CRITICAL THINKING

AND NURSING PROCESS

“Critical
Thinking: What
It Is and Why It
Counts,”
 Critical thinking is an active,
organized, cognitive process used to carefully
examine one’s thinking and the thinking of others

Paul and Elder’s (2005) definition

of critical thinking is similar:
“Critical thinking is a process by
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.”
 “How am I ever going to learn how to make
connections among all of the data I have
about a patient?”
 This is a common response for a
nursing student who is just learning
some of the most basic psychomotor
skills in preparation for practice.
 You need to understand that, just
like learning to give injections
safely and maintaining a sterile
field properly, you can learn to
think critically. This involves
 Using critical thinking to improve a patient care
• Mr. Smith is a 77-year-old man admitted to your general medicine unit with several
problems, including dehydration secondary to severe nausea and vomiting and a urinary
tract infection. His medication orders include hydrochlorothiazide 50 mg q am for mild
hypertension, ampicillin 2 g q6 hours. His IV order is D5LR at 125 mL/hour. His laboratory
values show a serum potassium level of 2.6 mEq/L. You recognize that this is low. Mr. Smith
seems weak and lethargic; his urine output has been 35 mL/hour for the past 2 hours. You
are concerned about him and his condition. A nurse using good critical thinking skills will
note the following: the source of his dehydration, his antibiotic order for his UTI, his low
potassium level, his IV rate, his low urinary output, and his daily use of a diuretic known to
be associated with potassium loss. His lethargy and weakness could be a product of his age
and general condition, but you also know that they are signs of hypokalemia. Critical
thinking does not stop at noting these issues, however.

• Critical thinking requires making a judgment about what to do with your concerns. A nurse
not using critical thinking may simply follow physician orders with the expectation that Mr.
Smith will feel better once his dehydration is reversed and his UTI is adequately treated.

• Using your good critical thinking skills, however, you come to the conclusion that Mr. Smith
may be better supported with a different approach to his care. You call his physician to
discuss your concerns, describing in detail the “big picture.” The specific, detailed
information that you communicate clearly allows the physician to reconsider Mr. Smith’s
medical regimen and proceed from a more informed position. The next day you are pleased
to see Mr. Smith walking in the hall when you come onto the unit at the beginning of your
shift. He says that he feels “like a new person.”
 Aspects of Critical Thinking
1. Reflection-Purposely thinking back or recalling a
situation to discover its purpose or meaning. Looking
back and reflecting on a client situation helps the nurse
to have insight and meaning in the situation.

• Reflection allows the nurse to look at a situation

honestly and do some self evaluation of the situation,
What was said and how did I respond, How did the
patient respond when I did the teaching or the
discharge instructions. How did the family react?

• Caution- Don’t over analyze- you’ll start second

guessing everything
2. Language-The ability to use language and express yourself is a
reflection of the ability to think meaningfully. Nurses must be
able to use language effectively (clearly and precisely). When
language is not well developed and the spoken word is not
clear and distinct it is a sign of sloppy thinking. We must
communicate (speak) clearly and distinctly with all of those
around us, peers, nurses, patients and families. To critically
think you must be able to organize and focus your own
thoughts.

3. Intuition- It is an inner sensing about a situation. This ability

to have intuition about clients come with time and
experience. Book points out that intuition can be the spark
that starts the flame of analytical thinking (the nurse seeks
more info that will confirm what they have been feeling and
concerned about for the patient Nurses also need to be aware
of what they do not know, and seek help appropriately
 Critical Thinking Competencies
• Scientific method= An approach to seeking truth or verifying facts.
SM is a formal way to approach a problem plan a solution, test the
solution, and come to a conclusion. Science fair. Nurse might
identify a problem and seek answers with a formal approach
(collecting data,formulating a hypothesis, testing the hypothesis,
evaluating the results.
• Problem solving- when problem is identified we seek information
about the problem and the information plus knowledge that we
already have to find solutions. Effective problem solving means
evaluating the solutions and deciding if we need to try other
solutions
• Decision making-This happens when there are several options or
courses of action that one might take to solve a problem or take care
of a situation. Decision making is an end point of critical thinking.
The pros/ cons or risks/benefits of each option is weighed to make a
final decision
 Group Activity
• White —Information. Asks the questions, “What information do
we have, what is needed, and how can we get it?”
• Red —Feelings, intuition, and emotion. Asks the questions, “What
are we, the patient, and the family feeling, and how do we know?”
• Black —Policies, codes, standards, protocols, laws. Asks the
questions, “What are the standards we should consider, and what
are the risks?”
• Yellow —Optimism. Asks the questions, “What are the benefits,
who benefits, and what are the values being expressed?”
• Green —Growth. Asks the questions, “Why don’t we try it this
way?” and “What are some different alternatives?”
• Blue —Focuses on thinking. Asks the questions, “How are we going
to proceed in thinking through this situation?” and “What have we
achieved and what do we want to achieve?”
 Case Study
Marianne is a 79-year-old woman who was
admitted to the emergency department yesterday
with a severe headache. Shortly after admission,
she became unresponsive; a brain scan revealed
she had experienced a hemorrhagic stroke.
Marianne’s pupils are dilated and do not respond
to light; she is breathing with the assistance of a
respirator. Her elderly husband and three adult
children are all assembled. The physician has
recommended surgery to remove the blood clot but
cannot offer much assurance that she will recover
function. She has no advance directives, but her
husband wants to “try everything.” The children
believe that she would not want to undergo this