43.2 Developing Critical Thinking

Learning objectives.

By the end of this section, you will be able to:

  • Analyze the types of thinking used in nursing
  • Recognize when to use the different types of thinking in nursing
  • Explore the application of knowledge to thinking in nursing
  • Appy Critical Thinking Indicators (CTIs) to decision making

Thinking is something we usually do subconsciously, because we are not usually “thinking about thinking.” However, with the ever-increasing autonomy being afforded to nurses, there is also an increased need for nurses to be able to critically think effectively and intentionally. Being able to critically think helps nurses’ problem solve, generate solutions, and make sound clinical judgments that affect the lives of their patients. Keep reading to learn more about how nurses use critical thinking in practice and how you can develop your own critical thinking skills.

Types of Thinking Used in Nursing

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. In nursing, critical thinking is a broad term that includes reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” On the other hand, clinical reasoning is defined as a complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions. Each of these types of thinking is described in more detail in the following sections.

Cognitive Thinking

The term cognitive thinking refers to the mental processes and abilities a nurse uses to interpret, analyze, and evaluate information in their practice. Basically, it encompasses how nurses think about the practice decisions they are making. Cognitive thinking and critical thinking go hand in hand because nurses must be able to use their knowledge and mental processes to devise solutions and actions when caring for patients. Using critical thinking means that nurses take extra steps to maintain patient safety and do not just follow orders. It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research. Critical thinkers possess certain attitudes that foster rational thinking:

  • confidence: believing in yourself to complete a task or activity
  • curiosity: asking “why” and wanting to know more
  • fair-mindedness: treating every viewpoint in an unbiased, unprejudiced way
  • independence of thought: thinking on your own
  • insight into egocentricity and sociocentricity: thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
  • integrity: being honest and demonstrating strong moral principles
  • intellectual humility: recognizing your intellectual limitations and abilities
  • interest in exploring thoughts and feelings: wanting to explore different ways of knowing
  • nonjudgmental: using professional ethical standards and not basing your judgments on your own personal or moral standards
  • perseverance: persisting in doing something despite it being difficult

Cognitive thinking is significant to nursing because it provides a foundation on which nurses can make rapid and accurate decisions in clinical practice. Nurses must be able to think quickly and make informed decisions to promote optimal patient outcomes.

Effective Thinking

To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process. Effective thinking in nursing involves the integration of clinical knowledge and critical thinking to make the best decisions for patients. For example, if a nurse was caring for a patient who presents with hypertension and new-onset left-sided weakness, it is important that the nurse be able to quickly consider potential causes for the weakness and implement immediate stroke protocols. Without the ability to critically think, the nurse may overlook the weakness as being unrelated to the hypertension and not consider the possibility of stroke, leading to a poor patient outcome. Thus, it is imperative that nurses develop effective thinking skills.

Inductive Reasoning

The term inductive reasoning involves noticing cues, making generalizations, and creating hypotheses. Cues are data that fall outside of expected findings and give the nurse a hint or indication of a patient’s potential problem or condition. The nurse organizes these cues into patterns and creates a generalization. A generalization is a judgment formed on the basis of a set of facts, cues, and observations and is similar to gathering pieces of a jigsaw puzzle into patterns until the whole picture becomes clearer. On the basis of generalizations created from patterns of data, the nurse creates a hypothesis regarding a patient problem. Remember, a hypothesis is a proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring. If a “why” is identified, then a solution can begin to be explored. No one can draw conclusions without first noticing cues. Paying close attention to a patient, the environment, and interactions with family members is critical for inductive reasoning. As you work to improve your inductive reasoning, begin by first noticing details about the things around you. Be mindful of your five primary senses: the things that you hear, feel, smell, taste, and see. Nurses need strong inductive reasoning patterns and be able to act quickly, especially in emergency situations. They can see how certain objects or events form a pattern (or a generalization) that indicates a common problem.

Consider this example: A nurse assesses a patient who has undergone surgery and finds the surgical incision site is red, warm, and tender to the touch. The nurse recognizes these cues form a pattern of signs of infection and creates a hypothesis that the incision has become infected. The provider is notified of the patient’s change in condition, and a new prescription is received for an antibiotic. This is an example of the use of inductive reasoning in nursing practice.

Deductive Reasoning

Another type of critical thinking is deductive reasoning ; it is referred to as “top-down thinking.” Deductive reasoning relies on using a general standard or rule to create a strategy. Nurses use standards set by their state’s Nurse Practice Act, federal regulations, the American Nursing Association, professional organizations, and their employer to make decisions about patient care and solve problems.

Think about this example: On the basis of research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking, because the intervention is applied to all patients regardless of whether they have difficulty sleeping or not.

Identify the Purpose of Thinking

Rationalizing the purpose of thinking is probably not something you do often, but it is the foundational first step in critical thinking. To effectively use critical thinking in practice, the nurse must first identify the purpose of thinking. For example, the nurse is caring for a patient who presents with fever, tachycardia, and shortness of breath. The patient also has an open, infected wound on the left foot that is not healing. The nurse must recognize that the patient is exhibiting signs and symptoms that may be indicative of an underlying problem. At this point, the nurse must be able to identify that the purpose of thinking with regard to the patient is to consider what might be happening with the patient and formulate a plan of care. This begins the process of critical thinking, which involves several steps: thinking ahead, thinking in action, and reflection on thinking.

Thinking Ahead

Thinking ahead in nursing involves considering what may be going on with the patient to anticipate potential outcomes and complications that may arise. Remember competent nurses are proactive versus reactive. Reactive nursing is letting situations arise and then responding to the change, but proactive nursing is recognizing cues behaviors and patterns that are leading up to a complicated event. Additionally, the nurse will formulate goals of care and must try to anticipate specific needs the patient will have. Considering the patient discussed in the preceding paragraph, the nurse should begin the process of thinking ahead about potential outcomes and complications. The nurse may hypothesize that the patient is starting to develop sepsis from the open wound on the foot so severe sepsis and/or septic shock could be a complication to begin preparing for. The nurse thinks ahead about goals of care for the patient and determines that wound care to prevent infection spread and sepsis is the priority goal at this time.

Thinking in Action

Thinking in action encompasses the thought processes occurring while the nurse is performing interventions. So, if the nurse in our example begins performing wound care, they are thinking about the best dressing to use, how to clean the wound, and if antibiotics should be considered. All of these thoughts are likely occurring as the nurse is providing the care; thus, they are examples of how the nurse is using thinking in action.

Reflection on Thinking

After performing interventions or making decisions, the nurse should reflect on the thinking that occurred. The nurse will use this thinking process to determine if the decision was reactive or responsive. Reactive decision-making involves responding to situations after they have occurred, often in a hurried or unplanned manner. These decisions tend to be impulsive and are driven by immediate needs or crises. Responsive decisions, on the other hand, involve careful deliberation about how to address a situation based on careful consideration of information. In our example, the nurse’s decision appears to have been responsive. The patient was exhibiting some altered vital signs, but nothing indicated that the situation had become emergent yet. The nurse was able to think carefully about the patient’s situation and determine that wound care was the highest priority and begin to implement care in a calm, deliberate manner. In an ideal world, all nursing decisions would be responsive, but in a lot of cases, they must be reactive because of situation severity and medical emergencies.

Application of Knowledge

During the outset of the critical thinking process, nurses must judge whether their knowledge is accurate, complete, factual, timely, and relevant. This can be done by applying knowledge to nursing practice in a multitude of ways, including drawing from past education and experience in nursing and using professional resources and standards. Each of these is discussed in more detail in the following sections.

Knowledge Base

Becoming a nurse requires years of schooling, which contributes to the development of a robust knowledge base. Nurses receive formal education and training that provides them foundational knowledge in anatomy, physiology, pharmacology, and patient care techniques, among many others. Additionally, nurses are required to complete continuing education courses specific to their chosen practice setting, further developing their knowledge base. When applying knowledge in practice, nurses can draw from their knowledge base and make informed decisions about patient care.

Experience in Nursing

Nursing is considered a practice. Nursing practice means we learn from our mistakes and our past experiences and apply this knowledge to our next patient or to the next population we serve. As nurses gain more experience, they can use what they have learned in practice and apply it to new patient situations. Each new encounter with a patient presents unique challenge and learning opportunities that contribute to the development of clinical expertise. Reflecting on these experiences allows nurses to recognize patterns, anticipate patient outcomes, and refine their decision-making processes. Whether they are identifying effective nursing interventions for common conditions, adapting care plans to individual patient needs, or navigating complex situations with compassion, nurses draw upon their accumulated knowledge base from clinical experience to provide high-quality, patient-centered care. Through reflection and continuous learning from past experiences, nurses enhance their clinical skills, ultimately improving patient outcomes.

Professional Resources and Standards

In addition to foundational knowledge bases and experience, nurses can also use professional resources and standards to gain and apply knowledge in practice. Nurses can refer to clinical practice guidelines that have been established by professional organizations and healthcare institutions to help provide a framework for implementing nursing interventions based on the best evidence. By following the guidelines, nurses are ensuring that their care aligns with established standards and promotes optimal patient outcomes. Additionally, nurses should remain up to date about new and emerging research in their practice area, which can be obtained by reading professional journals and publications and attending conferences, workshops, and other trainings. Nurses can use the information learned from these resources to influence practice and ensure the highest standards of care are being performed in their practice setting. By staying informed about the latest developments in nursing and health care, nurses enhance their knowledge base and can adapt their practice to incorporate new evidence and innovations. Along with professional development and staying current with professional practices, nursing students should actively seek and join professional organizations such as critical care nursing or oncology nursing societies because this will lead the student to become expert in that subject and stay relevant with current evidence and practice guidelines.

Clinical Safety and Procedures (QSEN)

Qsen competency: evidence-based practice.

Definition: Providing quality patient care based on up-to-date, theory-derived research and knowledge, rather than personal beliefs, advice, or traditional methods.

Knowledge: The nurse will describe how the strength and relevance of available evidence influences the choice of intervention in provision of patient-centered care.

Skill: The nurse will:

  • subscribe to professional journals that produce original research and evidence-based reports related to their specific area of practice
  • become familiar with current evidence-based clinical practice topics and guidelines
  • assist in creating a work environment that welcomes new evidence into standards of practice
  • question the rational for traditional methods of care that result in sub-par outcomes or adverse events

Attitude: The nurse will appreciate the importance of regularly reading relevant professional journals.

Critique of Decision

After determining the best course of action based on the application of knowledge, the nurse can critique the decisions that were made. Specifically, the nurse will use self-reflection to review their actions and thoughts that led them to the decision. The nurse will consider the outcomes of their chosen interventions, reflect on the effectiveness of their approach, and identify areas of improvement. Additionally, the nurse may seek feedback from colleagues to obtain different perspectives about decisions made. Soliciting input from others helps the nurse gain insight and learn from their peers to further inform their future practice. Reflection questions that the nurse may ask themselves to critique their decision include the following:

  • Was the patient goal or outcome met?
  • Could the intervention have been done differently? Could it have been done better?
  • What are alternative decisions that could have been made? What are the merits of each?

Critical Thinking Indicators

Certain behaviors that demonstrate the knowledge, skills, and attitudes that promote critical thinking are called critical thinking indicators (CTIs) . Critical thinking indicators are tangible actions that are performed to assess and improve your thinking skills.

4-Circle CT Model

There are many models and frameworks within nursing and other disciplines that attempt to explain the process of critical thinking. One of the most popular is Alfaro-LeFevre’s 4-Circle CT Model (Alfaro-LeFevre, 2016). This model breaks critical thinking into four components: personal characteristics, intellectual and cognitive abilities, interpersonal abilities and self-management, and technical skills. These four components overlap, forming interconnections in critical thinking.

Link to Learning

Learn more here about the 4-Circle CT Model and see an illustration of it.

Personal Critical Thinking Indicators

Personal CTIs are behaviors that are indicative of critical thinkers. Some of these behaviors that are most relevant to nursing include:

  • confidence and resilience: showing ability to reason and learn and overcoming problems
  • curiosity and inquisitiveness: asking questions and looking for the “why” behind things
  • effective communication: listening well, showing understanding for others thoughts and feelings, and speaking and writing with clarity
  • flexibility: changing approaches as needed to obtain the best results
  • honesty: looking for the truth and demonstrating integrity while adhering to moral and ethical standards
  • self-awareness: being able to identify one’s own knowledge gaps and acknowledge when thinking may be negatively influenced by emotions or self-interests.

Personal Knowledge and Intellectual Skills

Personal knowledge and intellectual skills encompass the knowledge gained from nursing school and clinical experiences. Examples of each of these kinds of skills are listed in Table 43.3 .

Personal Knowledge Intellectual Skills

Interpersonal and Self-Management Skills

Interpersonal and self-management skills encompass the knowledge and skills needed for effective collaboration. These include:

  • addressing conflicts fairly
  • advocating for patients, self, and others
  • dealing with complaints constructively
  • establishing empowered partnerships
  • facilitating and navigating change
  • fostering positive interpersonal relationships and promoting teamwork
  • giving and taking constructive criticism
  • leading, motivating, and managing others
  • managing stress, time, and energy
  • promoting a learning and safety culture
  • upholding healthy workplace standards
  • using skilled communication in high-stake situations

Technical Skills

Technical skills in nursing refer to the practical abilities and competencies that nurses use in the delivery of patient care. These skills are typically learned through education, training, and hands-on experience. Some common technical skills in nursing include:

  • administering medications
  • assisting with personal hygiene and activities of daily living
  • documentation and charting
  • inserting intravenous catheters
  • inserting urinary catheters and nasogastric tubes
  • performing tracheostomy care
  • performing wound care
  • taking vital signs

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What Are Critical Thinking Indicators (CTIs) In Nursing?

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.

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.

  • Nursing Concept Map (FREE Template)
  • Clinical Reasoning In Nursing (Explained W/ Example)
  • 8 Stages Of The Clinical Reasoning Cycle
  • How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples
  • What is the “5 Whys” Technique?
  • What Are Socratic Questions?

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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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, how to prepare for a critical thinking test: effective strategies and tips, strategic thinking tools: unlock your decision-making potential, decision making levels: understanding the hierarchy in organizations, all about non-linear thinking, download this free ebook.

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