6 critical thinking skills for at the bedside success

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Six critical thinking skills for at-the-bedside success

Ignatavicius, Donna D. RN, Cm, MS

ABOUT THE AUTHOR

Donna D. Ignatavicius, RN, Cm, MS, is president of DI Associates, Inc., in Hughesville, Md.

Learn how to identify and cultivate the nursing staff's critical thinking skills.

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Critical thinking is the one skillset you can't afford not to master

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What is critical thinking?

5 characteristics of critical thinking, what are critical thinking skills, and why are they important, 6 key critical thinking skills, critical thinking example in real-life, 13 ways to start thinking critically.

Whether you’re aiming to improve your performance at work or simply trying to live a more fulfilling life , you’ll need a variety of hard and soft skills to move the needle. Some skills come naturally to some people, while others need to develop them actively.

One of these skills is critical thinking. But critical thinking itself is made up of several types of skills that contribute to solving problems more effectively.

Let’s explore the different types of critical thinking skills and how you can start improving them to level up your career.

Critical thinking is the ability to analyze facts objectively and form a judgment. It is a form of emotional intelligence .

Someone with critical thinking skills can think clearly and rationally when the situation demands it. It allows them to perform problem-solving and decision-making more effectively. 

As a result, you can look further than what you see at face value. You’re able to analyze what you see from a situation and gain some insight that goes further than what’s obvious to anyone from the outside.

Critical thinking also requires being able to understand the logical connection between two or more ideas or concepts. For example, a team working on a company’s pricing strategy needs to think critically about several concepts. 

Both the marketing and sales teams must work together. They need to analyze how to maximize sales. But they need to do so while also meeting profit goals. It’s important to understand the logical connection between sales strategy and marketing logistics. It’s the only way to get a good outcome.

Critical thinking is different from creative thinking . Creative thinking is the ability to generate brand new, innovative ideas. On the other hand, critical thinking requires you to carefully and logically analyze what information is given to you. Both are important to maximize results in any given situation.

What defines critical thinking? How does it affect the decision-making process? Here are five characteristics that make up the ability to think critically.

1. Dispositions

Critical thinkers have specific traits that allow them to think the way they do. Some people are predisposed to these traits, while others need to develop them actively.

Some of these dispositions include:

• Open-mindedness
• Respecting evidence and reasoning
• Being able to consider different perspectives and points of view: in other words, having cognitive flexibility
• Not being stuck in one position
• Clarity and precision

2. Argument

Good critical thinkers need to make solid arguments. 

An argument is making a statement aided by supporting evidence. It’s important to use well thought-out arguments when you’re in a constructive conflict . When analyzing a situation critically, you’ll need to make several arguments in your own mind to come to a judgment. 

3. Reasoning

In addition to arguments, critical thinking also requires inferring conclusions. From the facts and arguments presented to you, you need to use reasoning skills to come to a logical conclusion. 

This conclusion will determine the best course of action to take.

4. Criteria

Critical thinking is sometimes a matter of discerning truth from fiction. Not all facts presented to you may have the same level of truth. Certain conditions need to be met for something to be considered believable, and a critical thinker needs to be able to understand that.

5. Metacognition

Metacognition is the ability to think about your own thinking. Critical thinkers should be able to analyze their thoughts so that they can judge whether or not they’ve thought everything through. This helps them come up with better hypotheses.

The critical thinking skills definition is: soft skills that help you in the critical thinking process. Developing these skills can improve your ability to think critically.

Critical thinking skills are considered one of many durable skills in the workplace . Many of these are soft skills that are also useful in other situations.

According to research by America Succeeds, critical thinking is in the top five most requested durable skills in job postings. Those top five durable skills get requested 2.6x more often than the top five hard skills. This goes to show that soft skills like critical thinking skills are in demand in the workplace.

Critical thinking skills are important for several reasons. These include helping you work independently and solve problems . Not all positions require ongoing critical thinking. But, those skills definitely matter to anyone who wants to uplevel their career. And even the most easygoing positions require at least some level of critical thinking skills.

For example, working as an accountant can be straightforward in most cases. But it may require critical thinking skills. For instance, what if certain expenses aren’t easily distributed in simple categories? Without critical thinking skills, an accountant will struggle to work independently and solve problems on their own.

Critical thinking abilities also matter in everyday life. Having a foundation for critical thinking can help you analyze several possible solutions for problems that pop up in the home. It can also help you:

• Analyze different viewpoints
• Come up with the best solution for complex problems
• Become a better learner

The key critical thinking skills are identifying biases, inference, research, identification, curiosity, and judging relevance.

Let’s explore these six critical thinking skills you should learn and why they’re so important to the critical thinking process.

1. Identifying biases

This critical thinking skill is necessary for metacognition, which is the fifth characteristic of critical thinking. It involves knowing when others have a cognitive bias and when you have one yourself.

Biases can influence how someone understands the facts presented to them. But when you’re aware of those biases, you can question yourself on those biases and consider other points of view.

Identifying biases is especially important for people who make hiring decisions. That’s because biases against groups of minorities can lead to inequalities in the workplace when not identified. 

For example, imagine a hiring manager comparing two resumes. Their gut feeling could guide them to discount one of the resumes due to a bias against the opposite gender. But let’s say this hiring manager realizes they have this bias. They can then question themselves on whether or not this bias is influencing their judgment. 

2. Inference

Inference is the ability to draw conclusions based on the information you have. Without inference, it can be difficult to take action once you’ve analyzed the facts presented to you. Processing information is key to coming up with a reasoned judgment.

For example, let’s go back to the accountant struggling to assign the correct category to a business expense. They can analyze other similar situations and infer the most logical category based on that information.

3. Research

Before you analyze facts and infer a conclusion, you need to find out what those facts are. Researching skills allow you to discover facts and figures to make an argument.

Not all situations will have the required information available to you. Researching skills are necessary to dig into a situation and gather the information you need to think critically.

Some situations don’t require further research. For example, a first responder who arrives on the scene of an automobile accident won’t perform further research. They’ll have to analyze what they see in front of them and decide which injuries are the most urgent to care for. 

On the other hand, someone performing a market analysis will need to research competitors and gather information before coming up with an opinion. 

4. Identification

Identification is different from inference and research. It involves being able to identify a problem but also what’s influencing that problem.

In short, identification is necessary for someone to realize that they need to think critically about something. Without proper identification skills, it will be difficult for someone to know when it’s time to analyze a situation. 

For example, let’s say you’re entering numbers in a spreadsheet. The numbers aren’t coming out as they usually do. Without identification skills, you could easily keep going without realizing there’s an issue. But when you identify what’s going on, you can see that something is broken in the spreadsheet’s formula.

Only once you identify the fact that the formula is broken can you start analyzing what’s going on to solve the issue.

5. Curiosity

Don’t be afraid to question everything and explore what you’re curious about. That’s because intellectual curiosity is a valuable skill, especially when it comes to critical thinking.

One way to practice curiosity is to adopt a beginner’s mindset . When you come into every situation with the mindset of a beginner, you’re able to keep an open mind. You’ll be able to perceive things you may not have noticed when keeping your mind closed.

6. Judging relevance

Not all information is equally pertinent. In order to make a critical judgment, it’s important to be able to judge the relevance of the information you have.

Take, for instance, basic online researching skills. You have access to a plethora of information on virtually every topic imaginable. But performing online research requires you to constantly judge the relevance of what you see. 

Without judging relevance, you’d spend too much time on details that don’t matter as much for the final desired outcome. But when you’re able to discern what’s most pertinent, you can give that information more weight as you’re thinking critically.

So what would critical thinking skills look like in a real-life situation?

Let’s imagine you’re working in software quality assurance (QA) as a team lead. But every time your team needs to enter bug regression, everyone gets bottlenecked because you must manually populate the spreadsheet used for the regression. While you do this task, your team cannot be productive without you.

This process happens once a week and easily wastes half an hour for each team member.

First, you must identify what’s going on. The team gets bottlenecked because only you, as the team lead, can access the information required to fill in the regression spreadsheet.

Next, you can research information. You can inquire to higher-ups about the reason why only you have access to this information. You can also speak to other teams about what potential solutions they’ve come up with to solve this problem.

Once you’ve done your research, it’s time to analyze the information and judge relevance. Some teams have solutions that don’t apply to you, so that information isn’t relevant anymore. 

Figure out if there are any personal biases before you analyze your information. 

For example, it’s possible that you don’t get along with one of the other team leads. As a result, you could discount the information they’ve given you. But by identifying this bias, you can look past your personal opinion of this person and see how valuable their solution is.

Based on what you’ve analyzed, it’s time to brainstorm and come up with a solution. You realize that creating a simple, automated script will save your team’s time. And it will do so without consuming too many resources from the engineering department.

Next, present your solution to your manager. Explain how you came to this conclusion. 

Now, let’s say your spreadsheet automation solution is approved. It’s important to go back and analyze what happens after implementing the solution. But only do this once the spreadsheet has been in place for long enough to gather plenty of information. 

Here’s an example. You could realize that the solution did solve the bottleneck. But, the script also slows down the spreadsheet and makes it difficult to work with. This would require you to go back to the drawing board and start the process all over again.

Want to start improving your own critical thinking skill sets? Here’s how you can improve critical thinking skills using 13 techniques:

• Play games that require critical thinking skills
• Ask more questions, even basic ones
• Question your assumptions
• Develop your technical skills so that you can identify problems more easily
• Find ways to solve more problems (at work and at home)
• Become aware of your mental processes, like the availability heuristic
• Think for yourself: don’t adopt other people’s opinions without questioning them first
• Seek out diversity of thought
• Start developing foresight
• Try active listening
• Weigh the consequences of different actions before you act
• Seek a mentor who can help you develop these skills
• Get professional coaching

How to improve your critical thinking skills 

Critical thinking skills aren’t always easy to develop. But it’s much easier to start thinking critically when you have someone to work with. Try a custom BetterUp demo to see how a coach can help you develop your critical thinking skills today.

Transform your life

Make meaningful changes and become the best version of yourself. BetterUp's professional Coaches are here to support your personal growth journey.

Maggie Wooll, MBA

Maggie Wooll is a researcher, author, and speaker focused on the evolving future of work. Formerly the lead researcher at the Deloitte Center for the Edge, she holds a Bachelor of Science in Education from Princeton University and an MBA from the University of Virginia Darden School of Business. Maggie is passionate about creating better work and greater opportunities for all.

How to develop critical thinking skills

What’s convergent thinking how to be a better problem-solver, why self-management is key to success and how to improve yours, the most critical skills for leaders are fundamentally human, the new skill set needed to succeed in the hybrid workplace, how intrapersonal skills shape teams, plus 5 ways to build them, how to be optimistic, building strength for tomorrow: new president of betterup care™ on extending proactive mental health across the enterprise, what is social well-being definition, types, and how to achieve it, what is lateral thinking 7 techniques to encourage creative ideas, 9 cognitive skill examples and how to improve them, 8 brainstorming techniques to harness the power of teamwork, how to pitch ideas: 8 tips to captivate any audience, what are analytical skills examples and how to level up, how divergent thinking can drive your creativity, how the minto pyramid principle can enhance your communication skills, stay connected with betterup, get our newsletter, event invites, plus product insights and research..

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• Corpus ID: 38896385

Critical thinking skills for at-the-bedside success.

• D. Ignatavicius
• Published in Nursing management 2001
• Education, Medicine

10 Citations

Promotion of critical thinking by using case studies as teaching method., running head : socratic method in critical thinking skills the effectiveness of the socratic method in developing critical thinking skills in english language learners.

• Highly Influenced

Peer review and critical thinking in nursing students

Education's quest for the golden answer: the need continues for critical thinking, critical thinking disposition among nurses working in puplic hospitals at port-said governorate, pedagogy of socratic method of teaching esp, understanding mentoring relationships., the nutrition care process and the nutrition support dietitian, study of errors among nursing students, the ability of newly qualified saudi nurses working on paediatric wards to recognise a deteriorating child: can a focused educational intervention impact on this, related papers.

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Critical Thinking at the Bedside: Providing Safe Passage to Patients

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The critical thinking ability of health care professionals can affect patient safety directly (Buerhaus, Donelan, Ulrich, Norman, & Dittus, 2005). The National League for Nursing (NLN, 2006) expects nursing graduates to be able to demonstrate critical thinking. Nursing programs are required to measure critical thinking as an outcome criterion for accreditation. This process of program accreditation is considered an indicator that a professional program offers a quality product. Based on NLN expectations, health care disciplines should diligently seek opportunities to enhance critical thinking by promoting qualitative and quantitative research that focuses on curriculum evaluation, enhancing educators' and faculty knowledge, and improving patient care outcomes.

Between the categories of logical and illogical opinions lies reasoned opinion. This pro - cess has dominion over emotion and focuses equally on process and outcome; it is called critical thinking (Paul & Elder, 2008). Critical thinking skills are widely sought in modern society. They can play an important role in various types of decision making: making a judgment about education, choosing a career, evaluating a job, deciding how to organize at work, and choosing a life partner (Paul & Elder, 2006).

The word critical derives etymologically from two Greek roots: kriticos (discerning judgment) and kriterion (standards). Etymologically, the word implies the development of " discerning judgment based on standards" (Online Etymology Dictionary, n.d., para 1). The intellectual roots of critical thinking applied to the practice of teaching were planted by Socrates 2,500 years ago. Socrates' practice was followed by the critical thinking of Plato, Aristotle, and the Greek skeptics (Knight, 2007).

The concept of critical thinking has become widespread in literature and has been studied in various settings. In general, U.S. corporations focus on applying creative organizational structures and information systems to promote critical thinking. In the 1980s, critical thinking gained widespread recognition as a behavioral science construct in the education system. In 1988, the nation's governors adopted the National Educational Goals, identifying critical thinking as a core skill. In 1990, the Secretary's Commission to Achieve Necessary Skills and the publication of America's Choice: High Skills or Low Wages focused national attention on the importance of critical thinking. Critical thinking skills and the study of behaviors are also woven into economic models of business productivity and policymaking across the...

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Critical thinking at the bedside: a practical perspective

Affiliation.

• 1 Department of Nursing and Midwifery, University of Hertfordshire.
• PMID: 14593262
• DOI: 10.12968/bjon.2003.12.19.11799

This article provides a comprehensive review of critical thinking from both a theoretical and, more importantly, a practical perspective. The theoretical detail with regard to critical thinking is extensive. The many models developed from the literature are often too complex and difficult to interpret in relation to clinical practice situations. If theory cannot be integrated into practice then its value to nursing should be questioned. The task now is to formalize and cement the connections between the two concepts at the bedside.

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• Encouraging reflection and critical thinking in practice. Price A. Price A. Nurs Stand. 2004 Aug 4-10;18(47):46-52, quiz 53-4. doi: 10.7748/ns2004.08.18.47.46.c3664. Nurs Stand. 2004. PMID: 15357553 Review.
• Critical thinking and patient outcomes: a review. Fesler-Birch DM. Fesler-Birch DM. Nurs Outlook. 2005 Mar-Apr;53(2):59-65. doi: 10.1016/j.outlook.2004.11.005. Nurs Outlook. 2005. PMID: 15858523 Review.
• Models, measurement, and strategies in developing critical-thinking skills. Brunt BA. Brunt BA. J Contin Educ Nurs. 2005 Nov-Dec;36(6):255-62. doi: 10.3928/0022-0124-20051101-05. J Contin Educ Nurs. 2005. PMID: 16372714 Review.
• A crisis in critical thinking. del Bueno D. del Bueno D. Nurs Educ Perspect. 2005 Sep-Oct;26(5):278-82. Nurs Educ Perspect. 2005. PMID: 16295306
• [The wheels of communication]. Lefebvre H. Lefebvre H. Perspect Infirm. 2008 Jul-Aug;5(6):27-9. Perspect Infirm. 2008. PMID: 18724524 French. No abstract available.

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6 Critical Thinking Skills You Need to Master Now

By Will Erstad on 01/22/2018

No matter what walk of life you come from, what industry you’re interested in pursuing or how much experience you’ve already garnered, we’ve all seen firsthand the importance of critical thinking skills. In fact, lacking such skills can truly make or break a person’s career, as the consequences of one’s inability to process and analyze information effectively can be massive.

“The ability to think critically is more important now than it has ever been,” urges Kris Potrafka , founder and CEO of Music Firsthand. “Everything is at risk if we don’t all learn to think more critically.” If people cannot think critically, he explains, they not only lessen their prospects of climbing the ladder in their respective industries, but they also become easily susceptible to things like fraud and manipulation.

With that in mind, you’re likely wondering what you can do to make sure you’re not one of those people. Developing your critical thinking skills is something that takes concentrated work. It can be best to begin by exploring the definition of critical thinking and the skills it includes—once you do, you can then venture toward the crucial question at hand: How can I improve?

This is no easy task, which is why we aimed to help break down the basic elements of critical thinking and offer suggestions on how you can hone your skills and become a better critical thinker.

What is critical thinking?

Even if you want to be a better critical thinker, it’s hard to improve upon something you can’t define. Critical thinking is the analysis of an issue or situation and the facts, data or evidence related to it. Ideally, critical thinking is to be done objectively—meaning without influence from personal feelings, opinions or biases—and it focuses solely on factual information.

Critical thinking is a skill that allows you to make logical and informed decisions to the best of your ability. For example, a child who has not yet developed such skills might believe the Tooth Fairy left money under their pillow based on stories their parents told them. A critical thinker, however, can quickly conclude that the existence of such a thing is probably unlikely—even if there are a few bucks under their pillow.

6 Crucial critical thinking skills (and how you can improve them)

While there’s no universal standard for what skills are included in the critical thinking process, we’ve boiled it down to the following six. Focusing on these can put you on the path to becoming an exceptional critical thinker.

1. Identification

The first step in the critical thinking process is to identify the situation or problem as well as the factors that may influence it. Once you have a clear picture of the situation and the people, groups or factors that may be influenced, you can then begin to dive deeper into an issue and its potential solutions.

How to improve: When facing any new situation, question or scenario, stop to take a mental inventory of the state of affairs and ask the following questions:

• Who is doing what?
• What seems to be the reason for this happening?
• What are the end results, and how could they change?

2. Research

When comparing arguments about an issue, independent research ability is key. Arguments are meant to be persuasive—that means the facts and figures presented in their favor might be lacking in context or come from questionable sources. The best way to combat this is independent verification; find the source of the information and evaluate.

How to improve: It can be helpful to develop an eye for unsourced claims. Does the person posing the argument offer where they got this information from? If you ask or try to find it yourself and there’s no clear answer, that should be considered a red flag. It’s also important to know that not all sources are equally valid—take the time to learn the difference between popular and scholarly articles .

3. Identifying biases

This skill can be exceedingly difficult, as even the smartest among us can fail to recognize biases. Strong critical thinkers do their best to evaluate information objectively. Think of yourself as a judge in that you want to evaluate the claims of both sides of an argument, but you’ll also need to keep in mind the biases each side may possess.

It is equally important—and arguably more difficult—to learn how to set aside your own personal biases that may cloud your judgment. “Have the courage to debate and argue with your own thoughts and assumptions,” Potrafka encourages. “This is essential for learning to see things from different viewpoints.”

How to improve: “Challenge yourself to identify the evidence that forms your beliefs, and assess whether or not your sources are credible,” offers Ruth Wilson, director of development at Brightmont Academy .

First and foremost, you must be aware that bias exists. When evaluating information or an argument, ask yourself the following:

• Who does this benefit?
• Does the source of this information appear to have an agenda?
• Is the source overlooking, ignoring or leaving out information that doesn’t support its beliefs or claims?
• Is this source using unnecessary language to sway an audience’s perception of a fact?

4. Inference

The ability to infer and draw conclusions based on the information presented to you is another important skill for mastering critical thinking. Information doesn’t always come with a summary that spells out what it means. You’ll often need to assess the information given and draw conclusions based upon raw data.

The ability to infer allows you to extrapolate and discover potential outcomes when assessing a scenario. It is also important to note that not all inferences will be correct. For example, if you read that someone weighs 260 pounds, you might infer they are overweight or unhealthy. Other data points like height and body composition, however, may alter that conclusion.

How to improve: An inference is an educated guess, and your ability to infer correctly can be polished by making a conscious effort to gather as much information as possible before jumping to conclusions. When faced with a new scenario or situation to evaluate, first try skimming for clues—things like headlines, images and prominently featured statistics—and then make a point to ask yourself what you think is going on.

5. Determining relevance

One of the most challenging parts of thinking critically during a challenging scenario is figuring out what information is the most important for your consideration. In many scenarios, you’ll be presented with information that may seem important, but it may pan out to be only a minor data point to consider.

How to improve: The best way to get better at determining relevance is by establishing a clear direction in what you’re trying to figure out. Are you tasked with finding a solution? Should you be identifying a trend? If you figure out your end goal, you can use this to inform your judgment of what is relevant.

Even with a clear objective, however, it can still be difficult to determine what information is truly relevant. One strategy for combating this is to make a physical list of data points ranked in order of relevance. When you parse it out this way, you’ll likely end up with a list that includes a couple of obviously relevant pieces of information at the top of your list, in addition to some points at the bottom that you can likely disregard. From there, you can narrow your focus on the less clear-cut topics that reside in the middle of your list for further evaluation.

6. Curiosity

It’s incredibly easy to sit back and take everything presented to you at face value, but that can also be also a recipe for disaster when faced with a scenario that requires critical thinking. It’s true that we’re all naturally curious—just ask any parent who has faced an onslaught of “Why?” questions from their child. As we get older, it can be easier to get in the habit of keeping that impulse to ask questions at bay. But that’s not a winning approach for critical thinking.

How to improve: While it might seem like a curious mind is just something you’re born with, you can still train yourself to foster that curiosity productively. All it takes is a conscious effort to ask open-ended questions about the things you see in your everyday life, and you can then invest the time to follow up on these questions.

“Being able to ask open-ended questions is an important skill to develop—and bonus points for being able to probe,” Potrafka says.

Become a better critical thinker

Thinking critically is vital for anyone looking to have a successful college career and a fruitful professional life upon graduation. Your ability to objectively analyze and evaluate complex subjects and situations will always be useful. Unlock your potential by practicing and refining the six critical thinking skills above.

Most professionals credit their time in college as having been crucial in the development of their critical thinking abilities. If you’re looking to improve your skills in a way that can impact your life and career moving forward, higher education is a fantastic venue through which to achieve that. For some of the surefire signs you’re ready to take the next step in your education, visit our article, “ 6 Signs You’re Ready to Be a College Student .”

RELATED ARTICLES:

• How To Build Your Management Skills
• 6 Common Concerns of Adult Learners (And Why They Shouldn’t Worry)
• I Hate My Job … What Should I Do?

EDITOR’S NOTE: This article was originally published in December 2012. It has since been updated.

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Promoting critical thinking through an evidence-based skills fair intervention

Journal of Research in Innovative Teaching & Learning

ISSN : 2397-7604

Article publication date: 23 November 2020

Issue publication date: 1 April 2022

The lack of critical thinking in new graduates has been a concern to the nursing profession. The purpose of this study was to investigate the effects of an innovative, evidence-based skills fair intervention on nursing students' achievements and perceptions of critical thinking skills development.

Design/methodology/approach

The explanatory sequential mixed-methods design was employed for this study.

The findings indicated participants perceived the intervention as a strategy for developing critical thinking.

Originality/value

The study provides educators helpful information in planning their own teaching practice in educating students.

Critical thinking

Evidence-based practice, skills fair intervention.

Gonzalez, H.C. , Hsiao, E.-L. , Dees, D.C. , Noviello, S.R. and Gerber, B.L. (2022), "Promoting critical thinking through an evidence-based skills fair intervention", Journal of Research in Innovative Teaching & Learning , Vol. 15 No. 1, pp. 41-54. https://doi.org/10.1108/JRIT-08-2020-0041

Emerald Publishing Limited

Copyright © 2020, Heidi C. Gonzalez, E-Ling Hsiao, Dianne C. Dees, Sherri R. Noviello and Brian L. Gerber

Published in Journal of Research in Innovative Teaching & Learning . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Critical thinking (CT) was defined as “cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge” ( Scheffer and Rubenfeld, 2000 , p. 357). Critical thinking is the basis for all professional decision-making ( Moore, 2007 ). The lack of critical thinking in student nurses and new graduates has been a concern to the nursing profession. It would negatively affect the quality of service and directly relate to the high error rates in novice nurses that influence patient safety ( Arli et al. , 2017 ; Saintsing et al. , 2011 ). It was reported that as many as 88% of novice nurses commit medication errors with 30% of these errors due to a lack of critical thinking ( Ebright et al. , 2004 ). Failure to rescue is another type of error common for novice nurses, reported as high as 37% ( Saintsing et al. , 2011 ). The failure to recognize trends or complications promptly or take action to stabilize the patient occurs when health-care providers do not recognize signs and symptoms of the early warnings of distress ( Garvey and CNE series, 2015 ). Internationally, this lack of preparedness and critical thinking attributes to the reported 35–60% attrition rate of new graduate nurses in their first two years of practice ( Goodare, 2015 ). The high attrition rate of new nurses has expensive professional and economic costs of $82,000 or more per nurse and negatively affects patient care ( Twibell et al. , 2012 ). Facione and Facione (2013) reported the failure to utilize critical thinking skills not only interferes with learning but also results in poor decision-making and unclear communication between health-care professionals, which ultimately leads to patient deaths.

Due to the importance of critical thinking, many nursing programs strive to infuse critical thinking into their curriculum to better prepare graduates for the realities of clinical practice that involves ever-changing, complex clinical situations and bridge the gap between education and practice in nursing ( Benner et al. , 2010 ; Kim et al. , 2019 ; Park et al. , 2016 ; Newton and Moore, 2013 ; Nibert, 2011 ). To help develop students' critical thinking skills, nurse educators must change the way they teach nursing, so they can prepare future nurses to be effective communicators, critical thinkers and creative problem solvers ( Rieger et al. , 2015 ). Nursing leaders also need to redefine teaching practice and educational guidelines that drive innovation in undergraduate nursing programs.

Evidence-based practice has been advocated to promote critical thinking and help reduce the research-practice gap ( Profetto-McGrath, 2005 ; Stanley and Dougherty, 2010 ). Evidence-based practice was defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient” ( Sackett et al. , 1996 , p. 71). Skills fair intervention, one type of evidence-based practice, can be used to engage students, promote active learning and develop critical thinking ( McCausland and Meyers, 2013 ; Roberts et al. , 2009 ). Skills fair intervention helps promote a consistent teaching practice of the psychomotor skills to the novice nurse that decreased anxiety, gave clarity of expectations to the students in the clinical setting and increased students' critical thinking skills ( Roberts et al. , 2009 ). The researchers of this study had an opportunity to create an active, innovative skills fair intervention for a baccalaureate nursing program in one southeastern state. This intervention incorporated evidence-based practice rationale with critical thinking prompts using Socratic questioning, evidence-based practice videos to the psychomotor skill rubrics, group work, guided discussions, expert demonstration followed by guided practice and blended learning in an attempt to promote and develop critical thinking in nursing students ( Hsu and Hsieh, 2013 ; Oermann et al. , 2011 ; Roberts et al. , 2009 ). The effects of an innovative skills fair intervention on senior baccalaureate nursing students' achievements and their perceptions of critical thinking development were examined in the study.

Literature review

The ability to use reasoned opinion focusing equally on processes and outcomes over emotions is called critical thinking ( Paul and Elder, 2008 ). Critical thinking skills are desired in almost every discipline and play a major role in decision-making and daily judgments. The roots of critical thinking date back to Socrates 2,500 years ago and can be traced to the ancient philosopher Aristotle ( Paul and Elder, 2012 ). Socrates challenged others by asking inquisitive questions in an attempt to challenge their knowledge. In the 1980s, critical thinking gained nationwide recognition as a behavioral science concept in the educational system ( Robert and Petersen, 2013 ). Many researchers in both education and nursing have attempted to define, measure and teach critical thinking for decades. However, a theoretical definition has yet to be accepted and established by the nursing profession ( Romeo, 2010 ). The terms critical literacy, CT, reflective thinking, systems thinking, clinical judgment and clinical reasoning are used synonymously in the reviewed literature ( Clarke and Whitney, 2009 ; Dykstra, 2008 ; Jones, 2010 ; Swing, 2014 ; Turner, 2005 ).

Watson and Glaser (1980) viewed critical thinking not only as cognitive skills but also as a combination of skills, knowledge and attitudes. Paul (1993) , the founder of the Foundation for Critical Thinking, offered several definitions of critical thinking and identified three essential components of critical thinking: elements of thought, intellectual standards and affective traits. Brunt (2005) stated critical thinking is a process of being practical and considered it to be “the process of purposeful thinking and reflective reasoning where practitioners examine ideas, assumptions, principles, conclusions, beliefs, and actions in the contexts of nursing practice” (p. 61). In an updated definition, Ennis (2011) described critical thinking as, “reasonable reflective thinking focused on deciding what to believe or do” (para. 1).

The most comprehensive attempt to define critical thinking was under the direction of Facione and sponsored by the American Philosophical Association ( Scheffer and Rubenfeld, 2000 ). Facione (1990) surveyed 53 experts from the arts and sciences using the Delphi method to define critical thinking as a “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as an explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which judgment, is based” (p. 2).

To come to a consensus definition for critical thinking, Scheffer and Rubenfeld (2000) also conducted a Delphi study. Their study consisted of an international panel of nurses who completed five rounds of sequenced questions to arrive at a consensus definition. Critical thinking was defined as “habits of mind” and “cognitive skills.” The elements of habits of mind included “confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection” ( Scheffer and Rubenfeld, 2000 , p. 352). The elements of cognitive skills were recognized as “analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge” ( Scheffer and Rubenfeld, 2000 , p. 352). In addition, Ignatavicius (2001) defined the development of critical thinking as a long-term process that must be practiced, nurtured and reinforced over time. Ignatavicius believed that a critical thinker required six cognitive skills: interpretation, analysis, evaluation, inference, explanation and self-regulation ( Chun-Chih et al. , 2015 ). According to Ignatavicius (2001) , the development of critical thinking is difficult to measure or describe because it is a formative rather than summative process.

Fero et al. (2009) noted that patient safety might be compromised if a nurse cannot provide clinically competent care due to a lack of critical thinking. The Institute of Medicine (2001) recommended five health care competencies: patient-centered care, interdisciplinary team care, evidence-based practice, informatics and quality improvement. Understanding the development and attainment of critical thinking is the key for gaining these future competencies ( Scheffer and Rubenfeld, 2000 ). The development of a strong scientific foundation for nursing practice depends on habits such as contextual perspective, inquisitiveness, creativity, analysis and reasoning skills. Therefore, the need to better understand how these critical thinking habits are developed in nursing students needs to be explored through additional research ( Fero et al. , 2009 ). Despite critical thinking being listed since the 1980s as an accreditation outcome criteria for baccalaureate programs by the National League for Nursing, very little improvement has been observed in practice ( McMullen and McMullen, 2009 ). James (2013) reported the number of patient harm incidents associated with hospital care is much higher than previously thought. James' study indicated that between 210,000 and 440,000 patients each year go to the hospital for care and end up suffering some preventable harm that contributes to their death. James' study of preventable errors is attributed to other sources besides nursing care, but having a nurse in place who can advocate and critically think for patients will make a positive impact on improving patient safety ( James, 2013 ; Robert and Peterson, 2013 ).

Adopting teaching practice to promote CT is a crucial component of nursing education. Research by Nadelson and Nadelson (2014) suggested evidence-based practice is best learned when integrated into multiple areas of the curriculum. Evidence-based practice developed its roots through evidence-based medicine, and the philosophical origins extend back to the mid-19th century ( Longton, 2014 ). Florence Nightingale, the pioneer of modern nursing, used evidence-based practice during the Crimean War when she recognized a connection between poor sanitary conditions and rising mortality rates of wounded soldiers ( Rahman and Applebaum, 2011 ). In professional nursing practice today, a commonly used definition of evidence-based practice is derived from Dr. David Sackett: the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient ( Sackett et al. , 1996 , p. 71). As professional nurses, it is imperative for patient safety to remain inquisitive and ask if the care provided is based on available evidence. One of the core beliefs of the American Nephrology Nurses' Association's (2019) 2019–2020 Strategic Plan is “Anna must support research to develop evidence-based practice, as well as to advance nursing science, and that as individual members, we must support, participate in, and apply evidence-based research that advances our own skills, as well as nursing science” (p. 1). Longton (2014) reported the lack of evidence-based practice in nursing resulted in negative outcomes for patients. In fact, when evidence-based practice was implemented, changes in policies and procedures occurred that resulted in decreased reports of patient harm and associated health-care costs. The Institute of Medicine (2011) recommendations included nurses being leaders in the transformation of the health-care system and achieving higher levels of education that will provide the ability to critically analyze data to improve the quality of care for patients. Student nurses must be taught to connect and integrate CT and evidence-based practice throughout their program of study and continue that practice throughout their careers.

One type of evidence-based practice that can be used to engage students, promote active learning and develop critical thinking is skills fair intervention ( McCausland and Meyers, 2013 ; Roberts et al. , 2009 ). Skills fair intervention promoted a consistent teaching approach of the psychomotor skills to the novice nurse that decreased anxiety, gave clarity of expectations to the students in the clinical setting and increased students' critical thinking skills ( Roberts et al. , 2009 ). The skills fair intervention used in this study is a teaching strategy that incorporated CT prompts, Socratic questioning, group work, guided discussions, return demonstrations and blended learning in an attempt to develop CT in nursing students ( Hsu and Hsieh, 2013 ; Roberts et al. , 2009 ). It melded evidence-based practice with simulated CT opportunities while students practiced essential psychomotor skills.

Research methodology

Context – skills fair intervention.

According to Roberts et al. (2009) , psychomotor skills decline over time even among licensed experienced professionals within as little as two weeks and may need to be relearned within two months without performing a skill. When applying this concept to student nurses for whom each skill is new, it is no wonder their competency result is diminished after having a summer break from nursing school. This skills fair intervention is a one-day event to assist baccalaureate students who had taken the summer off from their studies in nursing and all faculty participated in operating the stations. It incorporated evidence-based practice rationale with critical thinking prompts using Socratic questioning, evidence-based practice videos to the psychomotor skill rubrics, group work, guided discussions, expert demonstration followed by guided practice and blended learning in an attempt to promote and develop critical thinking in baccalaureate students.

Students were scheduled and placed randomly into eight teams based on attributes of critical thinking as described by Wittmann-Price (2013) : Team A – Perseverance, Team B – Flexibility, Team C – Confidence, Team D – Creativity, Team E – Inquisitiveness, Team F – Reflection, Team G – Analyzing and Team H – Intuition. The students rotated every 20 minutes through eight stations: Medication Administration: Intramuscular and Subcutaneous Injections, Initiating Intravenous Therapy, ten-minute Focused Physical Assessment, Foley Catheter Insertion, Nasogastric Intubation, Skin Assessment/Braden Score and Restraints, Vital Signs and a Safety Station. When the students completed all eight stations, they went to the “Check-Out” booth to complete a simple evaluation to determine their perceptions of the effectiveness of the innovative intervention. When the evaluations were complete, each of the eight critical thinking attribute teams placed their index cards into a hat, and a student won a small prize. All Junior 2, Senior 1 and Senior 2 students were required to attend the Skills Fair. The Skills Fair Team strove to make the event as festive as possible, engaging nursing students with balloons, candy, tri-boards, signs and fun pre and postactivities. The Skills Fair rubrics, scheduling and instructions were shared electronically with students and faculty before the skills fair intervention to ensure adequate preparation and continuous resource availability as students move forward into their future clinical settings.

Research design

Institutional review board (IRB) approval was obtained from XXX University to conduct this study and protect human subject rights. The explanatory sequential mixed-methods design was employed for this study. The design was chosen to identify what effects a skills fair intervention that had on senior baccalaureate nursing students' achievements on the Kaplan Critical Thinking Integrated Test (KCTIT) and then follow up with individual interviews to explore those test results in more depth. In total, 52 senior nursing students completed the KCTIT; 30 of them participated in the skills fair intervention and 22 of them did not participate. The KCTIT is a computerized 85-item exam in which 85 equates to 100%, making each question worth one point. It has high reliability and validity ( Kaplan Nursing, 2012 ; Swing, 2014 ). The reliability value of the KCTIT ranged from 0.72 to 0.89. A t -test was used to analyze the test results.

A total of 11 participants were purposefully selected based on a range of six high achievers and five low achievers on the KCTIT for open-ended one-on-one interviews. Each interview was conducted individually and lasted for about 60 minutes. An open-ended interview protocol was used to guide the flow of data collection. The interviewees' ages ranged from 21 to 30 years, with an average of 24 years. One of 11 interviewees was male. Among them, seven were White, three were Black and one was Indian American. The data collected were used to answer the following research questions: (1) What was the difference in achievements on the KCTIT among senior baccalaureate nursing students who participated in the skills fair intervention and students who did not participate? (2) What were the senior baccalaureate nursing students' perceptions of internal and external factors impacting the development of critical thinking skills during the skills fair intervention? and (3) What were the senior baccalaureate nursing students' perceptions of the skills fair intervention as a critical thinking developmental strategy?

Inductive content analysis was used to analyze interview data by starting with the close reading of the transcripts and writing memos for initial coding, followed by an analysis of patterns and relationships among the data for focused coding. The intercoder reliability was established for qualitative data analysis with a nursing expert. The lead researcher and the expert read the transcript several times and assigned a code to significant units of text that corresponded with answering the research questions. The codes were compared based on differences and similarities and sorted into subcategories and categories. Then, headings and subheadings were used based on similar comments to develop central themes and patterns. The process of establishing intercoder reliability helped to increase dependability, conformability and credibility of the findings ( Graneheim and Lundman, 2004 ). In addition, methods of credibility, confirmability, dependability and transferability were applied to increase the trustworthiness of this study ( Graneheim and Lundman, 2004 ). First, reflexivity was observed by keeping journals and memos. This practice allowed the lead researcher to reflect on personal views to minimize bias. Data saturation was reached through following the recommended number of participants as well as repeated immersion in the data during analysis until no new data surfaced. Member checking was accomplished through returning the transcript and the interpretation to the participants to check the accuracy and truthfulness of the findings. Finally, proper documentation was conducted to allow accurate crossreferencing throughout the study.

Quantitative results

Results for the quantitative portion showed there was no difference in scores on the KCTIT between senior nursing students who participated in the skills fair intervention and senior nursing students who did not participate, t (50) = −0.174, p  = 0.86 > 0.05. The test scores between the nonparticipant group ( M  = 67.59, SD = 5.81) and the participant group ( M  = 67.88, SD = 5.99) were almost equal.

Qualitative results

Initial coding.

The results from the initial coding and generated themes are listed in Table 1 . First, the participants perceived the skills fair intervention as “promoting experience” and “confidence” by practicing previously learned knowledge and reinforcing it with active learning strategies. Second, the participants perceived the skills fair intervention as a relaxed, nonthreatening learning environment due to the festive atmosphere, especially in comparison to other learning experiences in the nursing program. The nonthreatening environment of the skills fair intervention allowed students to learn without fear. Third, the majority of participants believed their critical thinking was strengthened after participating. Several participants believed their perception of critical thinking was “enhanced” or “reinforced” rather than significantly changed.

Focused coding results

The final themes were derived from the analysis of patterns and relationships among the content of the data using inductive content analysis ( Saldana, 2009 ). The following was examined across the focused coding process: (1) factors impacting critical thinking skills development during skills fair intervention and (2) skills fair intervention a critical thinking skills developmental strategy.

Factors impacting critical thinking skills development . The factors impacting the development of critical thinking during the skills fair intervention were divided into two themes: internal factors and external factors. The internal factors were characteristics innate to the students. The identified internal factors were (1) confidence and anxiety levels, (2) attitude and (3) age. The external factors were the outside influences that affected the students. The external factors were (1) experience and practice, (2) faculty involvement, (3) positive learning environment and (4) faculty prompts.

I think that confidence and anxiety definitely both have a huge impact on your ability to be able to really critically think. If you start getting anxious and panicking you cannot think through the process like you need too. I do not really think gender or age necessarily would have anything to do with critical thinking.

Definitely the confidence level, I think, the more advanced you get in the program, your confidence just keeps on growing. Level of anxiety, definitely… I think the people who were in the Skills Fair for the first time, had more anxiety because they did not really know to think, they did not know how strict it was going to be, or if they really had to know everything by the book. I think the Skills Fair helped everyone's confidence levels, but especially the Jr. 2's.

Attitude was an important factor in the development of critical thinking skills during the skills fair intervention as participants believed possessing a pleasant and positive attitude meant a student was eager to learn, participate, accept responsibility for completing duties and think seriously. Participant 6 believed attitude contributed to performance in the Skills Fair.

I feel like, certain things bring critical thinking out in you. And since I'm a little bit older than some of the other students, I have had more life experiences and am able to figure stuff out better. Older students have had more time to learn by trial and error, and this and that.

Like when I had clinical with you, you'd always tell us to know our patients' medications. To always know and be prepared to answer questions – because at first as a Junior 1 we did not do that in the clinical setting… and as a Junior 2, I did not really have to know my medications, but with you as a Senior 1, I started to realize that the patients do ask about their meds, so I was making sure that I knew everything before they asked it. And just having more practice with IVs – at first, I was really nervous, but when I got to my preceptorship – I had done so many IVs and with all of the practice, it just built up my confidence with that skill so when I performed that skill during the Fair, I was confident due to my clinical experiences and able to think and perform better.

I think teachers will always affect the ability to critically think just because you want [to] get the right answer because they are there and you want to seem smart to them [Laugh]. Also, if you are leading in the wrong direction of your thinking – they help steer you back to [in] the right direction so I think that was very helpful.

You could tell the faculty really tried to make it more laid back and fun, so everybody would have a good experience. The faculty had a good attitude. I think making it fun and active helped keep people positive. You know if people are negative and not motivated, nothing gets accomplished. The faculty did an amazing job at making the Skills Fair a positive atmosphere.

However, for some of the participants, a positive learning environment depended on their fellow students. The students were randomly assigned alphabetically to groups, and the groups were assigned to starting stations at the Skills Fair. The participants claimed some students did not want to participate and displayed cynicism toward the intervention. The participants believed their cynicism affected the positive learning environment making critical thinking more difficult during the Skills Fair.

Okay, when [instructor name] was demonstrating the Chevron technique right after we inserted the IV catheter and we were trying to secure the catheter, put on the extension set, and flush the line at what seemed to be all at the same time. I forgot about how you do not want to put the tape right over the hub of the catheter because when you go back in and try to assess the IV site – you're trying to assess whether or not it is patent or infiltrated – you have to visualize the insertion site. That was one of the things that I had been doing wrong because I was just so excited that I got the IV in the vein in the first place – that I did not think much about the tape or the tegaderm for sterility. So I think an important part of critical thinking is to be able to recognize when you've made a mistake and stop, stop yourself from doing it in the future (see Table 2 ).

Skills fair intervention as a developmental strategy for critical thinking . The participants identified the skills fair intervention was effective as a developmental strategy for critical thinking, as revealed in two themes: (1) develops alternative thinking and (2) thinking before doing (See Table 3 ).

Develops alternative thinking . The participants perceived the skills fair intervention helped enhance critical thinking and confidence by developing alternative thinking. Alternative thinking was described as quickly thinking of alternative solutions to problems based on the latest evidence and using that information to determine what actions were warranted to prevent complications and prevent injury. It helped make better connections through the learning of rationale between knowledge and skills and then applying that knowledge to prevent complications and errors to ensure the safety of patients. The participants stated the learning of rationale for certain procedures provided during the skills fair intervention such as the evidence and critical thinking prompts included in the rubrics helped reinforce this connection. The participants also shared they developed alternative thinking after participating in the skills fair intervention by noticing trends in data to prevent potential complications from the faculty prompts. Participant 1 stated her instructor prompted her alternative thinking through questioning about noticing trends to prevent potential complications. She said the following:

Another way critical thinking occurred during the skills fair was when [instructor name] was teaching and prompted us about what it would be like to care for a patient with a fractured hip – I think this was at the 10-minute focused assessment station, but I could be wrong. I remember her asking, “What do you need to be on the look-out for? What can go wrong?” I automatically did not think critically very well and was only thinking circulation in the leg, dah, dah, dah. But she was prompting us to think about mobility alterations and its effect on perfusion and oxygenation. She was trying to help us build those connections. And I think that's a lot of the aspects of critical thinking that gets overlooked with the nursing student – trouble making connections between our knowledge and applying it in practice.

Thinking before doing . The participants perceived thinking before doing, included thinking of how and why certain procedures, was necessary through self-examination prior to taking action. The hands-on situational learning allowed the participants in the skills fair intervention to better notice assessment data and think at a higher level as their previous learning of the skills was perceived as memorization of steps. This higher level of learning allowed participants to consider different future outcomes and analyze pertinent data before taking action.

I think what helped me the most is considering outcomes of my actions before I do anything. For instance, if you're thinking, “Okay. Well, I need to check their blood pressure before I administer this blood pressure medication – or the blood pressure could potentially bottom out.” I really do not want my patient to bottom out and get hypotensive because I administered a medication that was ordered, but not safe to give. I could prevent problems from happening if I know what to be on alert for and act accordingly. So ultimately knowing that in the clinical setting, I can prevent complications from happening and I save myself, my license, and promote patient safety. I think knowing that I've seen the importance of critical thinking already in practice has helped me value and understand why I should be critically thinking. Yes, we use the 5-rights of medication safety – but we also have to think. For instance, if I am going to administer insulin – what do I need to know or do to give this safely? What is the current blood sugar? Has the patient been eating? When is the next meal scheduled? Is the patient NPO for a procedure? Those are examples of questions to consider and the level of thinking that needs to take place prior to taking actions in the clinical setting.

Although the results of quantitative data showed no significant difference in scores on the KCTIT between the participant and nonparticipant groups, during the interviews some participants attributed this result to the test not being part of a course grade and believed students “did not try very hard to score well.” However, the participants who attended interviews did identify the skills fair intervention as a developmental strategy for critical thinking by helping them develop alternative thinking and thinking before doing. The findings are supported in the literature as (1) nurses must recognize signs of clinical deterioration and take action promptly to prevent potential complications ( Garvey and CNE series 2015 ) and (2) nurses must analyze pertinent data and consider all possible solutions before deciding on the most appropriate action for each patient ( Papathanasiou et al. , 2014 ).

The skills fair intervention also enhanced the development of self-confidence by participants practicing previously learned skills in a controlled, safe environment. The nonthreatening environment of the skills fair intervention allowed students to learn without fear and the majority of participants believed their critical thinking was strengthened after participating. The interview data also revealed a combination of internal and external factors that influenced the development of critical thinking during the skills fair intervention including confidence and anxiety levels, attitude, age, experience and practice, faculty involvement, positive learning environment and faculty prompts. These factors should be considered when addressing the promotion and development of critical thinking.

Conclusions, limitations and recommendations

A major concern in the nursing profession is the lack of critical thinking in student nurses and new graduates, which influences the decision-making of novice nurses and directly affects patient care and safety ( Saintsing et al. , 2011 ). Nurse educators must use evidence-based practice to prepare students to critically think with the complicated and constantly evolving environment of health care today ( Goodare, 2015 ; Newton and Moore, 2013 ). Evidence-based practice has been advocated to promote critical thinking ( Profetto-McGrath, 2005 ; Stanley and Dougherty, 2010 ). The skills fair intervention can be one type of evidence-based practice used to promote critical thinking ( McCausland and Meyers, 2013 ; Roberts et al. , 2009 ). The Intervention used in this study incorporated evidence-based practice rationale with critical thinking prompts using Socratic questioning, evidence-based practice videos to the psychomotor skill rubrics, group work, guided discussions, expert demonstration followed by guided practice and blended learning in an attempt to promote and develop critical thinking in nursing students.

The explanatory sequential mixed-methods design was employed to investigate the effects of the innovative skills fair intervention on senior baccalaureate nursing students' achievements and their perceptions of critical thinking skills development. Although the quantitative results showed no significant difference in scores on the KCTIT between students who participated in the skills fair intervention and those who did not, those who attended the interviews perceived their critical thinking was reinforced after the skills fair intervention and believed it was an effective developmental strategy for critical thinking, as it developed alternative thinking and thinking before doing. This information is useful for nurse educators who plan their own teaching practice to promote critical thinking and improve patient outcomes. The findings also provide schools and educators information that helps review their current approach in educating nursing students. As evidenced in the findings, the importance of developing critical thinking skills is crucial for becoming a safe, professional nurse. Internal and external factors impacting the development of critical thinking during the skills fair intervention were identified including confidence and anxiety levels, attitude, age, experience and practice, faculty involvement, positive learning environment and faculty prompts. These factors should be considered when addressing the promotion and development of critical thinking.

There were several limitations to this study. One of the major limitations of the study was the limited exposure of students' time of access to the skills fair intervention, as it was a one-day learning intervention. Another limitation was the sample selection and size. The skills fair intervention was limited to only one baccalaureate nursing program in one southeastern state. As such, the findings of the study cannot be generalized as it may not be representative of baccalaureate nursing programs in general. In addition, this study did not consider students' critical thinking achievements prior to the skills fair intervention. Therefore, no baseline measurement of critical thinking was available for a before and after comparison. Other factors in the nursing program could have affected the students' scores on the KCTIT, such as anxiety or motivation that was not taken into account in this study.

The recommendations for future research are to expand the topic by including other regions, larger samples and other baccalaureate nursing programs. In addition, future research should consider other participant perceptions, such as nurse educators, to better understand the development and growth of critical thinking skills among nursing students. Finally, based on participant perceptions, future research should include a more rigorous skills fair intervention to develop critical thinking and explore the link between confidence and critical thinking in nursing students.

Initial coding results

Factors impacting critical thinking skill development during skills fair intervention

Skills fair intervention as a developmental strategy for critical thinking

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Critical Thinking

Critical thinking skills.

Linda Bruce Hill, Alise Lamoreaux, Phyllis Nissila, Thomas Priester

Thinking comes naturally. You don’t have to make it happen—it just does. But you can make it happen in different ways. For example, you can think positively or negatively. You can think with “heart” and you can think with rational judgment. You can also think strategically and analytically, and mathematically and scientifically. These are a few of multiple ways in which the mind can process thought.

What are some forms of thinking you use? When do you use them, and why?

As a college student, you are tasked with engaging and expanding your thinking skills. One of the most important of these skills is critical thinking. Critical thinking is important because it relates to nearly all tasks, situations, topics, careers, environments, challenges, and opportunities. It’s a “domain-general” thinking skill—not a thinking skill that’s reserved for a one subject alone or restricted to a particular subject area.

Great leaders have highly attuned critical thinking skills, and you can, too. In fact, you probably have a lot of these skills already. Of all your thinking skills, critical thinking may have the greatest value.

What Is Critical Thinking?

Critical thinking is clear, reasonable, reflective thinking focused on deciding what to believe or do. It means asking probing questions like, “How do we know?” or “Is this true in every case or just in this instance?” It involves being skeptical and challenging assumptions, rather than simply memorizing facts or blindly accepting what you hear or read.

Imagine, for example, that you’re reading a history textbook. You wonder who wrote it and why, because you detect certain biases in the writing. You find that the author has a limited scope of research focused only on a particular group within a population. In this case, your critical thinking reveals that there are “other sides to the story.”

Who are critical thinkers, and what characteristics do they have in common? Critical thinkers are usually curious and reflective people . They like to explore and probe new areas and seek knowledge, clarification, and new solutions. They ask pertinent questions, evaluate statements and arguments, and they distinguish between facts and opinion. They are also willing to examine their own beliefs, possessing a manner of humility that allows them to admit lack of knowledge or understanding when needed. They are open to changing their mind. Perhaps most of all, they actively enjoy learning, and seeking new knowledge is a lifelong pursuit. The seek to improve on the quality of their thinking.

This may well be you!

No matter where you are on the road to being a critical thinker, you can always more fully develop and finely tune your skills. Doing so will help you develop more balanced arguments, express yourself clearly, read critically, and glean important information efficiently. Critical thinking skills will help you in any profession or any circumstance of life, from science to art to business to teaching. With critical thinking, you become a clearer thinker and problem solver.

The following video, from Lawrence Bland, presents the major concepts and benefits of critical thinking.

ACTIVITY: SELF-ASSESS YOUR CRITICAL THINKING STRATEGIES

• Assess your basic understanding of the skills involved in critical thinking.
• Visit the Quia Critical Thinking Quiz page and click on Start Now (you don’t need to enter your name). Select the best answer for each question, and then click on Submit Answers. A score of 70 percent or better on this quiz is considering passing.
• Based on the content of the questions, do you feel you use good critical thinking strategies in college? In what ways might you improve as a critical thinker?

Critical Thinking and Logic

Critical thinking is fundamentally a process of questioning information and data. You may question the information you read in a textbook, or you may question what a politician or a professor or a classmate says. You can also question a commonly-held belief or a new idea. With critical thinking, anything and everything is subject to question and examination for the purpose of logically constructing reasoned perspectives.

What Is Logic, and Why Is It Important in Critical Thinking?

The word logic comes from the Ancient Greek logike , referring to the science or art of reasoning. Using logic, a person evaluates arguments and reasoning and strives to distinguish between good and bad reasoning, or between truth and falsehood. Using logic, you can evaluate ideas or claims people make, make good decisions, and form sound beliefs about the world. [1]

Clarify Thinking

When you use critical thinking to evaluate information, you need to clarify your thinking to yourself and likely to others. Doing this well is mainly a process of asking and answering probing questions, such as the logic questions discussed earlier. Design your questions to fit your needs, but be sure to cover adequate ground. What is the purpose? What question are we trying to answer? What point of view is being expressed? What assumptions are we or others making? What are the facts and data we know, and how do we know them? What are the concepts we’re working with? What are the conclusions, and do they make sense? What are the implications?

Cultivate “Habits of Mind”

“Habits of mind” are the personal commitments, values, and standards you have about the principle of good thinking. Consider your intellectual commitments, values, and standards. Do you approach problems with an open mind, a respect for truth, and an inquiring attitude? Some good habits to have when thinking critically are being receptive to having your opinions changed, having respect for others, being independent and not accepting something is true until you’ve had the time to examine the available evidence, being fair-minded, having respect for a reason, having an inquiring mind, not making assumptions, and always, especially, questioning your own conclusions—in other words, developing an intellectual work ethic. Try to work these qualities into your daily life.

Developing Yourself As a Critical Thinker

Critical thinking is a desire to seek, patience to doubt, fondness to meditate, slowness to assert, readiness to consider, carefulness to dispose and set in order; and hatred for every kind of imposture. —Francis Bacon, philosopher

Critical thinking is a fundamental skill for college students, but it should also be a lifelong pursuit. Below are additional strategies to develop yourself as a critical thinker in college and in everyday life:

• Reflect and practice : Always reflect on what you’ve learned. Is it true all the time? How did you arrive at your conclusions?
• Use wasted time : It’s certainly important to make time for relaxing, but if you find you are indulging in too much of a good thing, think about using your time more constructively. Determine when you do your best thinking and try to learn something new during that part of the day.
• Redefine the way you see things : It can be very uninteresting to always think the same way. Challenge yourself to see familiar things in new ways. Put yourself in someone else’s shoes and consider things from a different angle or perspective.  If you’re trying to solve a problem, list all your concerns: what you need in order to solve it, who can help, what some possible barriers might be, etc. It’s often possible to reframe a problem as an opportunity. Try to find a solution where there seems to be none.
• Analyze the influences on your thinking and in your life : Why do you think or feel the way you do? Analyze your influences. Think about who in your life influences you. Do you feel or react a certain way because of social convention, or because you believe it is what is expected of you? Try to break out of any molds that may be constricting you.
• Express yourself : Critical thinking also involves being able to express yourself clearly. Most important in expressing yourself clearly is stating one point at a time. You might be inclined to argue every thought, but you might have greater impact if you focus just on your main arguments. This will help others to follow your thinking clearly. For more abstract ideas, assume that your audience may not understand. Provide examples, analogies, or metaphors where you can.
• Enhance your wellness : It’s easier to think critically when you take care of your mental and physical health. Try taking 10-minute activity breaks to reach 30 to 60 minutes of physical activity each day . Try taking a break between classes and walk to the coffee shop that’s farthest away. Scheduling physical activity into your day can help lower stress and increase mental alertness. Also, do your most difficult work when you have the most energy . Think about the time of day you are most effective and have the most energy. Plan to do your most difficult work during these times. And be sure to reach out for help . If you feel you need assistance with your mental or physical health, talk to a counselor or visit a doctor.

ACTIVITY: REFLECT ON CRITICAL THINKING

• Apply critical thinking strategies to your life

Directions:

• Think about someone you consider to be a critical thinker (friend, professor, historical figure, etc). What qualities does he/she have?
• Review some of the critical thinking strategies discussed on this page. Pick one strategy that makes sense to you. How can you apply this critical thinking technique to your academic work?
• Habits of mind are attitudes and beliefs that influence how you approach the world (i.e., inquiring attitude, open mind, respect for truth, etc). What is one habit of mind you would like to actively develop over the next year? How will you develop a daily practice to cultivate this habit?
• Write your responses in journal form, and submit according to your instructor’s guidelines.

The following text is an excerpt from an essay by Dr. Andrew Robert Baker, “Thinking Critically and Creatively. ” In these paragraphs, Dr. Baker underscores the importance of critical thinking—the imperative of critical thinking, really—to improving as students, teachers, and researchers. The follow-up portion of this essay appears in the Creative Thinking section of this course.

THINKING CRITICALLY AND CREATIVELY

Critical thinking skills are perhaps the most fundamental skills involved in making judgments and solving problems. You use them every day, and you can continue improving them.

The ability to think critically about a matter—to analyze a question, situation, or problem down to its most basic parts—is what helps us evaluate the accuracy and truthfulness of statements, claims, and information we read and hear. It is the sharp knife that, when honed, separates fact from fiction, honesty from lies, and the accurate from the misleading. We all use this skill to one degree or another almost every day. For example, we use critical thinking every day as we consider the latest consumer products and why one particular product is the best among its peers. Is it a quality product because a celebrity endorses it? Because a lot of other people may have used it? Because it is made by one company versus another? Or perhaps because it is made in one country or another? These are questions representative of critical thinking.

The academic setting demands more of us in terms of critical thinking than everyday life. It demands that we evaluate information and analyze myriad issues. It is the environment where our critical thinking skills can be the difference between success and failure. In this environment we must consider information in an analytical, critical manner. We must ask questions—What is the source of this information? Is this source an expert one and what makes it so? Are there multiple perspectives to consider on an issue? Do multiple sources agree or disagree on an issue? Does quality research substantiate information or opinion? Do I have any personal biases that may affect my consideration of this information?

It is only through purposeful, frequent, intentional questioning such as this that we can sharpen our critical thinking skills and improve as students, learners and researchers.

—Dr. Andrew Robert Baker,  Foundations of Academic Success: Words of Wisdom

Resources for Critical Thinking

• Glossary of Critical Thinking Terms
• Critical Thinking Self-Assessment
• Logical Fallacies Jeopardy Template
• Fallacies Files—Home
• Thinking Critically | Learning Commons
• Foundation for Critical Thinking
• To Analyze Thinking We Must Identify and Question Its Elemental Structures
• Critical Thinking in Everyday Life

LICENSES AND ATTRIBUTIONS

• Critical Thinking Skills. Authored by : Linda Bruce. Provided by : Lumen Learning. License : CC BY: Attribution
• Image of three students. Authored by : PopTech. Located at : https://flic.kr/p/8tXtQp . License : CC BY-SA: Attribution-ShareAlike
• Critical Thinking. Provided by : Critical and Creative Thinking Program. Located at : http://cct.wikispaces.umb.edu/Critical+Thinking . License : CC BY: Attribution
• Thinking Critically. Authored by : UBC Learning Commons. Provided by : The University of British Columbia, Vancouver Campus. Located at : http://www.oercommons.org/courses/learning-toolkit-critical-thinking/view . License : CC BY: Attribution
• Critical Thinking 101: Spectrum of Authority. Authored by : UBC Leap. Located at : https://youtu.be/9G5xooMN2_c . License : CC BY: Attribution
• Foundations of Academic Success. Authored by : Thomas C. Priester, editor. Provided by : Open SUNY Textbooks. Located at : http://textbooks.opensuny.org/foundations-of-academic-success/ . License : CC BY-NC-SA: Attribution-NonCommercial-ShareAlike
• Critical Thinking.wmv. Authored by : Lawrence Bland. Located at : https://youtu.be/WiSklIGUblo . License : All Rights Reserved . License Terms : Standard YouTube License

Media Attributions

• 4910867563_a1ffd0b738_z
• "logike." Wordnik. n.d. Web. 16 Feb 2016. ↵

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name: Linda Bruce Hill, Alise Lamoreaux, Phyllis Nissila, Thomas Priester

Critical Thinking Skills Copyright © 2021 by Linda Bruce Hill, Alise Lamoreaux, Phyllis Nissila, Thomas Priester is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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How to CRITICALLY THINK in Nursing School (Your COMPLETE Step-By-Step Guide)

Clinical , Med Surg

In this video, I’m walking you through the step-by-step process for how to critically think in nursing school.

I always found it crazy that when you get to nursing school, everyone throws around this phrase “critical thinking,” and they all expect you to know how to do it. But no one tells you what it even means!

So I’m going to walk you through how to critically think, step-by-step, so that you can FINALLY understand it and start doing it in nursing school.

HERE’S A BREAKDOWN OF WHAT WE’LL TALK ABOUT:

Planning ahead (1:22)

Connecting the dots (3:02)

Critical Thinking Model (4:50) D: Definition/Description (5:19) R: Reason/Rationale (5:55) C: Connection (6:22)

Cardiac Example (6:43) D: Definition/Description (6:55) R: Reason/Rationale (7:22) C: Connection (8:42)

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VIDEO TRANSCRIPT

In this video, I’m walking you through the step-by-step process for how to critically think in nursing school. I always found it crazy that when you get to nursing school, everyone throws around this phrase “critical thinking,” and they all expect you to know how to do it. But no one tells you what it even means! So I’m going to walk you through how to critically think, step-by-step, so that you can FINALLY understand it and start doing it. So hit that subscribe button and click the notification bell and let’s dive in.

So here’s the BEST news about critical thinking in nursing school: there’s really only 2 main parts to it,

• Planning ahead
• Connecting the dots between all the things you’re learning

That’s it. Doesn’t sound so bad, right?

But the problem is, actually being ABLE to plan ahead AND connect the dots. That is not an easy task. Thankfully, I have a step-by-step process that I’m going to walk you through to show you exactly how to connect the dots and critically think in nursing school. We’ll get to that in a minute. I also have a free critical thinking cheat sheet that walks you through this as well. The link is in the description below, so be sure to get it after watching this video, because it will REALLY help you as you study for your classes.

First, let’s talk about what it actually MEANS to plan ahead and connect the dots, and then we’ll dive into the nitty gritty on how to do it.

Planning ahead means, pretty much like it sounds, you’re always planning the next thing. You’re always thinking about your next move as a nurse. So if you’re going into a patient’s room,

• What are you going to do?
• What supplies do you need?
• Do they need water or an extra gown?
• Is their meal tray ready?
• What are you going to do when you’re in the room?
• Are you going to do an assessment and give meds?
• Flush their IV?
• Check their drains?

You should always have your game plan laid out BEFORE you walk into a patients room.

I had an instructor in nursing school who was absolutely brilliant, I totally loved her, she was the best. She had this rule that you had to do AT LEAST 3 THINGS every time you walked into a patients room. You had to batch your tasks and have a plan BEFORE you went in.

And throughout the clinical day, batching our tasks like this really added up so a LOT of time saved. So instead of going back and fourth, in and out of the room to grab random supplies or things, we always had a game plan going in, and knew what tasks we were going to do in the room. And it had to be AT LEAST 3 . And trust me, she would catch us and ask right before we walked into the patients room, so we always had to be prepared.

So that is planning ahead. You always need to be one-step ahead and know what you’re going to do next.

Thankfully, that part of critical thinking is pretty easy and straightforward.

Connecting the dots, however, is really where the fun starts to happen.

Connecting the dots in nursing school means that you’re comparing and contrasting all of the topics and concepts you’re learning about. You’re putting all the puzzle pieces together, both during lecture class, skills lab, and clinical.

So you understand the disease process of what’s going on with your patient, and you understand how that disease process is causing the signs and symptoms their showing, you know what to assess for, and you know what nursing interventions you expect to do.

This isn’t just memorizing a list of signs and symptoms and assessments, though. Critical thinking means that you’re able to compare and contrast it with other disorders, and put 2 and 2 together.

Don’t worry, I’m going to walk you through an example in a minute, so hang tight. This is ALL going to come together for you!

Before we get there, though, I want to give a shout out to Keona for our YouTube comment of the week, which says,

“This has helped me so much with understand. I need things to be broken down like this, I get it and don’t feel overwhelmed. That textbook can be intimidating! Thank you so much!”

Oh my, I TOTALLY agree. Those textbooks are filled with so much info, it can be super hard to know what to focus on and study. I’m so glad our videos have helped you out, friend! Thanks so much for being here!

And keep your comments coming. We read and respond to every one, and they make me so happy! Thank you so much for all of your support, you’re the BEST !

Now, as promised, let’s dive into exactly HOW to critically think.

I’m going to walk you through the CRITICAL THINKING MODEL , which is a model I created to walk you through exactly HOW to critically think, step-by-step.

Using this CRITICAL THINKING MODEL is going to be the difference between getting an A on an exam, and getting a C. You absolutely MUST know how to critically think to be successful in nursing school, pass your exams, and be a rock star at clinical.

So let’s walk through it and I’ll show you exactly how to do it:

The first step is the D, which stands for definition or description.

This is the very high level part, but we have to start here before we can move onto the other steps. Because if you don’t understand the basics, you won’t be able to understand the deeper level stuff.

So this means you’ll write out what it is, what you need to know about it, or what the description is of it.

And don’t worry, I’m going to put all this to an example here in a minute, so stay with me. It will all come together for you.

So the first step is the D, what’s the definition or description of the topic you’re learning about?

Now the next step is the R, which stands for reason or rationale.

This is the WHY behind the topic. You’ll write out WHY it happens and WHY it matters. This is the reasoning behind it. And most often, this step will be related to the pathophysiology. So if you’re studying a particular disorder and are writing out WHY it happens, this is where you’ll dive into the pathophysiology of what’s happening with the disorder.

Now, the next step is the C, which stands for connection.

This is really where your critical thinking skills will shine! You’ll connect the topic to everything else you’re learning about in nursing school. This is the HOW : how does this topic connect to everything else? This is where it really all starts to come together.

Okay, so now that we’ve gone over what it looks like, let’s put it to an example.

Let’s take a really complex example, like the cardiac system, and I’ll show you how this DRC CRITICAL THINKING MODEL works.

So the first step is the D: definition or description.

So the description of the cardiac system is that it pumps blood through the body, right? It contains the heart, the blood vessels, and the blood. And when it all works together, the heart pumps the blood into the blood vessels, to the organs, and then the blood comes back to the heart to be circulated again. That’s really the cardiac system in a nutshell, right?

So let’s move onto the deeper level, the R, which stands for reasoning or rationale.

So WHY does this matter? WHY is the cardiac system important? What’s the point?

So here we could write out what it’s purpose is and what it does, so WHY does it matter. Well, the blood in the cardiac system is rich with nutrients and oxygen, which are 2 things the organs need to function. Without those nutrients and the oxygen, the organs would fail, right?

The blood also takes AWAY deoxygenated blood and waste products from the organs. So as the organs and body tissues function throughout the day, they create waste products like carbon dioxide and lactic acid. It’s the bloods job to take these waste products and take them to where they need to go, so they can be removed from the body.

If the blood didn’t do it’s job, those waste products could build up to toxic levels in the body and cause major issues, like METABOLIC ACIDOSIS .

And no worries, if you need a refresher on the pathway of blood flow through the heart and how it all works, you can check THIS video out right here.

So that’s the R part of the DRC CRITICAL THINKING MODEL for the cardiac system: it transports nutrients and oxygen to the body tissues, and removes toxic waste products that the tissues don’t need.

Now, let’s move into the really good part, the C, which stands for connection.

How does the cardiac system CONNECT with everything else you’re learning in nursing school?

This is where the fun really begins!

The cardiac system really affects the entire body, but let’s focus on 2 main areas that it impacts:

• The kidneys

So in nursing school, you’ll probably study the respiratory system along with the cardiac system, and you might even study the renal system and kidneys along with it to, so that’s why I want to connect all 3 of those together for you. I’m basically going to give you all the answers here.

So let’s walk through it:

The cardiac system sends blood to all the other organs and tissues in the body, including the lungs and the kidneys.

So if the heart is pumping fine and the blood is circulating properly, the lungs and kidneys are happy campers and they can do their job just fine.

BUT , if the heart starts to fail, or the blood isn’t able to circulate properly, then that’s where we start to see problems.

If the blood isn’t able to get pumped out of the heart and move FORWARD to the body, then it is going to stagnate and stay in the heart, and back up in the system. And where’s the first place it’s going to back up into? The LUNGS ! If the left ventricle can’t pump blood to the body, it’s going to back up into the LUNGS !

Now, this will lead to a whole bunch of problems. What do you think will happen to the lungs when they have extra blood and fluid in them? Well, they’ll get filled with that fluid, right? So when you listen with your stethoscope, you will probably hear crackles, which are caused by all that fluid build up. Your patient may also have trouble breathing, since their lungs aren’t able to do all the gas exchange they need to because they have that layer of fluid in the lungs.

Now on the cardiac side, if blood isn’t going to the rest of the body, including the kidneys, what would you expect to see?

I’ll give you a few seconds to think about it, I know you can do it!

Okay, so if the heart isn’t able to pump blood to the rest of the body, including the kidneys, what would you expect to see? The first thing that came to my mind was a decreased urine output. If the kidneys aren’t getting enough blood, they aren’t going to be able to do their job and make urine, right? So they will have a decreased urine output.

On top of that, if the heart isn’t pumping blood to the body, you’ll probably notice that it’s harder to feel the patients pulses in their wrists or feet. If the blood isn’t pumping there as much, their pulses will be decreased. Their hands and feet might also be colder and pale since there’s not as much blood circulating to warm them up.

So you see how all of these things connect together? This is exactly what you’ll walk through during step number 3 of the DRC CRITICAL THINKING MODEL : connect the dots with everything else that you’re learning.

Really challenge yourself here. I don’t want you to stay high-level and call it good. No, I want you to dig deep and really try to put the concepts together.

If you’re a NursingSOS Member, be sure to log-into your dashboard and find the course that goes along with what you’re studying in class and watch those videos if you need help with it. I’ll walk you through the critical thinking for all of it, so it will make this process a whole lot easier for you!

Now in the next video, I’m going to tell you the TOP HABITS of highly successful nursing students. So if you want to succeed in nursing school, make sure you’re doing these things, they are super important!

And make sure you’ve clicked the notification bell to get notified when we post that video, or you might miss it.

Now make sure to like, comment, and share this video with a friend.

And click on one of these videos here so you can keep rocking nursing school, and go become the nurse that God created only YOU to be. And I’ll catch you in the next video.

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Critical Thinking and Gender Differences in Academic Self-regulation in Higher Education

• January 2016
• Journal of Applied Linguistics and Language Research 3(3):133-145
• 3(3):133-145

• International University of Imam Reza

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