Bevan B.

Balbuena, RN, MN
OUTLINE:

A. Critical Thinking
B. Nursing Process
1. Assessment
2. Nursing Diagnosis
3. Outcome Identification & Planning
4. Intervention
5. Evaluation
6. Documentation
At the end of this concept, the BSN 1 students will:
1. identify the components of the nursing process;
2. discuss the requirement for effective use of the nursing
process;
3. explain how critical thinking is used in nursing;
4. distinguish the relationships among knowledge,
experience, critical thinking, reflection, and nursing
judgment; and
5. explore ways to enhance and develop critical thinking
skills as they apply to nursing.
Nursing Process

“ A systematic, creative approach to thinking and

doing that nurses use to obtain, categorize and
analyze patient data and to plan actions to meet
patient needs.”
Nursing Process

“A type of problem solving process requiring the

use of decision making, clinical judgment and
variety of critical thinking skills.”
Critical Thinking

“ Goal-oriented, purposeful thinking that involves

many mental attitudes and skills, such as
determining which data are relevant and making
inferences. “

 Essential when a problem is ill defined and does

not have a single ‘best’ solution.
Problem solving

“ The mental activity of identifying a problem

(unsatisfactory state) and finding a reasonable
solution to it. “

 Requires decision making;

 may or may not require the use of critical thinking.
Decision Making

“ The process of choosing the best action to take -

the action most likely to produce the desired
outcome. Involves deliberation, judgment, and
choice. “

Decision must be made whenever there are mutually

exclusive choices, but not necessarily problems.
Clinical Reasoning

“Logical thinking that links thoughts together in

meaningful ways. Clinical reasoning is reflective,
concurrent and creative thinking about patients
and patient care.”
Reflection or Reflective Judgment

“A kind of critical thinking that considers a broad

array of possibilities and reflects on the merits of
each in a given situation.”

 Essential when a problem is complex and has no

simple “correct” solution.
Clinical Judgment

“The use of values or other criteria to evaluate or

draw conclusion about information.”

“Clinical judgments are conclusions and opinions

about patient’s health, drawn from patient data.
They may or may not be made using critical
thinking.“
Analysis/Critical Analysis

Analysis:
“The process of breaking down materials into
component parts and identifying the relationship
among them.”

Critical analysis:
“Is the questioning applied to a situation or idea to
determine essential information and ideas and
discard superfluous information and ideas.”
 “The art of thinking
about your thinking
while you are thinking
so as to make your thinking
more clear, precise, accurate,
relevant, consistent and fair.”
(Paul , 1988)

Wilkinson, J. (2001) Nursing Process and Critical Thinking. 3rd Edition. New Jersey: Prentice Hall.
Are you a
critical
thinker?
 explore the thinking and assumptions that
underlie your emotions?
 base your judgments on facts and reasoning, not
on personal feelings, self-interest or guesswork?
 suspend judgment until you have all the necessary
data?
 support your view with evidence?
 ask for clarification when you don’t understand?
 turn your mistakes into learning opportunities?
1. Rational and reasonable
 based on reasons; not on prejudice, preferences,
self-interest, or fear

2. Involves conceptualization
 Concept – mental image of reality, ideas about
events, objects or relationship between them
3. Requires reflection

 Reflection – to ponder, contemplate or deliberate

something.

 Reflective thinking – integrates past experiences

into the present to explore potential alternatives
4. Involves both cognitive (thinking) and attitude
(feelings)

5. Involves creative thinking

 It results in innovative ideas and products
6. Involves knowledge

Nursing knowledge
 Scientific knowledge - facts, information, principles,
theories, research findings and conceptual models
 used to describe, explain, and predict.
Ethical knowledge
 Knowledge of professional standard of conduct

Personal knowledge
 knowing and actualizing one’s self

Practice wisdom
 acquired from intuition, tradition, authority, trial and
error, clinical experience
1. Independent Thinking
2. Intellectual Humility
3. Intellectual Courage
4. Intellectual Empathy
5. Intellectual Integrity
6. Intellectual Perseverance
7. Intellectual Curiosity
8. Faith in reason
9. Fairmindedness
10. Interest in exploring thoughts and feelings
Independent Thinking

 Critical thinkers think for themselves.

 They consider a wide range of ideas,
learn from them and make their own
judgments about them.
Intellectual Humility

 Means being aware of the limits of

your knowledge and realizing that the
mind can be self-deceptive
 Admitting lack of knowledge or skill
can/will enable you to grow
professionally
 Rethinking conclusions in light of new
knowledge
Intellectual Courage

 Being willing to consider and

examine fairly your own beliefs and
the views of others, especially those
to which you may have a strongly
negative reaction
Intellectual Empathy

 the ability to imagine yourself in the

place of others in order to understand
them and their actions and beliefs.
Intellectual Integrity

 Being consistent in the thinking

standards you apply (e.g. clarity,
accuracy, completeness) – holding
yourself to the same rigorous
standards of proof to which you hold
others
Intellectual perseverance

 A sense of the need to struggle with

confusion and unsettled questions over
an extended period of time to achieve
understanding and insight.
Intellectual Curiosity

 An attitude of inquiry
 Having a mind filled with questions
Faith in reason

 Implies that people can, and should learn to think

logically for themselves
 Not afraid of disagreement
Fairmindedness

 Making impartial judgments

 Treating all viewpoints alike, without reference to
one’s own feelings or vested interests, or those of
one’s friends, community or nation
Interest in exploring thoughts and
feelings

 The critical thinker knows that

emotions can influence thinking and
that all thoughts create some level of
feeling
 CRITICAL THINKING SKILLS
1. Using language

 Precise, specific
 Avoid cliches, jargon,
euphemisms
2. Perceiving
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 Avoiding selective perception

 Recognizing differences in perception
 3. Believing and knowing

Distinguishing facts from interpretation

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Supporting facts, opinions, beliefs and

preferences
Opinion Judgment
Inference
- a view or judgment formed - the ability to make
- a conclusion reached on
about something, not considered decisions or
the basis of evidence and
necessarily based on fact or come to sensible
reasoning
knowledge. conclusions.
4. Clarifying
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 Questioning to clarify meaning of words and

phrases
 Questioning to clarify issues, beliefs, and points
of view
5. Comparing
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 Noting similarities and differences

 Classifying
 Comparing and contrasting ideals and actual
practice
 Transferring insights to new context
6. Judging / Evaluating
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 Providing evidence to support judgments

 Develop evaluation criteria
7. Reasoning

 Recognizing assumptions Photo source:

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 Distinguishing between relevant and irrelevant

data
 Evaluating sources of information
 Generating and evaluating solutions
 Exploring implications, consequences,
advantages/disadvantages