20 . Other teaching strategies may be more appropriate for the online learning environment. A detailed discussion can be found in Chapter 23 . Any discussion about teaching strategies would be incomplete without a review of learning resources, including instructional media or distance education delivery systems. These are discussed in Chapters 19 to 23 . The lecture is presented first, because this teaching strategy is frequently used by many teachers. Many other strategies can be used in nursing education. These strategies are alphabetized for ease of location. Each strategy discussed may have its place in a course, but its use depends on the content, the teacher, and the learners. Most of the strategies described after the lecture involve active learner participation in the learning process and emphasize adult learning and critical thinking concepts. Both teachers and students may resist this type of learning because the strategies are more flexible and less teacher centered than those typically used in the traditional college classroom. However, if one accepts that the learner must actively engage with the content or information to transform it into knowledge, the classroom should become student centered. Thus the traditional lecture may not always be the most appropriate strategy. Lecture Definition. Teacher presentation of content to students, usually accompanied by some type of visual aid or handout. Use. Clarify complex, confusing, or conflicting concepts; provide background information not available to students; change of pace from more experiential learning strategies; cover background information from scattered sources. Teaching Tips. 1.  Increased student participation can be achieved if the format of the feedback lecture is used ( Fuszard , 1995). For example, in a feedback lecture of 1 hour, a 6- to 10-minute group discussion period is inserted between two 20-minute lecture times. 2.  Use visual aids, handouts, and study guides so students can follow the sequence of the lecture. 3.  Students learn in various ways so add activities to the lecture that stimulate all learners. 4.  Read the article “What Is the Most Difficult Step We Must Take to Become Great Teachers?” by Nelson (2001) for some ideas on how to decrease the amount of class time devoted to lecture. Advantages. Time efficient for covering complex material; should raise further student questions that lend themselves to other teaching strategies. Disadvantages. Decreases student involvement in learning when content is readily available and easy to understand in a text or other reading assignment; lengthy preparation time for faculty; little involvement in the topic for students other than sitting through the lecture; may have a high cost in preparation and development of handouts and visual aids. Additional Reading. Amerson , 2006; Beers & Bowden, 2005; deTornyay & Thompson, 1982; Fuszard , 1995; Hoover , 1980; Johnson & Mighten, 2005; McKeachie , 1986; Nelson , 2001. Algorithms Definition. Step-by-step procedure for solving a complex procedure; breaks tasks into yes or no steps. Use. Any course in which frequent practice is required for student mastery of content, in which rules aid in problem solving, or in which the content can be broken into yes or no stages. Teaching Tips. 1.  Assess content for appropriate use of algorithm as a teaching strategy. 2.  Develop algorithm and accompanying student explanations of how to use. 3.  Allow 6 to 8 hours for the development of the first algorithms. 4.  Additional algorithms on similar content typically take less time to develop. Advantages. Shows students how to “spot” the most relevant information for problem solving; develops reliable, complex problem-solving abilities even in novice students; decreases the amount of one-on-one instruction often required when teaching problem-solving techniques; effective in teaching complex procedures that involve many steps; when used with case studies, may enhance learning; saves faculty teaching time over lecture type of presentations; saves student time in trying to remember and understand complex phenomena. Disadvantages. Teacher must clearly define the steps or students will not be able to complete the task accurately; students may need to be taught how to use algorithms in problem solving; development of algorithms can be time consuming for faculty. Additional Reading. Connor & Tillman, 1990; Rathbun & Ruth-Sahd, 2009. Argumentation, debate, structured controversy, and dilemmas Definition. The process of inquiry or reasoned judgment on a proposition aimed at demonstrating the truth or falsehood of something; involves the construction of logical arguments and oral defense of a proposition; requires the recognition of assumptions and evidence and use of inductive and deductive reasoning skills; allows identification of relationships. Teaching Tips. 1.  Strategy works best in an issues or topics course for students at a higher level of cognitive thinking. 2.  For the purpose of forming productive debate teams, it is helpful for students to know each other. 3.  Faculty should introduce the basic topics and structure the debate format early in the course to allow students adequate preparation time. 4.  Debate teams usually consist of five students: two students debate for the topic, two debate against the topic, and the fifth acts as the moderator. 5.  Debates follow a specified format, including opening comments, presentation of affirmative and negative viewpoints, rebuttal, and summary ( Fuszard , 1995). 6.  Encouraging students to debate the opposite of their personal opinion will increase student learning. Advantages. Develops analytical skills; develops ability to recognize complexities in many health care issues; broadens views of controversial topics; develops communication skills; increases student abilities to work in groups. Disadvantages. Requires a fairly high level of knowledge about the subject on the parts of both those presenting the debate and the audience; may require teaching students the art of debate; requires increased student preparation time; can create anxiety and conflict for students because of the confrontational nature of debate; students without adequate public speaking skills may also have increased anxiety; high time cost for students to work in groups. Additional Reading. Brookfield , 1992; Candela , Michael, & Mitchell, 2003; Fuszard , 1995; Garity , 2008; Garrett , Schoener, & Hood, 1996; Metcalf & Yankou, 2003; Mottola & Murphy, 2001; Pederson , 1993.

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Teaching strategies to promote critical thinking skills in nursing staff

• PMID: 7868746
• DOI: 10.3928/0022-0124-19941101-10

The promotion of critical thinking skills necessary for safe, effective, state-of-the-art nursing care is discussed in this article. Definitions of critical thinking and inductive and deductive reasoning are explored. Benner's (1986) research, based on Dreyfus and Dreyfus' (1980) model of skill acquisition, provides a basis for the various strategies mentioned to teach critical thinking. Implementation and evaluation of these strategies are addressed.

• Clinical Competence*
• Education, Nursing, Continuing / methods*
• Nursing Staff / education*
• Nursing Staff / standards
• Teaching / methods*