Critical Thinking in Nursing
Content
Critical Thinking in Nursing
Critical thinking in science and in nursing is a process of inquiry in which we try to gain a better understanding of the world—from stars and meteors to the human brain and behavior to entire ecosystems. Inquiry is based on a standard set of rules known as the scientific method. The scientific method is important because it provides a regulated process for conducting research:
Essential questioning: asking questions Possible answers: forming hypotheses Testing hypotheses: looking for answers
The scientific method is a process that other nurse researchers can then follow and repeat to reproduce and validate your results. Repetition of research studies gives the results more strength by increasing the amount of supporting evidence. For instance, you’d like to know that a medication you give a patient to fight a bacterial infection has been researched using a standard method, tested repeatedly, and has strong evidence supporting its effectiveness. Furthermore, you would want to be confident that it works on the specific bacteria your patient has and that it doesn’t have any dangerous side effects. The main ingredient of the scientific method is the ability to think, which sounds pretty easy, perhaps like breathing. But, you can learn to improve your thinking as you progress through college course work. Even thinking about your own thinking, called reflection, can help you. Reflection helps you understand your own biases, or your particular way of looking at phenomena, so that you can find out how your previous views might be getting in the way when what you need is a fresh perspective. Observation is a critical skill in inquiry, and you can learn to become an astute observer through practice. Another thinking skill you can learn is making connections between what you already know and what you are learning. This skill will help you put information together to make new discoveries or to come up with new solutions to old problems. Inquiry in nursing relies on asking critical questions. Questions help direct your inquiry; they help you decide where to go for information, what tests to perform, or what experiments to design. The more you improve your thinking through practice and experience, the better you will be at coming up with questions about the world, or your area of practice, and finding methods for answering those questions. Mind Actions and the Critical-Thinking Process The previously discussed basic actions your mind performs when asking important questions are the basic blocks you will use to build the critical-thinking processes you will explore in the next section. You rarely use the mind actions one at a time as they are presented here. Usually you combine them and repeat them. Sometimes they overlap. When you combine them in working toward a goal (a problem to solve, a decision to make), you are performing a thinking process. Important criticalthinking processes include: solving problems, making decisions, reasoning, opening your mind to new perspectives, and planning strategically. These thinking processes are similar in that they involve the steps of gathering, evaluating, and using information. As you will see, however, the sequence or combination of mind actions may vary considerably. How does critical thinking help you succeed in nursing? Problem solving and decision making are probably the two most crucial and common thinking processes used in nursing. Each requires various mind actions. They overlap somewhat, because every problem that needs solving requires you to make a decision. Each process is considered separately here. You will notice similarities in the steps involved in each.
Although both of these processes have multiple steps, you will not always have to work your way through each step. As you become more comfortable with solving problems and making decisions, your mind will automatically click through the steps you need whenever you encounter a problem or decision. Also, you will become more adept at evaluating which problems and decisions need serious consideration and which can be taken care of more quickly and simply. As you become an expert nurse, learning these skills will take many years of experience and reflection—so, start now! Problem Solving Life constantly presents problems to be solved, ranging from common daily problems (how to manage study time) to life-altering situations (how to design a child-custody plan during a divorce). Choosing a solution without thinking critically may have negative effects. If you move through the steps of a problem-solving process, however, you have a good chance of coming up with a favorable solution. Brainstorming Brainstorming is a crucial element of problem solving. You are brainstorming when you approach a problem by letting your mind free-associate, coming up with as many possible ideas, examples, or solutions as you can without immediately evaluating them as good or bad. Brainstorming is also referred to as divergent thinking; you start with the issue or problem and then let your mind diverge, or go in many different directions, in search of ideas or solutions. Following are some general guidelines for creative and successful brainstorming: 1. Don’t evaluate or criticize an idea right away. Write down your ideas so that you remember them. Evaluate them later, after you have had a chance to think about them. Try to avoid criticizing other people’s ideas as well. Students often become stifled when their ideas are evaluated during brainstorming. 2. Focus on quantity; don’t worry about quality until later. Generate as many ideas or examples as you can without worrying about which one is “right.” The more thoughts you generate, the better the chance that one may be useful. Brainstorming works well in groups. Group members can become inspired by, and make creative use of, one another’s ideas. 3. Let yourself play. People often hit on their most creative ideas when they are exercising or just relaxing. Often when your mind switches into play mode, it can more freely generate new thoughts. A thought that seems crazy might be a brilliant discovery. For example, the idea for Velcro came from examining how a burr sticks to clothing. Dreams can also be a source. 4. Use analogy. Think of similar situations and write down what you remember; what ideas or strategies have worked before? Analogy puts the similarity mind action to work recalling potentially helpful ideas and examples and stimulating your mind to come up with new ones. For example, the Velcro discovery is a product of analogy: when trying to figure out how two pieces of fabric could stick together, the inventor thought of the similar situation of a burr sticking to clothing. 5. 6. Don’t fear failure. Even Michael Jordan got cut from the basketball team as a high school sophomore in Wilmington, NC. If you insist on getting it right all the time, you may miss out on the creative path—often paved with failures—leading to the best possible solution. The Problem-Solving Process When you have a problem to solve, taking the following steps will maximize the number of possible solutions and will allow you to explore each one carefully.
Identify the problem accurately. What are the facts? Recall the details of the situation. To define a problem correctly, focus on its causes rather than its effects. Consider the Chinese saying: “Give a man a fish, and he will eat for a day. Teach a man to fish, and he will eat for a
lifetime.” You may state the problem first as “The man is hungry.” If you stay with this statement, giving him a fish seems like a good solution. Unfortunately, the problem returns— because hunger is an effect. Focusing on the probable cause brings a new definition: “The man does not know how to find food.” Given that his lack of knowledge is the true cause, teaching him to fish truly solves the problem. Analyze the problem. Analyze, or break down into understandable pieces, what surrounds the problem. What effects of the situation concern you? What causes these effects? Which causes are most powerful or significant? Are there hidden causes? Look at the causes and effects that surround the problem. Brainstorm possible solutions. Brainstorming helps you to think of examples of how you solved similar problems, consider what is different about this problem, and come up with new possible solutions. Remember that to get to the heart of a problem, you must base possible solutions on the most significant causes instead of putting a bandage on the effects. Explore each solution. Why might your solution work or not work? Might a solution work partially or in a particular situation? Evaluate ahead of time the pros and cons (positive and negative effects) of each proposed solution. Create a chain of causes and effects in your head, as far into the future as you can, to see where this solution might lead. Choose and implement the solution you decide is best. Decide how you will put your solution to work. Then, carry out your plan. Evaluate the solution that you acted on. What are the positive and negative effects of what you did? In terms of your needs and those of others, was it a useful solution or not? Could the solution use any adjustments to be more useful? In evaluating, you are collecting data. Refine the solution. Problem solving is a process. You may have opportunities to apply the same solution again. Evaluate repeatedly, making changes that you decide make the solution better (i.e., more closely related to the causes of the problem).
Decision Making Decisions are choices. Making a choice or decision requires thinking critically through the possible choices and evaluating which will work best for you, considering the situation. Before you begin the process, evaluate what kind of decision you have to make. Some decisions, such as what books to bring to class, are little day-to-day considerations that you can take care of quickly. Others, such as what to major in or whether to quit your part-time job, require thoughtful evaluation, time, and perhaps the input of others you trust. The following is a list of steps for thinking critically through the more complex kind of decision: 1. Identify a goal. Why is this decision necessary? What result do you want from this decision, and what is its value? Considering the desired effects can help you formulate your goal. 2. Establish needs. Recall the needs of everyone involved in the decision. Consider all who will be affected. 3. Name, investigate, and evaluate available options. Brainstorm possible choices, and then look at the facts surrounding each. Evaluate the good and bad effects of each possibility. Weigh these effects in light of the needs you have established and judge which is the best course of action. 4. Decide on a plan and take action. Make a choice based on your evaluation, and act on it. 5. Evaluate the result. Was it useful? Not useful? Some of both? Weigh the positive and negative effects. Look at this example to see one way of using the decision-making plan:
Step 1: Identify a goal. A student currently attends a small private college. Her goal is to become a physical therapist. The school has a good program, but her father has changed jobs and the family can no longer pay the tuition and fees.
Step 2: Establish needs. The student needs a school with a full physical therapy program; she and her parents need to cut costs; she needs to be able to transfer credits. Step 3: Evaluate options. Here are some possible decisions that the student might consider: a. Continue at the current college. Positive effects: No need to adjust to a new place or to new people; ability to continue course work as planned. Negative effects: Need to finance most of my tuition and costs on my own, such as through loans, grants, or work; may be difficult to find time to work as much as I would need to; might not qualify for aid. b. Transfer to the state college. Positive effects: Opportunity to reconnect with people there whom I know from high school; cheaper tuition and room costs; ability to transfer credits. Negative effects: Need to earn some money or get financial aid; physical therapy program is small and not very strong. c. Transfer to the community college. Positive effects: Many of the courses I need to continue with the physical therapy curriculum are available; school is close so I could live at home and avoid paying housing costs; credits will transfer; tuition is reasonable. Negative effects: No personal contacts; less independence; no bachelor’s degree offered. Step 4: Decide. In this case, the student might decide to go to the community college for two years and then transfer back to a four-year school to earn a bachelor’s degree in physical therapy. Although she might lose some independence and contact with friends, the positive effects are money saved, opportunity to spend time on studies rather than working to earn tuition, and the availability of classes that match the physical therapy program’s requirements. Step 5: Evaluate. If the student decides to transfer, she may find that it can be hard being back at home, although her parents are adjusting to her independence and she is trying to respect their concerns. Fewer social distractions result in her getting more work done. The financial situation is favorable. All things considered, she evaluates that this decision is a good one.
Making important decisions can take time. Think through your decisions thoroughly, considering your own ideas as well as those of others you trust, but don’t hesitate to act once you have your plan. You cannot benefit from your decision until you follow through on it.
Critical thinking in science and in nursing is a process of inquiry in which we try to gain a better understanding of the world—from stars and meteors to the human brain and behavior to entire ecosystems. Inquiry is based on a standard set of rules known as the scientific method. The scientific method is important because it provides a regulated process for conducting research:
Essential questioning: asking questions Possible answers: forming hypotheses Testing hypotheses: looking for answers
The scientific method is a process that other nurse researchers can then follow and repeat to reproduce and validate your results. Repetition of research studies gives the results more strength by increasing the amount of supporting evidence. For instance, you’d like to know that a medication you give a patient to fight a bacterial infection has been researched using a standard method, tested repeatedly, and has strong evidence supporting its effectiveness. Furthermore, you would want to be confident that it works on the specific bacteria your patient has and that it doesn’t have any dangerous side effects. The main ingredient of the scientific method is the ability to think, which sounds pretty easy, perhaps like breathing. But, you can learn to improve your thinking as you progress through college course work. Even thinking about your own thinking, called reflection, can help you. Reflection helps you understand your own biases, or your particular way of looking at phenomena, so that you can find out how your previous views might be getting in the way when what you need is a fresh perspective. Observation is a critical skill in inquiry, and you can learn to become an astute observer through practice. Another thinking skill you can learn is making connections between what you already know and what you are learning. This skill will help you put information together to make new discoveries or to come up with new solutions to old problems. Inquiry in nursing relies on asking critical questions. Questions help direct your inquiry; they help you decide where to go for information, what tests to perform, or what experiments to design. The more you improve your thinking through practice and experience, the better you will be at coming up with questions about the world, or your area of practice, and finding methods for answering those questions. Mind Actions and the Critical-Thinking Process The previously discussed basic actions your mind performs when asking important questions are the basic blocks you will use to build the critical-thinking processes you will explore in the next section. You rarely use the mind actions one at a time as they are presented here. Usually you combine them and repeat them. Sometimes they overlap. When you combine them in working toward a goal (a problem to solve, a decision to make), you are performing a thinking process. Important criticalthinking processes include: solving problems, making decisions, reasoning, opening your mind to new perspectives, and planning strategically. These thinking processes are similar in that they involve the steps of gathering, evaluating, and using information. As you will see, however, the sequence or combination of mind actions may vary considerably. How does critical thinking help you succeed in nursing? Problem solving and decision making are probably the two most crucial and common thinking processes used in nursing. Each requires various mind actions. They overlap somewhat, because every problem that needs solving requires you to make a decision. Each process is considered separately here. You will notice similarities in the steps involved in each.
Although both of these processes have multiple steps, you will not always have to work your way through each step. As you become more comfortable with solving problems and making decisions, your mind will automatically click through the steps you need whenever you encounter a problem or decision. Also, you will become more adept at evaluating which problems and decisions need serious consideration and which can be taken care of more quickly and simply. As you become an expert nurse, learning these skills will take many years of experience and reflection—so, start now! Problem Solving Life constantly presents problems to be solved, ranging from common daily problems (how to manage study time) to life-altering situations (how to design a child-custody plan during a divorce). Choosing a solution without thinking critically may have negative effects. If you move through the steps of a problem-solving process, however, you have a good chance of coming up with a favorable solution. Brainstorming Brainstorming is a crucial element of problem solving. You are brainstorming when you approach a problem by letting your mind free-associate, coming up with as many possible ideas, examples, or solutions as you can without immediately evaluating them as good or bad. Brainstorming is also referred to as divergent thinking; you start with the issue or problem and then let your mind diverge, or go in many different directions, in search of ideas or solutions. Following are some general guidelines for creative and successful brainstorming: 1. Don’t evaluate or criticize an idea right away. Write down your ideas so that you remember them. Evaluate them later, after you have had a chance to think about them. Try to avoid criticizing other people’s ideas as well. Students often become stifled when their ideas are evaluated during brainstorming. 2. Focus on quantity; don’t worry about quality until later. Generate as many ideas or examples as you can without worrying about which one is “right.” The more thoughts you generate, the better the chance that one may be useful. Brainstorming works well in groups. Group members can become inspired by, and make creative use of, one another’s ideas. 3. Let yourself play. People often hit on their most creative ideas when they are exercising or just relaxing. Often when your mind switches into play mode, it can more freely generate new thoughts. A thought that seems crazy might be a brilliant discovery. For example, the idea for Velcro came from examining how a burr sticks to clothing. Dreams can also be a source. 4. Use analogy. Think of similar situations and write down what you remember; what ideas or strategies have worked before? Analogy puts the similarity mind action to work recalling potentially helpful ideas and examples and stimulating your mind to come up with new ones. For example, the Velcro discovery is a product of analogy: when trying to figure out how two pieces of fabric could stick together, the inventor thought of the similar situation of a burr sticking to clothing. 5. 6. Don’t fear failure. Even Michael Jordan got cut from the basketball team as a high school sophomore in Wilmington, NC. If you insist on getting it right all the time, you may miss out on the creative path—often paved with failures—leading to the best possible solution. The Problem-Solving Process When you have a problem to solve, taking the following steps will maximize the number of possible solutions and will allow you to explore each one carefully.
Identify the problem accurately. What are the facts? Recall the details of the situation. To define a problem correctly, focus on its causes rather than its effects. Consider the Chinese saying: “Give a man a fish, and he will eat for a day. Teach a man to fish, and he will eat for a
lifetime.” You may state the problem first as “The man is hungry.” If you stay with this statement, giving him a fish seems like a good solution. Unfortunately, the problem returns— because hunger is an effect. Focusing on the probable cause brings a new definition: “The man does not know how to find food.” Given that his lack of knowledge is the true cause, teaching him to fish truly solves the problem. Analyze the problem. Analyze, or break down into understandable pieces, what surrounds the problem. What effects of the situation concern you? What causes these effects? Which causes are most powerful or significant? Are there hidden causes? Look at the causes and effects that surround the problem. Brainstorm possible solutions. Brainstorming helps you to think of examples of how you solved similar problems, consider what is different about this problem, and come up with new possible solutions. Remember that to get to the heart of a problem, you must base possible solutions on the most significant causes instead of putting a bandage on the effects. Explore each solution. Why might your solution work or not work? Might a solution work partially or in a particular situation? Evaluate ahead of time the pros and cons (positive and negative effects) of each proposed solution. Create a chain of causes and effects in your head, as far into the future as you can, to see where this solution might lead. Choose and implement the solution you decide is best. Decide how you will put your solution to work. Then, carry out your plan. Evaluate the solution that you acted on. What are the positive and negative effects of what you did? In terms of your needs and those of others, was it a useful solution or not? Could the solution use any adjustments to be more useful? In evaluating, you are collecting data. Refine the solution. Problem solving is a process. You may have opportunities to apply the same solution again. Evaluate repeatedly, making changes that you decide make the solution better (i.e., more closely related to the causes of the problem).
Decision Making Decisions are choices. Making a choice or decision requires thinking critically through the possible choices and evaluating which will work best for you, considering the situation. Before you begin the process, evaluate what kind of decision you have to make. Some decisions, such as what books to bring to class, are little day-to-day considerations that you can take care of quickly. Others, such as what to major in or whether to quit your part-time job, require thoughtful evaluation, time, and perhaps the input of others you trust. The following is a list of steps for thinking critically through the more complex kind of decision: 1. Identify a goal. Why is this decision necessary? What result do you want from this decision, and what is its value? Considering the desired effects can help you formulate your goal. 2. Establish needs. Recall the needs of everyone involved in the decision. Consider all who will be affected. 3. Name, investigate, and evaluate available options. Brainstorm possible choices, and then look at the facts surrounding each. Evaluate the good and bad effects of each possibility. Weigh these effects in light of the needs you have established and judge which is the best course of action. 4. Decide on a plan and take action. Make a choice based on your evaluation, and act on it. 5. Evaluate the result. Was it useful? Not useful? Some of both? Weigh the positive and negative effects. Look at this example to see one way of using the decision-making plan:
Step 1: Identify a goal. A student currently attends a small private college. Her goal is to become a physical therapist. The school has a good program, but her father has changed jobs and the family can no longer pay the tuition and fees.
Step 2: Establish needs. The student needs a school with a full physical therapy program; she and her parents need to cut costs; she needs to be able to transfer credits. Step 3: Evaluate options. Here are some possible decisions that the student might consider: a. Continue at the current college. Positive effects: No need to adjust to a new place or to new people; ability to continue course work as planned. Negative effects: Need to finance most of my tuition and costs on my own, such as through loans, grants, or work; may be difficult to find time to work as much as I would need to; might not qualify for aid. b. Transfer to the state college. Positive effects: Opportunity to reconnect with people there whom I know from high school; cheaper tuition and room costs; ability to transfer credits. Negative effects: Need to earn some money or get financial aid; physical therapy program is small and not very strong. c. Transfer to the community college. Positive effects: Many of the courses I need to continue with the physical therapy curriculum are available; school is close so I could live at home and avoid paying housing costs; credits will transfer; tuition is reasonable. Negative effects: No personal contacts; less independence; no bachelor’s degree offered. Step 4: Decide. In this case, the student might decide to go to the community college for two years and then transfer back to a four-year school to earn a bachelor’s degree in physical therapy. Although she might lose some independence and contact with friends, the positive effects are money saved, opportunity to spend time on studies rather than working to earn tuition, and the availability of classes that match the physical therapy program’s requirements. Step 5: Evaluate. If the student decides to transfer, she may find that it can be hard being back at home, although her parents are adjusting to her independence and she is trying to respect their concerns. Fewer social distractions result in her getting more work done. The financial situation is favorable. All things considered, she evaluates that this decision is a good one.
Making important decisions can take time. Think through your decisions thoroughly, considering your own ideas as well as those of others you trust, but don’t hesitate to act once you have your plan. You cannot benefit from your decision until you follow through on it.
