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UNIT 1 How Nurses Think
BOX 2-1 ■ Critical-Thinking Model
Contextual Awareness ■ Deciding what to observe and consider
■ Are there others who might help me develop more alternatives? ■ Of the possible actions I am considering, which one is most reasonable? Why are the others not as reasonable? ■ Of the possible actions that I am considering, which one is most likely to achieve the desired outcomes? Analyzing Assumptions ■ Recognizing and analyzing assumptions you are making about the situation and examining the beliefs that underlie your choices Questions for Focusing Thinking ■ What have I (or others) taken for granted in this situation? ■ Which beliefs/values are shaping my assumptions? ■ What assumptions contributed to the problem in this situation? ■ What rationale supports my assumptions? ■ How will I know my assumption is correct? ■ What biases do I have that may affect my thinking and my decisions in this situation? Reflecting Skeptically and Deciding What to Do ■ Questioning, analyzing, and reflecting on the rationale for your decisions Questions for Focusing Thinking ■ What aspects of this situation require the most careful attention? ■ What else might work in this situation? ■ Am I sure of my interpretation of this situation?
■ An awareness of what’s happening in the total situation, including values, cultural issues, interpersonal relationships, and environmental influences Questions for Focusing Thinking ■ What is going on in the situation that may influence the outcome? ■ What factors may influence my behavior and that of others in this situation (e.g., culture, roles, relationships, economic status)? ■ What about this situation have I seen before? What is different? What is new? ■ Who should be involved to improve the outcome? ■ What else was happening at the same time that affected me in this situation? ■ What happened just before this incident that made a difference? ■ What emotional responses influenced how I reacted in this situation? ■ What changes in behavior alerted me that something was wrong? Inquiry ■ Based on credible sources ■ Applying standards of good reasoning to your thinking when analyzing a situation and evaluating your actions Questions for Focusing Thinking ■ How do I go about getting the information I need? ■ What framework should I use to organize my information? ■ Do I have enough knowledge to decide? If not, what do I need to know? ■ Have I used a valid, reliable source of information (e.g., client, other professionals, references)? ■ Did I (do I need to) validate the data (e.g., with the client)? ■ What else do I need to know? What information is missing? ■ Are the data accurate? Precise? ■ What’s important and what’s not important in this situation? ■ Did I consider professional, ethical, and legal standards? ■ Have I jumped to conclusions? Considering Alternatives ■ Exploring and imagining as many alternatives as you can think of for the situation Questions for Focusing Thinking ■ What is one possible explanation for what is happening or what happened? ■ What are other explanations for what is happening? What is one thing I could do in this situation? ■ What are two more possibilities/alternatives?
■ Why is (was) it important to intervene? ■ What rationale do I have for my decisions?
■ In priority order, what should I do in this situation and why? ■ Having decided what was wrong/happening, what is the best response? ■ What might I delegate in this situation? ■ What got me started taking action? ■ What priorities were missed? ■ What was done? Why was it done? ■ What would I do differently after reflecting on this situation? Source : Model based on Brookfield, S. D. (1991). Developing critical thinkers. Jossey-Bass; McDonald, M. E. (2002). Systematic assessment of learning outcomes: Developing multiple-choice exams. Jones & Bartlett Publishers; Paul, R.W. (1993). Critical thinking:What every person needs to survive in a rapidly changing world (3rd ed.). Foundation for Critical Thinking; Raingruber, B., & Haffer,A. (2001). Using your head to land on your feet. F.A. Davis;Wilkinson, J. M. (2012). Nursing process and critical thinking (5th ed.). Prentice Hall; Victor-Chmil, J. (2013). Critical thinking versus clinical reasoning versus clinical judgment: Differential diagnosis. Nurse Educator , 38 (1), 34–36. https://doi.org/10.1097/NNE.0b013e318276dfbe; Von Colln-Appling, C., & Giuliano, D. (2017).A concept analysis of critical thinking:A guide for nurse educators. Nurse Education Today, 49, 106–109. https://doi.org/10.1016/j.nedt.2016.11.007
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