example of critical thinking in healthcare

The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What Is Critical Thinking In Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

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Developing critical thinking skills for delivering optimal care

Scott IA, Hubbard RE, Crock C, et al. Developing critical thinking skills for delivering optimal care. Intern Med J. 2021;51(4):488-493. doi: 10.1111/imj.15272

Sound critical thinking skills can help clinicians avoid cognitive biases and diagnostic errors. This article describes three critical thinking skills essential to effective clinical care – clinical reasoning, evidence-informed decision-making, and systems thinking – and approaches to develop these skills during clinician training.

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Changes in unprofessional behaviour, teamwork, and co-operation among hospital staff during the COVID-19 pandemic. September 28, 2022

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Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19. April 12, 2023

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Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016 March 3, 2017

Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. September 23, 2020

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Perceived patient safety culture in a critical care transport program. July 31, 2013

Video-based communication assessment of physician error disclosure skills by crowdsourced laypeople and patient advocates who experienced medical harm: reliability assessment with generalizability theory. May 18, 2022

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Diagnostic errors in hospitalized adults who died or were transferred to intensive care. January 17, 2024

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Multiple meanings of resilience: health professionals' experiences of a dual element training intervention designed to help them prepare for coping with error. March 31, 2021

Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive task analysis. March 10, 2021

TRIAD IX: can a patient testimonial safely help ensure prehospital appropriate critical versus end-of-life care? September 15, 2021

An act of performance: exploring residents' decision-making processes to seek help. April 14, 2021

Preventing home medication administration errors. March 14, 2022

A randomized trial of a multifactorial strategy to prevent serious fall injuries. July 29, 2020

Clinical predictors for unsafe direct discharge home patients from intensive care units. October 21, 2020

Association between limiting the number of open records in a tele-critical care setting and retract-reorder errors. July 21, 2021

Standardized assessment of medication reconciliation in post-acute care. April 27, 2022

Estimating the economic cost of nurse sensitive adverse events amongst patients in medical and surgical settings. June 16, 2021

Survey of nurses' experiences applying The Joint Commission's medication management titration standards. November 3, 2021

Effectiveness of acute care remote triage systems: a systematic review. February 5, 2020

Physician task load and the risk of burnout among US physicians in a national survey. December 2, 2020

Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers. September 23, 2020

Patient and physician perspectives of deprescribing potentially inappropriate medications in older adults with a history of falls: a qualitative study. May 5, 2021

We asked the experts: the WHO Surgical Safety Checklist and the COVID-19 pandemic: recommendations for content and implementation adaptations. March 17, 2021

Association between surgeon technical skills and patient outcomes. September 9, 2020

Influence of psychological safety and organizational support on the impact of humiliation on trainee well-being. June 8, 2022

Developing the Safer Dx Checklist of Ten Safety Recommendations for Health Care Organizations to address diagnostic errors. October 12, 2022

Comparison of health care worker satisfaction before vs after implementation of a communication and optimal resolution program in acute care hospitals. April 5, 2023

Not overstepping professional boundaries: the challenging role of nurses in simulated error disclosures. September 21, 2011

Temporal associations between EHR-derived workload, burnout, and errors: a prospective cohort study. July 20, 2022

Adherence to national guidelines for timeliness of test results communication to patients in the Veterans Affairs health care system. May 4, 2022

Deferral of care for serious non-COVID-19 conditions: a hidden harm of COVID-19. November 18, 2020

An observational study of postoperative handoff standardization failures. June 23, 2021

Content analysis of patient safety incident reports for older adult patient transfers, handovers, and discharges: do they serve organizations, staff, or patients? January 8, 2020

Exploring the impact of employee engagement and patient safety. September 14, 2022

Deprescribing for community-dwelling older adults: a systematic review and meta-analysis. September 16, 2020

The abrupt expansion of ambulatory telemedicine: implications for patient safety. February 9, 2022

Nurse's Achilles Heel: using big data to determine workload factors that impact near misses. April 14, 2021

A diagnostic time-out to improve differential diagnosis in pediatric abdominal pain. July 14, 2021

What safety events are reported for ambulatory care? Analysis of incident reports from a patient safety organization. October 21, 2020

Expert consensus on currently accepted measures of harm. September 9, 2020

The July Effect in podiatric medicine and surgery residency. July 14, 2021

The calm before the storm: utilizing in situ simulation to evaluate for preparedness of an alternative care hospital during COVID-19 pandemic. June 2, 2021

Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: a comparative cross-sectional study. June 22, 2022

The association between nurse staffing and omissions in nursing care: a systematic review. July 11, 2018

Creating a learning health system for improving diagnostic safety: pragmatic insights from US health care organizations. June 22, 2022

Effect of pharmacist counseling intervention on health care utilization following hospital discharge: a randomized control trial. June 8, 2016

Impact of the initial response to COVID-19 on long-term care for people with intellectual disability: an interrupted time series analysis of incident reports. October 14, 2020

Pediatric surgical errors: a systematic scoping review. July 20, 2022

Racial bias in pulse oximetry measurement. December 20, 2020

Accuracy of practitioner estimates of probability of diagnosis before and after testing. May 5, 2021

Recommendations for the safe, effective use of adaptive CDS in the US healthcare system: an AMIA position paper. April 21, 2021

Impact of interoperability of smart infusion pumps and an electronic medical record in critical care. September 23, 2020

Decreased incidence of cesarean surgical site infection rate with hospital-wide perioperative bundle. September 29, 2021

Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative. May 18, 2022

Second victim experiences of nurses in obstetrics and gynaecology: a Second Victim Experience and Support Tool Survey December 23, 2020

Understanding the second victim experience among multidisciplinary providers in obstetrics and gynecology. May 19, 2021

eSIMPLER: a dynamic, electronic health record-integrated checklist for clinical decision support during PICU daily rounds. June 16, 2021

Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1). May 5, 2021

Organizational safety climate and job enjoyment in hospital surgical teams with and without crew resource management training, January 26, 2022

Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial. March 1, 2023

The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care.  August 24, 2005

Safety II behavior in a pediatric intensive care unit. August 1, 2018

Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. October 21, 2020

The working hours of hospital staff nurses and patient safety. January 9, 2005

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Family Input for Quality and Safety (FIQS): using mobile technology for in-hospital reporting from families and patients. March 2, 2022

Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety. December 9, 2020

COVID-19: an emerging threat to antibiotic stewardship in the emergency department. October 21, 2020

Improving self-reported empathy and communication skills through harm in healthcare response training. January 26, 2022

Association between in-clinic opioid administration and discharge opioid prescription in urgent care: a retrospective cohort study. February 17, 2021

Predicting avoidable hospital events in Maryland. December 1, 2021

Specificity of computerized physician order entry has a significant effect on the efficiency of workflow for critically ill patients. April 21, 2005

Why do hospital prescribers continue antibiotics when it is safe to stop? Results of a choice experiment survey. September 2, 2020

COVID-19: patient safety and quality improvement skills to deploy during the surge. June 24, 2020

Patient safety skills in primary care: a national survey of GP educators. February 4, 2015

Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Difficult Airway Society and the Association of Anaesthetists. March 1, 2023

Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? June 8, 2011

Training in safe opioid prescribing and treatment of opioid use disorder in internal medicine residencies: a national survey of program directors. October 12, 2022

Diagnostic discordance, health information exchange, and inter-hospital transfer outcomes: a population study. June 20, 2018

Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs. March 10, 2021

Racial and ethnic harm in patient care is a patient safety issue. May 15, 2024

All in Her Head. The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today. March 20, 2024

The racial disparities in maternal mortality and impact of structural racism and implicit racial bias on pregnant Black women: a review of the literature. December 6, 2023

A scoping review exploring the confidence of healthcare professionals in assessing all skin tones. October 4, 2023

Patient safety in palliative care at the end of life from the perspective of complex thinking. August 16, 2023

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Factors influencing in-hospital prescribing errors: a systematic review. July 19, 2023

Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum. June 28, 2023

Context matters: toward a multilevel perspective on context in clinical reasoning and error. June 21, 2023

The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. June 14, 2023

Explicitly addressing implicit bias on inpatient rounds: student and faculty reflections. June 7, 2023

The time is now: addressing implicit bias in obstetrics and gynecology education. May 17, 2023

Listen to the whispers before they become screams: addressing Black maternal morbidity and mortality in the United States. May 3, 2023

Annual Perspective

Formalizing the hidden curriculum of performance enhancing errors. March 22, 2023

Implicit racial bias, health care provider attitudes, and perceptions of health care quality among African American college students in Georgia, USA. January 18, 2023

Structural racism and impact on sickle cell disease: sickle cell lives matter. January 11, 2023

The REPAIR Project: a prospectus for change toward racial justice in medical education and health sciences research: REPAIR project steering committee. January 11, 2023

Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning. January 11, 2023

Exploring the intersection of structural racism and ageism in healthcare. December 7, 2022

Calibrate Dx: A Resource to Improve Diagnostic Decisions. October 19, 2022

Improved Diagnostic Accuracy Through Probability-Based Diagnosis. September 28, 2022

Medical malpractice lawsuits involving trainees in obstetrics and gynecology in the USA. September 21, 2022

A state-of-the-art review of speaking up in healthcare. August 24, 2022

Skin cancer is a risk no matter the skin tone. But it may be overlooked in people with dark skin. August 17, 2022

Oxford Professional Practice: Handbook of Patient Safety. July 27, 2022

Narrowing the mindware gap in medicine. July 20, 2022

From principles to practice: embedding clinical reasoning as a longitudinal curriculum theme in a medical school programme. June 15, 2022

A call to action: next steps to advance diagnosis education in the health professions. June 8, 2022

Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study. April 27, 2022

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Cultivating Critical Thinking in Healthcare

Published: 06 January 2019

Critical thinking skills have been linked to improved patient outcomes, better quality patient care and improved safety outcomes in healthcare (Jacob et al. 2017).

Given this, it's necessary for educators in healthcare to stimulate and lead further dialogue about how these skills are taught , assessed and integrated into the design and development of staff and nurse education and training programs (Papp et al. 2014).

So, what exactly is critical thinking and how can healthcare educators cultivate it amongst their staff?

What is Critical Thinking?

In general terms, ‘ critical thinking ’ is often used, and perhaps confused, with problem-solving and clinical decision-making skills .

In practice, however, problem-solving tends to focus on the identification and resolution of a problem, whilst critical thinking goes beyond this to incorporate asking skilled questions and critiquing solutions .

Several formal definitions of critical thinking can be found in literature, but in the view of Kahlke and Eva (2018), most of these definitions have limitations. That said, Papp et al. (2014) offer a useful starting point, suggesting that critical thinking is:

‘The ability to apply higher order cognitive skills and the disposition to be deliberate about thinking that leads to action that is logical and appropriate.’

The Foundation for Critical Thinking (2017) expands on this and suggests that:

‘Critical thinking is that mode of thinking, about any subject, content, or problem, in which the thinker improves the quality of his or her thinking by skillfully analysing, assessing, and reconstructing it.’

They go on to suggest that critical thinking is:

• Self-directed
• Self-disciplined
• Self-monitored
• Self-corrective.

Key Qualities and Characteristics of a Critical Thinker

Given that critical thinking is a process that encompasses conceptualisation , application , analysis , synthesis , evaluation and reflection , what qualities should be expected from a critical thinker?

In answering this question, Fortepiani (2018) suggests that critical thinkers should be able to:

• Formulate clear and precise questions
• Gather, assess and interpret relevant information
• Reach relevant well-reasoned conclusions and solutions
• Think open-mindedly, recognising their own assumptions
• Communicate effectively with others on solutions to complex problems.

All of these qualities are important, however, good communication skills are generally considered to be the bedrock of critical thinking. Why? Because they help to create a dialogue that invites questions, reflections and an open-minded approach, as well as generating a positive learning environment needed to support all forms of communication.

Lippincott Solutions (2018) outlines a broad spectrum of characteristics attributed to strong critical thinkers. They include:

• Inquisitiveness with regard to a wide range of issues
• A concern to become and remain well-informed
• Alertness to opportunities to use critical thinking
• Self-confidence in one’s own abilities to reason
• Open mindedness regarding divergent world views
• Flexibility in considering alternatives and opinions
• Understanding the opinions of other people
• Fair-mindedness in appraising reasoning
• Honesty in facing one’s own biases, prejudices, stereotypes or egocentric tendencies
• A willingness to reconsider and revise views where honest reflection suggests that change is warranted.

Papp et al. (2014) also helpfully suggest that the following five milestones can be used as a guide to help develop competency in critical thinking:

Stage 1: Unreflective Thinker

At this stage, the unreflective thinker can’t examine their own actions and cognitive processes and is unaware of different approaches to thinking.

Stage 2: Beginning Critical Thinker

Here, the learner begins to think critically and starts to recognise cognitive differences in other people. However, external motivation  is needed to sustain reflection on the learners’ own thought processes.

Stage 3: Practicing Critical Thinker

By now, the learner is familiar with their own thinking processes and makes a conscious effort to practice critical thinking.

Stage 4: Advanced Critical Thinker

As an advanced critical thinker, the learner is able to identify different cognitive processes and consciously uses critical thinking skills.

Stage 5: Accomplished Critical Thinker

At this stage, the skilled critical thinker can take charge of their thinking and habitually monitors, revises and rethinks approaches for continual improvement of their cognitive strategies.

Facilitating Critical Thinking in Healthcare

A common challenge for many educators and facilitators in healthcare is encouraging students to move away from passive learning towards active learning situations that require critical thinking skills.

Just as there are similarities among the definitions of critical thinking across subject areas and levels, there are also several generally recognised hallmarks of teaching for critical thinking . These include:

• Promoting interaction among students as they learn
• Asking open ended questions that do not assume one right answer
• Allowing sufficient time to reflect on the questions asked or problems posed
• Teaching for transfer - helping learners to see how a newly acquired skill can apply to other situations and experiences.

(Lippincott Solutions 2018)

Snyder and Snyder (2008) also make the point that it’s helpful for educators and facilitators to be aware of any initial resistance that learners may have and try to guide them through the process. They should aim to create a learning environment where learners can feel comfortable thinking through an answer rather than simply having an answer given to them.

Examples include using peer coaching techniques , mentoring or preceptorship to engage students in active learning and critical thinking skills, or integrating project-based learning activities that require students to apply their knowledge in a realistic healthcare environment.

Carvalhoa et al. (2017) also advocate problem-based learning as a widely used and successful way of stimulating critical thinking skills in the learner. This view is echoed by Tsui-Mei (2015), who notes that critical thinking, systematic analysis and curiosity significantly improve after practice-based learning .

Integrating Critical Thinking Skills Into Curriculum Design

Most educators agree that critical thinking can’t easily be developed if the program curriculum is not designed to support it. This means that a deep understanding of the nature and value of critical thinking skills needs to be present from the outset of the curriculum design process , and not just bolted on as an afterthought.

In the view of Fortepiani (2018), critical thinking skills can be summarised by the statement that 'thinking is driven by questions', which means that teaching materials need to be designed in such a way as to encourage students to expand their learning by asking questions that generate further questions and stimulate the thinking process. Ideal questions are those that:

• Embrace complexity
• Challenge assumptions and points of view
• Question the source of information
• Explore variable interpretations and potential implications of information.

To put it another way, asking questions with limiting, thought-stopping answers inhibits the development of critical thinking. This means that educators must ideally be critical thinkers themselves .

Drawing these threads together, The Foundation for Critical Thinking (2017) offers us a simple reminder that even though it’s human nature to be ‘thinking’ most of the time, most thoughts, if not guided and structured, tend to be biased, distorted, partial, uninformed or even prejudiced.

They also note that the quality of work depends precisely on the quality of the practitioners’ thought processes. Given that practitioners are being asked to meet the challenge of ever more complex care, the importance of cultivating critical thinking skills, alongside advanced problem-solving skills , seems to be taking on new importance.

Additional Resources

• The Emotionally Intelligent Nurse | Ausmed Article
• Refining Competency-Based Assessment | Ausmed Article
• Socratic Questioning in Healthcare | Ausmed Article
• Carvalhoa, D P S R P et al. 2017, 'Strategies Used for the Promotion of Critical Thinking in Nursing Undergraduate Education: A Systematic Review', Nurse Education Today , vol. 57, pp. 103-10, viewed 7 December 2018, https://www.sciencedirect.com/science/article/abs/pii/S0260691717301715
• Fortepiani, L A 2017, 'Critical Thinking or Traditional Teaching For Health Professionals', PECOP Blog , 16 January, viewed 7 December 2018, https://blog.lifescitrc.org/pecop/2017/01/16/critical-thinking-or-traditional-teaching-for-health-professions/
• Jacob, E, Duffield, C & Jacob, D 2017, 'A Protocol For the Development of a Critical Thinking Assessment Tool for Nurses Using a Delphi Technique', Journal of Advanced Nursing, vol. 73, no. 8, pp. 1982-1988, viewed 7 December 2018, https://onlinelibrary.wiley.com/doi/10.1111/jan.13306
• Kahlke, R & Eva, K 2018, 'Constructing Critical Thinking in Health Professional Education', Perspectives on Medical Education , vol. 7, no. 3, pp. 156-165, viewed 7 December 2018, https://link.springer.com/article/10.1007/s40037-018-0415-z
• Lippincott Solutions 2018, 'Turning New Nurses Into Critical Thinkers', Lippincott Solutions , viewed 10 December 2018, https://www.wolterskluwer.com/en/expert-insights/turning-new-nurses-into-critical-thinkers
• Papp, K K 2014, 'Milestones of Critical Thinking: A Developmental Model for Medicine and Nursing', Academic Medicine , vol. 89, no. 5, pp. 715-720, https://journals.lww.com/academicmedicine/Fulltext/2014/05000/Milestones_of_Critical_Thinking___A_Developmental.14.aspx
• Snyder, L G & Snyder, M J 2008, 'Teaching Critical Thinking and Problem Solving Skills', The Delta Pi Epsilon Journal , vol. L, no. 2, pp. 90-99, viewed 7 December 2018, https://dme.childrenshospital.org/wp-content/uploads/2019/02/Optional-_Teaching-Critical-Thinking-and-Problem-Solving-Skills.pdf
• The Foundation for Critical Thinking 2017, Defining Critical Thinking , The Foundation for Critical Thinking, viewed 7 December 2018, https://www.criticalthinking.org/pages/our-conception-of-critical-thinking/411
• Tsui-Mei, H, Lee-Chun, H & Chen-Ju MSN, K 2015, 'How Mental Health Nurses Improve Their Critical Thinking Through Problem-Based Learning', Journal for Nurses in Professional Development , vol. 31, no. 3, pp. 170-175, viewed 7 December 2018, https://journals.lww.com/jnsdonline/Abstract/2015/05000/How_Mental_Health_Nurses_Improve_Their_Critical.8.aspx

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Two Examples of How I Used Critical Thinking to Care for my Patient (Real Life Nursing Stories) | NURSING.com

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Critical Thinking on the Nursing Floor

Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.

The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!

Critical Thinking in Nursing: Example 1

I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs for the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90s on oxygen.

I stopped. And thought. What the heck is going on?

I looked at his history. Congestive heart failure.

I looked at his intake and output. He was positive 1.5 liters.

I thought about how he’s got extra fluid in general, and because of his CHF, he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..

His lungs were clear earlier. I heard crackles throughout both lungs.

OK, so he’s got extra fluid that he can’t get out of his body. What do I know that will get rid of extra fluid and make him pee? Maybe some Lasix?

I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said “Give him 20 mg IV Lasix one time, and I’ll put the order in.” CLICK.

I gave the Lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.

Badda Bing Bada Boom!

Critical Thinking in Nursing: Example 2

My patient just had her right leg amputated above her knee. She was on a Dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. She told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with the goal of weaning off PCA.

“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?

I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.

I thought about nerve pain. I thought about other patients that report similar pain. Diabetics with neuropathy would talk about similar pain… “What did they do for it? ” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.

“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.

I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain after I described my patient’s type of pain and thought process.

“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner. ”

She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort were significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.

And that we did!

She was able to work with therapy more because her pain was tolerable and was finally able to get rest.

What the HELL is Critical Thinking . . . and Why Should I Care?

What your nursing professor won’t tell you about critical thinking .

by Ashely Adkins RN BSN

When I started nursing school, I remember thinking,   “how in the world am I going to remember all of this information, let alone be able to apply it and critically think?”   You are not alone if you feel like your critical thinking skills need a little bit of polishing.

Let’s step back for a moment, and take a walk down memory lane. It was my first semester of nursing school and I was sitting in my Fundamentals of Nursing course. We were learning about vital signs, assessments, labs, etc. Feeling overwhelmed with all of this new information (when are you   not   overwhelmed in nursing school?), I let my mind wonder to a low place…

Am I really cut out for this? Can I really do this? How can I possibly retain all of this information?  Do they really expect me to remember everything AND critically think at the same time?

One of my first-semester nursing professors said something to me that has stuck with me throughout my nursing years. It went a little something like this:

“Critical thinking does not develop overnight . It takes time. You don’t learn to talk overnight or walk overnight. You don’t   learn to critically think overnight .”

My professor was absolutely right.

As my journey throughout nursing school, and eventually on to being a “real nurse” continued, my critical thinking skills began to BLOSSOM. With every class, lecture, clinical shift, lab, and simulation, my critical thinking skills grew.

You may ask…how?

Well, let me tell you…

• Questioning

These are the key ingredients to growing your critical thinking skills.

Time.   Critical thinking takes time. As I mentioned before, you do not learn how to critically think overnight. It is important to set   realistic   expectations for yourself both in nursing school and in other aspects of your life.

Exposure.   It is next to impossible to critically think if you have never been exposed to something. How would you ever learn to talk if no one ever talked to you? The same thing applies to nursing and critical thinking.

Over time, your exposure to new materials and situations will cause you to think and ask yourself, “why?”

This leads me to my next point.   Questioning.   Do not be afraid to ask yourself…

“Why is this happening?”

“Why do I take a blood pressure and heart rate before I give a beta-blocker?”

“Why is it important to listen to a patient’s lung sounds before and after they receive a blood transfusion?”

It is important to constantly question yourself. Let your mind process your questions, and discover answers.

Confidence.   We always hear the phrase, “confidence is key!” And as cheesy as that phrase may be, it really holds true. So many times, we often times sell ourselves short.

YOU KNOW MORE THAN YOU THINK YOU KNOW.

In case you did not catch it the first time…

Be confident in your knowledge, because trust me, it is there. It may be hiding in one single neuron in the back of your brain, but it is there.

It is impossible to know everything. Even experienced nurses do not know everything.

And if they tell you that they do…they are wrong!

The   key   to critical thinking is   not about knowing everything ; It is about   how you respond when you do not know something .

How do you reason through a problem you do not know the answer to? Do you give up? Or do you persevere until you discover the answer?

If you are a nursing student preparing for the NCLEX, you know that the NCLEX   loves   critical thinking questions. NRSNG has some great tips and advice on   critical thinking when it comes to taking the NCLEX .

There are so many pieces to the puzzle when it comes to nursing, and it is normal to feel overwhelmed. The beauty of nursing is when all of those puzzle pieces come together to form a beautiful picture.

That is critical thinking.

Critical thinking is something you’ll do every day as a nurse and honestly, you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution, and trying it out. Critical thinking in nursing is just that but in a clinical setting.

We’ve written a MASSIVE lesson on Care Plans and Critical Thinking :

Mastering The COPD Nursing Care Plan in Just 10 Minutes!

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How Critical Thinking Skills Apply to Healthcare

Critical Thinking Includes

• The skill to draw conclusions.
• The skill to troubleshoot and problem-solve.
• The capability to use skills or knowledge in a variety of situations.

Examples of Everyday Critical Thinking

• Thinking about what steps should to be taken to avoid an accident.
•  Creating a list that gives ability to accomplish every task efficiently and effectively.
• Thinking through the process and dealing with issues that might arise. (missing an ingredient needed for a dish or finding out that the vacuum cleaner is broken)

Examples of Work-Related Critical Thinking

• Deciding how to deal with a customer who is upset over service or bill to ensure a happy customer.
• Handling a disagreement with another coworker.
• Presenting an issue or proposal to the supervisor.

Examples of Work-Related Critical Thinking Situations

• If you have worked in customer service then the same critical thinking skills that are used to deal with customers will be used to deal with patients in the medical field .
• If you have worked in a fast-paced environment requiring prioritizing then you will carry that skill over to the medical field.

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41+ Critical Thinking Examples (Definition + Practices)

Critical thinking is an essential skill in our information-overloaded world, where figuring out what is fact and fiction has become increasingly challenging.

But why is critical thinking essential? Put, critical thinking empowers us to make better decisions, challenge and validate our beliefs and assumptions, and understand and interact with the world more effectively and meaningfully.

Critical thinking is like using your brain's "superpowers" to make smart choices. Whether it's picking the right insurance, deciding what to do in a job, or discussing topics in school, thinking deeply helps a lot. In the next parts, we'll share real-life examples of when this superpower comes in handy and give you some fun exercises to practice it.

Critical Thinking Process Outline

Critical thinking means thinking clearly and fairly without letting personal feelings get in the way. It's like being a detective, trying to solve a mystery by using clues and thinking hard about them.

It isn't always easy to think critically, as it can take a pretty smart person to see some of the questions that aren't being answered in a certain situation. But, we can train our brains to think more like puzzle solvers, which can help develop our critical thinking skills.

Here's what it looks like step by step:

Spotting the Problem: It's like discovering a puzzle to solve. You see that there's something you need to figure out or decide.

Collecting Clues: Now, you need to gather information. Maybe you read about it, watch a video, talk to people, or do some research. It's like getting all the pieces to solve your puzzle.

Breaking It Down: This is where you look at all your clues and try to see how they fit together. You're asking questions like: Why did this happen? What could happen next?

Checking Your Clues: You want to make sure your information is good. This means seeing if what you found out is true and if you can trust where it came from.

Making a Guess: After looking at all your clues, you think about what they mean and come up with an answer. This answer is like your best guess based on what you know.

Explaining Your Thoughts: Now, you tell others how you solved the puzzle. You explain how you thought about it and how you answered. 

Checking Your Work: This is like looking back and seeing if you missed anything. Did you make any mistakes? Did you let any personal feelings get in the way? This step helps make sure your thinking is clear and fair.

And remember, you might sometimes need to go back and redo some steps if you discover something new. If you realize you missed an important clue, you might have to go back and collect more information.

Critical Thinking Methods

Just like doing push-ups or running helps our bodies get stronger, there are special exercises that help our brains think better. These brain workouts push us to think harder, look at things closely, and ask many questions.

It's not always about finding the "right" answer. Instead, it's about the journey of thinking and asking "why" or "how." Doing these exercises often helps us become better thinkers and makes us curious to know more about the world.

Now, let's look at some brain workouts to help us think better:

1. "What If" Scenarios

Imagine crazy things happening, like, "What if there was no internet for a month? What would we do?" These games help us think of new and different ideas.

Pick a hot topic. Argue one side of it and then try arguing the opposite. This makes us see different viewpoints and think deeply about a topic.

3. Analyze Visual Data

Check out charts or pictures with lots of numbers and info but no explanations. What story are they telling? This helps us get better at understanding information just by looking at it.

4. Mind Mapping

Write an idea in the center and then draw lines to related ideas. It's like making a map of your thoughts. This helps us see how everything is connected.

There's lots of mind-mapping software , but it's also nice to do this by hand.

5. Weekly Diary

Every week, write about what happened, the choices you made, and what you learned. Writing helps us think about our actions and how we can do better.

6. Evaluating Information Sources

Collect stories or articles about one topic from newspapers or blogs. Which ones are trustworthy? Which ones might be a little biased? This teaches us to be smart about where we get our info.

There are many resources to help you determine if information sources are factual or not.

7. Socratic Questioning

This way of thinking is called the Socrates Method, named after an old-time thinker from Greece. It's about asking lots of questions to understand a topic. You can do this by yourself or chat with a friend.

Start with a Big Question:

"What does 'success' mean?"

Dive Deeper with More Questions:

"Why do you think of success that way?" "Do TV shows, friends, or family make you think that?" "Does everyone think about success the same way?"

"Can someone be a winner even if they aren't rich or famous?" "Can someone feel like they didn't succeed, even if everyone else thinks they did?"

Look for Real-life Examples:

"Who is someone you think is successful? Why?" "Was there a time you felt like a winner? What happened?"

Think About Other People's Views:

"How might a person from another country think about success?" "Does the idea of success change as we grow up or as our life changes?"

Think About What It Means:

"How does your idea of success shape what you want in life?" "Are there problems with only wanting to be rich or famous?"

Look Back and Think:

"After talking about this, did your idea of success change? How?" "Did you learn something new about what success means?"

8. Six Thinking Hats 

Edward de Bono came up with a cool way to solve problems by thinking in six different ways, like wearing different colored hats. You can do this independently, but it might be more effective in a group so everyone can have a different hat color. Each color has its way of thinking:

White Hat (Facts): Just the facts! Ask, "What do we know? What do we need to find out?"

Red Hat (Feelings): Talk about feelings. Ask, "How do I feel about this?"

Black Hat (Careful Thinking): Be cautious. Ask, "What could go wrong?"

Yellow Hat (Positive Thinking): Look on the bright side. Ask, "What's good about this?"

Green Hat (Creative Thinking): Think of new ideas. Ask, "What's another way to look at this?"

Blue Hat (Planning): Organize the talk. Ask, "What should we do next?"

When using this method with a group:

• Explain all the hats.
• Decide which hat to wear first.
• Make sure everyone switches hats at the same time.
• Finish with the Blue Hat to plan the next steps.

9. SWOT Analysis

SWOT Analysis is like a game plan for businesses to know where they stand and where they should go. "SWOT" stands for Strengths, Weaknesses, Opportunities, and Threats.

There are a lot of SWOT templates out there for how to do this visually, but you can also think it through. It doesn't just apply to businesses but can be a good way to decide if a project you're working on is working.

Strengths: What's working well? Ask, "What are we good at?"

Weaknesses: Where can we do better? Ask, "Where can we improve?"

Opportunities: What good things might come our way? Ask, "What chances can we grab?"

Threats: What challenges might we face? Ask, "What might make things tough for us?"

Steps to do a SWOT Analysis:

• Goal: Decide what you want to find out.
• Research: Learn about your business and the world around it.
• Brainstorm: Get a group and think together. Talk about strengths, weaknesses, opportunities, and threats.
• Pick the Most Important Points: Some things might be more urgent or important than others.
• Make a Plan: Decide what to do based on your SWOT list.
• Check Again Later: Things change, so look at your SWOT again after a while to update it.

Now that you have a few tools for thinking critically, let’s get into some specific examples.

Everyday Examples

Life is a series of decisions. From the moment we wake up, we're faced with choices – some trivial, like choosing a breakfast cereal, and some more significant, like buying a home or confronting an ethical dilemma at work. While it might seem that these decisions are disparate, they all benefit from the application of critical thinking.

10. Deciding to buy something

Imagine you want a new phone. Don't just buy it because the ad looks cool. Think about what you need in a phone. Look up different phones and see what people say about them. Choose the one that's the best deal for what you want.

11. Deciding what is true

There's a lot of news everywhere. Don't believe everything right away. Think about why someone might be telling you this. Check if what you're reading or watching is true. Make up your mind after you've looked into it.

12. Deciding when you’re wrong

Sometimes, friends can have disagreements. Don't just get mad right away. Try to see where they're coming from. Talk about what's going on. Find a way to fix the problem that's fair for everyone.

13. Deciding what to eat

There's always a new diet or exercise that's popular. Don't just follow it because it's trendy. Find out if it's good for you. Ask someone who knows, like a doctor. Make choices that make you feel good and stay healthy.

14. Deciding what to do today

Everyone is busy with school, chores, and hobbies. Make a list of things you need to do. Decide which ones are most important. Plan your day so you can get things done and still have fun.

15. Making Tough Choices

Sometimes, it's hard to know what's right. Think about how each choice will affect you and others. Talk to people you trust about it. Choose what feels right in your heart and is fair to others.

16. Planning for the Future

Big decisions, like where to go to school, can be tricky. Think about what you want in the future. Look at the good and bad of each choice. Talk to people who know about it. Pick what feels best for your dreams and goals.

Job Examples

17. solving problems.

Workers brainstorm ways to fix a machine quickly without making things worse when a machine breaks at a factory.

18. Decision Making

A store manager decides which products to order more of based on what's selling best.

19. Setting Goals

A team leader helps their team decide what tasks are most important to finish this month and which can wait.

20. Evaluating Ideas

At a team meeting, everyone shares ideas for a new project. The group discusses each idea's pros and cons before picking one.

21. Handling Conflict

Two workers disagree on how to do a job. Instead of arguing, they talk calmly, listen to each other, and find a solution they both like.

22. Improving Processes

A cashier thinks of a faster way to ring up items so customers don't have to wait as long.

23. Asking Questions

Before starting a big task, an employee asks for clear instructions and checks if they have the necessary tools.

24. Checking Facts

Before presenting a report, someone double-checks all their information to make sure there are no mistakes.

25. Planning for the Future

A business owner thinks about what might happen in the next few years, like new competitors or changes in what customers want, and makes plans based on those thoughts.

26. Understanding Perspectives

A team is designing a new toy. They think about what kids and parents would both like instead of just what they think is fun.

School Examples

27. researching a topic.

For a history project, a student looks up different sources to understand an event from multiple viewpoints.

28. Debating an Issue

In a class discussion, students pick sides on a topic, like school uniforms, and share reasons to support their views.

29. Evaluating Sources

While writing an essay, a student checks if the information from a website is trustworthy or might be biased.

30. Problem Solving in Math

When stuck on a tricky math problem, a student tries different methods to find the answer instead of giving up.

31. Analyzing Literature

In English class, students discuss why a character in a book made certain choices and what those decisions reveal about them.

32. Testing a Hypothesis

For a science experiment, students guess what will happen and then conduct tests to see if they're right or wrong.

33. Giving Peer Feedback

After reading a classmate's essay, a student offers suggestions for improving it.

34. Questioning Assumptions

In a geography lesson, students consider why certain countries are called "developed" and what that label means.

35. Designing a Study

For a psychology project, students plan an experiment to understand how people's memories work and think of ways to ensure accurate results.

36. Interpreting Data

In a science class, students look at charts and graphs from a study, then discuss what the information tells them and if there are any patterns.

Critical Thinking Puzzles

Not all scenarios will have a single correct answer that can be figured out by thinking critically. Sometimes we have to think critically about ethical choices or moral behaviors. 

Here are some mind games and scenarios you can solve using critical thinking. You can see the solution(s) at the end of the post.

37. The Farmer, Fox, Chicken, and Grain Problem

A farmer is at a riverbank with a fox, a chicken, and a grain bag. He needs to get all three items across the river. However, his boat can only carry himself and one of the three items at a time. 

Here's the challenge:

• If the fox is left alone with the chicken, the fox will eat the chicken.
• If the chicken is left alone with the grain, the chicken will eat the grain.

How can the farmer get all three items across the river without any item being eaten? 

38. The Rope, Jar, and Pebbles Problem

You are in a room with two long ropes hanging from the ceiling. Each rope is just out of arm's reach from the other, so you can't hold onto one rope and reach the other simultaneously. 

Your task is to tie the two rope ends together, but you can't move the position where they hang from the ceiling.

You are given a jar full of pebbles. How do you complete the task?

39. The Two Guards Problem

Imagine there are two doors. One door leads to certain doom, and the other leads to freedom. You don't know which is which.

In front of each door stands a guard. One guard always tells the truth. The other guard always lies. You don't know which guard is which.

You can ask only one question to one of the guards. What question should you ask to find the door that leads to freedom?

40. The Hourglass Problem

You have two hourglasses. One measures 7 minutes when turned over, and the other measures 4 minutes. Using just these hourglasses, how can you time exactly 9 minutes?

41. The Lifeboat Dilemma

Imagine you're on a ship that's sinking. You get on a lifeboat, but it's already too full and might flip over. 

Nearby in the water, five people are struggling: a scientist close to finding a cure for a sickness, an old couple who've been together for a long time, a mom with three kids waiting at home, and a tired teenager who helped save others but is now in danger. 

You can only save one person without making the boat flip. Who would you choose?

42. The Tech Dilemma

You work at a tech company and help make a computer program to help small businesses. You're almost ready to share it with everyone, but you find out there might be a small chance it has a problem that could show users' private info. 

If you decide to fix it, you must wait two more months before sharing it. But your bosses want you to share it now. What would you do?

43. The History Mystery

Dr. Amelia is a history expert. She's studying where a group of people traveled long ago. She reads old letters and documents to learn about it. But she finds some letters that tell a different story than what most people believe. 

If she says this new story is true, it could change what people learn in school and what they think about history. What should she do?

The Role of Bias in Critical Thinking

Have you ever decided you don’t like someone before you even know them? Or maybe someone shared an idea with you that you immediately loved without even knowing all the details. 

This experience is called bias, which occurs when you like or dislike something or someone without a good reason or knowing why. It can also take shape in certain reactions to situations, like a habit or instinct. 

Bias comes from our own experiences, what friends or family tell us, or even things we are born believing. Sometimes, bias can help us stay safe, but other times it stops us from seeing the truth.

Not all bias is bad. Bias can be a mechanism for assessing our potential safety in a new situation. If we are biased to think that anything long, thin, and curled up is a snake, we might assume the rope is something to be afraid of before we know it is just a rope.

While bias might serve us in some situations (like jumping out of the way of an actual snake before we have time to process that we need to be jumping out of the way), it often harms our ability to think critically.

How Bias Gets in the Way of Good Thinking

Selective Perception: We only notice things that match our ideas and ignore the rest. 

It's like only picking red candies from a mixed bowl because you think they taste the best, but they taste the same as every other candy in the bowl. It could also be when we see all the signs that our partner is cheating on us but choose to ignore them because we are happy the way we are (or at least, we think we are).

Agreeing with Yourself: This is called “ confirmation bias ” when we only listen to ideas that match our own and seek, interpret, and remember information in a way that confirms what we already think we know or believe. 

An example is when someone wants to know if it is safe to vaccinate their children but already believes that vaccines are not safe, so they only look for information supporting the idea that vaccines are bad.

Thinking We Know It All: Similar to confirmation bias, this is called “overconfidence bias.” Sometimes we think our ideas are the best and don't listen to others. This can stop us from learning.

Have you ever met someone who you consider a “know it”? Probably, they have a lot of overconfidence bias because while they may know many things accurately, they can’t know everything. Still, if they act like they do, they show overconfidence bias.

There's a weird kind of bias similar to this called the Dunning Kruger Effect, and that is when someone is bad at what they do, but they believe and act like they are the best .

Following the Crowd: This is formally called “groupthink”. It's hard to speak up with a different idea if everyone agrees. But this can lead to mistakes.

An example of this we’ve all likely seen is the cool clique in primary school. There is usually one person that is the head of the group, the “coolest kid in school”, and everyone listens to them and does what they want, even if they don’t think it’s a good idea.

How to Overcome Biases

Here are a few ways to learn to think better, free from our biases (or at least aware of them!).

Know Your Biases: Realize that everyone has biases. If we know about them, we can think better.

Listen to Different People: Talking to different kinds of people can give us new ideas.

Ask Why: Always ask yourself why you believe something. Is it true, or is it just a bias?

Understand Others: Try to think about how others feel. It helps you see things in new ways.

Keep Learning: Always be curious and open to new information.

In today's world, everything changes fast, and there's so much information everywhere. This makes critical thinking super important. It helps us distinguish between what's real and what's made up. It also helps us make good choices. But thinking this way can be tough sometimes because of biases. These are like sneaky thoughts that can trick us. The good news is we can learn to see them and think better.

There are cool tools and ways we've talked about, like the "Socratic Questioning" method and the "Six Thinking Hats." These tools help us get better at thinking. These thinking skills can also help us in school, work, and everyday life.

We’ve also looked at specific scenarios where critical thinking would be helpful, such as deciding what diet to follow and checking facts.

Thinking isn't just a skill—it's a special talent we improve over time. Working on it lets us see things more clearly and understand the world better. So, keep practicing and asking questions! It'll make you a smarter thinker and help you see the world differently.

Critical Thinking Puzzles (Solutions)

The farmer, fox, chicken, and grain problem.

• The farmer first takes the chicken across the river and leaves it on the other side.
• He returns to the original side and takes the fox across the river.
• After leaving the fox on the other side, he returns the chicken to the starting side.
• He leaves the chicken on the starting side and takes the grain bag across the river.
• He leaves the grain with the fox on the other side and returns to get the chicken.
• The farmer takes the chicken across, and now all three items -- the fox, the chicken, and the grain -- are safely on the other side of the river.

The Rope, Jar, and Pebbles Problem

• Take one rope and tie the jar of pebbles to its end.
• Swing the rope with the jar in a pendulum motion.
• While the rope is swinging, grab the other rope and wait.
• As the swinging rope comes back within reach due to its pendulum motion, grab it.
• With both ropes within reach, untie the jar and tie the rope ends together.

The Two Guards Problem

The question is, "What would the other guard say is the door to doom?" Then choose the opposite door.

The Hourglass Problem

• Start both hourglasses. 
• When the 4-minute hourglass runs out, turn it over.
• When the 7-minute hourglass runs out, the 4-minute hourglass will have been running for 3 minutes. Turn the 7-minute hourglass over. 
• When the 4-minute hourglass runs out for the second time (a total of 8 minutes have passed), the 7-minute hourglass will run for 1 minute. Turn the 7-minute hourglass again for 1 minute to empty the hourglass (a total of 9 minutes passed).

The Boat and Weights Problem

Take the cat over first and leave it on the other side. Then, return and take the fish across next. When you get there, take the cat back with you. Leave the cat on the starting side and take the cat food across. Lastly, return to get the cat and bring it to the other side.

The Lifeboat Dilemma

There isn’t one correct answer to this problem. Here are some elements to consider:

• Moral Principles: What values guide your decision? Is it the potential greater good for humanity (the scientist)? What is the value of long-standing love and commitment (the elderly couple)? What is the future of young children who depend on their mothers? Or the selfless bravery of the teenager?
• Future Implications: Consider the future consequences of each choice. Saving the scientist might benefit millions in the future, but what moral message does it send about the value of individual lives?
• Emotional vs. Logical Thinking: While it's essential to engage empathy, it's also crucial not to let emotions cloud judgment entirely. For instance, while the teenager's bravery is commendable, does it make him more deserving of a spot on the boat than the others?
• Acknowledging Uncertainty: The scientist claims to be close to a significant breakthrough, but there's no certainty. How does this uncertainty factor into your decision?
• Personal Bias: Recognize and challenge any personal biases, such as biases towards age, profession, or familial status.

The Tech Dilemma

Again, there isn’t one correct answer to this problem. Here are some elements to consider:

• Evaluate the Risk: How severe is the potential vulnerability? Can it be easily exploited, or would it require significant expertise? Even if the circumstances are rare, what would be the consequences if the vulnerability were exploited?
• Stakeholder Considerations: Different stakeholders will have different priorities. Upper management might prioritize financial projections, the marketing team might be concerned about the product's reputation, and customers might prioritize the security of their data. How do you balance these competing interests?
• Short-Term vs. Long-Term Implications: While launching on time could meet immediate financial goals, consider the potential long-term damage to the company's reputation if the vulnerability is exploited. Would the short-term gains be worth the potential long-term costs?
• Ethical Implications : Beyond the financial and reputational aspects, there's an ethical dimension to consider. Is it right to release a product with a known vulnerability, even if the chances of it being exploited are low?
• Seek External Input: Consulting with cybersecurity experts outside your company might be beneficial. They could provide a more objective risk assessment and potential mitigation strategies.
• Communication: How will you communicate the decision, whatever it may be, both internally to your team and upper management and externally to your customers and potential users?

The History Mystery

Dr. Amelia should take the following steps:

• Verify the Letters: Before making any claims, she should check if the letters are actual and not fake. She can do this by seeing when and where they were written and if they match with other things from that time.
• Get a Second Opinion: It's always good to have someone else look at what you've found. Dr. Amelia could show the letters to other history experts and see their thoughts.
• Research More: Maybe there are more documents or letters out there that support this new story. Dr. Amelia should keep looking to see if she can find more evidence.
• Share the Findings: If Dr. Amelia believes the letters are true after all her checks, she should tell others. This can be through books, talks, or articles.
• Stay Open to Feedback: Some people might agree with Dr. Amelia, and others might not. She should listen to everyone and be ready to learn more or change her mind if new information arises.

Ultimately, Dr. Amelia's job is to find out the truth about history and share it. It's okay if this new truth differs from what people used to believe. History is about learning from the past, no matter the story.

Related posts:

• Experimenter Bias (Definition + Examples)
• Hasty Generalization Fallacy (31 Examples + Similar Names)
• Ad Hoc Fallacy (29 Examples + Other Names)
• Confirmation Bias (Examples + Definition)
• Equivocation Fallacy (26 Examples + Description)

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More From Forbes

The indispensable role of critical thinking in healthcare leadership.

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Dr. Hudson Garrett is the President and Chief Executive Officer of Community Health Associates , which is a leader in healthcare consulting.

In the fast-paced and complex landscape of healthcare, where decisions can have life-altering consequences, the value of critical thinking cannot be overstated. Critical thinking is not just a skill; it's a mindset—an essential tool for healthcare leaders to navigate uncertainty, make informed decisions and drive positive outcomes.

Understanding Critical Thinking In Healthcare

Critical thinking involves the ability to analyze, evaluate and synthesize information to form reasoned judgments and make sound decisions. In healthcare, where challenges are multifaceted and solutions are rarely straightforward, critical thinking enables leaders to:

1. Assess complex situations: Healthcare leaders encounter a myriad of complex challenges, from patient care decisions to organizational strategy. Critical thinking allows them to dissect these challenges, consider various perspectives and identify underlying issues to develop effective solutions.

2. Make informed decisions: Informed decision-making is paramount in healthcare, where outcomes directly impact patient well-being. Critical thinking empowers leaders to weigh evidence, anticipate consequences and choose the most appropriate course of action based on the available information and best practices.

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3. Promote innovation: Innovation drives progress in healthcare, from medical breakthroughs to operational efficiencies. Critical thinking encourages leaders to question conventional practices, explore alternative approaches and embrace new technologies to improve patient care and organizational performance. An organization must be committed to ongoing innovation both in process and in leadership development. This approach prevents stagnation and encourages growth at truly remarkable levels.

Putting Critical Thinking Into Practice

As a healthcare leader, I have witnessed firsthand the transformative power of critical thinking in addressing complex challenges and driving meaningful change. Here are three examples of how I've applied critical thinking in leadership.

1. Optimizing resource allocation: In a previous role as a department head, I faced the challenge of optimizing resource allocation to meet patient demand while managing budget constraints. Through critical thinking, I conducted a comprehensive analysis of patient flow, staff productivity and resource utilization. By identifying inefficiencies and implementing targeted interventions, such as workflow redesign and staff training initiatives, we were able to improve patient access, reduce wait times and maximize the efficiency of our resources.

2. Implementing quality improvement initiatives: In response to an increase in hospital-acquired infections, I spearheaded a quality improvement initiative aimed at reducing infection rates and enhancing patient safety. Through critical thinking, I led a multidisciplinary team in conducting root cause analyses, identifying contributing factors and developing evidence-based interventions. We then implemented standardized protocols, enhanced staff education and implemented robust surveillance systems, which helped us achieve a significant reduction in infection rates and improved patient outcomes.

3. Navigating ethical dilemmas: Healthcare leaders often encounter ethical dilemmas that require careful consideration and ethical decision-making. In a challenging scenario involving end-of-life care decisions, I relied on critical thinking to navigate conflicting interests, respect patient autonomy and uphold ethical principles. By facilitating open communication, engaging with patients and families and consulting with ethics committees, we were able to reach a consensus on a care plan that honored the patient's wishes and provided compassionate end-of-life care.

Building Your Critical Thinking Skills

I believe critical thinking has become a lost art in a way across healthcare and that modern medicine has, in many aspects, become algorithm-driven. This can create challenges when the patient or situation at hand does not fully fit into the box as defined by the algorithm. The ability to think strategically through a challenge and then leverage solutions in today's dynamic healthcare climate can prove to be invaluable.

Here are a few tips that I have personally found highly effective at addressing complex challenges while using a critical thinking methodology.

1. Start with the end in mind and establish your goal.

2. Remember that you are only able to control your reaction; you cannot directly control the challenge itself in many circumstances.

3. Think outside the box, and don't put constraints on your brainstorming. This will allow your creative juices to flow, and you will not find yourself constrained by guidelines.

4. Engage your trusted network of advisors. You can find tremendous strengths when you band together and bring in different perspectives, expertise and thoughts.

5. Never make assumptions about a solution. Just because it didn't work in the past doesn't mean it can't work now. Timing is everything.

Critical thinking is a fundamental competency for healthcare leaders. It enables them to effectively navigate complexity, drive innovation and promote excellence in patient care. By fostering a culture of critical thinking within healthcare organizations and drawing from personal examples to illustrate its practical application, leaders can enhance their decision-making capabilities, drive positive outcomes and, ultimately, improve the delivery of healthcare services to those who need it most.

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Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit

Margaret m. hayes.

1 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

2 Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and

Souvik Chatterjee

3 Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Massachusetts

Richard M. Schwartzstein

Associated data.

Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit. The five strategies are: make the thinking process explicit by helping learners understand that the brain uses two cognitive processes: type 1, an intuitive pattern-recognizing process, and type 2, an analytic process; discuss cognitive biases, such as premature closure, and teach residents to minimize biases by expressing uncertainty and keeping differentials broad; model and teach inductive reasoning by utilizing concept and mechanism maps and explicitly teach how this reasoning differs from the more commonly used hypothetico-deductive reasoning; use questions to stimulate critical thinking: “how” or “why” questions can be used to coach trainees and to uncover their thought processes; and assess and provide feedback on learner’s critical thinking. We believe these five strategies provide practical approaches for teaching critical thinking in the intensive care unit.

Critical thinking, the capacity to be deliberate about thinking and actively assess and regulate one’s cognition ( 1 – 4 ), is an essential skill for all physicians. Absent critical thinking, one typically relies on heuristics, a quick method or shortcut for problem solving, and can fall victim to cognitive biases ( 5 ). Cognitive biases can lead to diagnostic errors, which result in increased patient morbidity and mortality ( 6 ).

Diagnostic errors are the number one cause of medical malpractice claims ( 7 ) and are thought to account for approximately 10% of in-hospital deaths ( 8 ). Many factors contribute to diagnostic errors, including cognitive problems and systems issues ( 9 ), but it has been shown that cognitive errors are an important source of diagnostic error in almost 75% of cases ( 10 ). In addition, a recent report from the Risk Management Foundation, the research arm of the malpractice insurer for the Harvard Medical School hospitals, labeled more than half of the malpractice cases they evaluated as “assessment failures,” which included “narrow diagnostic focus, failure to establish a differential diagnosis, [and] reliance on a chronic condition of previous diagnosis ( 11 ).” In light of these data and the Institute of Medicine’s 2015 recommendation to “enhance health care professional education and training in the diagnostic process ( 8 ),” we present this framework as a practical approach to teaching critical thinking skills in the intensive care unit (ICU).

The process of critical thinking can be taught ( 3 ); however, methods of instruction are challenging ( 12 ), and there is no consensus on the most effective teaching model ( 13 , 14 ). Explicit teaching about reasoning, metacognition, cognitive biases, and debiasing strategies may help avoid cognitive errors ( 3 , 15 , 16 ) and enhance critical thinking ( 17 ), but empirical evidence to inform best educational practices is lacking. Assessment of critical thinking is also difficult ( 18 ). However, because it is of paramount importance to providing high-quality, safe, and effective patient care, we believe critical thinking should be both explicitly taught and explicitly assessed ( 12 , 18 ).

Critical thinking is particularly important in the fast-paced, high-acuity environment of the ICU, where medical errors can lead to serious harm ( 19 ). Despite the paucity of data to support an educational gold standard in this field, we propose five strategies, based on educational principles, we have found effective in teaching critical thinking in the ICU ( Figure 1 ). These strategies are not dependent on one another and often overlap. Using the following case scenario as an example for discussion, we provide a detailed explanation, as well as practical tips on how to employ these strategies.

A 45-year-old man with a history of hypertension presents to the emergency department with fatigue, sore throat, low-grade fever, and mild shortness of breath. On arrival to the emergency department, his heart rate is 110 and his blood pressure is 90/50 mm Hg. He is given 2 L fluids, but his blood pressure continues to fall, and norepinephrine is started. Physical examination is normal with the exception of dry mucous membranes. Laboratory studies performed on blood samples obtained before administration of intravenous fluid show: white blood cell count, 6.0 K/uL; hematocrit, 35%; lactate, 0.8 mmol/L; blood urea nitrogen, 40 mg/dL; and creatinine, 1.1 mg/dL. A chest radiograph shows no infiltrates. He is admitted to the medical intensive care unit. Attending: What is your assessment of this patient? Resident: This is a 45-year-old male with a history of hypertension who was sent to us from the emergency department with sepsis. Attending: That is interesting. I am puzzled: What is the source of infection? And how do you account for the low hematocrit in an essentially healthy man whom you believe to be volume depleted? Resident: Well, maybe pneumonia will appear on the X-ray in the next 24 hours. With respect to the hematocrit...I’m not really sure.

Five strategies to teach critical thinking skills in a critical care environment.

Strategy 1: Make the “Thinking Process” Explicit

In the ICU, many attendings are satisfied with the trainee simply putting forth an assessment and plan. In the case presented here, the resident’s assessment that the patient has sepsis is likely based on the resident remembering a few facts about sepsis (i.e., hypotension is not responsive to fluids) and recognizing a pattern (history of possible infection + fever + hypotension = sepsis). With this information, we may determine that the learner is operating at the lowest level of Bloom’s taxonomy: remembering ( 20 ) ( Figure 2 ), in this case, she seems to be using reflexive or automatic thought. In a busy ICU, it is tempting for the attending to simply overlook the response and proceed with one’s own plan, but we should be expecting more. As indicated in the attending’s response, we should make the thinking process explicit and push the resident up Bloom’s taxonomy: to describe, explain, apply, analyze, evaluate, and ultimately create ( 20 ) ( Figure 2 ).

The revised Bloom’s taxonomy. This schematic, first created in 1956, depicts six levels of the cognitive domain. Remembering is the lowest level; creating is the highest level. Adapted from Anderson and Krathwol ( 20 ).

Faculty members should probe the thought process used to arrive at the assessment and encourage the resident to think about her thinking; that is, to engage in the process of metacognition. We recommend doing this in real time as the trainee is presenting the case by asking “how” and “why” questions (see strategy 4).

Attending: Why do you think he has sepsis? Resident: Well, he came in with infectious symptoms. Also, his blood pressure is quite low, and it only improved slightly with fluids in the emergency department. Attending: Okay, but how is blood pressure generated? How could you explain hypotension using other data in the case, such as the low hematocrit?

If the trainee is encouraged to think about her thinking, she may conclude that she was trying to force a “pattern” of sepsis, perhaps because she frequently sees patients with sepsis and because the emergency department framed the case in that way. It is possible that she does not have enough experience in the ICU or specific knowledge about sepsis to accurately assess this patient; in the actual case, a third-year resident with significant ICU experience ultimately admitted to defaulting to pattern recognition.

One way to push learners up Bloom’s taxonomy is to help them understand dual-process theory: the idea that the brain uses two thinking processes, type 1 and type 2 (alternately known as system 1 and system 2). Type 1 thinking is the more intuitive process of decision making; type 2 is an analytical process ( 17 , 21 , 22 ). Type 1 thinking is immediate and unconscious, and the hallmark is pattern recognition; type 2 is deliberate and effortful ( 17 ).

Critical thinkers understand and recognize the dual processes ( 21 ) and the fact that type I thinking is common in their daily lives. Furthermore, they acknowledge that type 1 reasoning, which is often automatic and unconscious, can be prone to error. There is a paucity of data linking cognitive errors to the particular type of thinking ( 14 ), but many of these studies are plagued by the fact that they do not test the atypical pattern. As a consequence, they do not truly test the hypothesis that type 2 reasoning will reduce error in more complex cases. It has been shown that combining type 1 and type 2 thinking improves diagnostic accuracy compared with just using one method versus another ( 23 ). We believe that helping learners understand how their minds work will help them recognize when they may be falling into pattern recognition and when this will be problematic (e.g., when there are discordant data, or one can only quickly think of one diagnosis). By expecting more from our learners, by compelling them to understand, analyze, and evaluate, we must provide constant feedback and coaching to help them develop, and we must ask the right questions (see strategy 4) to guide them.

Strategy 2: Discuss Cognitive Biases and De-Biasing Strategies

Cognitive biases are thought patterns that deviate from the typical way of decision making or judging ( 24 ). These occur commonly when we are under stress or time constrained when making decisions. At this time, there are more than 100 described cognitive biases, some of which are more common in medicine than others ( 25 ). We believe that the six outlined in Table 1 are particularly prevalent in the ICU.

Six common biases frequently used in the intensive care unit

The definitions of these biases are based on their application and use in clinical medicine. Table adapted from Croskerry ( 6 ), Croskerry ( 27 ), and Hogarth ( 37 ).

Although there are many proponents of teaching cognitive biases ( 6 ), there are no studies showing that teaching these to trainees improves their clinical decision making ( 14 ), again recognizing that research in this area has often not focused on the scenarios in which cognitive bias is likely to lead to error. Most cognitive biases are quiescent until the right scenario presents itself ( 26 ), which makes them difficult to study in the clinical context. Imagine an overworked, tired resident in a busy ICU or one who received an incomplete sign-out or felt pressure from the system to make a quick decision to move along patient care. These scenarios occur daily in the ICU; as a consequence, we believe that teaching residents how to recognize biases and giving them strategies to debias is important.

The resident in the clinical scenario outlined here is falling prey to many biases in her assessment that the patient has sepsis. First, it is likely that on her ICU rotation she has seen many patients with sepsis, and thus sepsis is a diagnosis that is easily available to her mind (availability bias). Next, she is falling victim to confirmation bias: The presence of hypotension supports a diagnosis of sepsis and is disproportionately appreciated by the trainee compared with a white blood cell count of 6,000, which does not easily fit with the diagnosis and is ignored. Next, she anchors and prematurely closes on the diagnosis of sepsis and does not look for other possible explanations of hypotension. The resident does not realize that she is subject to these biases; explicitly discussing them will help her understand her thinking process, enable her to recognize when she may be jumping to conclusions, and help her identify when she must switch to type 2 thinking.

Attending: Why do you think he has sepsis? Resident: Well, he came in with infectious symptoms. Also, his blood pressure is quite low, and it did not improve with fluids in the emergency department. This is similar to the other patient with sepsis. Attending: I can see why sepsis easily comes to your mind, as we have recently admitted three other patients with sepsis. These patients had similar features to this patient, so your mind is jumping to that conclusion, but if we stop and think together about what pieces of the case don’t fit with sepsis, we may come up with a different diagnosis. Resident: Well, the lack of leukocytosis doesn’t make sense. Attending: Yes! I agree, that is a bit odd. Let’s broaden our differential and not anchor on sepsis. What else could this be?

Cognitive forcing strategies ( 16 ), the process of making trainees aware of their cognitive biases and then developing strategies to overcome the bias, may help this resident. Studies show that debiasing can be taught to emergency medicine trainees ( 27 ), and we believe it can also be taught to critical care trainees, who experience a similar fast-paced and high-stakes learning environment. Proposed debiasing strategies include encouraging trainees to consider alternative diagnoses ( 3 , 6 , 27 , 28 ) and promoting broad differentials. In particular, they need to be able to rethink cases when confronted with information that is not consistent with the working diagnosis; for example, leukocytosis, as above. They should be allowed to communicate their level of uncertainty, and we should not think less of them if they do not have a single final answer with a targeted plan ( 29 ). When we do not discuss inconsistent information, we essentially give trainees permission to ignore it.

Attending: In addition to the white blood cell count not fitting, I’m also struggling with the hematocrit: How is it 35% in the setting of presumed decreased intravascular volume? Resident: Hmm.... I’m actually not sure. You’re right, though, it doesn’t make sense. Attending: I agree. Let’s pause and think about how we are thinking about this case .

To a large degree, recognition of cognitive bias requires metacognition, defined as thinking about one’s thinking ( 3 , 16 , 27 ). This process is optimized with a familiarity with how the mind works; that is, a basic understanding of dual-process theory and cognitive biases. In the ICU, we find it easiest to engage in a group metacognition exercise. The attending asks, “How are we thinking about this case?” This allows both the attending and the team to reflect together on how and why the diagnosis has been made. This can provide insight into the tendency to prematurely close or limit considerations, which has been shown to be the most common cause of inaccurate clinical synthesis ( 10 ).

Other debiasing strategies include accountability ( 6 ) and feedback ( 25 , 30 ). Giving specific and in-the-moment feedback can help residents understand their decisions ( 25 ). It is our job as attendings to provide this feedback, and it is thought that this is one of the most effective debiasing strategies ( 25 ).

Strategy 3: Model and Teach Inductive Reasoning

In medicine, we classically teach clinical reasoning via the hypothetico-deductive strategy ( 31 ) and rarely discuss inductive reasoning. To date, there are no data proving the advantages of one strategy over another, but we believe that modeling inductive reasoning is an important part of critical thinking, especially when type 1 thinking provides limited answers. In hypothetico-deductive reasoning, physicians make a cognitive jump from a few facts to hypotheses framed as a differential diagnosis from which one then deduces characteristics that are matched to the patient ( 32 ). Because this way of thinking relies on memory and pattern recognition, we find that it is more subject to cognitive biases, including premature closure, than inductive reasoning.

In our case, the presence of hypotension leads the trainee to come up with a differential based primarily on that single observation; the resident thinks of diagnoses such as sepsis or cardiogenic shock. Contrast this way of thinking with inductive reasoning, which proceeds in an orderly way from multiple facts to hypotheses ( 32 ). In our case, putting together the facts of hypotension, decreased hematocrit, and elevated blood urea nitrogen/creatinine would lead to a broader list of possible explanations or hypotheses that would include bleeding (see Figure 3 to compare and contrast inductive and deductive reasoning). We propose that this way of thinking is grounded more deeply in pathophysiology, and we believe it leads to broader thinking, because trainees do not have to rely on memory, pattern recognition, or heuristics; rather, they can reason their way through the problem via an understanding of basic mechanisms of health and disease.

Schematic representations of deductive ( 1 ) and inductive ( 2 ) reasoning apropos to the clinical case. In deductive reasoning, one fact ( F ; hypotension ) is used to generated multiple hypotheses ( H ), and then facts that pertain to each are retrofitted ( red F* ; fever ). In inductive reasoning, facts are grouped and used to generate hypotheses. Adapted from Pottier ( 32 ).

Inductive reasoning can be practiced using both mechanism and concept maps. Mechanism maps are a visual representation of how the pathophysiology of disease leads to the clinical symptoms ( 33 ), whereas concept maps graphically represent relationships between multiple concepts ( 33 ) and make links explicit. Both types reinforce mechanistic thinking and can be used as tools to avoid cognitive biases. Using our case as an example, if the resident started with the hypotension and made a mechanism ( Figure 4A ) or concept ( Figure 4B ) map, she would be less likely to anchor on the diagnosis of sepsis. This process gives trainees a strategy to broaden their differential and a way to think about the case when they do not know what is going on.

( A ) A mechanism map of a 45-year-old man presenting with cough, shortness of breath. Found to have an increased BUN/Cr ration, a decreased hematocrit, and a normal white blood cell count. ( B ) A concept map of the clinical case. AFib = atrial fibrillation; BUN/Cr = blood urea nitrogen to creatinine ratio; CAD = coronary artery disease; CO/Q = cardiac output; CVP = central venous pressure; CXR = chest X-ray; GI = gastrointestinal; HR = heart rate; Hx HTN = history of hypertension; MAP = mean arterial pressure; RV = right ventricle; SV = stroke volume; SVR = systemic vascular resistance; WBC = white blood cell.

Although critics contend that these maps take time and do not have a place in the ICU, we find that quickly sketching a mechanism map on rounds while the case is being presented only takes 1–2 minutes and is a powerful way of making your method of clinical reasoning explicit to the learner. This can also be done later as a way to review pathophysiology. We hold monthly concept mapping sessions for our students ( 34 ) to improve their clinical reasoning skills, but find that in the ICU with residents, doing this quickly in real time with a mechanism map is more effective.

Strategy 4: Use Questions to Stimulate Critical Thinking

Questions can be used to engage the learners and inspire them to think critically. When questioning trainees, it is important to avoid the “quiz show” type questions that just test whether a trainee can recall a fact (e.g., “What is the most common cause of X”?). In our current advanced technological age, answers to this type of question reveal less about thinking abilities than how adept one is at searching the internet. These questions do not provide insight into the trainee’s understanding but can, we fear, subtly emphasize that the practice of medicine is about memorization, rather than thinking. In addition, this type of question is often perceived by the trainee as “pimping.” This can belittle the trainee while securing the attending physician’s place of power ( 35 ) and create a hostile learning environment.

Attending: Why do you think this patient is hypotensive? Attending: How does the BUN/creatinine ratio relate to the hypotension? Attending: How would you expect the intravascular volume depletion to affect his hematocrit?

Questions like these allow the trainee to elaborate on her knowledge, which feels much safer to the learner and provides the attending insight into her thinking.

Resident: If my theory of sepsis were correct, I would think the patient would be intravascularly dry and have a higher hematocrit. The fact that it is only 35% and that his BUN/creatinine ratio is consistent with a prerenal picture is making me worried that maybe the hypotension is not from sepsis but, rather, from bleeding. I think we need to evaluate for gastrointestinal bleeding.

When the right questions are used to coach the resident, her thought processes are uncovered and she can be guided to the correct diagnosis. Although experience and domain-specific knowledge are important, data indicate that in the majority of malpractice cases involving diagnostic error, the problem is not that the doctor did not know the diagnosis; rather, she did not think of it. Reasoning, rather than knowledge, is key to avoiding mistakes in cases with confounding data.

Strategy 5: Assess Your Learner’s Critical Thinking

It is difficult, but necessary for trainee development, to assess critical thinking ( 18 ). Milestones, ranging from challenged and unreflective thinkers to accomplished critical thinkers, have been proposed ( 18 ). This approach is helpful not only for providing feedback to trainees on their critical thinking but also to give the trainees a framework to guide reflection on how they are thinking (see Table 2 for a description of the milestones).

Milestones of critical thinking and the descriptions of each stage

Note that “Challenged thinker” is in italics because any thinker can be challenged as a result of environmental pressures or time constraints. Adapted from Papp ( 18 ).

It is important to note that anyone, even accomplished critical thinkers, can become “challenged critical thinkers” when the environment precludes critical thinking. This is particularly relevant in critical care. In a busy ICU, one is often faced with time pressure, which contributes to premature closure. In our case presented earlier, perhaps the resident had limited time to admit this patient, and thus settled on the diagnosis of sepsis. It is our hope that teaching trainees to recognize this risk will lead to fewer cognitive biases. Imagine a different exchange between faculty and resident:

Attending: How are you doing with the new admission? How are you thinking about the case? Resident: I’m concerned this is sepsis, but there are few pieces that don’t fit. However, given the two other admissions and the cardiac arrest on the floor who is heading our way, I haven’t been able to give this case as much thought as I would like to. Attending: Okay, do you want to work through the case together? Or could I help with some other tasks so you have more time to think about this?

This type of response reflects a practicing critical thinker: one who is aware of her limitations and thinking processes. This can only occur, however, if the attending creates an environment in which critical thinking is valued by making a safe space and asking the right questions.

Conclusions

The ICU is a high-acuity, fast-paced, and high-stakes environment in which critical thinking is imperative. Despite the limited empirical evidence to guide faculty on best teaching practices for enhancing reasoning skills, it is our hope that these strategies will provide practical approaches for teaching this topic in the ICU. Given how fast medical knowledge grows and how rapidly technology allows us to find factual information, it is important to teach enduring principles, such as how to think.

Our job in the ICU, where literal life-and-death decisions are made daily, is to teach trainees to focus on how we actually think about problems and to uncover cognitive biases that cause flawed thinking and may lead to diagnostic error. The focus of the preclerkship curriculum at the undergraduate level is increasingly moving away from transfer of content to application of knowledge ( 36 ). When teaching residents and fellows, faculty should also emphasize thinking skills by making the thinking process explicit, discussing cognitive biases, and debiasing strategies, modeling and teaching inductive reasoning, using questions to stimulate curiosity, and assessing critical thinking skills.

As Albert Einstein said, “Education... is not the learning of facts, but the training of the mind to think...” ( 38 ).

Supplementary Material

Author Contributions : M.M.H. contributed to manuscript drafting, figure creation, and editing; S.C. contributed to figure creation, critical review, and editing; and R.M.S. contributed to figure creation, critical review, and editing.

Author disclosures are available with the text of this article at www.atsjournals.org .

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Critical Thinking: A Simple Guide and Why It’s Important

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Critical Thinking: A Simple Guide and Why It’s Important was originally published on Ivy Exec .

Strong critical thinking skills are crucial for career success, regardless of educational background. It embodies the ability to engage in astute and effective decision-making, lending invaluable dimensions to professional growth.

At its essence, critical thinking is the ability to analyze, evaluate, and synthesize information in a logical and reasoned manner. It’s not merely about accumulating knowledge but harnessing it effectively to make informed decisions and solve complex problems. In the dynamic landscape of modern careers, honing this skill is paramount.

The Impact of Critical Thinking on Your Career

☑ problem-solving mastery.

Visualize critical thinking as the Sherlock Holmes of your career journey. It facilitates swift problem resolution akin to a detective unraveling a mystery. By methodically analyzing situations and deconstructing complexities, critical thinkers emerge as adept problem solvers, rendering them invaluable assets in the workplace.

☑ Refined Decision-Making

Navigating dilemmas in your career path resembles traversing uncertain terrain. Critical thinking acts as a dependable GPS, steering you toward informed decisions. It involves weighing options, evaluating potential outcomes, and confidently choosing the most favorable path forward.

☑ Enhanced Teamwork Dynamics

Within collaborative settings, critical thinkers stand out as proactive contributors. They engage in scrutinizing ideas, proposing enhancements, and fostering meaningful contributions. Consequently, the team evolves into a dynamic hub of ideas, with the critical thinker recognized as the architect behind its success.

☑ Communication Prowess

Effective communication is the cornerstone of professional interactions. Critical thinking enriches communication skills, enabling the clear and logical articulation of ideas. Whether in emails, presentations, or casual conversations, individuals adept in critical thinking exude clarity, earning appreciation for their ability to convey thoughts seamlessly.

☑ Adaptability and Resilience

Perceptive individuals adept in critical thinking display resilience in the face of unforeseen challenges. Instead of succumbing to panic, they assess situations, recalibrate their approaches, and persist in moving forward despite adversity.

☑ Fostering Innovation

Innovation is the lifeblood of progressive organizations, and critical thinking serves as its catalyst. Proficient critical thinkers possess the ability to identify overlooked opportunities, propose inventive solutions, and streamline processes, thereby positioning their organizations at the forefront of innovation.

☑ Confidence Amplification

Critical thinkers exude confidence derived from honing their analytical skills. This self-assurance radiates during job interviews, presentations, and daily interactions, catching the attention of superiors and propelling career advancement.

So, how can one cultivate and harness this invaluable skill?

✅ developing curiosity and inquisitiveness:.

Embrace a curious mindset by questioning the status quo and exploring topics beyond your immediate scope. Cultivate an inquisitive approach to everyday situations. Encourage a habit of asking “why” and “how” to deepen understanding. Curiosity fuels the desire to seek information and alternative perspectives.

✅ Practice Reflection and Self-Awareness:

Engage in reflective thinking by assessing your thoughts, actions, and decisions. Regularly introspect to understand your biases, assumptions, and cognitive processes. Cultivate self-awareness to recognize personal prejudices or cognitive biases that might influence your thinking. This allows for a more objective analysis of situations.

✅ Strengthening Analytical Skills:

Practice breaking down complex problems into manageable components. Analyze each part systematically to understand the whole picture. Develop skills in data analysis, statistics, and logical reasoning. This includes understanding correlation versus causation, interpreting graphs, and evaluating statistical significance.

✅ Engaging in Active Listening and Observation:

Actively listen to diverse viewpoints without immediately forming judgments. Allow others to express their ideas fully before responding. Observe situations attentively, noticing details that others might overlook. This habit enhances your ability to analyze problems more comprehensively.

✅ Encouraging Intellectual Humility and Open-Mindedness:

Foster intellectual humility by acknowledging that you don’t know everything. Be open to learning from others, regardless of their position or expertise. Cultivate open-mindedness by actively seeking out perspectives different from your own. Engage in discussions with people holding diverse opinions to broaden your understanding.

✅ Practicing Problem-Solving and Decision-Making:

Engage in regular problem-solving exercises that challenge you to think creatively and analytically. This can include puzzles, riddles, or real-world scenarios. When making decisions, consciously evaluate available information, consider various alternatives, and anticipate potential outcomes before reaching a conclusion.

✅ Continuous Learning and Exposure to Varied Content:

Read extensively across diverse subjects and formats, exposing yourself to different viewpoints, cultures, and ways of thinking. Engage in courses, workshops, or seminars that stimulate critical thinking skills. Seek out opportunities for learning that challenge your existing beliefs.

✅ Engage in Constructive Disagreement and Debate:

Encourage healthy debates and discussions where differing opinions are respectfully debated.

This practice fosters the ability to defend your viewpoints logically while also being open to changing your perspective based on valid arguments. Embrace disagreement as an opportunity to learn rather than a conflict to win. Engaging in constructive debate sharpens your ability to evaluate and counter-arguments effectively.

✅ Utilize Problem-Based Learning and Real-World Applications:

Engage in problem-based learning activities that simulate real-world challenges. Work on projects or scenarios that require critical thinking skills to develop practical problem-solving approaches. Apply critical thinking in real-life situations whenever possible.

This could involve analyzing news articles, evaluating product reviews, or dissecting marketing strategies to understand their underlying rationale.

In conclusion, critical thinking is the linchpin of a successful career journey. It empowers individuals to navigate complexities, make informed decisions, and innovate in their respective domains. Embracing and honing this skill isn’t just an advantage; it’s a necessity in a world where adaptability and sound judgment reign supreme.

So, as you traverse your career path, remember that the ability to think critically is not just an asset but the differentiator that propels you toward excellence.