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What Are Critical Thinking Indicators (CTIs) In Nursing?

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In this article, we will explore key critical thinking indicators in nursing and provide examples of how these indicators manifest in real-world situations.

What are Critical Thinking Indicators?

Critical Thinking Indicators (CTIs) are traits or skills that demonstrate a person’s ability to think critically and analytically.

They provide insights into how someone approaches complex problems, evaluates information, and makes well-reasoned decisions.

15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

  • What is Critical Thinking in Nursing? (Explained W/ Examples)

How to Improve Critical Thinking Skills in Nursing? (24 Strategies W/ Examples)

What are critical thinking indicators (ctis) in nursing, definition of critical thinking indicators (ctis) in nursing.

Critical thinking indicators in nursing can be defined as the skills, traits, and behaviors that demonstrate a nurse’s ability to analyze complex situations, make informed decisions, and provide high-quality patient care.

CTIs are critical in the healthcare field, where nurses frequently face diverse and often urgent challenges that necessitate thoughtful and well-reasoned responses.

CTIs help nurses navigate the complexities of healthcare, adapt to changing circumstances, and ensure the best possible outcomes for their patients.

Related: What is the 4-Circle CT Model?

Critical thinking indicators (ctis) in nursing.

Here are a few critical thinking indicators; take a moment to reflect on how many of these attributes manifest in your own behavior.

1. Self-Awareness:

Nurses who are self-aware acknowledge their biases and limitations, enabling them to provide objective care.

For example, a nurse might recognize their discomfort with a certain medical procedure and actively seek guidance from a colleague to ensure patient safety.

2. Genuine/Authentic:

Authentic nurses align their actions with their values, fostering trust and rapport with patients.

By demonstrating empathy and compassion, a nurse establishes a genuine connection with patients, which can significantly enhance the healing process.

3. Effective Communicator:

Effective communication is essential for nurses to understand patient needs and relay critical information.

A nurse who actively listens to a patient’s concerns and articulates medical instructions clearly ensures that patients are well-informed and empowered to manage their health.

4. Curious and Inquisitive:

Curiosity drives nurses to seek deeper understanding. When faced with a new treatment approach, a curious nurse might research alternative methods and consult with colleagues to explore innovative solutions for patient care.

5. Alert to Context:

Being attentive to changes in a patient’s condition is crucial. A nurse who notices a sudden change in a patient’s vital signs may investigate further to identify potential complications and take swift action.

6. Reflective and Self-Corrective:

Nurses who reflect on their actions and interactions can identify areas for improvement.

After a challenging shift, a nurse might review their decisions and consider seeking feedback from peers to enhance future performance.

7. Analytical and Insightful:

Analytical nurses identify patterns in patient data that might go unnoticed by others.

By recognizing a recurring symptom, a nurse can contribute to an accurate diagnosis and tailored treatment plan.

8. Logical and Intuitive:

Balancing logic and intuition is key. A nurse who uses both logical reasoning and intuition may suspect an adverse reaction to medication based on a patient’s sudden change in behavior, prompting timely intervention.

9. Confident and Resilient:

Confident nurses trust their abilities even in challenging situations. When a complex case arises, a nurse’s confidence can drive them to collaborate with the medical team to devise an effective care strategy.

10. Honest and Upright:

Honesty and integrity guide ethical decision-making. A nurse who acknowledges their own mistakes and takes responsibility fosters an environment of trust within the healthcare team.

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Adopting these critical thinking indicators (CTIs) in nursing practice is essential for improving patient care and fostering transformative changes in the healthcare setting.

Recommended Readings

Critical Thinking Indicators (CTIs)

Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach

Applying Nursing Process: The Foundation for Clinical Reasoning

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Personal Critical Thinking Indicators : Behaviors , Attitudes , and Characteristics

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Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis, theoretical model of critical thinking in diagnostic processes in nursing, is high fidelity simulation the most effective method for the development of non-technical skills in nursing a review of the current evidence, differences in clinical reasoning among nurses working in highly specialised paediatric care., nurses’ clinical reasoning, a cost-utility analysis of medium vs. high-fidelity human patient simulation manikins in nursing education., using concept maps in perioperative education., relationships between critical thinking ability and nursing competence in clinical nurses., registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study., do educational interventions improve nurses' clinical decision making and judgement a systematic review., related papers.

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Everyone thinks; it is our nature to do so. But much of our thinking, left to itself, is biased, distorted, partial, uninformed, or downright prejudiced. If we want to think well, we must understand at least the udiments of thought, the most basic structures out of which all thinking is made. We must learn how to take thinking apart.

All Thinking Is Defined by the Eight Elements That Make It Up. Eight basic structures are present in all thinking: Whenever we think, we think for a purpose within a point of view based on assumptions leading to implications and consequences. We use concepts, ideas and theories to interpret data, facts, and experiences in order to answer questions, solve problems, and resolve issues.

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Critical Thinking Models: A Comprehensive Guide for Effective Decision Making

Critical Thinking Models

Critical thinking models are valuable frameworks that help individuals develop and enhance their critical thinking skills . These models provide a structured approach to problem-solving and decision-making by encouraging the evaluation of information and arguments in a logical, systematic manner. By understanding and applying these models, one can learn to make well-reasoned judgments and decisions.

4 circle critical thinking model

Key Takeaways

Fundamentals of critical thinking.

4 circle critical thinking model

Definition and Importance

Critical thinking is the intellectual process of logically, objectively, and systematically evaluating information to form reasoned judgments, utilizing reasoning , logic , and evidence . It involves:

Core Cognitive Skills

Influence of cognitive biases.

A key aspect of critical thinking is recognizing and mitigating the impact of cognitive biases on our thought processes. Cognitive biases are cognitive shortcuts or heuristics that can lead to flawed reasoning and distort our understanding of a situation. Examples of cognitive biases include confirmation bias, anchoring bias, and availability heuristic.

To counter the influence of cognitive biases, critical thinkers must be aware of their own assumptions and strive to apply consistent and objective evaluation criteria in their thinking process. The practice of actively recognizing and addressing cognitive biases promotes an unbiased and rational approach to problem-solving and decision-making.

The Critical Thinking Process

4 circle critical thinking model

Stages of Critical Thinking

The critical thinking process starts with gathering and evaluating data . This stage involves identifying relevant information and ensuring it is credible and reliable. Next, an individual engages in analysis by examining the data closely to understand its context and interpret its meaning. This step can involve breaking down complex ideas into simpler components for better understanding.

Values play a significant role in the critical thinking process. Critical thinkers assess the significance of moral, ethical, or cultural values shaping the issue, argument, or decision at hand. They determine whether these values align with the evidence and logic they have analyzed.

Application in Decision Making

Critical thinking models, the red model.

The RED Model stands for Recognize Assumptions, Evaluate Arguments, and Draw Conclusions. It emphasizes the importance of questioning assumptions, weighing evidence, and reaching logical conclusions.

Bloom’s Taxonomy

Bloom’s Taxonomy is a hierarchical model that classifies cognitive skills into six levels of complexity. These levels are remembering, understanding, applying, analyzing, evaluating, and creating. By progressing through these levels, individuals can develop higher-order thinking skills.

Paul-Elder Model

The Paul-Elder Model introduces the concept of “elements of thought,” focusing on a structured approach to critical thinking. This model promotes intellectual standards, such as clarity, accuracy, and relevance. It consists of three stages:

The Halpern Critical Thinking Assessment

These four critical thinking models can be used as frameworks to improve and enhance cognitive abilities. By learning and practicing these models, individuals can become better equipped to analyze complex information, evaluate options, and make well-informed decisions.

Evaluating Information and Arguments

Evidence assessment, logic and fallacies.

Being aware of these fallacies enables a thinker to effectively evaluate the strength of an argument and make sound judgments accordingly.

Argument Analysis

Enhancing critical thinking, strategies for improvement, critical thinking in education.

In the field of education, critical thinking is an essential component of effective learning and pedagogy. Integrating critical thinking into the curriculum encourages student autonomy, fosters innovation, and improves student outcomes. Teachers can use various approaches to promote critical thinking, such as:

Developing a Critical Thinking Mindset

Critical thinking in various contexts, the workplace and beyond.

In the workplace context, critical thinkers are able to recognize assumptions, evaluate arguments, and draw conclusions, following models such as the RED model . They can also adapt their thinking to suit various scenarios, allowing them to tackle complex and diverse problems.

Creative and Lateral Thinking

In conclusion, critical thinking is a multifaceted skill that comprises various thought processes, including creative and lateral thinking. By embracing these skills, individuals can excel in the workplace and in their personal lives, making better decisions and solving problems effectively.

Overcoming Challenges

Recognizing and addressing bias.

By adopting these practices, individuals can minimize the impact of biases and enhance the overall quality of their critical thinking skills.

Dealing with Information Overload

By implementing these techniques, individuals can effectively manage information overload, enabling them to process and analyze data more effectively, leading to better decision-making.

Measuring Critical Thinking

Assessment tools and criteria.

Furthermore, criteria for assessing critical thinking often include precision, relevance, and the ability to gather and analyze relevant information. Some assessors utilize the Halpern Critical Thinking Assessment , which measures the application of cognitive skills such as deduction, observation, and induction in real-world scenarios.

The Role of IQ and Tests

Frequently asked questions, what are the main steps involved in the paul-elder critical thinking model.

The Paul-Elder Critical Thinking Model is a comprehensive framework for developing critical thinking skills. The main steps include: identifying the purpose, formulating questions, gathering information, identifying assumptions, interpreting information, and evaluating arguments. The model emphasizes clarity, accuracy, precision, relevance, depth, breadth, logic, and fairness throughout the critical thinking process. By following these steps, individuals can efficiently analyze and evaluate complex ideas and issues.

Can you list five techniques to enhance critical thinking skills?

What is the red model of critical thinking and how is it applied, how do the ‘3 c’s’ of critical thinking contribute to effective problem-solving.

The ‘3 C’s’ of critical thinking – Curiosity, Creativity, and Criticism – collectively contribute to effective problem-solving. Curiosity allows individuals to explore various perspectives and ask thought-provoking questions, while Creativity helps develop innovative solutions and unique approaches to challenges. Criticism, or the ability to evaluate and analyze ideas objectively, ensures that the problem-solving process remains grounded in logic and relevance.

What characteristics distinguish critical thinking from creative thinking?

What are some recommended books to help improve problem-solving and critical thinking skills, you may also like, the 7 best critical thinking books for beginners, critical thinking for strategic intelligence: a comprehensive guide, critical thinking skills in the workplace, why critical thinking is important for success, download this free ebook.

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Critical thinking models: definition, benefits, and skills

Critical thinking models: definition, benefits, and skills

In the age of memes and misinformation, critical thinking is a must. It's a crucial skill to differentiate between what may be true or false and develop (and explain) reasons for your beliefs.

The hardest part of critical thinking is knowing when to do it. Most of the time, it's easier to accept things as fact rather than to dig deeper to reach a conscious conclusion. This happens for various reasons. The most common being the ease of following the crowd and the fact it would be rather cumbersome to think critically about every single thing in the world!

How then do we know what to think critically about? How do we get the right answers, and how do we know they're correct? This is where a critical thinking model comes in. In this article, we’ll share three critical thinking models, essential critical reasoning skills, and why improving your critical thinking process is a good idea.

What Is Critical Thinking?

"Critical thinking is reasonable and reflective thinking focused on deciding what to believe or do.” This is how renowned professor and author Robert Hugh Ennis defines it. Put another way, the definition of critical thinking is careful consideration and analysis of information to reach a rational conclusion or decision. We practice critical thinking to inform—and own—our beliefs and actions and ensure they truly align with our values and intentions.

That said, critical thinking is not our natural way of thinking . Most of us are never aware of our brain's metacognitive actions, conceptualizations, or synthesis. Instead, we rely on habits, patterns, and competencies from past experiences to understand and interact with the world. While this may save us time and effort, it doesn’t always provide the best results—and often results in fallacies.

What Are Critical Thinking Models?

A critical thinking model provides the structure for practicing this type of thinking. It helps us notice our own thinking biases and allows us to try viewing the world objectively all while providing guidelines for asking the right questions, reaching logical conclusions, and explaining how we did it.

3 Critical Thinking Models That Are Useful in Everyday Life

Critical thinking model: Putting the pieces of a puzzle together

There are thousands of critical thinking models for almost any subject or discipline. Let’s take a look at three models of critical thinking we find useful in everyday life.

Proximate vs. Root Cause

The proximate vs. root cause critical thinking model encourages people to discover the primary cause of an event. A proximate cause is closest to the observed result or immediately responsible for it. In contrast, the root cause is the actual cause of the result. Both are causes of the event, but the root cause is the main cause, while the proximate cause is the immediate next cause.

This mental model forces you to look beyond obvious reasons to determine the core reason for impact. It helps with innovative problem-solving, so instead of relying on “Band-Aid solutions” or improving currently-existing solutions, you uncover the root of the matter and create something altogether new.

Example: You've gained a lot of weight since March 2021. Upon investigation, you may draw the following inferences:

  • Proximate cause: You burn fewer calories than you consume (moving less and eating more due to boredom or food accessibility), thus the weight gain.
  • Root cause: Your habits changed because of the lifestyle change from working at the office to working from home.

When you know the root cause of an issue, you can begin to deal with it to reduce the odds of recurrence. In this case, change your habits to fit the work-from-home lifestyle better. The proximate vs. root cause model improves your critical thinking ability and helps formulate a proper understanding of issues before working on them.

Cognitive Bias

Cognitive bias is a tendency to think in ways that can lead to deviations from rationality and objectivity. We all have cognitive biases. This error in thinking happens because of our tendency to process and interpret information swiftly, which can affect our decision-making and the eventual outcome of a situation.

Example: A soccer player scores a goal. In his mind, that means he's a great player. But if he had missed, he would reason that it was because the grass was wet. In self-serving bias, the tendency is to claim more responsibility for successes than failures. In other words: if there's a success, it's because I did something right. If there's a failure, it's something else's fault, not mine.

When you only pay attention or engage with news sources, stories, and conversations that confirm your worldview, you limit yourself from other perspectives and opinions that may be good for you without realizing it. Being aware of your own cognitive bias allows you to create some distance between how you expect the world to be and become more open to how it actually is on any given day.

The human brain is a powerful machine, but it has its limitations. One of them is neglecting facts and evidence to make sense of the world quickly and easily. This habit of mind may allow us to make faster decisions, but it doesn't serve us optimally. When unchecked, cognitive biases hinder fair-mindedness, inclusion, and impartiality.

Hanlon's Razor

"Never attribute to malice that which is adequately explained by incompetence."

Hanlon's Razor promotes good thinking and teaches us not to assume the worst intentions about people's actions without investigation. It helps regulate our emotions and improve relationships and decision-making. It also helps us develop empathy by giving others the benefit of the doubt and not assuming negative intent with evidence.

Example: You get to work earlier than usual on a Monday morning and notice your things scattered around. This must mean someone used your office! You immediately think a certain coworker did this to annoy you. But when you pause and consider, you realize that a coworker may have used your office during the weekend because it was vacant and they forgot their keys at home.

The stories we tell ourselves about why things happen the way they do are rarely true. It's worth spending some time to objectively view situations and choose a positive narrative that leads to better outcomes in our mental and emotional health and relationships.

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Critical Thinking Skills and Their Benefits

4 circle critical thinking model

Critical thinking skills are useful for everyone. They help us think coherently and make advancements with our personal and professional goals. Some of the benefits you can gain from critical thinking are:

  • Greater reflective thinking and self-awareness
  • Ability to audit new information
  • Better interpersonal relationships
  • More creative thinking and problem-solving skills
  • Expanded open-mindedness
  • Improved communication and presentation skills
  • Freedom from past experiences and attachments

To gain these types of benefits, it’s important to practice the critical thinking skills listed below.

1. Observation

Observation is the foundation for critical thinking. It’s the ability to notice and predict opportunities, problems, and solutions. Taking the time to observe helps you process information better. Positive habits like meditating, journaling, and active listening will help you improve your observation skills.

2. Analysis

After observing, it's time to analyze the information. Analyzing helps you gain a clearer grasp of the situation at hand. Ask questions that help you get a clearer picture of the subject and get to the root cause or reason. For example, if you’re analyzing a controversial tweet you read, you may ask questions such as:

  • Who wrote this?
  • What is it about?
  • When was it written?
  • Why did they write it? Do they have a hidden agenda?
  • How sound is the premise?
  • What if this tweet was altered to send a misleading message?

These questions help you break your subject into rational bits and consider the relationship between each one and the whole.

3. Inference

Inference is the ability to draw conclusions from the information you've analyzed and other relevant data. It's a higher-level critical thinking skill that helps you reach careful decisions rather than hastily drawn (and likely biased) conclusions.

4. Communication

Once you have a solid foundation for your beliefs, communicating your theory is the next essential part of critical thinking. Share your point of view and get feedback from others to know if it holds up. You can improve your communication skills by participating in thematic forum discussions and sharing your research and insights with others in your community, both online and offline.

5. Problem-solving

Problem-solving is one of the main reasons for critical thinking. The end goal of critical thinking is using your new conclusion to close gaps and solve problems. You start by identifying your viewpoint, analyzing relevant information, and deciding on the right solution for a particular scenario. You can improve your problem-solving skills by self-learning the subject at hand and considering hidden, alternative outcomes.

Tap Into the Power of Critical Thinking

Becoming a critical thinker is challenging but oh-so worth it. It leads to continuous growth in all areas of your life: better relationships, confidence, and problem-solving skills. Critical thinking helps us overcome familiar patterns and ways of thinking, opening us to new perspectives.

To improve your critical thinking, spend time honing the five crucial critical thinking skills: observation, analysis, inference, communication, and problem-solving. Have fun with the process as you pay more attention to your beliefs and experiences and other people's perspectives and experiences as well.

You can use critical thinking models to guide your critical thinking journey, prompting you to realize when to pause and ask questions and when to accept the answers you have and move on. For example, in today’s age of misinformation, you may learn that it’s almost always counterproductive to engage with news and information from unknown sources.

Critical thinking is needed to remove scales from our eyes and improve our knowledge and experience of the world, but it’s also important to know when to turn our attention to focus on a new subject and move on.

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  • Paul-Elder Critical Thinking Framework

Critical thinking is that mode of thinking – about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. (Paul and Elder, 2001). The Paul-Elder framework has three components:

  • The elements of thought (reasoning)
  • The  intellectual standards that should be applied to the elements of reasoning
  • The intellectual traits associated with a cultivated critical thinker that result from the consistent and disciplined application of the intellectual standards to the elements of thought

Graphic Representation of Paul-Elder Critical Thinking Framework

According to Paul and Elder (1997), there are two essential dimensions of thinking that students need to master in order to learn how to upgrade their thinking. They need to be able to identify the "parts" of their thinking, and they need to be able to assess their use of these parts of thinking.

Elements of Thought (reasoning)

The "parts" or elements of thinking are as follows:

  • All reasoning has a purpose
  • All reasoning is an attempt to figure something out, to settle some question, to solve some problem
  • All reasoning is based on assumptions
  • All reasoning is done from some point of view
  • All reasoning is based on data, information and evidence
  • All reasoning is expressed through, and shaped by, concepts and ideas
  • All reasoning contains inferences or interpretations by which we draw conclusions and give meaning to data
  • All reasoning leads somewhere or has implications and consequences

Universal Intellectual Standards

The intellectual standards that are to these elements are used to determine the quality of reasoning. Good critical thinking requires having a command of these standards. According to Paul and Elder (1997 ,2006), the ultimate goal is for the standards of reasoning to become infused in all thinking so as to become the guide to better and better reasoning. The intellectual standards include:

Intellectual Traits

Consistent application of the standards of thinking to the elements of thinking result in the development of intellectual traits of:

  • Intellectual Humility
  • Intellectual Courage
  • Intellectual Empathy
  • Intellectual Autonomy
  • Intellectual Integrity
  • Intellectual Perseverance
  • Confidence in Reason
  • Fair-mindedness

Characteristics of a Well-Cultivated Critical Thinker

Habitual utilization of the intellectual traits produce a well-cultivated critical thinker who is able to:

  • Raise vital questions and problems, formulating them clearly and precisely
  • Gather and assess relevant information, using abstract ideas to interpret it effectively
  • Come to well-reasoned conclusions and solutions, testing them against relevant criteria and standards;
  • Think open-mindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences; and
  • Communicate effectively with others in figuring out solutions to complex problems

Paul, R. and Elder, L. (2010). The Miniature Guide to Critical Thinking Concepts and Tools. Dillon Beach: Foundation for Critical Thinking Press.

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Does self-directed learning with simulation improve critical thinking and motivation of nursing students a pre-post intervention study with the maes© methodology.

4 circle critical thinking model

1. Introduction

  • To evaluate the learning motivation strategies of nursing students before and after the self-directed simulation training program (MAES©).
  • To analyze the critical thinking of nursing students before and after the self-directed simulation training program (MAES©).

2. Materials and Methods

2.1. design, 2.2. participants, 2.3. study variables, 2.4. instruments, 2.5. procedure, 2.6. data analysis, 2.7. ethical considerations, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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n (%)Missing
QuestionnaireCuPCPE5 (6.49%)
MSLQ4416 (20.78%)
Both56 (72.73%)
GenderWomen67 (87.01%)
Men10 (12.99%)
Previous experience with simulationNo63 (81.82%)1
Yes13 (16.88%)
Previous clinical experienceNo58 (75.32%)1
Yes18 (23.38%)
Previous educationNo/None36 (46.75%)
Yes41 (53.25%)
Mean (SD)
Age (years) 22.07 (2.175)1
CuPCPE QuestionnaireMean (SD *)Difference (%)p-Value **
PrePost
Total Questionnaire 340.5 (39.15)357.5 (34.68)17 (3.9%)<0.001
Personal dimension121.9 (13.46)124.4 (12.67)2.5 (1.6%)0.033
Intellectual and cognitive dimension137.9 (17.46)146.6 (15.81)8.7 (4.9%)<0.001
Interpersonal and self-management dimension60.8 (15.81)65.9 (8.47)5.1 (6.4%)<0.001
Technical dimension19.9 (2.75)20.6 (2.64)0.7 (2.9%)0.031
MSLQ44 QuestionnaireMean (SD *)Difference (%)p-Value **
PrePost
Total Questionnaire231.9 (20.98)237.4 (20.84)5.5 (1.8%)0.003
Motivation section
  Self-efficacy subscale237.4 (20.84)51.9 (6.64)1.3 (2.1%)0.039
  Intrinsic value subscale51.9 (6.64)53.2 (5.57)0.7 (1.1%)0.189
  Test anxiety subscale53.2 (5.57)47.6 (7.38)0.4 (1.4%)0.354
  Total Subcale47.6 (7.38)48.3 (6.69)1.6 (1%)0.155
Learning Strategies Section
  Use of learning strategies subscale48.3 (6.69)18.9 (5.34)2.4 (2.6%)0.001
  Self-regulation subscale18.9 (5.34)18.5 (5.87)1.5 (2.4%)0.030
  Total Subcale18.5 (5.87)118.4 (12.77)3.9 (2.5%)0.002
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Share and Cite

Arizo-Luque, V.; Ramirez-Baena, L.; Pujalte-Jesús, M.J.; Rodríguez-Herrera, M.Á.; Lozano-Molina, A.; Arrogante, O.; Díaz-Agea, J.L. Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology. Healthcare 2022 , 10 , 927. https://doi.org/10.3390/healthcare10050927

Arizo-Luque V, Ramirez-Baena L, Pujalte-Jesús MJ, Rodríguez-Herrera MÁ, Lozano-Molina A, Arrogante O, Díaz-Agea JL. Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology. Healthcare . 2022; 10(5):927. https://doi.org/10.3390/healthcare10050927

Arizo-Luque, Vanessa, Lucía Ramirez-Baena, María José Pujalte-Jesús, María Ángeles Rodríguez-Herrera, Ainhoa Lozano-Molina, Oscar Arrogante, and José Luis Díaz-Agea. 2022. "Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology" Healthcare 10, no. 5: 927. https://doi.org/10.3390/healthcare10050927

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Alfaro-LeFevre Circular Model for Competence Assessment

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In 2015, an instrument was designed based on the Alfaro-LeFevre model in order to evaluate the critical thinking of care nurses at the Hospital Universitari Vall d’Hebron.

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4 circle critical thinking model

HOSPITAL UNIVERSITARI VALL D'HEBRON

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4 circle critical thinking model

BACKGROUND The need for more user-centred care and of evidence-based practices are aspects which highlight critical thinking as a professional competence. At a theoretical level, Alfaro-LeFevre put forth a thinking model based on four elements: personal characteristics, intellectual abilities, interpersonal and self-management abilities and technical abilities. However, no instrument has been found for its empirical evaluation.   METHODS Psychometric and correlation descriptive study. A set of elements was generated and a panel of experts evaluated the validity of the content of the new instrument based on the Alfaro-LeFevre circular model. Afterwards, the validation was performed on a sample of 339 nursing professionals at the Hospital Vall d’Hebron (Barcelona), who were selected by stratified sampling with proportional allocation of their units, between March and April 2015.   RESULTS The validity index of the Nursing Practice Critical Thinking Evaluation Questionnaire content (in Spanish, CuPCPE) was 0.85. The alpha Cronbach overall value was 0.96. The coefficient of intra-class correlation was 0.77. The factorial confirmatory analysis showed that the resulting model adapted to the theoretical four-dimensional theoretical model proposed. Care nurses were observed to present moderate levels of critical thinking. Among other noteworthy results, statistically significant differences were found (p   CONCLUSIONS Critical thinking is related to specific sociodemographic and professional variables. The CuPCPE psychometric properties reinforce its use in the clinical environment and in future studies.   Source of information: Catalanurses.cat: Avaluació del pensament crític en infermeres d’hospitalització segons el model circular d’Alfaro-LeFevre [Internet]. Catalonia [query performed on September 8, 2018]. Available at https://www.catalanurses.cat/projectes/avaluacio-del-pensament-critic-en-infermeres-dhospitalitzacio-segons-el-model-circular-dalfaro-lefevre/    

-       To know the level of critical thinking of the nursing collective at the hospital. -       To study the Alfaro-LeFevre circular model.

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Explotació dades de la formació prevista i realitzada en un simple Excel

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18 Sep 2018

HOSPITAL DE CAMPDEVÀNOL

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25 Sep 2018

Xavier Garcia HOSPITAL DE PALAMÓS

Reducció de costos en el Servei de neteja mitjançant l’anàlisi dels recursos i responsabilitats

Reducció de costos en el Servei de neteja mitjançant l’anàlisi dels recursos i responsabilitats

Ramón Roca HOSPITAL DE CAMPDEVÀNOL

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FFI Practitioner: October 6, 2021 for web

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Thanks to this week’s contributor and FFI Fellow, Dean Fowler, for providing an overview of his Four-Circle Model. In the article, Dean explains how his model builds upon the Three-Circle Model and can be utilized by advisors to help understand and map the role of individuals in the system and their relationship to their family.

Over the past forty years, two themes have been critical for shaping consulting with family businesses: first, a systemic approach, and second – in more recent years – the inclusion of the next generation in transition planning. In this article, I discuss my Four-Circle Model for consulting with family enterprises that is both systemic and honors the next generation as individuated adults. My purpose is not to critique the more well-known Three-Circle Model, but rather to offer a proposed enhancement to the systemic approach for understanding families in business and families of wealth.

Prof. John Davis is a pioneer in the field of family business. The main purpose for developing his original Three-Circle Model was to identify the distinct roles held in the family business and how those roles shape individual perspectives . For more than 40 years, numerous consultants and researchers have used the systemic approach described by the Davis-Taguri model to explore a broad range of other topics as well.

The Three-Circle Model of the Family Business System

The celebration of the 40 th anniversary of the Three-Circle Model was explored in depth in two issues of the FFI Practitioner (see the sidebar for the two interviews with John Davis).

On the one hand, models, theories, and paradigms are powerful tools to focus our attention when studying a given discipline. On the other hand, models may also limit the questions we ask, the topics we explore, and our understanding of critical issues. 1 My Four-Circle Model focuses attention on the role of individual adults in relationship to their own family of origin and broadens the systemic approach to working with and studying business families.

In the 1980s, when FFI was first holding national conferences, I presented my Four-Circle Model for studying families in business at several workshops. After discussing my model and research ideas with the Psycho-Dynamic Family Business group (PDFB) in 1993, I was encouraged to complete research to determine how the Four-Circle Model could be used to identify the most critical competencies that business families had to master for success. That research was published in the proceedings at the 1999 FFI conference.

The Four-Circle Model is different from the Three-Circle Model in four significant ways:

  • The addition of the “individual circle” is critical, because in a family-owned business, advisors are often dealing with a family of adults, and healthy adults have typically individuated themselves from their family of origin. Healthy adult families are intentional. In my judgment, intergenerational family therapies, such as those developed by Murray Bowen 2 and James Framo, 3 are well suited to examine the systemic relationships between adults and their families of origin.
  • The model focuses attention on competencies, particularly the competencies that must be mastered at each of the four intersection areas illustrated in the diagram.
  • Individuals and/or individual beneficiaries, not families, own family businesses.
  • Individuals such as board members and advisors who are not family members fit into the model in Sector 8.

The Four-Circle Model

Based on my research, twelve statistically reliable “factors” were identified that represent the competencies that must be mastered by individuals and their families for success:

Competencies of Intersection 1: Between adult individuals and their family of origin

  • Maturity – Individuals must separate both emotionally and financially from their family of origin and develop a strong sense of their own self-esteem.
  • Purpose – Adults must determine their own purpose by developing and pursuing passions either inside or outside the family business.
  • Communication – Families must listen for understanding as well as to be understood and develop strong communication skills.

Competencies of Intersection 2: Between the family and the business

  • Roles – Clear guidelines should be established concerning appropriate boundaries between the business and the family, so that roles can be differentiated.
  • Business Competency – Business competency deals with developing a broad-based knowledge of the business.
  • Compensation – Families must determine how to balance family fairness with the best business practices, based on national and regional compensation plans.

Competencies of Intersection 3: Between the business and ownership

  • Strategy – For long-term success across generations, the owners and the business must develop a clear and comprehensive strategy with a mission, vision, and goals for growth.
  • Structure – The organizational structure of the business must support the strategy. This requires having the right people in the right roles.
  • Leadership – Professionalization of the business may be necessary, perhaps by having qualified family members coupled with a capable non-family executive leadership team.

Competencies of Intersection 4: Between ownership and adult individuals

  • Succession – Based on the strategy and structure of the business, the transition of management from one generation to the next is critical. This succession may include next-gen family leaders, or a non-family president/CEO.
  • Governance – Either an advisory board or a fiduciary board of directors should be in place for the long-term success of the business.
  • Estate Planning – Estate, financial, and tax planning should support rather than drive the other competencies. The ownership transition plan should capture the voice, vision, and values of both the current and next generation shareholders.

The Four-Circle Model and the related twelve competencies from my research have shaped my consulting practice for decades. With an emphasis on adult individuals, and the individuation process, my primary client is the next generation–individuals, siblings, and/or cousins.

The senior generation gives legal permission to their advisors including the attorneys, accountants, insurance, and financial planning professionals to work directly with the successor generation. The next generation of adults then would design the optimal structure for the transition of the business and ownership, so that the business and the family will be setup to thrive in the future. In addition to planning with a team of advisors, the next generation also works on mastering the twelve competencies for future success and the implementation of the recommended structures and policies for the intergenerational transition. The process often takes several years, working interactively through a family or owners council, through which the next generation makes their recommendations to the senior generation, who controls the voting shares for their approval.

Based on my research using the Four-Circle Model, I developed an online assessment process with a questionnaire and report that benchmark how family members, non-family executives, and advisors–from the perspective of different sub-groups (roles ala Davis) –assess how the family is mastering these twelve competencies. 4

1 In his seminal work The Structure of Scientific Revolutions (1970) , Thomas Kuhn demonstrated that scientific theories are in fact “paradigms.” From the perspective of the sociology of knowledge, Kuhn argued that scientific communities share a common set of theories and ideas that are excellent tools to explore problems. However, in the history of science, there is a paradigm shift through which new theories emerge – for example from Newtonian physics to Einstein’s theory of relativity. Kuhn’s position contrasts with classical rationalism put forth by Karl Popper.

2 For key principles regarding Bowen read The Eight Concepts of Bowen Theory First Edition by  Dr. Roberta M Gilbert  or see the website https://www.thebowencenter.org/

3 Family-Of-Origin Therapy: An Intergenerational Approach by  James L. Framo

4 This online assessment and questionnaire can be found at ( https://www.deanfowler.com )

About the Contributor

Dean R. Fowler

Dean R. Fowler, PhD, FFI Fellow has advised business families for 38 years as well as facilitating Forums for Family Business TM – peer advisory boards – that specialize in personal and professional development through diversified experiences and accountability, while focusing on successful intergenerational transitions. He is the author of several books, including Love, Power and Money: Family Business between Generations . He can be reached at [email protected] .

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  2. What Is The 4-Circle Critical Thinking (CT) Model?

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  3. 4 Circle Critical Thinking Model: Addressing Mr. P safety

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  4. Figure 10–1 from Personal Critical Thinking Indicators : Behaviors

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  5. 4 Circle Critical Thinking Model: Addressing Mr. P safety

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COMMENTS

  1. What Is The 4-Circle Critical Thinking (CT) Model?

    The 4-Circle Critical Thinking Model is a framework designed to help individuals develop and enhance their critical thinking skills. It was created by Rosalinda Alfaro-LeFevre, a nurse and educator who has written extensively about critical thinking in healthcare and nursing practice. The 4-Circle Critical Thinking Model consists of four ...

  2. PDF Microsoft Word

    To improve thinking, leaders, teachers, health professionals and learners must be "on the same page" about exactly what the evidence suggests CT and CR entail. This document includes CT definitions, underlying assumptions, CT characteristics and skills, the 4-Circle CT Model®, and supporting references.

  3. PDF Critical Thinking Indicators (CTIs)

    Critical Thinking & Clinical Judgment in Nursing: A Practical Approach to Outcome-focused Thinking, 4th Ed, and Applying Nursing Process: A Tool for Critical Thinking, 7th Ed. CTIs describe behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice.

  4. PDF 0003-ch0001-9781437727760.indd

    What ' s Familiar What ' s New 4-Circle CT Model: Get the Picture? Thinking Ahead, Thinking-in-Action, Thinking Back (Refl ecting) Putting It All Together Critical Thinking Exercises Key Points/Summary

  5. Development and Psychometric Properties of the Nursing Critical

    The purpose of the study was to develop and validate an instrument to assess critical thinking ability in nurses working in health care based on the 4-Circle CT Model of Alfaro-LeFevre, which we have called the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice).

  6. What Are Critical Thinking Indicators (CTIs) In Nursing?

    In this article, we will explore key critical thinking indicators in nursing and provide examples of how these indicators manifest in real-world situations.

  7. The Alfaro-Le Fevre's 4-Circle Critical Thinking Model

    Download scientific diagram | The Alfaro-Le Fevre's 4-Circle Critical Thinking Model from publication: Critical Thinking and Decision Making: Essential Skills in Nursing | Critical thinking and ...

  8. Personal Critical Thinking Indicators

    Figure 10-1 • Alfaro-LeFevre's 4-Circle Critical Thinking Model. Adapted with permission from Critical Thinking Indicators (CTIs): 2014 Evidence-Based Version, by R. Alfaro-LeFevre, 2014.

  9. The nursing critical thinking in clinical practice questionnaire for

    Alfaro-LeFevre (2019) proposed the 4-Circle Critical Thinking (CT) model, a theoretical model that describes the construct of critical thinking as the integration of four components: personal characteristics, intellectual or cognitive skills, interpersonal and self-management skills and technical skills.

  10. PDF Clinical Critical Thinking (CT) Cards..

    Draw the 4-Circle CT model (see next page and Alfaro-LeFevre, 2004, 2006). Draw a line out of each of the circles, identifying knowledge, skills, or competencies you want to work on.

  11. Development and Psychometric Properties of the Nursing Critical

    The Critical Thinking for Nursing Professionals Questionnaire (CuPCPE) [21] is based on the Alfaro-LeFevre 4-Circle CT Model, which defines critical thinking using 109 items with a Likert scale ...

  12. Clinical nurses's critical thinking level according to sociodemographic

    The 4-Circle CT Model describes the construct of critical thinking as the integration of four components: personal characteristic, intellectual and cognitive abilities, interpersonal abilities and self-management and technical abilities.

  13. Wheel of Reason

    Welcome to the wheel of reason, the section of our critical thinking academy focused on helping you develop your ability to analyze articles, essays, books, texts of any kind, professional and academic subjects, concepts, work products and constructs, as well as problems and issues you face in your professional or personal life.

  14. Critical Thinking, Clinical Reasoning, and Clinical Judgment, 7th

    Develop the critical thinking and reasoning skills you need to make sound clinical judgments! Alfaro-LeFevre's Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach, 7th Edition brings these concepts to life through engaging text, diverse learning activities, and real-life examples. Easy-to-understand language and a "how-to" approach equip you to become a sensible ...

  15. Critical Thinking Models: A Comprehensive Guide for Effective Decision

    Enhance your decision-making skills with our comprehensive guide to critical thinking models. Learn effective strategies for better outcomes. Explore now!

  16. Critical Thinking Models: Definition, Benefits, and Skills

    Learn three critical thinking models, essential critical reasoning skills, and why improving your critical thinking process is a good idea.

  17. Paul-Elder Critical Thinking Framework

    Paul-Elder Critical Thinking Framework Critical thinking is that mode of thinking - about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. (Paul and Elder, 2001).

  18. Nursing Critical Thinking in Clinical Practice Questionnaire

    The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice; Zuriguel‐Pérez et al., 2017) was developed to measure the critical thinking (CT) abilities of nurses in a clinical setting. The items were generated from the 79 critical thinking indicators in the 4-Circle CT Model of Alfaro-LeFevre (2016) and from a review of the literature on critical thinking, on the ...

  19. Does Self-Directed Learning with Simulation Improve Critical Thinking

    In this sense, we adopted the well-established 4-Circle Critical Thinking Model of Alfaro-LeFevre [ 45 ], standardized patients were included in our clinical simulation sessions, and all the MAES© sessions concluded with a structured debriefing phase, thus fulfilling all the requirements defined by the INACSL Standards of Best Practice ...

  20. Alfaro-LeFevre Circular Model for Competence Assessment

    In 2015, an instrument was designed based on the Alfaro-LeFevre model in order to evaluate the critical thinking of care nurses at the Hospital Universitari Vall d'Hebron.

  21. The Four-Circle Model

    That research was published in the proceedings at the 1999 FFI conference. The Four-Circle Model is different from the Three-Circle Model in four significant ways: The addition of the "individual circle" is critical, because in a family-owned business, advisors are often dealing with a family of adults, and healthy adults have typically ...

  22. PDF Clinical nurses's critical thinking level according to sociodemographic

    The 4-Circle CT Model describes the construct of critical thinking as the integration of four components: personal characteristic, intellectual and cognitive abilities, interpersonal abilities and ...