critical thinking is process not outcome

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critical thinking

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• Stanford Encyclopedia of Philosophy - Critical Thinking
• Internet Encyclopedia of Philosophy - Critical Thinking
• Monash University - Student Academic Success - What is critical thinking?
• Oklahoma State University Pressbooks - Critical Thinking - Introduction to Critical Thinking
• University of Louisville - Critical Thinking

critical thinking , in educational theory, mode of cognition using deliberative reasoning and impartial scrutiny of information to arrive at a possible solution to a problem. From the perspective of educators, critical thinking encompasses both a set of logical skills that can be taught and a disposition toward reflective open inquiry that can be cultivated . The term critical thinking was coined by American philosopher and educator John Dewey in the book How We Think (1910) and was adopted by the progressive education movement as a core instructional goal that offered a dynamic modern alternative to traditional educational methods such as rote memorization.

Critical thinking is characterized by a broad set of related skills usually including the abilities to

• break down a problem into its constituent parts to reveal its underlying logic and assumptions
• recognize and account for one’s own biases in judgment and experience
• collect and assess relevant evidence from either personal observations and experimentation or by gathering external information
• adjust and reevaluate one’s own thinking in response to what one has learned
• form a reasoned assessment in order to propose a solution to a problem or a more accurate understanding of the topic at hand

Theorists have noted that such skills are only valuable insofar as a person is inclined to use them. Consequently, they emphasize that certain habits of mind are necessary components of critical thinking. This disposition may include curiosity, open-mindedness, self-awareness, empathy , and persistence.

Although there is a generally accepted set of qualities that are associated with critical thinking, scholarly writing about the term has highlighted disagreements over its exact definition and whether and how it differs from related concepts such as problem solving . In addition, some theorists have insisted that critical thinking be regarded and valued as a process and not as a goal-oriented skill set to be used to solve problems. Critical-thinking theory has also been accused of reflecting patriarchal assumptions about knowledge and ways of knowing that are inherently biased against women.

Dewey, who also used the term reflective thinking , connected critical thinking to a tradition of rational inquiry associated with modern science. From the turn of the 20th century, he and others working in the overlapping fields of psychology , philosophy , and educational theory sought to rigorously apply the scientific method to understand and define the process of thinking. They conceived critical thinking to be related to the scientific method but more open, flexible, and self-correcting; instead of a recipe or a series of steps, critical thinking would be a wider set of skills, patterns, and strategies that allow someone to reason through an intellectual topic, constantly reassessing assumptions and potential explanations in order to arrive at a sound judgment and understanding.

In the progressive education movement in the United States , critical thinking was seen as a crucial component of raising citizens in a democratic society. Instead of imparting a particular series of lessons or teaching only canonical subject matter, theorists thought that teachers should train students in how to think. As critical thinkers, such students would be equipped to be productive and engaged citizens who could cooperate and rationally overcome differences inherent in a pluralistic society.

Beginning in the 1970s and ’80s, critical thinking as a key outcome of school and university curriculum leapt to the forefront of U.S. education policy. In an atmosphere of renewed Cold War competition and amid reports of declining U.S. test scores, there were growing fears that the quality of education in the United States was falling and that students were unprepared. In response, a concerted effort was made to systematically define curriculum goals and implement standardized testing regimens , and critical-thinking skills were frequently included as a crucially important outcome of a successful education. A notable event in this movement was the release of the 1980 report of the Rockefeller Commission on the Humanities that called for the U.S. Department of Education to include critical thinking on its list of “basic skills.” Three years later the California State University system implemented a policy that required every undergraduate student to complete a course in critical thinking.

Critical thinking continued to be put forward as a central goal of education in the early 21st century. Its ubiquity in the language of education policy and in such guidelines as the Common Core State Standards in the United States generated some criticism that the concept itself was both overused and ill-defined. In addition, an argument was made by teachers, theorists, and others that educators were not being adequately trained to teach critical thinking.

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Diane halpern’s four-part model.

• What is Critical Thinking?
• William Perry Model
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Halpern extensively describes the model in Thought and Knowledge: An Introduction to Critical Thinking , a text popular for use in stand-alone critical thinking courses at colleges and currently in its fifth edition.  Halpern embeds the four parts of the model within the definition she provides for critical thinking. Halpern defines critical thinking as “the use of those cognitive skills or strategies that increase the probability of a desirable outcome” and further labels critical thinking as “purposeful, reasoned…goal-directed” and “involved in solving problems, formulating inferences, calculating likelihoods, and making decisions” (8). The definition also stipulates that the thinker must be using appropriate skills for a particular “context” and “type of thinking task” (8). The four-part model then aligns with these definition components and elaborates upon them.

The model’s first part is the overt teaching and learning of specific critical thinking skills and is also delineated in the book’s appendix (Halpern 563-92).

The model’s part two, that “develop[ing] the disposition” of a critical thinker relates to essential “attitudes” such as the “willingness to plan…flexibility…persistence… [and] admit[ting] errors,” as well as “chang[ing] your mind when the evidence changes.” Halpern indicates these attitudes undergird all thinking that raises the chances of attaining goals and solving problems (18-25).

Halpern’s part three centers on student transfer of the critical skills. Along with teaching students specific critical thinking skills, instructors also need to teach students to identify circumstances that require those skills and which skills are necessary in a particular circumstance (Halpern 25-6). To transfer skills, Halpern argues that students must move past “the domain-specific surface characteristics” to identify the “structural aspects of the problem or argument” that “trigger the recall of the thinking skill” (25).

Finally, the fourth part requires students to use metacognition to track the effectiveness of their thinking (Halpern 27). Decisions, goals, and problem solving feature significantly in Halpern’s definition and model. Both the definition and model account for uncertainty in the decision-making process because the result of critical thinking skills need not be “a desirable outcome” but instead a higher chance of such an outcome (8).

Works Cited

Halpern, diane f.  thought and knowledge: an introduction to critical thinking.  5th edition, psychology press, 2014..

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Defining Critical Thinking

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Critical Thinking

Critical thinking is a widely accepted educational goal. Its definition is contested, but the competing definitions can be understood as differing conceptions of the same basic concept: careful thinking directed to a goal. Conceptions differ with respect to the scope of such thinking, the type of goal, the criteria and norms for thinking carefully, and the thinking components on which they focus. Its adoption as an educational goal has been recommended on the basis of respect for students’ autonomy and preparing students for success in life and for democratic citizenship. “Critical thinkers” have the dispositions and abilities that lead them to think critically when appropriate. The abilities can be identified directly; the dispositions indirectly, by considering what factors contribute to or impede exercise of the abilities. Standardized tests have been developed to assess the degree to which a person possesses such dispositions and abilities. Educational intervention has been shown experimentally to improve them, particularly when it includes dialogue, anchored instruction, and mentoring. Controversies have arisen over the generalizability of critical thinking across domains, over alleged bias in critical thinking theories and instruction, and over the relationship of critical thinking to other types of thinking.

2.1 Dewey’s Three Main Examples

2.2 dewey’s other examples, 2.3 further examples, 2.4 non-examples, 3. the definition of critical thinking, 4. its value, 5. the process of thinking critically, 6. components of the process, 7. contributory dispositions and abilities, 8.1 initiating dispositions, 8.2 internal dispositions, 9. critical thinking abilities, 10. required knowledge, 11. educational methods, 12.1 the generalizability of critical thinking, 12.2 bias in critical thinking theory and pedagogy, 12.3 relationship of critical thinking to other types of thinking, other internet resources, related entries.

Use of the term ‘critical thinking’ to describe an educational goal goes back to the American philosopher John Dewey (1910), who more commonly called it ‘reflective thinking’. He defined it as

active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it, and the further conclusions to which it tends. (Dewey 1910: 6; 1933: 9)

and identified a habit of such consideration with a scientific attitude of mind. His lengthy quotations of Francis Bacon, John Locke, and John Stuart Mill indicate that he was not the first person to propose development of a scientific attitude of mind as an educational goal.

In the 1930s, many of the schools that participated in the Eight-Year Study of the Progressive Education Association (Aikin 1942) adopted critical thinking as an educational goal, for whose achievement the study’s Evaluation Staff developed tests (Smith, Tyler, & Evaluation Staff 1942). Glaser (1941) showed experimentally that it was possible to improve the critical thinking of high school students. Bloom’s influential taxonomy of cognitive educational objectives (Bloom et al. 1956) incorporated critical thinking abilities. Ennis (1962) proposed 12 aspects of critical thinking as a basis for research on the teaching and evaluation of critical thinking ability.

Since 1980, an annual international conference in California on critical thinking and educational reform has attracted tens of thousands of educators from all levels of education and from many parts of the world. Also since 1980, the state university system in California has required all undergraduate students to take a critical thinking course. Since 1983, the Association for Informal Logic and Critical Thinking has sponsored sessions in conjunction with the divisional meetings of the American Philosophical Association (APA). In 1987, the APA’s Committee on Pre-College Philosophy commissioned a consensus statement on critical thinking for purposes of educational assessment and instruction (Facione 1990a). Researchers have developed standardized tests of critical thinking abilities and dispositions; for details, see the Supplement on Assessment . Educational jurisdictions around the world now include critical thinking in guidelines for curriculum and assessment.

For details on this history, see the Supplement on History .

2. Examples and Non-Examples

Before considering the definition of critical thinking, it will be helpful to have in mind some examples of critical thinking, as well as some examples of kinds of thinking that would apparently not count as critical thinking.

Dewey (1910: 68–71; 1933: 91–94) takes as paradigms of reflective thinking three class papers of students in which they describe their thinking. The examples range from the everyday to the scientific.

Transit : “The other day, when I was down town on 16th Street, a clock caught my eye. I saw that the hands pointed to 12:20. This suggested that I had an engagement at 124th Street, at one o’clock. I reasoned that as it had taken me an hour to come down on a surface car, I should probably be twenty minutes late if I returned the same way. I might save twenty minutes by a subway express. But was there a station near? If not, I might lose more than twenty minutes in looking for one. Then I thought of the elevated, and I saw there was such a line within two blocks. But where was the station? If it were several blocks above or below the street I was on, I should lose time instead of gaining it. My mind went back to the subway express as quicker than the elevated; furthermore, I remembered that it went nearer than the elevated to the part of 124th Street I wished to reach, so that time would be saved at the end of the journey. I concluded in favor of the subway, and reached my destination by one o’clock.” (Dewey 1910: 68–69; 1933: 91–92)

Ferryboat : “Projecting nearly horizontally from the upper deck of the ferryboat on which I daily cross the river is a long white pole, having a gilded ball at its tip. It suggested a flagpole when I first saw it; its color, shape, and gilded ball agreed with this idea, and these reasons seemed to justify me in this belief. But soon difficulties presented themselves. The pole was nearly horizontal, an unusual position for a flagpole; in the next place, there was no pulley, ring, or cord by which to attach a flag; finally, there were elsewhere on the boat two vertical staffs from which flags were occasionally flown. It seemed probable that the pole was not there for flag-flying.

“I then tried to imagine all possible purposes of the pole, and to consider for which of these it was best suited: (a) Possibly it was an ornament. But as all the ferryboats and even the tugboats carried poles, this hypothesis was rejected. (b) Possibly it was the terminal of a wireless telegraph. But the same considerations made this improbable. Besides, the more natural place for such a terminal would be the highest part of the boat, on top of the pilot house. (c) Its purpose might be to point out the direction in which the boat is moving.

“In support of this conclusion, I discovered that the pole was lower than the pilot house, so that the steersman could easily see it. Moreover, the tip was enough higher than the base, so that, from the pilot’s position, it must appear to project far out in front of the boat. Moreover, the pilot being near the front of the boat, he would need some such guide as to its direction. Tugboats would also need poles for such a purpose. This hypothesis was so much more probable than the others that I accepted it. I formed the conclusion that the pole was set up for the purpose of showing the pilot the direction in which the boat pointed, to enable him to steer correctly.” (Dewey 1910: 69–70; 1933: 92–93)

Bubbles : “In washing tumblers in hot soapsuds and placing them mouth downward on a plate, bubbles appeared on the outside of the mouth of the tumblers and then went inside. Why? The presence of bubbles suggests air, which I note must come from inside the tumbler. I see that the soapy water on the plate prevents escape of the air save as it may be caught in bubbles. But why should air leave the tumbler? There was no substance entering to force it out. It must have expanded. It expands by increase of heat, or by decrease of pressure, or both. Could the air have become heated after the tumbler was taken from the hot suds? Clearly not the air that was already entangled in the water. If heated air was the cause, cold air must have entered in transferring the tumblers from the suds to the plate. I test to see if this supposition is true by taking several more tumblers out. Some I shake so as to make sure of entrapping cold air in them. Some I take out holding mouth downward in order to prevent cold air from entering. Bubbles appear on the outside of every one of the former and on none of the latter. I must be right in my inference. Air from the outside must have been expanded by the heat of the tumbler, which explains the appearance of the bubbles on the outside. But why do they then go inside? Cold contracts. The tumbler cooled and also the air inside it. Tension was removed, and hence bubbles appeared inside. To be sure of this, I test by placing a cup of ice on the tumbler while the bubbles are still forming outside. They soon reverse” (Dewey 1910: 70–71; 1933: 93–94).

Dewey (1910, 1933) sprinkles his book with other examples of critical thinking. We will refer to the following.

Weather : A man on a walk notices that it has suddenly become cool, thinks that it is probably going to rain, looks up and sees a dark cloud obscuring the sun, and quickens his steps (1910: 6–10; 1933: 9–13).

Disorder : A man finds his rooms on his return to them in disorder with his belongings thrown about, thinks at first of burglary as an explanation, then thinks of mischievous children as being an alternative explanation, then looks to see whether valuables are missing, and discovers that they are (1910: 82–83; 1933: 166–168).

Typhoid : A physician diagnosing a patient whose conspicuous symptoms suggest typhoid avoids drawing a conclusion until more data are gathered by questioning the patient and by making tests (1910: 85–86; 1933: 170).

Blur : A moving blur catches our eye in the distance, we ask ourselves whether it is a cloud of whirling dust or a tree moving its branches or a man signaling to us, we think of other traits that should be found on each of those possibilities, and we look and see if those traits are found (1910: 102, 108; 1933: 121, 133).

Suction pump : In thinking about the suction pump, the scientist first notes that it will draw water only to a maximum height of 33 feet at sea level and to a lesser maximum height at higher elevations, selects for attention the differing atmospheric pressure at these elevations, sets up experiments in which the air is removed from a vessel containing water (when suction no longer works) and in which the weight of air at various levels is calculated, compares the results of reasoning about the height to which a given weight of air will allow a suction pump to raise water with the observed maximum height at different elevations, and finally assimilates the suction pump to such apparently different phenomena as the siphon and the rising of a balloon (1910: 150–153; 1933: 195–198).

Diamond : A passenger in a car driving in a diamond lane reserved for vehicles with at least one passenger notices that the diamond marks on the pavement are far apart in some places and close together in others. Why? The driver suggests that the reason may be that the diamond marks are not needed where there is a solid double line separating the diamond lane from the adjoining lane, but are needed when there is a dotted single line permitting crossing into the diamond lane. Further observation confirms that the diamonds are close together when a dotted line separates the diamond lane from its neighbour, but otherwise far apart.

Rash : A woman suddenly develops a very itchy red rash on her throat and upper chest. She recently noticed a mark on the back of her right hand, but was not sure whether the mark was a rash or a scrape. She lies down in bed and thinks about what might be causing the rash and what to do about it. About two weeks before, she began taking blood pressure medication that contained a sulfa drug, and the pharmacist had warned her, in view of a previous allergic reaction to a medication containing a sulfa drug, to be on the alert for an allergic reaction; however, she had been taking the medication for two weeks with no such effect. The day before, she began using a new cream on her neck and upper chest; against the new cream as the cause was mark on the back of her hand, which had not been exposed to the cream. She began taking probiotics about a month before. She also recently started new eye drops, but she supposed that manufacturers of eye drops would be careful not to include allergy-causing components in the medication. The rash might be a heat rash, since she recently was sweating profusely from her upper body. Since she is about to go away on a short vacation, where she would not have access to her usual physician, she decides to keep taking the probiotics and using the new eye drops but to discontinue the blood pressure medication and to switch back to the old cream for her neck and upper chest. She forms a plan to consult her regular physician on her return about the blood pressure medication.

Candidate : Although Dewey included no examples of thinking directed at appraising the arguments of others, such thinking has come to be considered a kind of critical thinking. We find an example of such thinking in the performance task on the Collegiate Learning Assessment (CLA+), which its sponsoring organization describes as

a performance-based assessment that provides a measure of an institution’s contribution to the development of critical-thinking and written communication skills of its students. (Council for Aid to Education 2017)

A sample task posted on its website requires the test-taker to write a report for public distribution evaluating a fictional candidate’s policy proposals and their supporting arguments, using supplied background documents, with a recommendation on whether to endorse the candidate.

Immediate acceptance of an idea that suggests itself as a solution to a problem (e.g., a possible explanation of an event or phenomenon, an action that seems likely to produce a desired result) is “uncritical thinking, the minimum of reflection” (Dewey 1910: 13). On-going suspension of judgment in the light of doubt about a possible solution is not critical thinking (Dewey 1910: 108). Critique driven by a dogmatically held political or religious ideology is not critical thinking; thus Paulo Freire (1968 [1970]) is using the term (e.g., at 1970: 71, 81, 100, 146) in a more politically freighted sense that includes not only reflection but also revolutionary action against oppression. Derivation of a conclusion from given data using an algorithm is not critical thinking.

What is critical thinking? There are many definitions. Ennis (2016) lists 14 philosophically oriented scholarly definitions and three dictionary definitions. Following Rawls (1971), who distinguished his conception of justice from a utilitarian conception but regarded them as rival conceptions of the same concept, Ennis maintains that the 17 definitions are different conceptions of the same concept. Rawls articulated the shared concept of justice as

a characteristic set of principles for assigning basic rights and duties and for determining… the proper distribution of the benefits and burdens of social cooperation. (Rawls 1971: 5)

Bailin et al. (1999b) claim that, if one considers what sorts of thinking an educator would take not to be critical thinking and what sorts to be critical thinking, one can conclude that educators typically understand critical thinking to have at least three features.

• It is done for the purpose of making up one’s mind about what to believe or do.
• The person engaging in the thinking is trying to fulfill standards of adequacy and accuracy appropriate to the thinking.
• The thinking fulfills the relevant standards to some threshold level.

One could sum up the core concept that involves these three features by saying that critical thinking is careful goal-directed thinking. This core concept seems to apply to all the examples of critical thinking described in the previous section. As for the non-examples, their exclusion depends on construing careful thinking as excluding jumping immediately to conclusions, suspending judgment no matter how strong the evidence, reasoning from an unquestioned ideological or religious perspective, and routinely using an algorithm to answer a question.

If the core of critical thinking is careful goal-directed thinking, conceptions of it can vary according to its presumed scope, its presumed goal, one’s criteria and threshold for being careful, and the thinking component on which one focuses. As to its scope, some conceptions (e.g., Dewey 1910, 1933) restrict it to constructive thinking on the basis of one’s own observations and experiments, others (e.g., Ennis 1962; Fisher & Scriven 1997; Johnson 1992) to appraisal of the products of such thinking. Ennis (1991) and Bailin et al. (1999b) take it to cover both construction and appraisal. As to its goal, some conceptions restrict it to forming a judgment (Dewey 1910, 1933; Lipman 1987; Facione 1990a). Others allow for actions as well as beliefs as the end point of a process of critical thinking (Ennis 1991; Bailin et al. 1999b). As to the criteria and threshold for being careful, definitions vary in the term used to indicate that critical thinking satisfies certain norms: “intellectually disciplined” (Scriven & Paul 1987), “reasonable” (Ennis 1991), “skillful” (Lipman 1987), “skilled” (Fisher & Scriven 1997), “careful” (Bailin & Battersby 2009). Some definitions specify these norms, referring variously to “consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends” (Dewey 1910, 1933); “the methods of logical inquiry and reasoning” (Glaser 1941); “conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication” (Scriven & Paul 1987); the requirement that “it is sensitive to context, relies on criteria, and is self-correcting” (Lipman 1987); “evidential, conceptual, methodological, criteriological, or contextual considerations” (Facione 1990a); and “plus-minus considerations of the product in terms of appropriate standards (or criteria)” (Johnson 1992). Stanovich and Stanovich (2010) propose to ground the concept of critical thinking in the concept of rationality, which they understand as combining epistemic rationality (fitting one’s beliefs to the world) and instrumental rationality (optimizing goal fulfillment); a critical thinker, in their view, is someone with “a propensity to override suboptimal responses from the autonomous mind” (2010: 227). These variant specifications of norms for critical thinking are not necessarily incompatible with one another, and in any case presuppose the core notion of thinking carefully. As to the thinking component singled out, some definitions focus on suspension of judgment during the thinking (Dewey 1910; McPeck 1981), others on inquiry while judgment is suspended (Bailin & Battersby 2009, 2021), others on the resulting judgment (Facione 1990a), and still others on responsiveness to reasons (Siegel 1988). Kuhn (2019) takes critical thinking to be more a dialogic practice of advancing and responding to arguments than an individual ability.

In educational contexts, a definition of critical thinking is a “programmatic definition” (Scheffler 1960: 19). It expresses a practical program for achieving an educational goal. For this purpose, a one-sentence formulaic definition is much less useful than articulation of a critical thinking process, with criteria and standards for the kinds of thinking that the process may involve. The real educational goal is recognition, adoption and implementation by students of those criteria and standards. That adoption and implementation in turn consists in acquiring the knowledge, abilities and dispositions of a critical thinker.

Conceptions of critical thinking generally do not include moral integrity as part of the concept. Dewey, for example, took critical thinking to be the ultimate intellectual goal of education, but distinguished it from the development of social cooperation among school children, which he took to be the central moral goal. Ennis (1996, 2011) added to his previous list of critical thinking dispositions a group of dispositions to care about the dignity and worth of every person, which he described as a “correlative” (1996) disposition without which critical thinking would be less valuable and perhaps harmful. An educational program that aimed at developing critical thinking but not the correlative disposition to care about the dignity and worth of every person, he asserted, “would be deficient and perhaps dangerous” (Ennis 1996: 172).

Dewey thought that education for reflective thinking would be of value to both the individual and society; recognition in educational practice of the kinship to the scientific attitude of children’s native curiosity, fertile imagination and love of experimental inquiry “would make for individual happiness and the reduction of social waste” (Dewey 1910: iii). Schools participating in the Eight-Year Study took development of the habit of reflective thinking and skill in solving problems as a means to leading young people to understand, appreciate and live the democratic way of life characteristic of the United States (Aikin 1942: 17–18, 81). Harvey Siegel (1988: 55–61) has offered four considerations in support of adopting critical thinking as an educational ideal. (1) Respect for persons requires that schools and teachers honour students’ demands for reasons and explanations, deal with students honestly, and recognize the need to confront students’ independent judgment; these requirements concern the manner in which teachers treat students. (2) Education has the task of preparing children to be successful adults, a task that requires development of their self-sufficiency. (3) Education should initiate children into the rational traditions in such fields as history, science and mathematics. (4) Education should prepare children to become democratic citizens, which requires reasoned procedures and critical talents and attitudes. To supplement these considerations, Siegel (1988: 62–90) responds to two objections: the ideology objection that adoption of any educational ideal requires a prior ideological commitment and the indoctrination objection that cultivation of critical thinking cannot escape being a form of indoctrination.

Despite the diversity of our 11 examples, one can recognize a common pattern. Dewey analyzed it as consisting of five phases:

• suggestions , in which the mind leaps forward to a possible solution;
• an intellectualization of the difficulty or perplexity into a problem to be solved, a question for which the answer must be sought;
• the use of one suggestion after another as a leading idea, or hypothesis , to initiate and guide observation and other operations in collection of factual material;
• the mental elaboration of the idea or supposition as an idea or supposition ( reasoning , in the sense on which reasoning is a part, not the whole, of inference); and
• testing the hypothesis by overt or imaginative action. (Dewey 1933: 106–107; italics in original)

The process of reflective thinking consisting of these phases would be preceded by a perplexed, troubled or confused situation and followed by a cleared-up, unified, resolved situation (Dewey 1933: 106). The term ‘phases’ replaced the term ‘steps’ (Dewey 1910: 72), thus removing the earlier suggestion of an invariant sequence. Variants of the above analysis appeared in (Dewey 1916: 177) and (Dewey 1938: 101–119).

The variant formulations indicate the difficulty of giving a single logical analysis of such a varied process. The process of critical thinking may have a spiral pattern, with the problem being redefined in the light of obstacles to solving it as originally formulated. For example, the person in Transit might have concluded that getting to the appointment at the scheduled time was impossible and have reformulated the problem as that of rescheduling the appointment for a mutually convenient time. Further, defining a problem does not always follow after or lead immediately to an idea of a suggested solution. Nor should it do so, as Dewey himself recognized in describing the physician in Typhoid as avoiding any strong preference for this or that conclusion before getting further information (Dewey 1910: 85; 1933: 170). People with a hypothesis in mind, even one to which they have a very weak commitment, have a so-called “confirmation bias” (Nickerson 1998): they are likely to pay attention to evidence that confirms the hypothesis and to ignore evidence that counts against it or for some competing hypothesis. Detectives, intelligence agencies, and investigators of airplane accidents are well advised to gather relevant evidence systematically and to postpone even tentative adoption of an explanatory hypothesis until the collected evidence rules out with the appropriate degree of certainty all but one explanation. Dewey’s analysis of the critical thinking process can be faulted as well for requiring acceptance or rejection of a possible solution to a defined problem, with no allowance for deciding in the light of the available evidence to suspend judgment. Further, given the great variety of kinds of problems for which reflection is appropriate, there is likely to be variation in its component events. Perhaps the best way to conceptualize the critical thinking process is as a checklist whose component events can occur in a variety of orders, selectively, and more than once. These component events might include (1) noticing a difficulty, (2) defining the problem, (3) dividing the problem into manageable sub-problems, (4) formulating a variety of possible solutions to the problem or sub-problem, (5) determining what evidence is relevant to deciding among possible solutions to the problem or sub-problem, (6) devising a plan of systematic observation or experiment that will uncover the relevant evidence, (7) carrying out the plan of systematic observation or experimentation, (8) noting the results of the systematic observation or experiment, (9) gathering relevant testimony and information from others, (10) judging the credibility of testimony and information gathered from others, (11) drawing conclusions from gathered evidence and accepted testimony, and (12) accepting a solution that the evidence adequately supports (cf. Hitchcock 2017: 485).

Checklist conceptions of the process of critical thinking are open to the objection that they are too mechanical and procedural to fit the multi-dimensional and emotionally charged issues for which critical thinking is urgently needed (Paul 1984). For such issues, a more dialectical process is advocated, in which competing relevant world views are identified, their implications explored, and some sort of creative synthesis attempted.

If one considers the critical thinking process illustrated by the 11 examples, one can identify distinct kinds of mental acts and mental states that form part of it. To distinguish, label and briefly characterize these components is a useful preliminary to identifying abilities, skills, dispositions, attitudes, habits and the like that contribute causally to thinking critically. Identifying such abilities and habits is in turn a useful preliminary to setting educational goals. Setting the goals is in its turn a useful preliminary to designing strategies for helping learners to achieve the goals and to designing ways of measuring the extent to which learners have done so. Such measures provide both feedback to learners on their achievement and a basis for experimental research on the effectiveness of various strategies for educating people to think critically. Let us begin, then, by distinguishing the kinds of mental acts and mental events that can occur in a critical thinking process.

• Observing : One notices something in one’s immediate environment (sudden cooling of temperature in Weather , bubbles forming outside a glass and then going inside in Bubbles , a moving blur in the distance in Blur , a rash in Rash ). Or one notes the results of an experiment or systematic observation (valuables missing in Disorder , no suction without air pressure in Suction pump )
• Feeling : One feels puzzled or uncertain about something (how to get to an appointment on time in Transit , why the diamonds vary in spacing in Diamond ). One wants to resolve this perplexity. One feels satisfaction once one has worked out an answer (to take the subway express in Transit , diamonds closer when needed as a warning in Diamond ).
• Wondering : One formulates a question to be addressed (why bubbles form outside a tumbler taken from hot water in Bubbles , how suction pumps work in Suction pump , what caused the rash in Rash ).
• Imagining : One thinks of possible answers (bus or subway or elevated in Transit , flagpole or ornament or wireless communication aid or direction indicator in Ferryboat , allergic reaction or heat rash in Rash ).
• Inferring : One works out what would be the case if a possible answer were assumed (valuables missing if there has been a burglary in Disorder , earlier start to the rash if it is an allergic reaction to a sulfa drug in Rash ). Or one draws a conclusion once sufficient relevant evidence is gathered (take the subway in Transit , burglary in Disorder , discontinue blood pressure medication and new cream in Rash ).
• Knowledge : One uses stored knowledge of the subject-matter to generate possible answers or to infer what would be expected on the assumption of a particular answer (knowledge of a city’s public transit system in Transit , of the requirements for a flagpole in Ferryboat , of Boyle’s law in Bubbles , of allergic reactions in Rash ).
• Experimenting : One designs and carries out an experiment or a systematic observation to find out whether the results deduced from a possible answer will occur (looking at the location of the flagpole in relation to the pilot’s position in Ferryboat , putting an ice cube on top of a tumbler taken from hot water in Bubbles , measuring the height to which a suction pump will draw water at different elevations in Suction pump , noticing the spacing of diamonds when movement to or from a diamond lane is allowed in Diamond ).
• Consulting : One finds a source of information, gets the information from the source, and makes a judgment on whether to accept it. None of our 11 examples include searching for sources of information. In this respect they are unrepresentative, since most people nowadays have almost instant access to information relevant to answering any question, including many of those illustrated by the examples. However, Candidate includes the activities of extracting information from sources and evaluating its credibility.
• Identifying and analyzing arguments : One notices an argument and works out its structure and content as a preliminary to evaluating its strength. This activity is central to Candidate . It is an important part of a critical thinking process in which one surveys arguments for various positions on an issue.
• Judging : One makes a judgment on the basis of accumulated evidence and reasoning, such as the judgment in Ferryboat that the purpose of the pole is to provide direction to the pilot.
• Deciding : One makes a decision on what to do or on what policy to adopt, as in the decision in Transit to take the subway.

By definition, a person who does something voluntarily is both willing and able to do that thing at that time. Both the willingness and the ability contribute causally to the person’s action, in the sense that the voluntary action would not occur if either (or both) of these were lacking. For example, suppose that one is standing with one’s arms at one’s sides and one voluntarily lifts one’s right arm to an extended horizontal position. One would not do so if one were unable to lift one’s arm, if for example one’s right side was paralyzed as the result of a stroke. Nor would one do so if one were unwilling to lift one’s arm, if for example one were participating in a street demonstration at which a white supremacist was urging the crowd to lift their right arm in a Nazi salute and one were unwilling to express support in this way for the racist Nazi ideology. The same analysis applies to a voluntary mental process of thinking critically. It requires both willingness and ability to think critically, including willingness and ability to perform each of the mental acts that compose the process and to coordinate those acts in a sequence that is directed at resolving the initiating perplexity.

Consider willingness first. We can identify causal contributors to willingness to think critically by considering factors that would cause a person who was able to think critically about an issue nevertheless not to do so (Hamby 2014). For each factor, the opposite condition thus contributes causally to willingness to think critically on a particular occasion. For example, people who habitually jump to conclusions without considering alternatives will not think critically about issues that arise, even if they have the required abilities. The contrary condition of willingness to suspend judgment is thus a causal contributor to thinking critically.

Now consider ability. In contrast to the ability to move one’s arm, which can be completely absent because a stroke has left the arm paralyzed, the ability to think critically is a developed ability, whose absence is not a complete absence of ability to think but absence of ability to think well. We can identify the ability to think well directly, in terms of the norms and standards for good thinking. In general, to be able do well the thinking activities that can be components of a critical thinking process, one needs to know the concepts and principles that characterize their good performance, to recognize in particular cases that the concepts and principles apply, and to apply them. The knowledge, recognition and application may be procedural rather than declarative. It may be domain-specific rather than widely applicable, and in either case may need subject-matter knowledge, sometimes of a deep kind.

Reflections of the sort illustrated by the previous two paragraphs have led scholars to identify the knowledge, abilities and dispositions of a “critical thinker”, i.e., someone who thinks critically whenever it is appropriate to do so. We turn now to these three types of causal contributors to thinking critically. We start with dispositions, since arguably these are the most powerful contributors to being a critical thinker, can be fostered at an early stage of a child’s development, and are susceptible to general improvement (Glaser 1941: 175)

8. Critical Thinking Dispositions

Educational researchers use the term ‘dispositions’ broadly for the habits of mind and attitudes that contribute causally to being a critical thinker. Some writers (e.g., Paul & Elder 2006; Hamby 2014; Bailin & Battersby 2016a) propose to use the term ‘virtues’ for this dimension of a critical thinker. The virtues in question, although they are virtues of character, concern the person’s ways of thinking rather than the person’s ways of behaving towards others. They are not moral virtues but intellectual virtues, of the sort articulated by Zagzebski (1996) and discussed by Turri, Alfano, and Greco (2017).

On a realistic conception, thinking dispositions or intellectual virtues are real properties of thinkers. They are general tendencies, propensities, or inclinations to think in particular ways in particular circumstances, and can be genuinely explanatory (Siegel 1999). Sceptics argue that there is no evidence for a specific mental basis for the habits of mind that contribute to thinking critically, and that it is pedagogically misleading to posit such a basis (Bailin et al. 1999a). Whatever their status, critical thinking dispositions need motivation for their initial formation in a child—motivation that may be external or internal. As children develop, the force of habit will gradually become important in sustaining the disposition (Nieto & Valenzuela 2012). Mere force of habit, however, is unlikely to sustain critical thinking dispositions. Critical thinkers must value and enjoy using their knowledge and abilities to think things through for themselves. They must be committed to, and lovers of, inquiry.

A person may have a critical thinking disposition with respect to only some kinds of issues. For example, one could be open-minded about scientific issues but not about religious issues. Similarly, one could be confident in one’s ability to reason about the theological implications of the existence of evil in the world but not in one’s ability to reason about the best design for a guided ballistic missile.

Facione (1990a: 25) divides “affective dispositions” of critical thinking into approaches to life and living in general and approaches to specific issues, questions or problems. Adapting this distinction, one can usefully divide critical thinking dispositions into initiating dispositions (those that contribute causally to starting to think critically about an issue) and internal dispositions (those that contribute causally to doing a good job of thinking critically once one has started). The two categories are not mutually exclusive. For example, open-mindedness, in the sense of willingness to consider alternative points of view to one’s own, is both an initiating and an internal disposition.

Using the strategy of considering factors that would block people with the ability to think critically from doing so, we can identify as initiating dispositions for thinking critically attentiveness, a habit of inquiry, self-confidence, courage, open-mindedness, willingness to suspend judgment, trust in reason, wanting evidence for one’s beliefs, and seeking the truth. We consider briefly what each of these dispositions amounts to, in each case citing sources that acknowledge them.

• Attentiveness : One will not think critically if one fails to recognize an issue that needs to be thought through. For example, the pedestrian in Weather would not have looked up if he had not noticed that the air was suddenly cooler. To be a critical thinker, then, one needs to be habitually attentive to one’s surroundings, noticing not only what one senses but also sources of perplexity in messages received and in one’s own beliefs and attitudes (Facione 1990a: 25; Facione, Facione, & Giancarlo 2001).
• Habit of inquiry : Inquiry is effortful, and one needs an internal push to engage in it. For example, the student in Bubbles could easily have stopped at idle wondering about the cause of the bubbles rather than reasoning to a hypothesis, then designing and executing an experiment to test it. Thus willingness to think critically needs mental energy and initiative. What can supply that energy? Love of inquiry, or perhaps just a habit of inquiry. Hamby (2015) has argued that willingness to inquire is the central critical thinking virtue, one that encompasses all the others. It is recognized as a critical thinking disposition by Dewey (1910: 29; 1933: 35), Glaser (1941: 5), Ennis (1987: 12; 1991: 8), Facione (1990a: 25), Bailin et al. (1999b: 294), Halpern (1998: 452), and Facione, Facione, & Giancarlo (2001).
• Self-confidence : Lack of confidence in one’s abilities can block critical thinking. For example, if the woman in Rash lacked confidence in her ability to figure things out for herself, she might just have assumed that the rash on her chest was the allergic reaction to her medication against which the pharmacist had warned her. Thus willingness to think critically requires confidence in one’s ability to inquire (Facione 1990a: 25; Facione, Facione, & Giancarlo 2001).
• Courage : Fear of thinking for oneself can stop one from doing it. Thus willingness to think critically requires intellectual courage (Paul & Elder 2006: 16).
• Open-mindedness : A dogmatic attitude will impede thinking critically. For example, a person who adheres rigidly to a “pro-choice” position on the issue of the legal status of induced abortion is likely to be unwilling to consider seriously the issue of when in its development an unborn child acquires a moral right to life. Thus willingness to think critically requires open-mindedness, in the sense of a willingness to examine questions to which one already accepts an answer but which further evidence or reasoning might cause one to answer differently (Dewey 1933; Facione 1990a; Ennis 1991; Bailin et al. 1999b; Halpern 1998, Facione, Facione, & Giancarlo 2001). Paul (1981) emphasizes open-mindedness about alternative world-views, and recommends a dialectical approach to integrating such views as central to what he calls “strong sense” critical thinking. In three studies, Haran, Ritov, & Mellers (2013) found that actively open-minded thinking, including “the tendency to weigh new evidence against a favored belief, to spend sufficient time on a problem before giving up, and to consider carefully the opinions of others in forming one’s own”, led study participants to acquire information and thus to make accurate estimations.
• Willingness to suspend judgment : Premature closure on an initial solution will block critical thinking. Thus willingness to think critically requires a willingness to suspend judgment while alternatives are explored (Facione 1990a; Ennis 1991; Halpern 1998).
• Trust in reason : Since distrust in the processes of reasoned inquiry will dissuade one from engaging in it, trust in them is an initiating critical thinking disposition (Facione 1990a, 25; Bailin et al. 1999b: 294; Facione, Facione, & Giancarlo 2001; Paul & Elder 2006). In reaction to an allegedly exclusive emphasis on reason in critical thinking theory and pedagogy, Thayer-Bacon (2000) argues that intuition, imagination, and emotion have important roles to play in an adequate conception of critical thinking that she calls “constructive thinking”. From her point of view, critical thinking requires trust not only in reason but also in intuition, imagination, and emotion.
• Seeking the truth : If one does not care about the truth but is content to stick with one’s initial bias on an issue, then one will not think critically about it. Seeking the truth is thus an initiating critical thinking disposition (Bailin et al. 1999b: 294; Facione, Facione, & Giancarlo 2001). A disposition to seek the truth is implicit in more specific critical thinking dispositions, such as trying to be well-informed, considering seriously points of view other than one’s own, looking for alternatives, suspending judgment when the evidence is insufficient, and adopting a position when the evidence supporting it is sufficient.

Some of the initiating dispositions, such as open-mindedness and willingness to suspend judgment, are also internal critical thinking dispositions, in the sense of mental habits or attitudes that contribute causally to doing a good job of critical thinking once one starts the process. But there are many other internal critical thinking dispositions. Some of them are parasitic on one’s conception of good thinking. For example, it is constitutive of good thinking about an issue to formulate the issue clearly and to maintain focus on it. For this purpose, one needs not only the corresponding ability but also the corresponding disposition. Ennis (1991: 8) describes it as the disposition “to determine and maintain focus on the conclusion or question”, Facione (1990a: 25) as “clarity in stating the question or concern”. Other internal dispositions are motivators to continue or adjust the critical thinking process, such as willingness to persist in a complex task and willingness to abandon nonproductive strategies in an attempt to self-correct (Halpern 1998: 452). For a list of identified internal critical thinking dispositions, see the Supplement on Internal Critical Thinking Dispositions .

Some theorists postulate skills, i.e., acquired abilities, as operative in critical thinking. It is not obvious, however, that a good mental act is the exercise of a generic acquired skill. Inferring an expected time of arrival, as in Transit , has some generic components but also uses non-generic subject-matter knowledge. Bailin et al. (1999a) argue against viewing critical thinking skills as generic and discrete, on the ground that skilled performance at a critical thinking task cannot be separated from knowledge of concepts and from domain-specific principles of good thinking. Talk of skills, they concede, is unproblematic if it means merely that a person with critical thinking skills is capable of intelligent performance.

Despite such scepticism, theorists of critical thinking have listed as general contributors to critical thinking what they variously call abilities (Glaser 1941; Ennis 1962, 1991), skills (Facione 1990a; Halpern 1998) or competencies (Fisher & Scriven 1997). Amalgamating these lists would produce a confusing and chaotic cornucopia of more than 50 possible educational objectives, with only partial overlap among them. It makes sense instead to try to understand the reasons for the multiplicity and diversity, and to make a selection according to one’s own reasons for singling out abilities to be developed in a critical thinking curriculum. Two reasons for diversity among lists of critical thinking abilities are the underlying conception of critical thinking and the envisaged educational level. Appraisal-only conceptions, for example, involve a different suite of abilities than constructive-only conceptions. Some lists, such as those in (Glaser 1941), are put forward as educational objectives for secondary school students, whereas others are proposed as objectives for college students (e.g., Facione 1990a).

The abilities described in the remaining paragraphs of this section emerge from reflection on the general abilities needed to do well the thinking activities identified in section 6 as components of the critical thinking process described in section 5 . The derivation of each collection of abilities is accompanied by citation of sources that list such abilities and of standardized tests that claim to test them.

Observational abilities : Careful and accurate observation sometimes requires specialist expertise and practice, as in the case of observing birds and observing accident scenes. However, there are general abilities of noticing what one’s senses are picking up from one’s environment and of being able to articulate clearly and accurately to oneself and others what one has observed. It helps in exercising them to be able to recognize and take into account factors that make one’s observation less trustworthy, such as prior framing of the situation, inadequate time, deficient senses, poor observation conditions, and the like. It helps as well to be skilled at taking steps to make one’s observation more trustworthy, such as moving closer to get a better look, measuring something three times and taking the average, and checking what one thinks one is observing with someone else who is in a good position to observe it. It also helps to be skilled at recognizing respects in which one’s report of one’s observation involves inference rather than direct observation, so that one can then consider whether the inference is justified. These abilities come into play as well when one thinks about whether and with what degree of confidence to accept an observation report, for example in the study of history or in a criminal investigation or in assessing news reports. Observational abilities show up in some lists of critical thinking abilities (Ennis 1962: 90; Facione 1990a: 16; Ennis 1991: 9). There are items testing a person’s ability to judge the credibility of observation reports in the Cornell Critical Thinking Tests, Levels X and Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005). Norris and King (1983, 1985, 1990a, 1990b) is a test of ability to appraise observation reports.

Emotional abilities : The emotions that drive a critical thinking process are perplexity or puzzlement, a wish to resolve it, and satisfaction at achieving the desired resolution. Children experience these emotions at an early age, without being trained to do so. Education that takes critical thinking as a goal needs only to channel these emotions and to make sure not to stifle them. Collaborative critical thinking benefits from ability to recognize one’s own and others’ emotional commitments and reactions.

Questioning abilities : A critical thinking process needs transformation of an inchoate sense of perplexity into a clear question. Formulating a question well requires not building in questionable assumptions, not prejudging the issue, and using language that in context is unambiguous and precise enough (Ennis 1962: 97; 1991: 9).

Imaginative abilities : Thinking directed at finding the correct causal explanation of a general phenomenon or particular event requires an ability to imagine possible explanations. Thinking about what policy or plan of action to adopt requires generation of options and consideration of possible consequences of each option. Domain knowledge is required for such creative activity, but a general ability to imagine alternatives is helpful and can be nurtured so as to become easier, quicker, more extensive, and deeper (Dewey 1910: 34–39; 1933: 40–47). Facione (1990a) and Halpern (1998) include the ability to imagine alternatives as a critical thinking ability.

Inferential abilities : The ability to draw conclusions from given information, and to recognize with what degree of certainty one’s own or others’ conclusions follow, is universally recognized as a general critical thinking ability. All 11 examples in section 2 of this article include inferences, some from hypotheses or options (as in Transit , Ferryboat and Disorder ), others from something observed (as in Weather and Rash ). None of these inferences is formally valid. Rather, they are licensed by general, sometimes qualified substantive rules of inference (Toulmin 1958) that rest on domain knowledge—that a bus trip takes about the same time in each direction, that the terminal of a wireless telegraph would be located on the highest possible place, that sudden cooling is often followed by rain, that an allergic reaction to a sulfa drug generally shows up soon after one starts taking it. It is a matter of controversy to what extent the specialized ability to deduce conclusions from premisses using formal rules of inference is needed for critical thinking. Dewey (1933) locates logical forms in setting out the products of reflection rather than in the process of reflection. Ennis (1981a), on the other hand, maintains that a liberally-educated person should have the following abilities: to translate natural-language statements into statements using the standard logical operators, to use appropriately the language of necessary and sufficient conditions, to deal with argument forms and arguments containing symbols, to determine whether in virtue of an argument’s form its conclusion follows necessarily from its premisses, to reason with logically complex propositions, and to apply the rules and procedures of deductive logic. Inferential abilities are recognized as critical thinking abilities by Glaser (1941: 6), Facione (1990a: 9), Ennis (1991: 9), Fisher & Scriven (1997: 99, 111), and Halpern (1998: 452). Items testing inferential abilities constitute two of the five subtests of the Watson Glaser Critical Thinking Appraisal (Watson & Glaser 1980a, 1980b, 1994), two of the four sections in the Cornell Critical Thinking Test Level X (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005), three of the seven sections in the Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005), 11 of the 34 items on Forms A and B of the California Critical Thinking Skills Test (Facione 1990b, 1992), and a high but variable proportion of the 25 selected-response questions in the Collegiate Learning Assessment (Council for Aid to Education 2017).

Experimenting abilities : Knowing how to design and execute an experiment is important not just in scientific research but also in everyday life, as in Rash . Dewey devoted a whole chapter of his How We Think (1910: 145–156; 1933: 190–202) to the superiority of experimentation over observation in advancing knowledge. Experimenting abilities come into play at one remove in appraising reports of scientific studies. Skill in designing and executing experiments includes the acknowledged abilities to appraise evidence (Glaser 1941: 6), to carry out experiments and to apply appropriate statistical inference techniques (Facione 1990a: 9), to judge inductions to an explanatory hypothesis (Ennis 1991: 9), and to recognize the need for an adequately large sample size (Halpern 1998). The Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005) includes four items (out of 52) on experimental design. The Collegiate Learning Assessment (Council for Aid to Education 2017) makes room for appraisal of study design in both its performance task and its selected-response questions.

Consulting abilities : Skill at consulting sources of information comes into play when one seeks information to help resolve a problem, as in Candidate . Ability to find and appraise information includes ability to gather and marshal pertinent information (Glaser 1941: 6), to judge whether a statement made by an alleged authority is acceptable (Ennis 1962: 84), to plan a search for desired information (Facione 1990a: 9), and to judge the credibility of a source (Ennis 1991: 9). Ability to judge the credibility of statements is tested by 24 items (out of 76) in the Cornell Critical Thinking Test Level X (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005) and by four items (out of 52) in the Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005). The College Learning Assessment’s performance task requires evaluation of whether information in documents is credible or unreliable (Council for Aid to Education 2017).

Argument analysis abilities : The ability to identify and analyze arguments contributes to the process of surveying arguments on an issue in order to form one’s own reasoned judgment, as in Candidate . The ability to detect and analyze arguments is recognized as a critical thinking skill by Facione (1990a: 7–8), Ennis (1991: 9) and Halpern (1998). Five items (out of 34) on the California Critical Thinking Skills Test (Facione 1990b, 1992) test skill at argument analysis. The College Learning Assessment (Council for Aid to Education 2017) incorporates argument analysis in its selected-response tests of critical reading and evaluation and of critiquing an argument.

Judging skills and deciding skills : Skill at judging and deciding is skill at recognizing what judgment or decision the available evidence and argument supports, and with what degree of confidence. It is thus a component of the inferential skills already discussed.

Lists and tests of critical thinking abilities often include two more abilities: identifying assumptions and constructing and evaluating definitions.

In addition to dispositions and abilities, critical thinking needs knowledge: of critical thinking concepts, of critical thinking principles, and of the subject-matter of the thinking.

We can derive a short list of concepts whose understanding contributes to critical thinking from the critical thinking abilities described in the preceding section. Observational abilities require an understanding of the difference between observation and inference. Questioning abilities require an understanding of the concepts of ambiguity and vagueness. Inferential abilities require an understanding of the difference between conclusive and defeasible inference (traditionally, between deduction and induction), as well as of the difference between necessary and sufficient conditions. Experimenting abilities require an understanding of the concepts of hypothesis, null hypothesis, assumption and prediction, as well as of the concept of statistical significance and of its difference from importance. They also require an understanding of the difference between an experiment and an observational study, and in particular of the difference between a randomized controlled trial, a prospective correlational study and a retrospective (case-control) study. Argument analysis abilities require an understanding of the concepts of argument, premiss, assumption, conclusion and counter-consideration. Additional critical thinking concepts are proposed by Bailin et al. (1999b: 293), Fisher & Scriven (1997: 105–106), Black (2012), and Blair (2021).

According to Glaser (1941: 25), ability to think critically requires knowledge of the methods of logical inquiry and reasoning. If we review the list of abilities in the preceding section, however, we can see that some of them can be acquired and exercised merely through practice, possibly guided in an educational setting, followed by feedback. Searching intelligently for a causal explanation of some phenomenon or event requires that one consider a full range of possible causal contributors, but it seems more important that one implements this principle in one’s practice than that one is able to articulate it. What is important is “operational knowledge” of the standards and principles of good thinking (Bailin et al. 1999b: 291–293). But the development of such critical thinking abilities as designing an experiment or constructing an operational definition can benefit from learning their underlying theory. Further, explicit knowledge of quirks of human thinking seems useful as a cautionary guide. Human memory is not just fallible about details, as people learn from their own experiences of misremembering, but is so malleable that a detailed, clear and vivid recollection of an event can be a total fabrication (Loftus 2017). People seek or interpret evidence in ways that are partial to their existing beliefs and expectations, often unconscious of their “confirmation bias” (Nickerson 1998). Not only are people subject to this and other cognitive biases (Kahneman 2011), of which they are typically unaware, but it may be counter-productive for one to make oneself aware of them and try consciously to counteract them or to counteract social biases such as racial or sexual stereotypes (Kenyon & Beaulac 2014). It is helpful to be aware of these facts and of the superior effectiveness of blocking the operation of biases—for example, by making an immediate record of one’s observations, refraining from forming a preliminary explanatory hypothesis, blind refereeing, double-blind randomized trials, and blind grading of students’ work. It is also helpful to be aware of the prevalence of “noise” (unwanted unsystematic variability of judgments), of how to detect noise (through a noise audit), and of how to reduce noise: make accuracy the goal, think statistically, break a process of arriving at a judgment into independent tasks, resist premature intuitions, in a group get independent judgments first, favour comparative judgments and scales (Kahneman, Sibony, & Sunstein 2021). It is helpful as well to be aware of the concept of “bounded rationality” in decision-making and of the related distinction between “satisficing” and optimizing (Simon 1956; Gigerenzer 2001).

Critical thinking about an issue requires substantive knowledge of the domain to which the issue belongs. Critical thinking abilities are not a magic elixir that can be applied to any issue whatever by somebody who has no knowledge of the facts relevant to exploring that issue. For example, the student in Bubbles needed to know that gases do not penetrate solid objects like a glass, that air expands when heated, that the volume of an enclosed gas varies directly with its temperature and inversely with its pressure, and that hot objects will spontaneously cool down to the ambient temperature of their surroundings unless kept hot by insulation or a source of heat. Critical thinkers thus need a rich fund of subject-matter knowledge relevant to the variety of situations they encounter. This fact is recognized in the inclusion among critical thinking dispositions of a concern to become and remain generally well informed.

Experimental educational interventions, with control groups, have shown that education can improve critical thinking skills and dispositions, as measured by standardized tests. For information about these tests, see the Supplement on Assessment .

What educational methods are most effective at developing the dispositions, abilities and knowledge of a critical thinker? In a comprehensive meta-analysis of experimental and quasi-experimental studies of strategies for teaching students to think critically, Abrami et al. (2015) found that dialogue, anchored instruction, and mentoring each increased the effectiveness of the educational intervention, and that they were most effective when combined. They also found that in these studies a combination of separate instruction in critical thinking with subject-matter instruction in which students are encouraged to think critically was more effective than either by itself. However, the difference was not statistically significant; that is, it might have arisen by chance.

Most of these studies lack the longitudinal follow-up required to determine whether the observed differential improvements in critical thinking abilities or dispositions continue over time, for example until high school or college graduation. For details on studies of methods of developing critical thinking skills and dispositions, see the Supplement on Educational Methods .

12. Controversies

Scholars have denied the generalizability of critical thinking abilities across subject domains, have alleged bias in critical thinking theory and pedagogy, and have investigated the relationship of critical thinking to other kinds of thinking.

McPeck (1981) attacked the thinking skills movement of the 1970s, including the critical thinking movement. He argued that there are no general thinking skills, since thinking is always thinking about some subject-matter. It is futile, he claimed, for schools and colleges to teach thinking as if it were a separate subject. Rather, teachers should lead their pupils to become autonomous thinkers by teaching school subjects in a way that brings out their cognitive structure and that encourages and rewards discussion and argument. As some of his critics (e.g., Paul 1985; Siegel 1985) pointed out, McPeck’s central argument needs elaboration, since it has obvious counter-examples in writing and speaking, for which (up to a certain level of complexity) there are teachable general abilities even though they are always about some subject-matter. To make his argument convincing, McPeck needs to explain how thinking differs from writing and speaking in a way that does not permit useful abstraction of its components from the subject-matters with which it deals. He has not done so. Nevertheless, his position that the dispositions and abilities of a critical thinker are best developed in the context of subject-matter instruction is shared by many theorists of critical thinking, including Dewey (1910, 1933), Glaser (1941), Passmore (1980), Weinstein (1990), Bailin et al. (1999b), and Willingham (2019).

McPeck’s challenge prompted reflection on the extent to which critical thinking is subject-specific. McPeck argued for a strong subject-specificity thesis, according to which it is a conceptual truth that all critical thinking abilities are specific to a subject. (He did not however extend his subject-specificity thesis to critical thinking dispositions. In particular, he took the disposition to suspend judgment in situations of cognitive dissonance to be a general disposition.) Conceptual subject-specificity is subject to obvious counter-examples, such as the general ability to recognize confusion of necessary and sufficient conditions. A more modest thesis, also endorsed by McPeck, is epistemological subject-specificity, according to which the norms of good thinking vary from one field to another. Epistemological subject-specificity clearly holds to a certain extent; for example, the principles in accordance with which one solves a differential equation are quite different from the principles in accordance with which one determines whether a painting is a genuine Picasso. But the thesis suffers, as Ennis (1989) points out, from vagueness of the concept of a field or subject and from the obvious existence of inter-field principles, however broadly the concept of a field is construed. For example, the principles of hypothetico-deductive reasoning hold for all the varied fields in which such reasoning occurs. A third kind of subject-specificity is empirical subject-specificity, according to which as a matter of empirically observable fact a person with the abilities and dispositions of a critical thinker in one area of investigation will not necessarily have them in another area of investigation.

The thesis of empirical subject-specificity raises the general problem of transfer. If critical thinking abilities and dispositions have to be developed independently in each school subject, how are they of any use in dealing with the problems of everyday life and the political and social issues of contemporary society, most of which do not fit into the framework of a traditional school subject? Proponents of empirical subject-specificity tend to argue that transfer is more likely to occur if there is critical thinking instruction in a variety of domains, with explicit attention to dispositions and abilities that cut across domains. But evidence for this claim is scanty. There is a need for well-designed empirical studies that investigate the conditions that make transfer more likely.

It is common ground in debates about the generality or subject-specificity of critical thinking dispositions and abilities that critical thinking about any topic requires background knowledge about the topic. For example, the most sophisticated understanding of the principles of hypothetico-deductive reasoning is of no help unless accompanied by some knowledge of what might be plausible explanations of some phenomenon under investigation.

Critics have objected to bias in the theory, pedagogy and practice of critical thinking. Commentators (e.g., Alston 1995; Ennis 1998) have noted that anyone who takes a position has a bias in the neutral sense of being inclined in one direction rather than others. The critics, however, are objecting to bias in the pejorative sense of an unjustified favoring of certain ways of knowing over others, frequently alleging that the unjustly favoured ways are those of a dominant sex or culture (Bailin 1995). These ways favour:

• reinforcement of egocentric and sociocentric biases over dialectical engagement with opposing world-views (Paul 1981, 1984; Warren 1998)
• distancing from the object of inquiry over closeness to it (Martin 1992; Thayer-Bacon 1992)
• indifference to the situation of others over care for them (Martin 1992)
• orientation to thought over orientation to action (Martin 1992)
• being reasonable over caring to understand people’s ideas (Thayer-Bacon 1993)
• being neutral and objective over being embodied and situated (Thayer-Bacon 1995a)
• doubting over believing (Thayer-Bacon 1995b)
• reason over emotion, imagination and intuition (Thayer-Bacon 2000)
• solitary thinking over collaborative thinking (Thayer-Bacon 2000)
• written and spoken assignments over other forms of expression (Alston 2001)
• attention to written and spoken communications over attention to human problems (Alston 2001)
• winning debates in the public sphere over making and understanding meaning (Alston 2001)

A common thread in this smorgasbord of accusations is dissatisfaction with focusing on the logical analysis and evaluation of reasoning and arguments. While these authors acknowledge that such analysis and evaluation is part of critical thinking and should be part of its conceptualization and pedagogy, they insist that it is only a part. Paul (1981), for example, bemoans the tendency of atomistic teaching of methods of analyzing and evaluating arguments to turn students into more able sophists, adept at finding fault with positions and arguments with which they disagree but even more entrenched in the egocentric and sociocentric biases with which they began. Martin (1992) and Thayer-Bacon (1992) cite with approval the self-reported intimacy with their subject-matter of leading researchers in biology and medicine, an intimacy that conflicts with the distancing allegedly recommended in standard conceptions and pedagogy of critical thinking. Thayer-Bacon (2000) contrasts the embodied and socially embedded learning of her elementary school students in a Montessori school, who used their imagination, intuition and emotions as well as their reason, with conceptions of critical thinking as

thinking that is used to critique arguments, offer justifications, and make judgments about what are the good reasons, or the right answers. (Thayer-Bacon 2000: 127–128)

Alston (2001) reports that her students in a women’s studies class were able to see the flaws in the Cinderella myth that pervades much romantic fiction but in their own romantic relationships still acted as if all failures were the woman’s fault and still accepted the notions of love at first sight and living happily ever after. Students, she writes, should

be able to connect their intellectual critique to a more affective, somatic, and ethical account of making risky choices that have sexist, racist, classist, familial, sexual, or other consequences for themselves and those both near and far… critical thinking that reads arguments, texts, or practices merely on the surface without connections to feeling/desiring/doing or action lacks an ethical depth that should infuse the difference between mere cognitive activity and something we want to call critical thinking. (Alston 2001: 34)

Some critics portray such biases as unfair to women. Thayer-Bacon (1992), for example, has charged modern critical thinking theory with being sexist, on the ground that it separates the self from the object and causes one to lose touch with one’s inner voice, and thus stigmatizes women, who (she asserts) link self to object and listen to their inner voice. Her charge does not imply that women as a group are on average less able than men to analyze and evaluate arguments. Facione (1990c) found no difference by sex in performance on his California Critical Thinking Skills Test. Kuhn (1991: 280–281) found no difference by sex in either the disposition or the competence to engage in argumentative thinking.

The critics propose a variety of remedies for the biases that they allege. In general, they do not propose to eliminate or downplay critical thinking as an educational goal. Rather, they propose to conceptualize critical thinking differently and to change its pedagogy accordingly. Their pedagogical proposals arise logically from their objections. They can be summarized as follows:

• Focus on argument networks with dialectical exchanges reflecting contesting points of view rather than on atomic arguments, so as to develop “strong sense” critical thinking that transcends egocentric and sociocentric biases (Paul 1981, 1984).
• Foster closeness to the subject-matter and feeling connected to others in order to inform a humane democracy (Martin 1992).
• Develop “constructive thinking” as a social activity in a community of physically embodied and socially embedded inquirers with personal voices who value not only reason but also imagination, intuition and emotion (Thayer-Bacon 2000).
• In developing critical thinking in school subjects, treat as important neither skills nor dispositions but opening worlds of meaning (Alston 2001).
• Attend to the development of critical thinking dispositions as well as skills, and adopt the “critical pedagogy” practised and advocated by Freire (1968 [1970]) and hooks (1994) (Dalgleish, Girard, & Davies 2017).

A common thread in these proposals is treatment of critical thinking as a social, interactive, personally engaged activity like that of a quilting bee or a barn-raising (Thayer-Bacon 2000) rather than as an individual, solitary, distanced activity symbolized by Rodin’s The Thinker . One can get a vivid description of education with the former type of goal from the writings of bell hooks (1994, 2010). Critical thinking for her is open-minded dialectical exchange across opposing standpoints and from multiple perspectives, a conception similar to Paul’s “strong sense” critical thinking (Paul 1981). She abandons the structure of domination in the traditional classroom. In an introductory course on black women writers, for example, she assigns students to write an autobiographical paragraph about an early racial memory, then to read it aloud as the others listen, thus affirming the uniqueness and value of each voice and creating a communal awareness of the diversity of the group’s experiences (hooks 1994: 84). Her “engaged pedagogy” is thus similar to the “freedom under guidance” implemented in John Dewey’s Laboratory School of Chicago in the late 1890s and early 1900s. It incorporates the dialogue, anchored instruction, and mentoring that Abrami (2015) found to be most effective in improving critical thinking skills and dispositions.

What is the relationship of critical thinking to problem solving, decision-making, higher-order thinking, creative thinking, and other recognized types of thinking? One’s answer to this question obviously depends on how one defines the terms used in the question. If critical thinking is conceived broadly to cover any careful thinking about any topic for any purpose, then problem solving and decision making will be kinds of critical thinking, if they are done carefully. Historically, ‘critical thinking’ and ‘problem solving’ were two names for the same thing. If critical thinking is conceived more narrowly as consisting solely of appraisal of intellectual products, then it will be disjoint with problem solving and decision making, which are constructive.

Bloom’s taxonomy of educational objectives used the phrase “intellectual abilities and skills” for what had been labeled “critical thinking” by some, “reflective thinking” by Dewey and others, and “problem solving” by still others (Bloom et al. 1956: 38). Thus, the so-called “higher-order thinking skills” at the taxonomy’s top levels of analysis, synthesis and evaluation are just critical thinking skills, although they do not come with general criteria for their assessment (Ennis 1981b). The revised version of Bloom’s taxonomy (Anderson et al. 2001) likewise treats critical thinking as cutting across those types of cognitive process that involve more than remembering (Anderson et al. 2001: 269–270). For details, see the Supplement on History .

As to creative thinking, it overlaps with critical thinking (Bailin 1987, 1988). Thinking about the explanation of some phenomenon or event, as in Ferryboat , requires creative imagination in constructing plausible explanatory hypotheses. Likewise, thinking about a policy question, as in Candidate , requires creativity in coming up with options. Conversely, creativity in any field needs to be balanced by critical appraisal of the draft painting or novel or mathematical theory.

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Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Chapter 6 clinical reasoning, decisionmaking, and action: thinking critically and clinically.

Patricia Benner ; Ronda G. Hughes ; Molly Sutphen .

Affiliations

This chapter examines multiple thinking strategies that are needed for high-quality clinical practice. Clinical reasoning and judgment are examined in relation to other modes of thinking used by clinical nurses in providing quality health care to patients that avoids adverse events and patient harm. The clinician’s ability to provide safe, high-quality care can be dependent upon their ability to reason, think, and judge, which can be limited by lack of experience. The expert performance of nurses is dependent upon continual learning and evaluation of performance.

• Critical Thinking

Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years. 1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. The American Philosophical Association (APA) defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based. 2 A more expansive general definition of critical thinking is

. . . in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and a commitment to overcome our native egocentrism and sociocentrism. Every clinician must develop rigorous habits of critical thinking, but they cannot escape completely the situatedness and structures of the clinical traditions and practices in which they must make decisions and act quickly in specific clinical situations. 3

There are three key definitions for nursing, which differ slightly. Bittner and Tobin defined critical thinking as being “influenced by knowledge and experience, using strategies such as reflective thinking as a part of learning to identify the issues and opportunities, and holistically synthesize the information in nursing practice” 4 (p. 268). Scheffer and Rubenfeld 5 expanded on the APA definition for nurses through a consensus process, resulting in the following definition:

Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, openmindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge 6 (Scheffer & Rubenfeld, p. 357).

The National League for Nursing Accreditation Commission (NLNAC) defined critical thinking as:

the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research 7 (p. 8).

These concepts are furthered by the American Association of Colleges of Nurses’ definition of critical thinking in their Essentials of Baccalaureate Nursing :

Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity 8 (p. 9).

Course work or ethical experiences should provide the graduate with the knowledge and skills to:

• Use nursing and other appropriate theories and models, and an appropriate ethical framework;
• Apply research-based knowledge from nursing and the sciences as the basis for practice;
• Use clinical judgment and decision-making skills;
• Engage in self-reflective and collegial dialogue about professional practice;
• Evaluate nursing care outcomes through the acquisition of data and the questioning of inconsistencies, allowing for the revision of actions and goals;
• Engage in creative problem solving 8 (p. 10).

Taken together, these definitions of critical thinking set forth the scope and key elements of thought processes involved in providing clinical care. Exactly how critical thinking is defined will influence how it is taught and to what standard of care nurses will be held accountable.

Professional and regulatory bodies in nursing education have required that critical thinking be central to all nursing curricula, but they have not adequately distinguished critical reflection from ethical, clinical, or even creative thinking for decisionmaking or actions required by the clinician. Other essential modes of thought such as clinical reasoning, evaluation of evidence, creative thinking, or the application of well-established standards of practice—all distinct from critical reflection—have been subsumed under the rubric of critical thinking. In the nursing education literature, clinical reasoning and judgment are often conflated with critical thinking. The accrediting bodies and nursing scholars have included decisionmaking and action-oriented, practical, ethical, and clinical reasoning in the rubric of critical reflection and thinking. One might say that this harmless semantic confusion is corrected by actual practices, except that students need to understand the distinctions between critical reflection and clinical reasoning, and they need to learn to discern when each is better suited, just as students need to also engage in applying standards, evidence-based practices, and creative thinking.

The growing body of research, patient acuity, and complexity of care demand higher-order thinking skills. Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes. These skills can be cultivated by educators who display the virtues of critical thinking, including independence of thought, intellectual curiosity, courage, humility, empathy, integrity, perseverance, and fair-mindedness. 9

The process of critical thinking is stimulated by integrating the essential knowledge, experiences, and clinical reasoning that support professional practice. The emerging paradigm for clinical thinking and cognition is that it is social and dialogical rather than monological and individual. 10–12 Clinicians pool their wisdom and multiple perspectives, yet some clinical knowledge can be demonstrated only in the situation (e.g., how to suction an extremely fragile patient whose oxygen saturations sink too low). Early warnings of problematic situations are made possible by clinicians comparing their observations to that of other providers. Clinicians form practice communities that create styles of practice, including ways of doing things, communication styles and mechanisms, and shared expectations about performance and expertise of team members.

By holding up critical thinking as a large umbrella for different modes of thinking, students can easily misconstrue the logic and purposes of different modes of thinking. Clinicians and scientists alike need multiple thinking strategies, such as critical thinking, clinical judgment, diagnostic reasoning, deliberative rationality, scientific reasoning, dialogue, argument, creative thinking, and so on. In particular, clinicians need forethought and an ongoing grasp of a patient’s health status and care needs trajectory, which requires an assessment of their own clarity and understanding of the situation at hand, critical reflection, critical reasoning, and clinical judgment.

Critical Reflection, Critical Reasoning, and Judgment

Critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case. Critical reflective skills are essential for clinicians; however, these skills are not sufficient for the clinician who must decide how to act in particular situations and avoid patient injury. For example, in everyday practice, clinicians cannot afford to critically reflect on the well-established tenets of “normal” or “typical” human circulatory systems when trying to figure out a particular patient’s alterations from that typical, well-grounded understanding that has existed since Harvey’s work in 1628. 13 Yet critical reflection can generate new scientifically based ideas. For example, there is a lack of adequate research on the differences between women’s and men’s circulatory systems and the typical pathophysiology related to heart attacks. Available research is based upon multiple, taken-for-granted starting points about the general nature of the circulatory system. As such, critical reflection may not provide what is needed for a clinician to act in a situation. This idea can be considered reasonable since critical reflective thinking is not sufficient for good clinical reasoning and judgment. The clinician’s development of skillful critical reflection depends upon being taught what to pay attention to, and thus gaining a sense of salience that informs the powers of perceptual grasp. The powers of noticing or perceptual grasp depend upon noticing what is salient and the capacity to respond to the situation.

Critical reflection is a crucial professional skill, but it is not the only reasoning skill or logic clinicians require. The ability to think critically uses reflection, induction, deduction, analysis, challenging assumptions, and evaluation of data and information to guide decisionmaking. 9 , 14 , 15 Critical reasoning is a process whereby knowledge and experience are applied in considering multiple possibilities to achieve the desired goals, 16 while considering the patient’s situation. 14 It is a process where both inductive and deductive cognitive skills are used. 17 Sometimes clinical reasoning is presented as a form of evaluating scientific knowledge, sometimes even as a form of scientific reasoning. Critical thinking is inherent in making sound clinical reasoning. 18

An essential point of tension and confusion exists in practice traditions such as nursing and medicine when clinical reasoning and critical reflection become entangled, because the clinician must have some established bases that are not questioned when engaging in clinical decisions and actions, such as standing orders. The clinician must act in the particular situation and time with the best clinical and scientific knowledge available. The clinician cannot afford to indulge in either ritualistic unexamined knowledge or diagnostic or therapeutic nihilism caused by radical doubt, as in critical reflection, because they must find an intelligent and effective way to think and act in particular clinical situations. Critical reflection skills are essential to assist practitioners to rethink outmoded or even wrong-headed approaches to health care, health promotion, and prevention of illness and complications, especially when new evidence is available. Breakdowns in practice, high failure rates in particular therapies, new diseases, new scientific discoveries, and societal changes call for critical reflection about past assumptions and no-longer-tenable beliefs.

Clinical reasoning stands out as a situated, practice-based form of reasoning that requires a background of scientific and technological research-based knowledge about general cases, more so than any particular instance. It also requires practical ability to discern the relevance of the evidence behind general scientific and technical knowledge and how it applies to a particular patient. In dong so, the clinician considers the patient’s particular clinical trajectory, their concerns and preferences, and their particular vulnerabilities (e.g., having multiple comorbidities) and sensitivities to care interventions (e.g., known drug allergies, other conflicting comorbid conditions, incompatible therapies, and past responses to therapies) when forming clinical decisions or conclusions.

Situated in a practice setting, clinical reasoning occurs within social relationships or situations involving patient, family, community, and a team of health care providers. The expert clinician situates themselves within a nexus of relationships, with concerns that are bounded by the situation. Expert clinical reasoning is socially engaged with the relationships and concerns of those who are affected by the caregiving situation, and when certain circumstances are present, the adverse event. Halpern 19 has called excellent clinical ethical reasoning “emotional reasoning” in that the clinicians have emotional access to the patient/family concerns and their understanding of the particular care needs. Expert clinicians also seek an optimal perceptual grasp, one based on understanding and as undistorted as possible, based on an attuned emotional engagement and expert clinical knowledge. 19 , 20

Clergy educators 21 and nursing and medical educators have begun to recognize the wisdom of broadening their narrow vision of rationality beyond simple rational calculation (exemplified by cost-benefit analysis) to reconsider the need for character development—including emotional engagement, perception, habits of thought, and skill acquisition—as essential to the development of expert clinical reasoning, judgment, and action. 10 , 22–24 Practitioners of engineering, law, medicine, and nursing, like the clergy, have to develop a place to stand in their discipline’s tradition of knowledge and science in order to recognize and evaluate salient evidence in the moment. Diagnostic confusion and disciplinary nihilism are both threats to the clinician’s ability to act in particular situations. However, the practice and practitioners will not be self-improving and vital if they cannot engage in critical reflection on what is not of value, what is outmoded, and what does not work. As evidence evolves and expands, so too must clinical thought.

Clinical judgment requires clinical reasoning across time about the particular, and because of the relevance of this immediate historical unfolding, clinical reasoning can be very different from the scientific reasoning used to formulate, conduct, and assess clinical experiments. While scientific reasoning is also socially embedded in a nexus of social relationships and concerns, the goal of detached, critical objectivity used to conduct scientific experiments minimizes the interactive influence of the research on the experiment once it has begun. Scientific research in the natural and clinical sciences typically uses formal criteria to develop “yes” and “no” judgments at prespecified times. The scientist is always situated in past and immediate scientific history, preferring to evaluate static and predetermined points in time (e.g., snapshot reasoning), in contrast to a clinician who must always reason about transitions over time. 25 , 26

Techne and Phronesis

Distinctions between the mere scientific making of things and practice was first explored by Aristotle as distinctions between techne and phronesis. 27 Learning to be a good practitioner requires developing the requisite moral imagination for good practice. If, for example, patients exercise their rights and refuse treatments, practitioners are required to have the moral imagination to understand the probable basis for the patient’s refusal. For example, was the refusal based upon catastrophic thinking, unrealistic fears, misunderstanding, or even clinical depression?

Techne, as defined by Aristotle, encompasses the notion of formation of character and habitus 28 as embodied beings. In Aristotle’s terms, techne refers to the making of things or producing outcomes. 11 Joseph Dunne defines techne as “the activity of producing outcomes,” and it “is governed by a means-ends rationality where the maker or producer governs the thing or outcomes produced or made through gaining mastery over the means of producing the outcomes, to the point of being able to separate means and ends” 11 (p. 54). While some aspects of medical and nursing practice fall into the category of techne, much of nursing and medical practice falls outside means-ends rationality and must be governed by concern for doing good or what is best for the patient in particular circumstances, where being in a relationship and discerning particular human concerns at stake guide action.

Phronesis, in contrast to techne, includes reasoning about the particular, across time, through changes or transitions in the patient’s and/or the clinician’s understanding. As noted by Dunne, phronesis is “characterized at least as much by a perceptiveness with regard to concrete particulars as by a knowledge of universal principles” 11 (p. 273). This type of practical reasoning often takes the form of puzzle solving or the evaluation of immediate past “hot” history of the patient’s situation. Such a particular clinical situation is necessarily particular, even though many commonalities and similarities with other disease syndromes can be recognized through signs and symptoms and laboratory tests. 11 , 29 , 30 Pointing to knowledge embedded in a practice makes no claim for infallibility or “correctness.” Individual practitioners can be mistaken in their judgments because practices such as medicine and nursing are inherently underdetermined. 31

While phronetic knowledge must remain open to correction and improvement, real events, and consequences, it cannot consistently transcend the institutional setting’s capacities and supports for good practice. Phronesis is also dependent on ongoing experiential learning of the practitioner, where knowledge is refined, corrected, or refuted. The Western tradition, with the notable exception of Aristotle, valued knowledge that could be made universal and devalued practical know-how and experiential learning. Descartes codified this preference for formal logic and rational calculation.

Aristotle recognized that when knowledge is underdetermined, changeable, and particular, it cannot be turned into the universal or standardized. It must be perceived, discerned, and judged, all of which require experiential learning. In nursing and medicine, perceptual acuity in physical assessment and clinical judgment (i.e., reasoning across time about changes in the particular patient or the clinician’s understanding of the patient’s condition) fall into the Greek Aristotelian category of phronesis. Dewey 32 sought to rescue knowledge gained by practical activity in the world. He identified three flaws in the understanding of experience in Greek philosophy: (1) empirical knowing is the opposite of experience with science; (2) practice is reduced to techne or the application of rational thought or technique; and (3) action and skilled know-how are considered temporary and capricious as compared to reason, which the Greeks considered as ultimate reality.

In practice, nursing and medicine require both techne and phronesis. The clinician standardizes and routinizes what can be standardized and routinized, as exemplified by standardized blood pressure measurements, diagnoses, and even charting about the patient’s condition and treatment. 27 Procedural and scientific knowledge can often be formalized and standardized (e.g., practice guidelines), or at least made explicit and certain in practice, except for the necessary timing and adjustments made for particular patients. 11 , 22

Rational calculations available to techne—population trends and statistics, algorithms—are created as decision support structures and can improve accuracy when used as a stance of inquiry in making clinical judgments about particular patients. Aggregated evidence from clinical trials and ongoing working knowledge of pathophysiology, biochemistry, and genomics are essential. In addition, the skills of phronesis (clinical judgment that reasons across time, taking into account the transitions of the particular patient/family/community and transitions in the clinician’s understanding of the clinical situation) will be required for nursing, medicine, or any helping profession.

Thinking Critically

Being able to think critically enables nurses to meet the needs of patients within their context and considering their preferences; meet the needs of patients within the context of uncertainty; consider alternatives, resulting in higher-quality care; 33 and think reflectively, rather than simply accepting statements and performing tasks without significant understanding and evaluation. 34 Skillful practitioners can think critically because they have the following cognitive skills: information seeking, discriminating, analyzing, transforming knowledge, predicating, applying standards, and logical reasoning. 5 One’s ability to think critically can be affected by age, length of education (e.g., an associate vs. a baccalaureate decree in nursing), and completion of philosophy or logic subjects. 35–37 The skillful practitioner can think critically because of having the following characteristics: motivation, perseverance, fair-mindedness, and deliberate and careful attention to thinking. 5 , 9

Thinking critically implies that one has a knowledge base from which to reason and the ability to analyze and evaluate evidence. 38 Knowledge can be manifest by the logic and rational implications of decisionmaking. Clinical decisionmaking is particularly influenced by interpersonal relationships with colleagues, 39 patient conditions, availability of resources, 40 knowledge, and experience. 41 Of these, experience has been shown to enhance nurses’ abilities to make quick decisions 42 and fewer decision errors, 43 support the identification of salient cues, and foster the recognition and action on patterns of information. 44 , 45

Clinicians must develop the character and relational skills that enable them to perceive and understand their patient’s needs and concerns. This requires accurate interpretation of patient data that is relevant to the specific patient and situation. In nursing, this formation of moral agency focuses on learning to be responsible in particular ways demanded by the practice, and to pay attention and intelligently discern changes in patients’ concerns and/or clinical condition that require action on the part of the nurse or other health care workers to avert potential compromises to quality care.

Formation of the clinician’s character, skills, and habits are developed in schools and particular practice communities within a larger practice tradition. As Dunne notes,

A practice is not just a surface on which one can display instant virtuosity. It grounds one in a tradition that has been formed through an elaborate development and that exists at any juncture only in the dispositions (slowly and perhaps painfully acquired) of its recognized practitioners. The question may of course be asked whether there are any such practices in the contemporary world, whether the wholesale encroachment of Technique has not obliterated them—and whether this is not the whole point of MacIntyre’s recipe of withdrawal, as well as of the post-modern story of dispossession 11 (p. 378).

Clearly Dunne is engaging in critical reflection about the conditions for developing character, skills, and habits for skillful and ethical comportment of practitioners, as well as to act as moral agents for patients so that they and their families receive safe, effective, and compassionate care.

Professional socialization or professional values, while necessary, do not adequately address character and skill formation that transform the way the practitioner exists in his or her world, what the practitioner is capable of noticing and responding to, based upon well-established patterns of emotional responses, skills, dispositions to act, and the skills to respond, decide, and act. 46 The need for character and skill formation of the clinician is what makes a practice stand out from a mere technical, repetitious manufacturing process. 11 , 30 , 47

In nursing and medicine, many have questioned whether current health care institutions are designed to promote or hinder enlightened, compassionate practice, or whether they have deteriorated into commercial institutional models that focus primarily on efficiency and profit. MacIntyre points out the links between the ongoing development and improvement of practice traditions and the institutions that house them:

Lack of justice, lack of truthfulness, lack of courage, lack of the relevant intellectual virtues—these corrupt traditions, just as they do those institutions and practices which derive their life from the traditions of which they are the contemporary embodiments. To recognize this is of course also to recognize the existence of an additional virtue, one whose importance is perhaps most obvious when it is least present, the virtue of having an adequate sense of the traditions to which one belongs or which confront one. This virtue is not to be confused with any form of conservative antiquarianism; I am not praising those who choose the conventional conservative role of laudator temporis acti. It is rather the case that an adequate sense of tradition manifests itself in a grasp of those future possibilities which the past has made available to the present. Living traditions, just because they continue a not-yet-completed narrative, confront a future whose determinate and determinable character, so far as it possesses any, derives from the past 30 (p. 207).

It would be impossible to capture all the situated and distributed knowledge outside of actual practice situations and particular patients. Simulations are powerful as teaching tools to enable nurses’ ability to think critically because they give students the opportunity to practice in a simplified environment. However, students can be limited in their inability to convey underdetermined situations where much of the information is based on perceptions of many aspects of the patient and changes that have occurred over time. Simulations cannot have the sub-cultures formed in practice settings that set the social mood of trust, distrust, competency, limited resources, or other forms of situated possibilities.

One of the hallmark studies in nursing providing keen insight into understanding the influence of experience was a qualitative study of adult, pediatric, and neonatal intensive care unit (ICU) nurses, where the nurses were clustered into advanced beginner, intermediate, and expert level of practice categories. The advanced beginner (having up to 6 months of work experience) used procedures and protocols to determine which clinical actions were needed. When confronted with a complex patient situation, the advanced beginner felt their practice was unsafe because of a knowledge deficit or because of a knowledge application confusion. The transition from advanced beginners to competent practitioners began when they first had experience with actual clinical situations and could benefit from the knowledge gained from the mistakes of their colleagues. Competent nurses continuously questioned what they saw and heard, feeling an obligation to know more about clinical situations. In doing do, they moved from only using care plans and following the physicians’ orders to analyzing and interpreting patient situations. Beyond that, the proficient nurse acknowledged the changing relevance of clinical situations requiring action beyond what was planned or anticipated. The proficient nurse learned to acknowledge the changing needs of patient care and situation, and could organize interventions “by the situation as it unfolds rather than by preset goals 48 (p. 24). Both competent and proficient nurses (that is, intermediate level of practice) had at least two years of ICU experience. 48 Finally, the expert nurse had a more fully developed grasp of a clinical situation, a sense of confidence in what is known about the situation, and could differentiate the precise clinical problem in little time. 48

Expertise is acquired through professional experience and is indicative of a nurse who has moved beyond mere proficiency. As Gadamer 29 points out, experience involves a turning around of preconceived notions, preunderstandings, and extends or adds nuances to understanding. Dewey 49 notes that experience requires a prepared “creature” and an enriched environment. The opportunity to reflect and narrate one’s experiential learning can clarify, extend, or even refute experiential learning.

Experiential learning requires time and nurturing, but time alone does not ensure experiential learning. Aristotle linked experiential learning to the development of character and moral sensitivities of a person learning a practice. 50 New nurses/new graduates have limited work experience and must experience continuing learning until they have reached an acceptable level of performance. 51 After that, further improvements are not predictable, and years of experience are an inadequate predictor of expertise. 52

The most effective knower and developer of practical knowledge creates an ongoing dialogue and connection between lessons of the day and experiential learning over time. Gadamer, in a late life interview, highlighted the open-endedness and ongoing nature of experiential learning in the following interview response:

Being experienced does not mean that one now knows something once and for all and becomes rigid in this knowledge; rather, one becomes more open to new experiences. A person who is experienced is undogmatic. Experience has the effect of freeing one to be open to new experience … In our experience we bring nothing to a close; we are constantly learning new things from our experience … this I call the interminability of all experience 32 (p. 403).

Practical endeavor, supported by scientific knowledge, requires experiential learning, the development of skilled know-how, and perceptual acuity in order to make the scientific knowledge relevant to the situation. Clinical perceptual and skilled know-how helps the practitioner discern when particular scientific findings might be relevant. 53

Often experience and knowledge, confirmed by experimentation, are treated as oppositions, an either-or choice. However, in practice it is readily acknowledged that experiential knowledge fuels scientific investigation, and scientific investigation fuels further experiential learning. Experiential learning from particular clinical cases can help the clinician recognize future similar cases and fuel new scientific questions and study. For example, less experienced nurses—and it could be argued experienced as well—can use nursing diagnoses practice guidelines as part of their professional advancement. Guidelines are used to reflect their interpretation of patients’ needs, responses, and situation, 54 a process that requires critical thinking and decisionmaking. 55 , 56 Using guidelines also reflects one’s problem identification and problem-solving abilities. 56 Conversely, the ability to proficiently conduct a series of tasks without nursing diagnoses is the hallmark of expertise. 39 , 57

Experience precedes expertise. As expertise develops from experience and gaining knowledge and transitions to the proficiency stage, the nurses’ thinking moves from steps and procedures (i.e., task-oriented care) toward “chunks” or patterns 39 (i.e., patient-specific care). In doing so, the nurse thinks reflectively, rather than merely accepting statements and performing procedures without significant understanding and evaluation. 34 Expert nurses do not rely on rules and logical thought processes in problem-solving and decisionmaking. 39 Instead, they use abstract principles, can see the situation as a complex whole, perceive situations comprehensively, and can be fully involved in the situation. 48 Expert nurses can perform high-level care without conscious awareness of the knowledge they are using, 39 , 58 and they are able to provide that care with flexibility and speed. Through a combination of knowledge and skills gained from a range of theoretical and experiential sources, expert nurses also provide holistic care. 39 Thus, the best care comes from the combination of theoretical, tacit, and experiential knowledge. 59 , 60

Experts are thought to eventually develop the ability to intuitively know what to do and to quickly recognize critical aspects of the situation. 22 Some have proposed that expert nurses provide high-quality patient care, 61 , 62 but that is not consistently documented—particularly in consideration of patient outcomes—and a full understanding between the differential impact of care rendered by an “expert” nurse is not fully understood. In fact, several studies have found that length of professional experience is often unrelated and even negatively related to performance measures and outcomes. 63 , 64

In a review of the literature on expertise in nursing, Ericsson and colleagues 65 found that focusing on challenging, less-frequent situations would reveal individual performance differences on tasks that require speed and flexibility, such as that experienced during a code or an adverse event. Superior performance was associated with extensive training and immediate feedback about outcomes, which can be obtained through continual training, simulation, and processes such as root-cause analysis following an adverse event. Therefore, efforts to improve performance benefited from continual monitoring, planning, and retrospective evaluation. Even then, the nurse’s ability to perform as an expert is dependent upon their ability to use intuition or insights gained through interactions with patients. 39

Intuition and Perception

Intuition is the instant understanding of knowledge without evidence of sensible thought. 66 According to Young, 67 intuition in clinical practice is a process whereby the nurse recognizes something about a patient that is difficult to verbalize. Intuition is characterized by factual knowledge, “immediate possession of knowledge, and knowledge independent of the linear reasoning process” 68 (p. 23). When intuition is used, one filters information initially triggered by the imagination, leading to the integration of all knowledge and information to problem solve. 69 Clinicians use their interactions with patients and intuition, drawing on tacit or experiential knowledge, 70 , 71 to apply the correct knowledge to make the correct decisions to address patient needs. Yet there is a “conflated belief in the nurses’ ability to know what is best for the patient” 72 (p. 251) because the nurses’ and patients’ identification of the patients’ needs can vary. 73

A review of research and rhetoric involving intuition by King and Appleton 62 found that all nurses, including students, used intuition (i.e., gut feelings). They found evidence, predominately in critical care units, that intuition was triggered in response to knowledge and as a trigger for action and/or reflection with a direct bearing on the analytical process involved in patient care. The challenge for nurses was that rigid adherence to checklists, guidelines, and standardized documentation, 62 ignored the benefits of intuition. This view was furthered by Rew and Barrow 68 , 74 in their reviews of the literature, where they found that intuition was imperative to complex decisionmaking, 68 difficult to measure and assess in a quantitative manner, and was not linked to physiologic measures. 74

Intuition is a way of explaining professional expertise. 75 Expert nurses rely on their intuitive judgment that has been developed over time. 39 , 76 Intuition is an informal, nonanalytically based, unstructured, deliberate calculation that facilitates problem solving, 77 a process of arriving at salient conclusions based on relatively small amounts of knowledge and/or information. 78 Experts can have rapid insight into a situation by using intuition to recognize patterns and similarities, achieve commonsense understanding, and sense the salient information combined with deliberative rationality. 10 Intuitive recognition of similarities and commonalities between patients are often the first diagnostic clue or early warning, which must then be followed up with critical evaluation of evidence among the competing conditions. This situation calls for intuitive judgment that can distinguish “expert human judgment from the decisions” made by a novice 79 (p. 23).

Shaw 80 equates intuition with direct perception. Direct perception is dependent upon being able to detect complex patterns and relationships that one has learned through experience are important. Recognizing these patterns and relationships generally occurs rapidly and is complex, making it difficult to articulate or describe. Perceptual skills, like those of the expert nurse, are essential to recognizing current and changing clinical conditions. Perception requires attentiveness and the development of a sense of what is salient. Often in nursing and medicine, means and ends are fused, as is the case for a “good enough” birth experience and a peaceful death.

• Applying Practice Evidence

Research continues to find that using evidence-based guidelines in practice, informed through research evidence, improves patients’ outcomes. 81–83 Research-based guidelines are intended to provide guidance for specific areas of health care delivery. 84 The clinician—both the novice and expert—is expected to use the best available evidence for the most efficacious therapies and interventions in particular instances, to ensure the highest-quality care, especially when deviations from the evidence-based norm may heighten risks to patient safety. Otherwise, if nursing and medicine were exact sciences, or consisted only of techne, then a 1:1 relationship could be established between results of aggregated evidence-based research and the best path for all patients.

Evaluating Evidence

Before research should be used in practice, it must be evaluated. There are many complexities and nuances in evaluating the research evidence for clinical practice. Evaluation of research behind evidence-based medicine requires critical thinking and good clinical judgment. Sometimes the research findings are mixed or even conflicting. As such, the validity, reliability, and generalizability of available research are fundamental to evaluating whether evidence can be applied in practice. To do so, clinicians must select the best scientific evidence relevant to particular patients—a complex process that involves intuition to apply the evidence. Critical thinking is required for evaluating the best available scientific evidence for the treatment and care of a particular patient.

Good clinical judgment is required to select the most relevant research evidence. The best clinical judgment, that is, reasoning across time about the particular patient through changes in the patient’s concerns and condition and/or the clinician’s understanding, are also required. This type of judgment requires clinicians to make careful observations and evaluations of the patient over time, as well as know the patient’s concerns and social circumstances. To evolve to this level of judgment, additional education beyond clinical preparation if often required.

Sources of Evidence

Evidence that can be used in clinical practice has different sources and can be derived from research, patient’s preferences, and work-related experience. 85 , 86 Nurses have been found to obtain evidence from experienced colleagues believed to have clinical expertise and research-based knowledge 87 as well as other sources.

For many years now, randomized controlled trials (RCTs) have often been considered the best standard for evaluating clinical practice. Yet, unless the common threats to the validity (e.g., representativeness of the study population) and reliability (e.g., consistency in interventions and responses of study participants) of RCTs are addressed, the meaningfulness and generalizability of the study outcomes are very limited. Relevant patient populations may be excluded, such as women, children, minorities, the elderly, and patients with multiple chronic illnesses. The dropout rate of the trial may confound the results. And it is easier to get positive results published than it is to get negative results published. Thus, RCTs are generalizable (i.e., applicable) only to the population studied—which may not reflect the needs of the patient under the clinicians care. In instances such as these, clinicians need to also consider applied research using prospective or retrospective populations with case control to guide decisionmaking, yet this too requires critical thinking and good clinical judgment.

Another source of available evidence may come from the gold standard of aggregated systematic evaluation of clinical trial outcomes for the therapy and clinical condition in question, be generated by basic and clinical science relevant to the patient’s particular pathophysiology or care need situation, or stem from personal clinical experience. The clinician then takes all of the available evidence and considers the particular patient’s known clinical responses to past therapies, their clinical condition and history, the progression or stages of the patient’s illness and recovery, and available resources.

In clinical practice, the particular is examined in relation to the established generalizations of science. With readily available summaries of scientific evidence (e.g., systematic reviews and practice guidelines) available to nurses and physicians, one might wonder whether deep background understanding is still advantageous. Might it not be expendable, since it is likely to be out of date given the current scientific evidence? But this assumption is a false opposition and false choice because without a deep background understanding, the clinician does not know how to best find and evaluate scientific evidence for the particular case in hand. The clinician’s sense of salience in any given situation depends on past clinical experience and current scientific evidence.

Evidence-Based Practice

The concept of evidence-based practice is dependent upon synthesizing evidence from the variety of sources and applying it appropriately to the care needs of populations and individuals. This implies that evidence-based practice, indicative of expertise in practice, appropriately applies evidence to the specific situations and unique needs of patients. 88 , 89 Unfortunately, even though providing evidence-based care is an essential component of health care quality, it is well known that evidence-based practices are not used consistently.

Conceptually, evidence used in practice advances clinical knowledge, and that knowledge supports independent clinical decisions in the best interest of the patient. 90 , 91 Decisions must prudently consider the factors not necessarily addressed in the guideline, such as the patient’s lifestyle, drug sensitivities and allergies, and comorbidities. Nurses who want to improve the quality and safety of care can do so though improving the consistency of data and information interpretation inherent in evidence-based practice.

Initially, before evidence-based practice can begin, there needs to be an accurate clinical judgment of patient responses and needs. In the course of providing care, with careful consideration of patient safety and quality care, clinicians must give attention to the patient’s condition, their responses to health care interventions, and potential adverse reactions or events that could harm the patient. Nonetheless, there is wide variation in the ability of nurses to accurately interpret patient responses 92 and their risks. 93 Even though variance in interpretation is expected, nurses are obligated to continually improve their skills to ensure that patients receive quality care safely. 94 Patients are vulnerable to the actions and experience of their clinicians, which are inextricably linked to the quality of care patients have access to and subsequently receive.

The judgment of the patient’s condition determines subsequent interventions and patient outcomes. Attaining accurate and consistent interpretations of patient data and information is difficult because each piece can have different meanings, and interpretations are influenced by previous experiences. 95 Nurses use knowledge from clinical experience 96 , 97 and—although infrequently—research. 98–100

Once a problem has been identified, using a process that utilizes critical thinking to recognize the problem, the clinician then searches for and evaluates the research evidence 101 and evaluates potential discrepancies. The process of using evidence in practice involves “a problem-solving approach that incorporates the best available scientific evidence, clinicians’ expertise, and patient’s preferences and values” 102 (p. 28). Yet many nurses do not perceive that they have the education, tools, or resources to use evidence appropriately in practice. 103

Reported barriers to using research in practice have included difficulty in understanding the applicability and the complexity of research findings, failure of researchers to put findings into the clinical context, lack of skills in how to use research in practice, 104 , 105 amount of time required to access information and determine practice implications, 105–107 lack of organizational support to make changes and/or use in practice, 104 , 97 , 105 , 107 and lack of confidence in one’s ability to critically evaluate clinical evidence. 108

When Evidence Is Missing

In many clinical situations, there may be no clear guidelines and few or even no relevant clinical trials to guide decisionmaking. In these cases, the latest basic science about cellular and genomic functioning may be the most relevant science, or by default, guestimation. Consequently, good patient care requires more than a straightforward, unequivocal application of scientific evidence. The clinician must be able to draw on a good understanding of basic sciences, as well as guidelines derived from aggregated data and information from research investigations.

Practical knowledge is shaped by one’s practice discipline and the science and technology relevant to the situation at hand. But scientific, formal, discipline-specific knowledge are not sufficient for good clinical practice, whether the discipline be law, medicine, nursing, teaching, or social work. Practitioners still have to learn how to discern generalizable scientific knowledge, know how to use scientific knowledge in practical situations, discern what scientific evidence/knowledge is relevant, assess how the particular patient’s situation differs from the general scientific understanding, and recognize the complexity of care delivery—a process that is complex, ongoing, and changing, as new evidence can overturn old.

Practice communities like individual practitioners may also be mistaken, as is illustrated by variability in practice styles and practice outcomes across hospitals and regions in the United States. This variability in practice is why practitioners must learn to critically evaluate their practice and continually improve their practice over time. The goal is to create a living self-improving tradition.

Within health care, students, scientists, and practitioners are challenged to learn and use different modes of thinking when they are conflated under one term or rubric, using the best-suited thinking strategies for taking into consideration the purposes and the ends of the reasoning. Learning to be an effective, safe nurse or physician requires not only technical expertise, but also the ability to form helping relationships and engage in practical ethical and clinical reasoning. 50 Good ethical comportment requires that both the clinician and the scientist take into account the notions of good inherent in clinical and scientific practices. The notions of good clinical practice must include the relevant significance and the human concerns involved in decisionmaking in particular situations, centered on clinical grasp and clinical forethought.

The Three Apprenticeships of Professional Education

We have much to learn in comparing the pedagogies of formation across the professions, such as is being done currently by the Carnegie Foundation for the Advancement of Teaching. The Carnegie Foundation’s broad research program on the educational preparation of the profession focuses on three essential apprenticeships:

To capture the full range of crucial dimensions in professional education, we developed the idea of a three-fold apprenticeship: (1) intellectual training to learn the academic knowledge base and the capacity to think in ways important to the profession; (2) a skill-based apprenticeship of practice; and (3) an apprenticeship to the ethical standards, social roles, and responsibilities of the profession, through which the novice is introduced to the meaning of an integrated practice of all dimensions of the profession, grounded in the profession’s fundamental purposes. 109

This framework has allowed the investigators to describe tensions and shortfalls as well as strengths of widespread teaching practices, especially at articulation points among these dimensions of professional training.

Research has demonstrated that these three apprenticeships are taught best when they are integrated so that the intellectual training includes skilled know-how, clinical judgment, and ethical comportment. In the study of nursing, exemplary classroom and clinical teachers were found who do integrate the three apprenticeships in all of their teaching, as exemplified by the following anonymous student’s comments:

With that as well, I enjoyed the class just because I do have clinical experience in my background and I enjoyed it because it took those practical applications and the knowledge from pathophysiology and pharmacology, and all the other classes, and it tied it into the actual aspects of like what is going to happen at work. For example, I work in the emergency room and question: Why am I doing this procedure for this particular patient? Beforehand, when I was just a tech and I wasn’t going to school, I’d be doing it because I was told to be doing it—or I’d be doing CPR because, you know, the doc said, start CPR. I really enjoy the Care and Illness because now I know the process, the pathophysiological process of why I’m doing it and the clinical reasons of why they’re making the decisions, and the prioritization that goes on behind it. I think that’s the biggest point. Clinical experience is good, but not everybody has it. Yet when these students transition from school and clinicals to their job as a nurse, they will understand what’s going on and why.

The three apprenticeships are equally relevant and intertwined. In the Carnegie National Study of Nursing Education and the companion study on medical education as well as in cross-professional comparisons, teaching that gives an integrated access to professional practice is being examined. Once the three apprenticeships are separated, it is difficult to reintegrate them. The investigators are encouraged by teaching strategies that integrate the latest scientific knowledge and relevant clinical evidence with clinical reasoning about particular patients in unfolding rather than static cases, while keeping the patient and family experience and concerns relevant to clinical concerns and reasoning.

Clinical judgment or phronesis is required to evaluate and integrate techne and scientific evidence.

Within nursing, professional practice is wise and effective usually to the extent that the professional creates relational and communication contexts where clients/patients can be open and trusting. Effectiveness depends upon mutual influence between patient and practitioner, student and learner. This is another way in which clinical knowledge is dialogical and socially distributed. The following articulation of practical reasoning in nursing illustrates the social, dialogical nature of clinical reasoning and addresses the centrality of perception and understanding to good clinical reasoning, judgment and intervention.

Clinical Grasp *

Clinical grasp describes clinical inquiry in action. Clinical grasp begins with perception and includes problem identification and clinical judgment across time about the particular transitions of particular patients. Garrett Chan 20 described the clinician’s attempt at finding an “optimal grasp” or vantage point of understanding. Four aspects of clinical grasp, which are described in the following paragraphs, include (1) making qualitative distinctions, (2) engaging in detective work, (3) recognizing changing relevance, and (4) developing clinical knowledge in specific patient populations.

Making Qualitative Distinctions

Qualitative distinctions refer to those distinctions that can be made only in a particular contextual or historical situation. The context and sequence of events are essential for making qualitative distinctions; therefore, the clinician must pay attention to transitions in the situation and judgment. Many qualitative distinctions can be made only by observing differences through touch, sound, or sight, such as the qualities of a wound, skin turgor, color, capillary refill, or the engagement and energy level of the patient. Another example is assessing whether the patient was more fatigued after ambulating to the bathroom or from lack of sleep. Likewise the quality of the clinician’s touch is distinct as in offering reassurance, putting pressure on a bleeding wound, and so on. 110

Engaging in Detective Work, Modus Operandi Thinking, and Clinical Puzzle Solving

Clinical situations are open ended and underdetermined. Modus operandi thinking keeps track of the particular patient, the way the illness unfolds, the meanings of the patient’s responses as they have occurred in the particular time sequence. Modus operandi thinking requires keeping track of what has been tried and what has or has not worked with the patient. In this kind of reasoning-in-transition, gains and losses of understanding are noticed and adjustments in the problem approach are made.

We found that teachers in a medical surgical unit at the University of Washington deliberately teach their students to engage in “detective work.” Students are given the daily clinical assignment of “sleuthing” for undetected drug incompatibilities, questionable drug dosages, and unnoticed signs and symptoms. For example, one student noted that an unusual dosage of a heart medication was being given to a patient who did not have heart disease. The student first asked her teacher about the unusually high dosage. The teacher, in turn, asked the student whether she had asked the nurse or the patient about the dosage. Upon the student’s questioning, the nurse did not know why the patient was receiving the high dosage and assumed the drug was for heart disease. The patient’s staff nurse had not questioned the order. When the student asked the patient, the student found that the medication was being given for tremors and that the patient and the doctor had titrated the dosage for control of the tremors. This deliberate approach to teaching detective work, or modus operandi thinking, has characteristics of “critical reflection,” but stays situated and engaged, ferreting out the immediate history and unfolding of events.

Recognizing Changing Clinical Relevance

The meanings of signs and symptoms are changed by sequencing and history. The patient’s mental status, color, or pain level may continue to deteriorate or get better. The direction, implication, and consequences for the changes alter the relevance of the particular facts in the situation. The changing relevance entailed in a patient transitioning from primarily curative care to primarily palliative care is a dramatic example, where symptoms literally take on new meanings and require new treatments.

Developing Clinical Knowledge in Specific Patient Populations

Extensive experience with a specific patient population or patients with particular injuries or diseases allows the clinician to develop comparisons, distinctions, and nuanced differences within the population. The comparisons between many specific patients create a matrix of comparisons for clinicians, as well as a tacit, background set of expectations that create population- and patient-specific detective work if a patient does not meet the usual, predictable transitions in recovery. What is in the background and foreground of the clinician’s attention shifts as predictable changes in the patient’s condition occurs, such as is seen in recovering from heart surgery or progressing through the predictable stages of labor and delivery. Over time, the clinician develops a deep background understanding that allows for expert diagnostic and interventions skills.

Clinical Forethought

Clinical forethought is intertwined with clinical grasp, but it is much more deliberate and even routinized than clinical grasp. Clinical forethought is a pervasive habit of thought and action in nursing practice, and also in medicine, as clinicians think about disease and recovery trajectories and the implications of these changes for treatment. Clinical forethought plays a role in clinical grasp because it structures the practical logic of clinicians. At least four habits of thought and action are evident in what we are calling clinical forethought: (1) future think, (2) clinical forethought about specific patient populations, (3) anticipation of risks for particular patients, and (4) seeing the unexpected.

Future think

Future think is the broadest category of this logic of practice. Anticipating likely immediate futures helps the clinician make good plans and decisions about preparing the environment so that responding rapidly to changes in the patient is possible. Without a sense of salience about anticipated signs and symptoms and preparing the environment, essential clinical judgments and timely interventions would be impossible in the typically fast pace of acute and intensive patient care. Future think governs the style and content of the nurse’s attentiveness to the patient. Whether in a fast-paced care environment or a slower-paced rehabilitation setting, thinking and acting with anticipated futures guide clinical thinking and judgment. Future think captures the way judgment is suspended in a predictive net of anticipation and preparing oneself and the environment for a range of potential events.

Clinical forethought about specific diagnoses and injuries

This habit of thought and action is so second nature to the experienced nurse that the new or inexperienced nurse may have difficulty finding out about what seems to other colleagues as “obvious” preparation for particular patients and situations. Clinical forethought involves much local specific knowledge about who is a good resource and how to marshal support services and equipment for particular patients.

Examples of preparing for specific patient populations are pervasive, such as anticipating the need for a pacemaker during surgery and having the equipment assembled ready for use to save essential time. Another example includes forecasting an accident victim’s potential injuries, and recognizing that intubation might be needed.

Anticipation of crises, risks, and vulnerabilities for particular patients

This aspect of clinical forethought is central to knowing the particular patient, family, or community. Nurses situate the patient’s problems almost like a topography of possibilities. This vital clinical knowledge needs to be communicated to other caregivers and across care borders. Clinical teaching could be improved by enriching curricula with narrative examples from actual practice, and by helping students recognize commonly occurring clinical situations in the simulation and clinical setting. For example, if a patient is hemodynamically unstable, then managing life-sustaining physiologic functions will be a main orienting goal. If the patient is agitated and uncomfortable, then attending to comfort needs in relation to hemodynamics will be a priority. Providing comfort measures turns out to be a central background practice for making clinical judgments and contains within it much judgment and experiential learning.

When clinical teaching is too removed from typical contingencies and strong clinical situations in practice, students will lack practice in active thinking-in-action in ambiguous clinical situations. In the following example, an anonymous student recounted her experiences of meeting a patient:

I was used to different equipment and didn’t know how things went, didn’t know their routine, really. You can explain all you want in class, this is how it’s going to be, but when you get there … . Kim was my first instructor and my patient that she assigned me to—I walked into the room and he had every tube imaginable. And so I was a little overwhelmed. It’s not necessarily even that he was that critical … . She asked what tubes here have you seen? Well, I know peripheral lines. You taught me PICC [peripherally inserted central catheter] lines, and we just had that, but I don’t really feel comfortable doing it by myself, without you watching to make sure that I’m flushing it right and how to assess it. He had a chest tube and I had seen chest tubes, but never really knew the depth of what you had to assess and how you make sure that it’s all kosher and whatever. So she went through the chest tube and explained, it’s just bubbling a little bit and that’s okay. The site, check the site. The site looked okay and that she’d say if it wasn’t okay, this is what it might look like … . He had a feeding tube. I had done feeding tubes but that was like a long time ago in my LPN experiences schooling. So I hadn’t really done too much with the feeding stuff either … . He had a [nasogastric] tube, and knew pretty much about that and I think at the time it was clamped. So there were no issues with the suction or whatever. He had a Foley catheter. He had a feeding tube, a chest tube. I can’t even remember but there were a lot.

As noted earlier, a central characteristic of a practice discipline is that a self-improving practice requires ongoing experiential learning. One way nurse educators can enhance clinical inquiry is by increasing pedagogies of experiential learning. Current pedagogies for experiential learning in nursing include extensive preclinical study, care planning, and shared postclinical debriefings where students share their experiential learning with their classmates. Experiential learning requires open learning climates where students can discuss and examine transitions in understanding, including their false starts, or their misconceptions in actual clinical situations. Nursing educators typically develop open and interactive clinical learning communities, so that students seem committed to helping their classmates learn from their experiences that may have been difficult or even unsafe. One anonymous nurse educator described how students extend their experiential learning to their classmates during a postclinical conference:

So for example, the patient had difficulty breathing and the student wanted to give the meds instead of addressing the difficulty of breathing. Well, while we were sharing information about their patients, what they did that day, I didn’t tell the student to say this, but she said, ‘I just want to tell you what I did today in clinical so you don’t do the same thing, and here’s what happened.’ Everybody’s listening very attentively and they were asking her some questions. But she shared that. She didn’t have to. I didn’t tell her, you must share that in postconference or anything like that, but she just went ahead and shared that, I guess, to reinforce what she had learned that day but also to benefit her fellow students in case that thing comes up with them.

The teacher’s response to this student’s honesty and generosity exemplifies her own approach to developing an open community of learning. Focusing only on performance and on “being correct” prevents learning from breakdown or error and can dampen students’ curiosity and courage to learn experientially.

Seeing the unexpected

One of the keys to becoming an expert practitioner lies in how the person holds past experiential learning and background habitual skills and practices. This is a skill of foregrounding attention accurately and effectively in response to the nature of situational demands. Bourdieu 29 calls the recognition of the situation central to practical reasoning. If nothing is routinized as a habitual response pattern, then practitioners will not function effectively in emergencies. Unexpected occurrences may be overlooked. However, if expectations are held rigidly, then subtle changes from the usual will be missed, and habitual, rote responses will inappropriately rule. The clinician must be flexible in shifting between what is in background and foreground. This is accomplished by staying curious and open. The clinical “certainty” associated with perceptual grasp is distinct from the kind of “certainty” achievable in scientific experiments and through measurements. Recognition of similar or paradigmatic clinical situations is similar to “face recognition” or recognition of “family resemblances.” This concept is subject to faulty memory, false associative memories, and mistaken identities; therefore, such perceptual grasp is the beginning of curiosity and inquiry and not the end. Assessment and validation are required. In rapidly moving clinical situations, perceptual grasp is the starting point for clarification, confirmation, and action. Having the clinician say out loud how he or she is understanding the situation gives an opportunity for confirmation and disconfirmation from other clinicians present. 111 The relationship between foreground and background of attention needs to be fluid, so that missed expectations allow the nurse to see the unexpected. For example, when the background rhythm of a cardiac monitor changes, the nurse notices, and what had been background tacit awareness becomes the foreground of attention. A hallmark of expertise is the ability to notice the unexpected. 20 Background expectations of usual patient trajectories form with experience. Tacit expectations for patient trajectories form that enable the nurse to notice subtle failed expectations and pay attention to early signs of unexpected changes in the patient's condition. Clinical expectations gained from caring for similar patient populations form a tacit clinical forethought that enable the experienced clinician to notice missed expectations. Alterations from implicit or explicit expectations set the stage for experiential learning, depending on the openness of the learner.

Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, and clinical judgment. The high-performance expectation of nurses is dependent upon the nurses’ continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities.

This section of the paper was condensed and paraphrased from Benner, Hooper-Kyriakidis, and Stannard. 23 Patricia Hooper-Kyriakidis wrote the section on clinical grasp, and Patricia Benner wrote the section on clinical forethought.

• Cite this Page Benner P, Hughes RG, Sutphen M. Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 6.
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• What Is Critical Thinking? | Definition & Examples

What Is Critical Thinking? | Definition & Examples

Published on May 30, 2022 by Eoghan Ryan . Revised on May 31, 2023.

Critical thinking is the ability to effectively analyze information and form a judgment .

To think critically, you must be aware of your own biases and assumptions when encountering information, and apply consistent standards when evaluating sources .

Critical thinking skills help you to:

• Identify credible sources
• Evaluate and respond to arguments
• Assess alternative viewpoints
• Test hypotheses against relevant criteria

Table of contents

Why is critical thinking important, critical thinking examples, how to think critically, other interesting articles, frequently asked questions about critical thinking.

Critical thinking is important for making judgments about sources of information and forming your own arguments. It emphasizes a rational, objective, and self-aware approach that can help you to identify credible sources and strengthen your conclusions.

Critical thinking is important in all disciplines and throughout all stages of the research process . The types of evidence used in the sciences and in the humanities may differ, but critical thinking skills are relevant to both.

In academic writing , critical thinking can help you to determine whether a source:

• Is free from research bias
• Provides evidence to support its research findings
• Considers alternative viewpoints

Outside of academia, critical thinking goes hand in hand with information literacy to help you form opinions rationally and engage independently and critically with popular media.

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Critical thinking can help you to identify reliable sources of information that you can cite in your research paper . It can also guide your own research methods and inform your own arguments.

Outside of academia, critical thinking can help you to be aware of both your own and others’ biases and assumptions.

Academic examples

However, when you compare the findings of the study with other current research, you determine that the results seem improbable. You analyze the paper again, consulting the sources it cites.

You notice that the research was funded by the pharmaceutical company that created the treatment. Because of this, you view its results skeptically and determine that more independent research is necessary to confirm or refute them. Example: Poor critical thinking in an academic context You’re researching a paper on the impact wireless technology has had on developing countries that previously did not have large-scale communications infrastructure. You read an article that seems to confirm your hypothesis: the impact is mainly positive. Rather than evaluating the research methodology, you accept the findings uncritically.

Nonacademic examples

However, you decide to compare this review article with consumer reviews on a different site. You find that these reviews are not as positive. Some customers have had problems installing the alarm, and some have noted that it activates for no apparent reason.

You revisit the original review article. You notice that the words “sponsored content” appear in small print under the article title. Based on this, you conclude that the review is advertising and is therefore not an unbiased source. Example: Poor critical thinking in a nonacademic context You support a candidate in an upcoming election. You visit an online news site affiliated with their political party and read an article that criticizes their opponent. The article claims that the opponent is inexperienced in politics. You accept this without evidence, because it fits your preconceptions about the opponent.

There is no single way to think critically. How you engage with information will depend on the type of source you’re using and the information you need.

However, you can engage with sources in a systematic and critical way by asking certain questions when you encounter information. Like the CRAAP test , these questions focus on the currency , relevance , authority , accuracy , and purpose of a source of information.

When encountering information, ask:

• Who is the author? Are they an expert in their field?
• What do they say? Is their argument clear? Can you summarize it?
• When did they say this? Is the source current?
• Where is the information published? Is it an academic article? Is it peer-reviewed ?
• Why did the author publish it? What is their motivation?
• How do they make their argument? Is it backed up by evidence? Does it rely on opinion, speculation, or appeals to emotion ? Do they address alternative arguments?

Critical thinking also involves being aware of your own biases, not only those of others. When you make an argument or draw your own conclusions, you can ask similar questions about your own writing:

• Am I only considering evidence that supports my preconceptions?
• Is my argument expressed clearly and backed up with credible sources?
• Would I be convinced by this argument coming from someone else?

If you want to know more about ChatGPT, AI tools , citation , and plagiarism , make sure to check out some of our other articles with explanations and examples.

• ChatGPT vs human editor
• ChatGPT citations
• Is ChatGPT trustworthy?
• Using ChatGPT for your studies
• What is ChatGPT?
• Chicago style
• Paraphrasing

 Plagiarism

• Types of plagiarism
• Self-plagiarism
• Avoiding plagiarism
• Academic integrity
• Consequences of plagiarism
• Common knowledge

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Critical thinking refers to the ability to evaluate information and to be aware of biases or assumptions, including your own.

Like information literacy , it involves evaluating arguments, identifying and solving problems in an objective and systematic way, and clearly communicating your ideas.

Critical thinking skills include the ability to:

You can assess information and arguments critically by asking certain questions about the source. You can use the CRAAP test , focusing on the currency , relevance , authority , accuracy , and purpose of a source of information.

Ask questions such as:

• Who is the author? Are they an expert?
• How do they make their argument? Is it backed up by evidence?

A credible source should pass the CRAAP test  and follow these guidelines:

• The information should be up to date and current.
• The author and publication should be a trusted authority on the subject you are researching.
• The sources the author cited should be easy to find, clear, and unbiased.
• For a web source, the URL and layout should signify that it is trustworthy.

Information literacy refers to a broad range of skills, including the ability to find, evaluate, and use sources of information effectively.

Being information literate means that you:

• Know how to find credible sources
• Use relevant sources to inform your research
• Understand what constitutes plagiarism
• Know how to cite your sources correctly

Confirmation bias is the tendency to search, interpret, and recall information in a way that aligns with our pre-existing values, opinions, or beliefs. It refers to the ability to recollect information best when it amplifies what we already believe. Relatedly, we tend to forget information that contradicts our opinions.

Although selective recall is a component of confirmation bias, it should not be confused with recall bias.

On the other hand, recall bias refers to the differences in the ability between study participants to recall past events when self-reporting is used. This difference in accuracy or completeness of recollection is not related to beliefs or opinions. Rather, recall bias relates to other factors, such as the length of the recall period, age, and the characteristics of the disease under investigation.

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What is Critical Thinking?

Critical thinking is the ability to think clearly and rationally, understanding the logical connection between ideas.  Critical thinking has been the subject of much debate and thought since the time of early Greek philosophers such as Plato and Socrates and has continued to be a subject of discussion into the modern age, for example the ability to recognise fake news .

Critical thinking might be described as the ability to engage in reflective and independent thinking.

In essence, critical thinking requires you to use your ability to reason. It is about being an active learner rather than a passive recipient of information.

Critical thinkers rigorously question ideas and assumptions rather than accepting them at face value. They will always seek to determine whether the ideas, arguments and findings represent the entire picture and are open to finding that they do not.

Critical thinkers will identify, analyse and solve problems systematically rather than by intuition or instinct.

Someone with critical thinking skills can:

Understand the links between ideas.

Determine the importance and relevance of arguments and ideas.

Recognise, build and appraise arguments.

Identify inconsistencies and errors in reasoning.

Approach problems in a consistent and systematic way.

Reflect on the justification of their own assumptions, beliefs and values.

Critical thinking is thinking about things in certain ways so as to arrive at the best possible solution in the circumstances that the thinker is aware of. In more everyday language, it is a way of thinking about whatever is presently occupying your mind so that you come to the best possible conclusion.

Critical Thinking is:

A way of thinking about particular things at a particular time; it is not the accumulation of facts and knowledge or something that you can learn once and then use in that form forever, such as the nine times table you learn and use in school.

The Skills We Need for Critical Thinking

The skills that we need in order to be able to think critically are varied and include observation, analysis, interpretation, reflection, evaluation, inference, explanation, problem solving, and decision making.

Specifically we need to be able to:

Think about a topic or issue in an objective and critical way.

Identify the different arguments there are in relation to a particular issue.

Evaluate a point of view to determine how strong or valid it is.

Recognise any weaknesses or negative points that there are in the evidence or argument.

Notice what implications there might be behind a statement or argument.

Provide structured reasoning and support for an argument that we wish to make.

The Critical Thinking Process

You should be aware that none of us think critically all the time.

Sometimes we think in almost any way but critically, for example when our self-control is affected by anger, grief or joy or when we are feeling just plain ‘bloody minded’.

On the other hand, the good news is that, since our critical thinking ability varies according to our current mindset, most of the time we can learn to improve our critical thinking ability by developing certain routine activities and applying them to all problems that present themselves.

Once you understand the theory of critical thinking, improving your critical thinking skills takes persistence and practice.

Try this simple exercise to help you to start thinking critically.

Think of something that someone has recently told you. Then ask yourself the following questions:

Who said it?

Someone you know? Someone in a position of authority or power? Does it matter who told you this?

What did they say?

Did they give facts or opinions? Did they provide all the facts? Did they leave anything out?

Where did they say it?

Was it in public or in private? Did other people have a chance to respond an provide an alternative account?

When did they say it?

Was it before, during or after an important event? Is timing important?

Why did they say it?

Did they explain the reasoning behind their opinion? Were they trying to make someone look good or bad?

How did they say it?

Were they happy or sad, angry or indifferent? Did they write it or say it? Could you understand what was said?

What are you Aiming to Achieve?

One of the most important aspects of critical thinking is to decide what you are aiming to achieve and then make a decision based on a range of possibilities.

Once you have clarified that aim for yourself you should use it as the starting point in all future situations requiring thought and, possibly, further decision making. Where needed, make your workmates, family or those around you aware of your intention to pursue this goal. You must then discipline yourself to keep on track until changing circumstances mean you have to revisit the start of the decision making process.

However, there are things that get in the way of simple decision making. We all carry with us a range of likes and dislikes, learnt behaviours and personal preferences developed throughout our lives; they are the hallmarks of being human. A major contribution to ensuring we think critically is to be aware of these personal characteristics, preferences and biases and make allowance for them when considering possible next steps, whether they are at the pre-action consideration stage or as part of a rethink caused by unexpected or unforeseen impediments to continued progress.

The more clearly we are aware of ourselves, our strengths and weaknesses, the more likely our critical thinking will be productive.

The Benefit of Foresight

Perhaps the most important element of thinking critically is foresight.

Almost all decisions we make and implement don’t prove disastrous if we find reasons to abandon them. However, our decision making will be infinitely better and more likely to lead to success if, when we reach a tentative conclusion, we pause and consider the impact on the people and activities around us.

The elements needing consideration are generally numerous and varied. In many cases, consideration of one element from a different perspective will reveal potential dangers in pursuing our decision.

For instance, moving a business activity to a new location may improve potential output considerably but it may also lead to the loss of skilled workers if the distance moved is too great. Which of these is the more important consideration? Is there some way of lessening the conflict?

These are the sort of problems that may arise from incomplete critical thinking, a demonstration perhaps of the critical importance of good critical thinking.

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In Summary:

Critical thinking is aimed at achieving the best possible outcomes in any situation. In order to achieve this it must involve gathering and evaluating information from as many different sources possible.

Critical thinking requires a clear, often uncomfortable, assessment of your personal strengths, weaknesses and preferences and their possible impact on decisions you may make.

Critical thinking requires the development and use of foresight as far as this is possible. As Doris Day sang, “the future’s not ours to see”.

Implementing the decisions made arising from critical thinking must take into account an assessment of possible outcomes and ways of avoiding potentially negative outcomes, or at least lessening their impact.

• Critical thinking involves reviewing the results of the application of decisions made and implementing change where possible.

It might be thought that we are overextending our demands on critical thinking in expecting that it can help to construct focused meaning rather than examining the information given and the knowledge we have acquired to see if we can, if necessary, construct a meaning that will be acceptable and useful.

After all, almost no information we have available to us, either externally or internally, carries any guarantee of its life or appropriateness.  Neat step-by-step instructions may provide some sort of trellis on which our basic understanding of critical thinking can blossom but it doesn’t and cannot provide any assurance of certainty, utility or longevity.

Continue to: Critical Thinking and Fake News Critical Reading

See also: Analytical Skills Understanding and Addressing Conspiracy Theories Introduction to Neuro-Linguistic Programming (NLP)

Can Critical Thinking Be Done Wrong?

Considering "degrees" of critical thinking..

Posted October 25, 2019

Be it in class, an academic presentation, or in everyday conversation, a question I’m often asked after explaining critical thinking (CT) is whether or not it’s something that can be done "wrong." Or, similarly, can it be done, but just with a few, minor errors? The degree of "wrongness" here is interesting and important to consider in coming to understand what are two quite distinct concepts.

Consistent with a previous post on this blog, " No Such Thing as 'Good' Critical Thinking ," where I noted that there is no such thing as good or bad critical thinking, CT cannot be done wrong, because if it is done wrong, then it’s not really critical thinking, is it? As a result, if CT isn’t wrong or bad, then what would "good CT" be like?

Well, good CT is just CT. Simply, was it conducted or not? In a way, it’s like being pregnant —you either are or you aren’t—there’s no "kind of pregnant." Much like this example, one does not conduct "good" CT or "kind of good" CT. You either thought critically, or you didn’t.

On the other hand, it can be said that CT has been conducted even if there are minor errors—depending, of course, on the types of errors. But small errors (e.g., missing a step in logic) do not make for "bad" CT, they just extend the amount of CT that is still required. So, in a way, it could be argued that there’s a threshold for thinking that constitutes CT at one end and being incorrect at another, similar to how we conceptualized Cognitive Continuum Theory in a recent post.

However, that’s not entirely accurate either, because one doesn’t require CT to be correct—perhaps the absence of CT , rather than incorrect , is a better way of putting it. That is, CT is a tool and a series of dispositions towards thinking, not necessarily an outcome. An outcome can be wrong or right; and in the event that the outcome is wrong, then we know that it’s less likely that CT was engaged. However, though the outcome might be wrong, it doesn’t necessarily mean that CT wasn’t engaged; rather, like in the context of making a few, minor errors, it just means that further CT is required.

With that, the nature of "degrees" of CT may depend on, as a previous commenter on this blog noted, whether someone is participating in CT in good faith. For example, if someone is attempting CT in good faith, then they’re applying the tool(s) of CT in an unbiased way. They may be wrong about a couple of things, but they will be open to both feedback about these "mistakes" and, as addressed above, extending their CT about the topic (i.e., they will continue until a reasonable, unbiased conclusion is drawn).

I would argue that this is CT because no thought is perfect—there will always be mistakes. What makes it CT is the process used to get there and the willingness to make it as accurate as it can be. Alternatively, one might perfectly execute the skills of CT, but do so in a biased way, not one that can necessarily be detectable, but in a manner aimed at deception . Is that CT? Well, it’s a good application of CT as a tool, but it’s also evidence of a lack of disposition towards CT (particularly the dispositions of truth-seeking and open-mindedness)—in which case, we cannot call this CT.

In conclusion, I reiterate the message from a previous post— there is no such thing as good CT or bad CT . A concept is either thought about in a critical manner, or it isn’t. An outcome can be wrong or right, but the process—the tool(s) used—was either CT, or it wasn’t. Though the conclusion may not always be right, if the process is conducted correctly and in good faith, then it’s OK to be wrong, just as long as the individual is willing to extend this thinking by continuing on to right the wrongs.

Christopher Dwyer, Ph.D., is a lecturer at the Technological University of the Shannon in Athlone, Ireland.

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Critical Thinking Is About Asking Better Questions

• John Coleman

Six practices to sharpen your inquiry.

Critical thinking is the ability to analyze and effectively break down an issue in order to make a decision or find a solution. At the heart of critical thinking is the ability to formulate deep, different, and effective questions. For effective questioning, start by holding your hypotheses loosely. Be willing to fundamentally reconsider your initial conclusions — and do so without defensiveness. Second, listen more than you talk through active listening. Third, leave your queries open-ended, and avoid yes-or-no questions. Fourth, consider the counterintuitive to avoid falling into groupthink. Fifth, take the time to stew in a problem, rather than making decisions unnecessarily quickly. Last, ask thoughtful, even difficult, follow-ups.

Are you tackling a new and difficult problem at work? Recently promoted and trying to both understand your new role and bring a fresh perspective? Or are you new to the workforce and seeking ways to meaningfully contribute alongside your more experienced colleagues? If so, critical thinking — the ability to analyze and effectively break down an issue in order to make a decision or find a solution — will be core to your success. And at the heart of critical thinking is the ability to formulate deep, different, and effective questions.

• JC John Coleman is the author of the HBR Guide to Crafting Your Purpose . Subscribe to his free newsletter, On Purpose , follow him on Twitter @johnwcoleman, or contact him at johnwilliamcoleman.com.

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Solving Problems Through Critical Thinking

Critical thinking is the ability to collect and analyze information (by asking the right questions) to come to the best conclusion possible. Strong critical thinkers analyze information from a variety of viewpoints in order to identify the best course of action. Being able to think critically is important in virtually every industry and applicable across a wide range of positions. That’s because critical thinking isn’t subject-specific—rather, it’s your ability to parse through information, data, statistics, and other details in order to identify a satisfactory solution.

Developing your critical thinking skills improves your problem-solving skills, boosts your data-driven decision-making ability, and gives you a methodology to tackle complex problems. Good critical thinkers are comfortable with ambiguity and are willing to challenge their hypotheses in order to come to the best conclusions.

There’s a lot that goes into the full critical thinking process, and not every decision needs to be this thought out. Sometimes, it’s enough to put aside bias and approach a process logically. In other, more complex cases, the best way to identify the ideal outcome is to go through the entire critical thinking process. To get started, consider these steps to critical thinking.

7 Step Critical Thinking Process

• Identify the problem. Be as precise as possible. The narrower the issue, the easier it is to find solutions or answers.
• Gather data, opinions, and arguments. Gathering varied information is essential for your ability to apply the critical thinking process. If you don’t get enough information, your ability to make a final decision will be skewed.
• Is the information reliable?
• Is the information significant?
• Is there enough information or data to support the given hypotheses?
• Are the sources you found unbiased?
• Are you sure you weren’t biased in your search for answers?
• Reach a conclusion. Identify various possible conclusions and decide which (if any) of them are sufficiently supported. It is important to weigh strengths and limitations of all possible options. To identify the best solution, draw connections between causes and effects.
• Present your solution. Share your conclusion with other project stakeholders.
• Did it solve the initial problem?
• What lessons—whether positive or negative—can you learn from this experience to improve your critical thinking for next time?

This problem-solving process creates an environment where critical thinking becomes a working part of finding a solution. For individuals who struggle with this method, you may want to consider some training in critical thinking. Duke Learning & Organization Development is offering a “Critical Thinking Skills: Strategies for Improving” course on August 10th (you can register HERE ).

Overall, this process promotes critical thinking in your employees. As well, you can use critical thinking for making plans and creating a mission. The value added to your organization includes improved engagement, insight and productivity from your team.

References:

Business.com (2023, March 6) Lynette Reed: Building Critical Thinking Skills to Solve Problems at Work

Asana (2021, September 29) Julia Martins: How to Build Your Critical Thinking Skills in 7 Steps

Zety (2023, January 9) Michael Tomaszewski: Top 8 Critical Thinking Skills and Ways to Improve Them

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How to build your critical thinking skills in 7 steps (with examples)

Critical thinking is, well, critical. By building these skills, you improve your ability to analyze information and come to the best decision possible. In this article, we cover the basics of critical thinking, as well as the seven steps you can use to implement the full critical thinking process. 

Critical thinking comes from asking the right questions to come to the best conclusion possible. Strong critical thinkers analyze information from a variety of viewpoints in order to identify the best course of action.

Don’t worry if you don’t think you have strong critical thinking abilities. In this article, we’ll help you build a foundation for critical thinking so you can absorb, analyze, and make informed decisions. 

What is critical thinking? 

Critical thinking is the ability to collect and analyze information to come to a conclusion. Being able to think critically is important in virtually every industry and applicable across a wide range of positions. That’s because critical thinking isn’t subject-specific—rather, it’s your ability to parse through information, data, statistics, and other details in order to identify a satisfactory solution. 

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Top 8 critical thinking skills

Like most soft skills, critical thinking isn’t something you can take a class to learn. Rather, this skill consists of a variety of interpersonal and analytical skills. Developing critical thinking is more about learning to embrace open-mindedness and bringing analytical thinking to your problem framing process. 

In no particular order, the eight most important critical thinking skills are:

Analytical thinking: Part of critical thinking is evaluating data from multiple sources in order to come to the best conclusions. Analytical thinking allows people to reject bias and strive to gather and consume information to come to the best conclusion. 

Open-mindedness: This critical thinking skill helps you analyze and process information to come to an unbiased conclusion. Part of the critical thinking process is letting your personal biases go and coming to a conclusion based on all of the information. 

Problem solving : Because critical thinking emphasizes coming to the best conclusion based on all of the available information, it’s a key part of problem solving. When used correctly, critical thinking helps you solve any problem—from a workplace challenge to difficulties in everyday life. 

Self-regulation: Self-regulation refers to the ability to regulate your thoughts and set aside any personal biases to come to the best conclusion. In order to be an effective critical thinker, you need to question the information you have and the decisions you favor—only then can you come to the best conclusion. 

Observation: Observation skills help critical thinkers look for things beyond face value. To be a critical thinker you need to embrace multiple points of view, and you can use observation skills to identify potential problems.

Interpretation: Not all data is made equal—and critical thinkers know this. In addition to gathering information, it’s important to evaluate which information is important and relevant to your situation. That way, you can draw the best conclusions from the data you’ve collected. 

Evaluation: When you attempt to answer a hard question, there is rarely an obvious answer. Even though critical thinking emphasizes putting your biases aside, you need to be able to confidently make a decision based on the data you have available. 

Communication: Once a decision has been made, you also need to share this decision with other stakeholders. Effective workplace communication includes presenting evidence and supporting your conclusion—especially if there are a variety of different possible solutions. 

7 steps to critical thinking

Critical thinking is a skill that you can build by following these seven steps. The seven steps to critical thinking help you ensure you’re approaching a problem from the right angle, considering every alternative, and coming to an unbiased conclusion.

 First things first: When to use the 7 step critical thinking process

There’s a lot that goes into the full critical thinking process, and not every decision needs to be this thought out. Sometimes, it’s enough to put aside bias and approach a process logically. In other, more complex cases, the best way to identify the ideal outcome is to go through the entire critical thinking process. 

The seven-step critical thinking process is useful for complex decisions in areas you are less familiar with. Alternatively, the seven critical thinking steps can help you look at a problem you’re familiar with from a different angle, without any bias. 

If you need to make a less complex decision, consider another problem solving strategy instead. Decision matrices are a great way to identify the best option between different choices. Check out our article on 7 steps to creating a decision matrix .

1. Identify the problem

Before you put those critical thinking skills to work, you first need to identify the problem you’re solving. This step includes taking a look at the problem from a few different perspectives and asking questions like: 

What’s happening? 

Why is this happening? 

What assumptions am I making? 

At first glance, how do I think we can solve this problem? 

A big part of developing your critical thinking skills is learning how to come to unbiased conclusions. In order to do that, you first need to acknowledge the biases that you currently have. Does someone on your team think they know the answer? Are you making assumptions that aren’t necessarily true? Identifying these details helps you later on in the process. 

2. Research

At this point, you likely have a general idea of the problem—but in order to come up with the best solution, you need to dig deeper. 

During the research process, collect information relating to the problem, including data, statistics, historical project information, team input, and more. Make sure you gather information from a variety of sources, especially if those sources go against your personal ideas about what the problem is or how to solve it.

Gathering varied information is essential for your ability to apply the critical thinking process. If you don’t get enough information, your ability to make a final decision will be skewed. Remember that critical thinking is about helping you identify the objective best conclusion. You aren’t going with your gut—you’re doing research to find the best option

3. Determine data relevance

Just as it’s important to gather a variety of information, it is also important to determine how relevant the different information sources are. After all, just because there is data doesn’t mean it’s relevant. 

Once you’ve gathered all of the information, sift through the noise and identify what information is relevant and what information isn’t. Synthesizing all of this information and establishing significance helps you weigh different data sources and come to the best conclusion later on in the critical thinking process. 

To determine data relevance, ask yourself:

How reliable is this information? 

How significant is this information? 

Is this information outdated? Is it specialized in a specific field? 

4. Ask questions

One of the most useful parts of the critical thinking process is coming to a decision without bias. In order to do so, you need to take a step back from the process and challenge the assumptions you’re making. 

We all have bias—and that isn’t necessarily a bad thing. Unconscious biases (also known as cognitive biases) often serve as mental shortcuts to simplify problem solving and aid decision making. But even when biases aren’t inherently bad, you must be aware of your biases in order to put them aside when necessary. 

Before coming to a solution, ask yourself:

Am I making any assumptions about this information? 

Are there additional variables I haven’t considered? 

Have I evaluated the information from every perspective? 

Are there any viewpoints I missed? 

5. Identify the best solution

Finally, you’re ready to come to a conclusion. To identify the best solution, draw connections between causes and effects. Use the facts you’ve gathered to evaluate the most objective conclusion. 

Keep in mind that there may be more than one solution. Often, the problems you’re facing are complex and intricate. The critical thinking process doesn’t necessarily lead to a cut-and-dry solution—instead, the process helps you understand the different variables at play so you can make an informed decision. 

6. Present your solution

Communication is a key skill for critical thinkers. It isn’t enough to think for yourself—you also need to share your conclusion with other project stakeholders. If there are multiple solutions, present them all. There may be a case where you implement one solution, then test to see if it works before implementing another solution. 

7. Analyze your decision

The seven-step critical thinking process yields a result—and you then need to put that solution into place. After you’ve implemented your decision, evaluate whether or not it was effective. Did it solve the initial problem? What lessons—whether positive or negative—can you learn from this experience to improve your critical thinking for next time? 

Depending on how your team shares information, consider documenting lessons learned in a central source of truth. That way, team members that are making similar or related decisions in the future can understand why you made the decision you made and what the outcome was. 

Example of critical thinking in the workplace

Imagine you work in user experience design (UX). Your team is focused on pricing and packaging and ensuring customers have a clear understanding of the different services your company offers. Here’s how to apply the critical thinking process in the workplace in seven steps: 

Start by identifying the problem

Your current pricing page isn’t performing as well as you want. You’ve heard from customers that your services aren’t clear, and that the page doesn’t answer the questions they have. This page is really important for your company, since it’s where your customers sign up for your service. You and your team have a few theories about why your current page isn’t performing well, but you decide to apply the critical thinking process to ensure you come to the best decision for the page. 

Gather information about how the problem started

Part of identifying the problem includes understanding how the problem started. The pricing and packaging page is important—so when your team initially designed the page, they certainly put a lot of thought into it. Before you begin researching how to improve the page, ask yourself: 

Why did you design the pricing page the way you did? 

Which stakeholders need to be involved in the decision making process? 

Where are users getting stuck on the page?

Are any features currently working?

Then, you research

In addition to understanding the history of the pricing and packaging page, it’s important to understand what works well. Part of this research means taking a look at what your competitor’s pricing pages look like. 

Ask yourself: 

How have our competitors set up their pricing pages?

Are there any pricing page best practices? 

How does color, positioning, and animation impact navigation? 

Are there any standard page layouts customers expect to see? 

Organize and analyze information

You’ve gathered all of the information you need—now you need to organize and analyze it. What trends, if any, are you noticing? Is there any particularly relevant or important information that you have to consider? 

Ask open-ended questions to reduce bias

In the case of critical thinking, it’s important to address and set bias aside as much as possible. Ask yourself: 

Is there anything I’m missing? 

Have I connected with the right stakeholders? 

Are there any other viewpoints I should consider? 

Determine the best solution for your team

You now have all of the information you need to design the best pricing page. Depending on the complexity of the design, you may want to design a few options to present to a small group of customers or A/B test on the live website.

Present your solution to stakeholders

Critical thinking can help you in every element of your life, but in the workplace, you must also involve key project stakeholders . Stakeholders help you determine next steps, like whether you’ll A/B test the page first. Depending on the complexity of the issue, consider hosting a meeting or sharing a status report to get everyone on the same page. 

Analyze the results

No process is complete without evaluating the results. Once the new page has been live for some time, evaluate whether it did better than the previous page. What worked? What didn’t? This also helps you make better critical decisions later on.

Critically successful 

Critical thinking takes time to build, but with effort and patience you can apply an unbiased, analytical mind to any situation. Critical thinking makes up one of many soft skills that makes you an effective team member, manager, and worker. If you’re looking to hone your skills further, read our article on the 25 project management skills you need to succeed . 

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Improving Students’ Critical Thinking Outcomes: An Process-Learning Strategy in Eight Steps

Permissions : This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Please contact [email protected] to use this work in a way not covered by the license.

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This article describes an eight-step strategy through which students learn to critically analyze situations that they have encountered in their clinical practice. The method was derived from Stephen Brookfield’s four components of critical thinking and his suggestions for themes that relate to nursing culturalization. The approach used to develop this model has implications for educators in all fields because it illustrates a method for integrating the learning of critical thinking processes with their real-world applications.

Although educators in all disciplines share a general interest in developing students’ ability to think critically, nurse educators are especially challenged because they must prepare their students to perform technical; interpersonal, and critical thinking skills simultaneously. They must learn to function as safe, competent, and skillful clinical nurse practitioners in a complex health care environment in which new information and new clinical situations continually emerge (del Bueno, 1990; Miller & Malcolm,1990).

In 1988, the U. S. Department of Education issued a mandate that required accrediting agencies to consider evidence of educational outcomes when conducting program reviews (U. S. Department of Education, 1988). As a result, nursing education’s accrediting agency, the National League for Nursing (NLN), changed its accreditation criteria to include five required outcomes, including critical thinking, in Baccalaureate and Higher Degree Programs (National League for Nursing, 1991). As defined by the NLN, critical thinking should reflect student skills in reasoning, analysis, research, or decision making relevant to the discipline of nursing (National League for Nursing, 1992). In addition to these developments, the U.S. Department of Health and Human Services published a list of national health promotion and disease prevention objectives that supported the need to balance nursing education’s program content and learning strategies (U.S. Department of Health and Human Services, 1992).

These factors provided the impetus for the authors’ development of a process-focused critical thinking strategy. The authors’ employment setting is a baccalaureate nursing program with over 500 nursing student majors, located in an urban area of the Southeastern region of the country. Students participating in the critical thinking activity selected acute cardiology nursing for their clinical learning setting in a nursing synthesis course. The cardiology nursing unit is located in a large urban regional medical center complex.

Conceptual Framework

In his 1987 book on developing critical thinkers, Stephen Brookfield posited four components of critical thinking: (1) identifying and challenging assumptions; (2) challenging the importance of context; (3) imagining and exploring alternatives; (4) reflective skepticism. More recently, Brookfield (1993) also suggested a “phenomenography of nurses as critical thinkers” to account for how nurses learn and experience critical thinking. Each of these culturalization themes has important implications for anyone who practices critical thinking in the field of nursing (and, potentially, many other professional fields): impostership, cultural suicide, lost innocence, roadrunning, and community. Because these themes are less widely known than Brookfield’s components of critical thinking, they require some elaboration. A complete exploration of these themes is beyond the scope of this article, but brief definitions, based on Brookfield (1993), follows.

“Impostorship,” common to many professionals, is a feeling of underlying incompetence that often does not diminish with years of practice. Imposters must always appear to know what they are doing and they live in fear that they will be “exposed” for the hopeless incompetents that really are. “Cultural suicide” refers to a kind of cultural alienation that can result when critically aware nurses question their colleagues who are less critically aware: … nurses who expect their efforts to ignite a fire of enthusiasm for critical reflection and democratic experimentation may be sorely disappointed when they find themselves regarded as uncooperative subversives (and) whistleblowers … (p. 201). The theme of “lost innocence” relates to the often sad discovery that there are no perfect, unchanging models of clinical practice, but only ‘‘the contextual ambiguity of practice” (p. 203). “Roadrunning” (inspired by the Warner Brothers cartoon) describes the state of limbo that occurs in the process of critical thinking when “we realize that the old ways of thinking and acting no longer make sense, but … new ones have not yet formed to take their place” (p. 204). Brookfield explores this theme in the context of the rhythm and pace of the epistimologic, transformational process of critical thinking. “Community” is a more positive and hopeful theme that relates to the development of “emotionally sustaining peer groups” that may consist of just four or five good friends who “know that experiencing dissonance, challenging assumptions, taking new perspectives, and falling foul of conservative administrators are generic aspects of the critical process, not idiosyncratic events” (p. 205).

Brookfield’s four components of critical thinking and his culturalization themes provided the conceptual framework for the authors’ eight-step learning strategy for critical thinking. The process is initiated in Step One by the examination of a critical incident (a real-life situation) in nursing care. Steps Three, Four, Five, and Six incorporate Brookfield’s four components of critical thinking, and his culturalization themes involve Steps Two and Seven. In Step Eight students explore the usefulness of critical incidents as a means of achieving their’ learning outcomes.

The Eight-Step Process: Critical Thinking in Clinical Practice

Step one: identify a critical incident.

In Step One students first identify critical incidents they encountered during clinical practice. As Brookfield (1993) advises, students are instructed to think about episodes in which they experienced “good” or ‘‘bad” forms of clinical practice. A critical incident cited by a student in the class is described below and used as an example in the remaining steps of the process:

The 40 year old cardiac patient was experiencing chest pain, nausea, vomiting, and headache. He was unable to take his oral medications for the heart condition and other problems. The student nurse notified the staff nurse assigned to the patient. The nurse told her not to “bother” the patient’s physician because they had talked with him earlier and he was aware of the patient’s present condition and had not given any additional orders to treat the patient. The nurse refused to call the physician for the student nurse.

Step Two: Note Personal Experience

An inability to relieve the patient of symptoms prompted the student to engage in critical thinking. The most helpful resource was the patient’s understanding of the students desire to care him and the faculty serving as a resource when the staff nurse differed in the student’s decision to call the physician. The helplessness experienced by the student nurse after the staff nurse refused to call the physician was the low point of the episode.

Step Three: Identify & Challenge Assumptions

Nurses rely on the medical doctor and or medications for relieving patient’s symptoms.

Staff nurse showed more compassion and caring for the physician than for the patient.

Staff nurse feared physician actions more than patient as a consumer of health care.

Student nurse had more compassion and caring for the patient than did the primary nurse assigned to his care.

The patient was passive in his ability to treat himself and required the care of his admitting physician.

The staff nurse and student nurse were in conflict with the method of treatment.

Step Four: Challenge the Importance of Context

Developmental context issues identified by the student nurse included the patient’s loss of role functions: i.e. head of household, family provider, faced with serious debilitating heart disease at an early age.

Professional context issues included student nurse-staff nurse relationships, student nurse-physician relationships. Students were concerned with care of this patient only and their perspective on the situation concerned only the patient, as opposed to staff nurses who were concerned with a myriad of other issues such as the physician’s actions, the days unit staffing, and previous experiences in caring for the patient.

Step Five: Imagine and Explore Alternatives

Student nurse could state she was caring for the patient also and would call the physician without the staff nurse’s permission.

The student nurse could confer with a faculty member and request the faculty member call the physician.

The student nurse could present the situation to the nurse responsible for all patients care on the unit.

The student could explain to the patient the staff nurse’s decision to not call the physician and perhaps the patient could call the physician from his room telephone.

The staff nurse could reassess the patient’s chest pain and other symptoms, and call the physician to report the changes with additional orders to treat the patient’s current status.

The student could reevaluate the situation from a more holistic viewpoint of the patient.

The student could provide nursing comfort measures for the symptoms noted for the patient without relying totally on the medical regimen.

Step Six: Reflective Skepticism

Are the decisions made by the unit nurses regarding assigned patients made with an awareness that the decisions have an impact on all members of the health care team?

Are nurses a part of a collaborative effort to assure that quality care standards are maintained?

Are unit nurses accepting the accountability and responsibility for providing nursing care to all patients according to the hospitals established standards of care?

Is the patient allowed to participate in decisions related to his/her plan of care?

Are the patient’s rights a factor in this situation?

Step Seven: Consequences of Critical Thinking Experience

Calling the physician without the nurse’s permission would be cultural suicide for the student. The student with less experience and nursing knowledge has questioned the nursing care practices of a “real” nurse.

Impostership may be a consequence also. The student nurse may agree with the staff nurse’s decision to not call the physician but the “correct” decision is to be a patient advocate.

The situation is jolting to a student nurse who envisions nursing practice as nursing education has shaped the student’s image of nursing practice. The student’s way of interpreting nursing practice and the way nursing is practiced differs. This jolting, halting, and fluctuating rhythm is “roadrunning.”

The student nurse realizes that nursing care practices and decisions involving patient care are complex and there are no set rules to serve as a rigid guide. Hence, another consequence may be “lost innocence.’’

Step Eight: Impact of Thinking Critically on Learning Outcomes

Patient care decisions learned in education programs may differ in nursing practice since many variables are considered in actual nursing practice situations.

Nurses standards of care may differ from student nurses, from ones ascribed to, and from ones reflected in actual nursing practice.

Nurses practice nursing from a medical model of care more than from an interdisciplinary patient care framework.

Conclusions and Recommendations

Students were pleased with their critical thinking experience in this class, citing the use of real clinical situations as a basis for learning and how the process assisted them in clarifying course objectives, understanding the management theory of the course, and validating clinical outcome behaviors. The richness of the critical incidents they chose helped make the method a success. They explored situations relating to issues of management, patients and families, nurse-physician relationships, and clinical nursing practice. Students also participated freely in discussions and they differed widely in their individual responses during each step of the process.

The eight-step critical thinking process encourages students to engage in critical thinking, to view situations from broad perspectives, and to seek solutions to problems and situations experienced in clinical practice settings. This learning strategy incorporates the realities of nursing practice, merges nursing education with practice, and involves students in affective, cognitive, and psychomotor domains of learning. It provides students with enhanced skills in critical thinking and prepares them to function in a dynamic and complex health care system. Baccalaureate nursing education programs seeking accreditation could document their graduates’ critical thinking abilities using this strategy at all levels of the curriculum. Completing the eight-step critical thinking learning strategy could also serve as an alternative clinical learning method for Registered Nurse students and students absent from clinical practice.

Brookfield’s culturalization themes for nursing and their relationship to critical thinking clearly have parallels in other professional fields. Educators in these fields might find it useful to study the extent to which the themes apply in other fields and possibly identify additional themes that could be used to teach the application and consequences of critical thinking in the real world. Critical incidents for use in the program could be suggested by recent graduates or developed by teachers, based on their own real-life experiences. Using Brookfield’s model of the four components of critical thinking as a basis for analyizing these incidents, multi-step processes such as the one described in this article could be established in many other fields.

• Allen, D., Bowers, B. & Diekelmann, N. (1989). Writing to learn: A reconceptualization of thinking and writing in the nursing curriculum. Journal of Nursing Education, 28 (1), 6-10.
• Brookfield, S., (1987). Developing critical thinkers: Challenging adults to explore alternative ways of thinking and acting. San Francisco: Jossey-Bass Publishers.
• Brookfield, S. (1993). On impostership, cultural suicide, and other dangers: How nurses learn critical thinking. Journal of Continuing Education in Nursing, 5 (24), 197-205.
• del Bueno, D.J. (1990). Experience, education, and nurses’ ability to make clinical judgments. Nursing and Health Care, 11 (6), 290-293.
• Foster, P.J. Larson, D. & Loveless, E.M. (1993). Helping students learn to make ethical decisions. Holistic Nursing Practice, 7 (3), 28-35.
• Kramer, M. K. (1993). Concept clarification and critical thinking: Integrated processes. Journal of Nursing Education, 32 (9), 406-414.
• Lewis, J. B. (1992). The AIDS care dilemma: An exercise in critical thinking. The Journal of Nursing Education, 31 (3), 136-137.
• Miller, M.A., Malcolm, N.S. (1990). Critical thinking in the nursing curriculum. Nursing and Health Care, 11 (2), 67-73.
• National League for Nursing, (1989). Curriculum revolution: Reconceptualizing nursing education. New York: National League for Nursing Press.
• National League for Nursing, (1991). National League for Nursing Accreditation Criteria: 1991. New York: National League for Nursing Press.
• National League for Nursing, (1992). Perspective in Nursing-1991-1993. New York: National League for Nursing Press.
• U. S. Department of Education (1988). Secretary’s procedures and criteria for recognition of accrediting agencies. Federal Register, 53 (127),25088-25099.
• U.S. Department of Health and Human Services Public Health Service. (1992). Healthy people 2000 national health promotion and disease prevention objectives. Boston:Jones and Bartlett Publishers.

Essential Learning Outcomes: Critical/Creative Thinking

• Civic Responsibility
• Critical/Creative Thinking
• Cultural Sensitivity
• Information Literacy
• Oral Communication
• Quantitative Reasoning
• Written Communication
• Diversity, Equity & Inclusion

Description

Guide to Critical/Creative Thinking

Intended Learning Outcome:

Analyze, evaluate, and synthesize information in order to consider problems/ideas and transform them in innovative or imaginative ways (See below for definitions)

Assessment may include but is not limited to the following criteria and intended outcomes:

Analyze problems/ideas critically and/or creatively

• Formulates appropriate questions to consider problems/issues
• Evaluates costs and benefits of a solution
• Identifies possible solutions to problems or resolution to issues
• Applies innovative and imaginative approaches to problems/ideas

Synthesize information/ideas into a coherent whole

• Seeks and compares information that leads to informed decisions/opinions
• Applies fact and opinion appropriately
• Expands upon ideas to foster new lines of inquiry
• Synthesizes ideas into a coherent whole

Evaluate synthesized information in order to transform problems/ideas in innovative or imaginative ways

• Applies synthesized information to inform effective decisions
• Experiments with creating a novel idea, question, or product
• Uses new approaches and takes appropriate risks without going beyond the guidelines of the assignment
• Evaluates and reflects on the decision through a process that takes into account the complexities of an issue

From Association of American Colleges & Universities, LEAP outcomes and VALUE rubrics:   Critical thinking  is a habit of mind characterized by the comprehensive exploration of issues, ideas, artifacts, and events before accepting or formulating an opinion or conclusion.

Creative thinking  is both the capacity to combine or synthesize existing ideas, images, or expertise in original ways and the experience of thinking, reacting, and working in an imaginative way characterized by a high degree of innovation, divergent thinking, and risk taking.

Elements, excerpts, and ideas borrowed with permission form Assessing Outcomes and Improving Achievement: Tips and tools for Using Rubrics , edited by Terrel L. Rhodes. Copyright 2010 by the Association of American Colleges and Universities.

How to Align - Critical/Creative Thinking

• Critical/Creative Thinking ELO Tutorial

Critical/Creative Thinking Rubric

Analyze, evaluate, and synthesize information in order to consider problems/ideas and transform them into innovative or imaginative ways.

Elements, excerpts, and ideas borrowed with permission form  Assessing Outcomes and Improving Achievement: Tips and tools for Using Rubrics , edited by Terrel L. Rhodes. Copyright 2010 by the Association of American Colleges and Universities.

Sample Assignments

• Cleveland Museum of Art tour (Just Mercy) Assignment contributed by Chris Wolken, Matt Lafferty, Luke Schuleter and Sara Clark.
• Disaster Analysis This assignment was created by faculty at Durham College in Canada The purpose of this assignment is to evaluate students’ ability to think critically about how natural disasters are portrayed in the media.
• Laboratory Report-Critical Thinking Assignment contributed by Anne Distler.
• (Re)Imaginings assignment ENG 1020 Assignment contributed by Sara Fuller.
• Sustainability Project-Part 1 Waste Journal Assignment contributed by Anne Distler.
• Sustainability Project-Part 2 Research Assignment contributed by Anne Distler.
• Sustainability Project-Part 3 Waste Journal Continuation Assignment contributed by Anne Distler.
• Sustainability Project-Part 4 Reflection Assignment contributed by Anne Distler.
• Reconstructed Landscapes (VCPH) Assignment contributed by Jonathan Wayne
• Book Cover Design (VCIL)) Assignment contributed by George Kopec

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'Babbling' and 'hoarse': Biden's debate performance sends Democrats into a panic

ATLANTA — President Joe Biden was supposed to put the nation’s mind at ease over his physical and mental capacity with his debate showing Thursday night. 

But from the onset of the debate, Biden, 81, seemingly struggled even to talk, mostly summoning a weak, raspy voice. In the opening minutes, he repeatedly tripped over his words, misspoke and lost his train of thought.  

In one of the most notable moments, Biden ended a rambling statement that lacked focus by saying, “We finally beat Medicare,” before moderators cut him off and transitioned back to former President Donald Trump. 

While Biden warmed up and gained more of a rhythm as the debate progressed, he struggled to land a punch against Trump, much less fact-check everything Trump said as he unleashed a torrent of bad information.

Trump also pounced on Biden, saying at one point that he didn’t understand what Biden had just said with regard to the border. 

“I don’t know if he knows what he said, either,” Trump said.   

Nearly an hour into the debate, a Biden aide and others familiar with his situation offered up an explanation for his hoarseness: He has a cold.

But there were problems aside from the shakiness of Biden's voice. When he wasn't talking, he often stared off into the distance. Trump frequently steamrolled over Biden, accusing him of being a criminal and of peddling misinformation — many times without a response from Biden, though he did fire back with a handful of one-liners throughout.

The Biden campaign acknowledged that the debate would be a critical moment in the election, with officials hoping it could shake up the race to his benefit. Most polls have found the race to be neck and neck, with razor-thin margins that have moved negligibly for months, even after a New York jury found Trump guilty on 34 felony counts . 

Questions about Biden’s age and frailty have dragged down his polling numbers for months. The public concerns are exacerbated by deceptively edited videos , some of which have gone viral, that cut off relevant parts of an event, making it appear as if Biden is wandering or confused. This was Biden’s first opportunity since the State of the Union speech to dispel that narrative. 

Instead of a new beginning, many Democrats saw it as a moment for panic. 

“Democrats just committed collective suicide,” said a party strategist who has worked on presidential campaigns. “Biden sounds hoarse, looks tired and is babbling. He is reaffirming everything voters already perceived. President Biden can’t win. This debate is a nail in the political coffin.” 

“It’s hard to argue that we shouldn’t nominate someone else,” a Democratic consultant who works on down-ballot races said. 

Biden did ramp up as the debate progressed. 

“Only one of us is a convicted felon, and I’m looking at him,” Biden said to Trump. That was one moment that tested particularly well in the Biden campaign's internal real-time polling at the time of the debate, according to a person familiar with the polling. 

An aide said that it was “not an ideal start” for Biden at the beginning of the debate but that there was “no mass panic” at the campaign headquarters in Delaware.

The muting of the candidates' microphones at the debate, a stipulation both campaigns agreed to before the debate, added a new dimension to the faceoff. The first Biden-Trump match-up in 2020 was marked by repeated interruptions by Trump, leading to moments of frustration for Biden.

“Will you shut up, man?” Biden complained at that first Cleveland debate. 

Reaction pours in

“I’m thinking the Democrats are thinking about who the Barry Goldwater is who can walk in tomorrow and tell the president he needs to step aside,” said Ben Proto, chairman of the Connecticut Republican Party.

In 1974, after key Watergate tapes were made public, Sen. Barry Goldwater, R-Ariz., went to see President Richard Nixon alongside other prominent lawmakers, telling Nixon that he would be convicted by the Senate and that he should step aside — which he did.

Biden’s campaign defended his performance, saying he offered a “positive and winning vision” for America.

“On the other side of the stage was Donald Trump, who offered a dark and backwards window into what America will look like if he steps foot back in the White House: a country where women are forced to beg for the health care they need to stay alive. A country that puts the interests of billionaires over working people,” Biden campaign chair Jen O’Malley Dillon said in a statement. “And a former president who not once, not twice, but three times, failed to promise he would accept the results of a free and fair election this November.”

Some Democrats also defended Biden presidency more broadly after the debate, pointing to his policies over Trump's.

"One thing this debate won’t change is Trump’s base instinct to sell out anyone to make a quick buck or put his own image on a steak, golf course or even the Holy Bible," said Brandon Weathersby, a spokesman with the pro-Biden American Bridge 21st Century super PAC. "Trump puts himself first every time, and that won’t change if he becomes president again."

Trump, meanwhile, has fended off his own questions over whether he’s diminished by age, including his struggles to stay on topic and his meandering when he’s speaking . Biden has posited that Trump “snapped” after his 2020 election loss and is unstable, which he aired again Thursday night.

Trump often gave his typical rambling responses and seemed at times to make up factoids and figures.

“During my four years, I had the best environmental numbers ever, and my top environmental people gave me that statistic just before I walked on the stage, actually,” Trump said.

Trump also said he would lower insulin prices for seniors, but it was Biden who signed legislation in 2022 that lowered out-of-pocket costs for people on Medicare to $35 a month and covered all insulin products. 

Setting the stage for the fall

The first debate during the 2020 election cycle was in early September, meaning the first 2024 general election debate was significantly earlier than usual — more than two months ahead of Labor Day, which is often seen as the point when most voters start to pay attention to presidential contests.

“Debates move numbers,” said Matt Gorman, a longtime Republican strategist who worked for presidential campaign of Sen. Tim Scott of South Carolina. “And with this so early — and the next one not until September — you’re stuck with the narrative for four long months.

“And one and the other’s performance will set the tone for the next one,” he added.

For months, Trump’s team has been hammering Biden’s mental acuity, a strategy that is at odds with how campaigns generally handle the lead-up to debates, when they try to build up opponents as deft debaters to set expectations.

The expectations for Biden were low, and by almost all estimates he was unable to clear them.

“Biden just had to beat himself; unfortunately the stumbling and diminished Joe Biden the world has come to know made Trump look competent and energetic,” said a former Trump campaign official who isn’t working for his campaign this year. “I expect there will be some loud calls from Democrats for a change on the top of the ticket.”

“The floor for Biden was so low,” the person added. “After Biden’s debate performance, it seems the floor is 6 feet under.”

The 90-minute debate hit on a wide variety of topics, but many of the most dominant themes were centered on those that have been most prominent on the campaign trail over the past few months.

Trump hit Biden on two big policy fights that have stubbornly dogged his campaign: immigration and inflation. 

Since Biden took office, 15 million jobs have been created and the unemployment rate sits at a relatively low 4%, but prices for consumer goods have remained high, and they provided a consistent line of attack from the Trump campaign and Republicans more broadly.

In one heated exchange, Trump point-blank said “he caused the inflation.” Biden said in response there was less inflation under Trump because he tanked the economy. 

“There was no inflation when I came into office,” Biden said before that rejoinder — a quote Republicans quickly used as evidence that all of the current price hikes happened on Biden’s watch.

Trump continued to attack Biden over his border policies, which his campaign has used as one of its biggest lines of attack throughout the campaign. That often including amplifying each time an undocumented migrant commits a crime even though the data doesn’t support the idea of a migrant crime wave .

“ We have a border that is the most dangerous place anywhere in the world,” Trump said.

Earlier this year, Trump used his influence over congressional Republicans to block a bipartisan border deal that Biden supported.

Biden also tried to land a punch about Jan. 6, trying to build on the oft-discussed idea that Trump’s returning to the White House would be a threat to democracy.

“He encouraged those folks to go up to Capitol Hill,” Biden said. “He sat there for three hours being begged by his vice president and many colleagues on the Republican side to do something.”

Trump deflected, arguing the Biden should be “ashamed” for arresting those who participated in the attempted insurrection. 

Natasha Korecki is a senior national political reporter for NBC News.

Matt Dixon is a senior national politics reporter for NBC News, based in Florida.

Jonathan Allen is a senior national politics reporter for NBC News, based in Washington.