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C HAP T E R 7

The Importance
of Critical Thinking
Learning Objectives
After completing this chapter, the student should be able to:

1. Define critical thinking.

2. Discuss the importance of developing critical thinking skills.
3. Demonstrate the skills of a creative thinker.

Creativity comes from “Action out of the critical thinking activities. You may pick the
center of one’s own experience” coupled most boring class on campus, give an unsatis-
factory oral presentation, or say something awk-
with the responsibility to receive both
ward in a nursing class, but you will learn from
consequence and happiness. each experience and use this knowledge to make
—KNODAL better decisions in the future. Learning critical
The term “critical thinking” may be new to you. thinking skills so that you can apply them to
Perhaps you are wondering how critical thinking clinical nursing should be a powerful motivation
differs from just plain thinking. Being a critical for you to learn them well. You need critical
thinker is the hallmark of being an educated per- thinking ability to be able to think through
son. People who do not think critically generally a patient emergency or other patient-related
are obedient to what is asked of them; they con- problems. If you don’t have critical thinking
sider neither the consequences of their actions abilities, there is a high probability that you will
nor alternatives. Living in a modern society, we harm a patient.
are presented with unlimited choices about who
to be, what to buy, and what to do. We have to What Is Critical Thinking?
make decisions, and so we must learn the skills
of critical thinking. You are taking care of an older patient ready to
In school, you are given many opportunities be discharged from your hospital who will
to develop and use critical thinking skills. When require daily dressing changes as well as the
you register for your classes, write a paper, make coordination of multiple medications. When his
an oral presentation, or simply think through a spouse comes to take him home, you notice that
problem, you are participating in school-related she has severe arthritis in her hands. When

97
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98 CHAPTER 7 | The Importance of Critical Thinking

giving her the discharge papers to sign, she

states “Show me where to sign, I can’t see very BOX 7-1
well.” The charge nurse told you this patient is
ready to go home, but you are concerned that Aspects of Critical Thinking
your patient will not have the support at home 1. Thinking beyond the known information
he will need to manage his dressing changes and 2. Considering options
medications. You recognize that your patient is 3. Looking at information from multiple
going to need additional resources to meet his sources
health needs, so you speak with the patient to
4. Identifying patterns and relationships
see if he has other family in the area who can as-
sist with his care. You also consult with the so- 5. Integrating information from various
cial worker and charge nurse to see if your sources
patient would qualify for follow-up care through
a home care agency. Finally, you do some re-
search to find other community resources avail-
able to assist your patient. REFLECTIVE THINKING
By asking questions and looking for alterna- Record in your class notebook a time when
tives, you find out that the patient has an adult you were a critical thinker. The experience
son who is willing to assist his father. You help could have been when you were a child,
the family make arrangements for home care to new parent, or a nursing assistant. It was a
do the daily dressing changes and monitor his time when you thought “outside of the box.”
medication schedule. There is also a community What happened to you when you thought
the problem or concern through and arrived
organization that will send a volunteer to assist
at a place different from any place you had
your patient with his personal care. You now feel
gone to before in your mind? Describe the
comfortable discharging your patient. This is an experience and how you felt about it. Be
example of critical thinking. prepared to share it in classroom discussion.
People demonstrate critical thinking when
they show the ability (1) to think beyond what
has been said or shown to them, (2) to consider
Critical thinking allows you to move beyond
options related to the information they have
the here and now and build new realities. Do you
received, and (3) to evaluate and make decisions
remember studying Christopher Columbus?
based on multiple sources of information. Do
Among other things, he had the courage to sail
you make mental connections? Forge links in
to the edge of a flat world. We now know the
your mind? Go beyond the given? See patterns,
world is round, but Columbus didn’t. He had a
relationships, and context? Such mental abilities
vision, however; he had listened to other sailors
can be learned, making critical thinking a normal
and studied maps, and he critically examined all
part of your thought process.
of the information he received. Then he sailed on
In nursing school, you learn about medica-
a world that was round instead of flat. Other er-
tions, and you learn about the individuality
roneous thoughts that have occurred throughout
of people. If you are unable to think of alterna-
history include the following:
tives for a patient who is having a serious drug
reaction based on his or her individual metab- 1. “Bleeding” people will make them better.
olism, the patient will suffer from your inability 2. Illnesses result from an imbalance in the
to integrate information, which is one aspect four vital fluids: blood, phlegm, water,
of critical thinking (Box 7-1). Critical thinking and bile.
is much more than knowing the facts to pass
3. Blood originated in the liver where it was
a test. It is knowing the facts and being able
mixed with air.
to apply them accurately, with an awareness
of personhood for each individual. Being able 4. Fingernails continue to grow after you die.
to think critically is one attribute of a compe- 5. Going outside in the cold will make
tent nurse. you sick.
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CHAPTER 7 | The Importance of Critical Thinking 99

As a student nurse, you are not spending generally is at odds with thorough thinking.
hours each week learning to “bleed” patients be- In all probability, you need to talk to people,
cause someone looked at the procedure and had check your facts from a book, and spend time
an idea about doing it differently. Critical think- pondering if you are going to make the right
ing is a path to freedom from half-truths and de- decision on a complex issue. Thorough thinking
ception. It is the path to defining and redesigning does not allow for immediate “yes” or “no”
concepts of truth. responses. In answer to requests for an imme-
diate decision, you need to develop the courage
Thorough Thinking to say, “I don’t know.” Then find out what the
answer is by applying thorough thinking. Just
Many people respond negatively to the term crit- as skilled students are thorough thinkers, so are
ical thinking. Perhaps you could consider replac- skilled nurses.
ing it with the term thorough thinking. I am not
sure the term should be replaced, but thorough Thorough or Critical Thinking
thinking is a concept well worth exploring. Both as Applied to Science
terms are valuable. When you consider a moral
dilemma, you need to do thorough thinking. You Consider the following: Most famous scientists
are asked to examine values for yourself and the and mathematicians probably made lucky guesses
patient, look at all possible options, consider the at one time or another about the truths they’re
alternatives, and make a decision that could be credited with discovering. The reason for their
evaluated after it had been implemented. This is fame is that they were able to prove their discov-
an example of thorough thinking. It is neither eries to others. You may experience an important
“gut” reaction response nor unquestioningly fol- insight, but unless you can prove to others that it’s
lowing the rules. It is complex, takes time, and new as well as valid, not many people are going
considers the needs of all persons in the situation. to accept it. Insights, no matter how profound
The modern world is fast-paced. It asks us they may be to those who experience them, must
to make decisions almost immediately, which be backed up by evidence.

FOCUSED LEARNING CHART

Thorough Thinking Is an Essential
Aspect of Critical Thinking
DO DO NOT
Look at all possible options. Use your gut reaction as a solution.
Consider at least three alternatives or Unquestioningly follow the rules.
possible solutions.
Have the courage to say “I don’t know.” Respond to the pressures of our fast-
paced society for quick decisions.
Take the time to determine the most
effective solution to a problem by
checking with others, doing a literature
review, and spending time thinking
about it.
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100 CHAPTER 7 | The Importance of Critical Thinking

Basic college geometry is modeled on prin- I saw Halley’s comet in 1986, which was the
ciples developed 23 centuries ago by the Greek last time it appeared. It was beautiful, and my
mathematician, Euclid, often referred to as the appreciation for it increased when I realized a
“Father of Geometry.” He defined his terms man who didn’t have a computer or modern
carefully and proposed statements that were telescopes defined the comet’s motions in the
readily acceptable to the scientific community 1600s. What Halley did with the resources avail-
of his day. Every carpenter and mechanic today able to him is amazing. His finest resource was
recognizes that the sum of the angles of a his mind.
triangle must equal two right angles and must
total 180 degrees. The applied science of Thorough or Critical Thinking
surveying is based in great measure on the as Applied to Nursing
truths of Euclid.
The astronomer Edmund Halley, for whom Thorough thinking has strong roots in the growth
a comet was named, observed his comet in and refinement of nursing as a profession. Flo-
1682 and recorded data concerning its motion rence Nightingale was a statistician, innovator,
through the solar system. Based on these data, and teacher. She took women who were poor and
Halley concluded, in a work published in 1705, abused and envisioned what an education could
that the comet would return at approximately do for them. Then she gave them the education
75-year intervals. Using both his own observa- they needed to be nurses. Nightingale’s vision
tions and the work on gravitation published developed into schools of nursing throughout
by the physicist-philosopher Isaac Newton, Great Britain and the United States. When
Halley was able to infer that the comet would Nightingale went to Kaiserworth School of
return sometime in December 1758. Halley died Nursing in Germany, she spent her first few
in 1743, but 15 years later, on Christmas Day weeks learning how to scrub floors. Such were
1758, the comet appeared. What a success, and the duties and limitations of nurses during that
what a triumph for reason! Halley’s observa- era. Nightingale foresaw a different era and edu-
tions, coupled with Newton’s theory, taken as cated women to come in contact with patients
axioms and postulates, allowed him to calculate and administer care. She developed an entirely
a prediction accurate to 1 month in 75 years. new type of nursing.
The motion of comets, which previously had When Jean Watson critically reviewed nurs-
been considered erratic and even mysterious, ing in the medical model and believed it was
was resolved to a system of laws that could lacking the principles inherent to every nurse, she
predict their behavior. was referring to holistic care. Watson’s work de-
veloped the concept of nursing as a profession
that could define its own practice rather than a
profession that modeled itself after medicine.
The point of this chapter is not simply to teach
you how to gain and use knowledge but rather to
use original thinking to create new knowledge.
Critical thinking is thorough thinking, which
cannot be done well without the skill of creative
thinking.
Have you ever had the “aha” experience in
your education? The “aha” is that moment when,
as a nurse, you pick up symptoms that no one
else did. It could also be a teacher finding the
perfect topic to engage a student in research, or
a parent finally understanding a child’s behavior.
Halley’s comet makes its appearance every The “aha” experience comes from thinking cre-
75 years. (Source: Courtesy of Mt. Wilson atively and critically so that a new idea—one you
Observatory.) have never had before—emerges.
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CHAPTER 7 | The Importance of Critical Thinking 101

Creative Thinking may be outlandish, but the process can be fruitful.

I often assign a term paper to students in the Lead-
Creative thinking is the hallmark of being a crit- ership and Management class I teach in which the
ical thinker. I am amazed at my 2-year-old grand- students are to determine what they want to learn
daughter and her ability to play creatively. She and then are to document their learning. I have
can be a dog on all fours using her tongue to lick received some wonderful papers describing
milk from a dish, or convert the pantry into a the learning experiences of students who did
home for her toy zebras (I have to knock to gain something they really wanted to do. For example,
admittance!). I have hope that she will continue two women chose to go to Washington, DC, to
to be creative as she learns and grows! There are learn all they could about the proposed changes
a variety of ways to be creative; some are listed in the Medicare laws. They made appointments to
in Box 7-2 for you. interview their state senators and representatives
and arranged for a tour of the National Archives
where they learned how to research Medicare
REFLECTIVE THINKING
laws and obtain copies of the documents. They
I am sure you have had “aha” moments in also got special passes for a tour of the White
your life. Take some time to identify one and House from one of the senators and scheduled
record it in your class notebook. Explain the time to tour the historic sites. How did they think
problem that caused you to discover the
of such a creative and meaningful approach to
new information that was the “aha.” What
their topic? They brainstormed!
impact did it have on your life? How did you
feel about coming up with a new idea? Was Before you begin your brainstorming session,
the idea effective for your problem? sit quietly for a minute or two to relax your mind
so that new ideas can come to the forefront. Then
set your timer for the allotted time and begin
CONDUCT A BRAINSTORMING writing as fast as you can. If you are brainstorm-
SESSION ing in a group, assign a scribe to record all of the
There are rules associated with brainstorming. ideas so that the group process is not hindered.
Rule 1 is that every idea is a good idea, so write it The purpose of brainstorming is to get as many
down. Rule 2 is to set a time limit for the session. ideas as possible, so every idea is valued and
Some purposes of brainstorming are to find recorded. Many of us would have rejected the
solutions, create plans, and discover new ideas. idea of traveling to Washington, DC, to gather
Brainstorming can be done alone or with a small data for a paper as “crazy.” We would have
group; you may want to try both approaches. You missed a great idea; every idea is to be recorded
could brainstorm with yourself to choose a topic no matter how implausible it sounds!
for your next term paper. You may brainstorm After the brainstorming session, review all of
with the interdisciplinary team for solutions to a the ideas and determine which are not workable.
home care patient who is noncompliant with
medications.
Another purpose of brainstorming is to gener-
ate as many ideas as possible. Some of your ideas

BOX 7-2

Ways to Be Creative
1. Conduct brainstorming sessions
2. Focus and let go
3. Cultivate creative serendipity
4. Keep idea files
These students are brainstorming.
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102 CHAPTER 7 | The Importance of Critical Thinking

These can be tossed. Edit the remaining ideas What works for you when your mind is tired?
until they are usable. By looking at a large What letting-go activities are effective for you?
variety of possible solutions, you are enhancing For some, it is pacing while listening to music.
your ability to be a creative thinker. Others exercise; some take a short nap. You need
to determine what your letting-go activities
FOCUS AND LET GO are and consciously use them to rest your mind.
Being creative requires energy. When you are in Letting go enhances your creativity, lessens your
the creative mode, you are focused. Your mind is mental fatigue, and moves you along the road to
working on nothing but the creative idea that has being a critical thinker.
come to you. You may recognize it as a great idea
but need to spend time struggling with how to CULTIVATE CREATIVE SERENDIPITY
implement it. Perhaps the idea needs to be devel- Serendipity is the ability to see something
oped into a larger project or made clearer of value when you weren’t looking for it at all.
and more focused. These and other aspects of History is full of serendipitous events. Here are
creative activities take time and energy. two to consider.
When you are intensely focused, you are l Edward Jenner discovered the smallpox vac-
using your conscious mind. If your idea is to cine, but he was not looking for it! Jenner
travel to Washington, DC, for your paper, you noticed that milkmaids seldom got the
need to work consciously on identifying the dreaded disease, and by investigating such a
funding, planning the itinerary, and reserving a serendipitous idea, he determined that cows
hotel room. When you “let go,” or leave the cre- with mild cases of cowpox immunized the
ative idea, you are allowing your subconscious women. Now, smallpox is all but eradicated.
mind to work. You can’t determine what your
l Alexander Fleming discovered penicillin
subconscious mind will be doing while you
are out buying groceries, attending your child’s because of a serendipitous event. Fleming
PTA meeting, or sleeping. If you have been was testing bacteria in Petri dishes in a room
consciously working on something important to with an open window (the era before air con-
you, however, your subconscious mind generally ditioning). A spore of Penicillium notatum, a
continues the work while you are letting go, and type of mold, blew in the window and landed
later a good idea comes to your conscious mind. in Fleming’s Petri dish, killing the bacteria.
When you work so there is time to focus and Fleming did not lament the destruction of his
to let go, your work will be much more creative original experiment. Instead, he creatively
than if you worked at it endlessly. This is one looked at what happened by isolating the
reason why students generally do not do better mold. Because of his serendipity, penicillin
when they pull “all-nighters” for a test. They was discovered. Over time, penicillin has
have been in focus mode for so long with no let- saved millions of lives, and the drug is
ting-go time that their mind is tired. When currently in its fourth and fifth generation of
I work on time-consuming projects, such as this development from Fleming’s original mold.
textbook, I may be sitting at my computer for What if Jenner and Fleming had not been cre-
8 to 10 hours a day. That would not be an effec- ative thinkers? The thought of not having peni-
tive strategy if I were not good at focusing and cillin to combat infection or of not having the
letting go. When I write for hours, I do get men- smallpox vaccine changes the entire scope of
tally tired. One of the ways I maintain my focus healthcare as we know it.
is to type with my eyes closed. I write while You too can experience serendipity. To learn
I listen to the soft tapping of the keys. When I this skill, be attentive to the world in which you
feel really tired, I stop. I may put in a load of live. Read more than your textbooks (think of it
laundry (it just feels good to do something else), as subconscious brain work or letting go). Reach
prepare a meal, or go for a short ride. When out to diverse people. Talk to people you meet on
I return, I have rested my mind with a letting-go the street and waiting with you in lines. Read a
activity, and I can write again. magazine that’s new to you. Then give yourself
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CHAPTER 7 | The Importance of Critical Thinking 103

time to think consciously and subconsciously REFINE IDEAS AND FOLLOW

about these many new ideas. Let searching for THROUGH
new ideas become a habit. It is a fun way to look Taking an idea to a productive place—refining
at the world, and I find it takes some of the pres- ideas and following through—requires real
sure off the high performance demands made on genius. Examples include raising the money to
most of us. Go through life expecting to make go to Washington, DC, or writing the short story
discoveries, and you will. that you dreamed about last night. Don’t lose
KEEP IDEA FILES your ideas. Take the time and energy to imple-
ment them.
I realize the notion of keeping an idea file may
Being creative within a safe framework is im-
seem like just too much for a busy nursing
portant for being a nurse. You may be the person
student. Remember the goal is to be an outstand-
who figures out how to position Mr. Carrigan,
ing nurse and critical thinker. This goal can be
a challenging orthopedic patient, or you may
achieved when you have developed creative
be the creative person who designs a staffing
thinking skills. It is important for you to expose
schedule that changes the existing paradigm and
yourself to new ideas (i.e., people, reading,
makes staff members much happier. (Remember
classes), and it is just as important to find a way
paradigm is a way of thinking or looking at
to preserve the new ideas so that you can use
things.)
them now and in the future. This is the purpose
Don’t go to the trouble to learn creative
of an idea file.
thinking and then never use your wonderful
You will need regular file folders and index
ideas. Keep adding to your file, and use the
cards for a card file. Store your files in a file
information you have gathered in every possible
drawer, a sturdy box, or a box designed specifi-
situation. The purpose of learning creative
cally for filing use. Carry index cards with you
thinking skills is to enhance your critical think-
in your book bag or briefcase so that you have a
ing ability.
convenient place to record all of the great new
ideas you encounter. It is such a waste to take the
courage to talk to a perfect stranger in the gro- Critical Thinking
cery line, have the stranger tell you the greatest
joke, and forget the joke by the time you get I have cared for the victims of gang induction
home because you didn’t have note cards with procedures, such as a shooting or a vicious gang
you. Or you may be sitting next to a pond, listen- rape. The gang members involved followed their
ing to the delightful sounds of nature, enjoying leader without question. They were not critical
this perfect scene when the solution to a major thinkers. You are not a critical thinker if you ac-
problem comes to you. Because you have noth- cept the information given to you without ques-
ing to write it on, you lose it almost immediately. tioning it or evaluating it for clarity and accuracy.
Some great ideas are just that fragile, so make Critical thinking is the way to make thinking an
note of them. adventure.
Your cards eventually will go into your file You should question everything you read in
drawer or box. File according to subject, and this book. Don’t just accept what I write as the
use dividers to keep things organized. You may truth. Critically examine the content and think it
file newspaper or journal articles (photocopy through. Critical thinking is paradigm-shifting
them) or comments made by a teacher during work. You may never think the same after read-
your clinical work. Once you have a system for ing this chapter. That would be good because
recording your ideas, review them occasionally. critical thinking is about analyzing and evaluat-
By reviewing your file, you will find the joke ing information, which may entail changing your
you need for a presentation in your speech class views. As a student, you have instructors to assist
or the perfect reference for a paper you are and support you in learning to think critically. In
writing. The message is to value and take care of Box 7-3, you will find some critical thinking
creative ideas, both yours and others. concepts you may want to consider.
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104 CHAPTER 7 | The Importance of Critical Thinking

you have the courage to admit you don’t know,

BOX 7-3 perhaps others will be honest enough to do it
as well.
Critical Thinking Concepts
1. Be willing to say “I don’t know”
Mr. Carrigan Revisited
2. Define your terms to allow for clear
Earlier in this chapter, I mentioned Mr. Carrigan
communication
and the need to position him. Mr. Carrigan is an
3. Practice tolerance 80-year-old man with a fractured hip and femur
4. Understand before criticizing from a fall. He has a Foley catheter, intravenous
5. Consider the source of your information (IV) fluids, and a low pain tolerance. It is his first
postoperative day, and he is on bed rest until the
6. Ask questions
surgeon thinks he can bear weight on his fragile
7. Look for all possible solutions leg. Mr. Carrigan doesn’t want to move because
8. Be willing to change your mind given it hurts. If you don’t position him well and repo-
new information sition him frequently, he is a likely candidate for
pneumonia or a blood clot. A fellow student is
assigned to Mr. Carrigan and calls you in to help
decide how to position him. Rather than cause
unnecessary pain for Mr. Carrigan by trying to
move him without more information, you say,
“I don’t know.”
Your fellow student likely will not like your
answer. In our fast-paced world, everyone wants
an immediate answer to questions, without
requiring thought or planning. You are a critical
thinker, however, so you are honest in your
response. Your answer is based on the patient’s
need not to suffer unnecessary pain. You believe
that you need someone with more experience to
teach you how to care for Mr. Carrigan.
This LPN is working with a team to develop a Mr. Carrigan needs to be turned. What clini-
care plan for her patient. cal reasoning process will you use to get enough
information to solve the problem? Based on
your clinical reasoning, what is your plan for
BE WILLING TO SAY “I DON’T
Mr. Carrigan? My thought process is detailed in
KNOW”
the following list, but this list reflects my think-
As mentioned previously, it is important to be ing only. In your creative mind, you may have
able to say, “I don’t know.” I am not encourag- other ways to resolve the problem. If your list
ing you to use this response when a teacher asks meets the overall objective of safety and care,
you about content you should have studied for you should use your list. Being creative and
class. It is not an excuse for not studying or not being critical in your thinking mean that there is
doing your homework. It also is an inappropriate more than one way to solve a problem. Here is
response when you are asked whether your my list of things I would do as a student to get
patient has been administered his or her medica- Mr. Carrigan turned and positioned:
tions. When asked a question that you honestly
do not know the answer to, however, you need 1. Talk to Mr. Carrigan. Is he alert? Does he
to say, “I don’t know.” Then you need to find the have ideas about how to position him? How
answer. Brainstorm, or ask someone with more much pain is he in at the moment?
experience to help you, or perform a library 2. I have determined that Mr. Carrigan is alert
search to obtain the information you need. If and in pain. Ask the medication nurse to
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CHAPTER 7 | The Importance of Critical Thinking 105

give him something for the pain. By doing speaking to do the same. Then ask an appropriate
this first, the medication will have time to question, such as, “What do you consider effec-
be effective (approximately 20 minutes) tive pain control?” assuming that is your topic of
when you return with a solution for turning discussion. Many nurses disagree about this
and positioning Mr. Carrigan. issue. As a nurse who practices caring theory,
3. Find your clinical preceptor. This is the your definition of pain management may be dif-
person who is responsible for you and the ferent from that of a nurse who does not practice
patients to whom you are assigned. He caring. Is this the time to determine which
or she also is a registered nurse (RN) with approach is correct? No. Simply define the terms
education and experience. Don’t neglect to for both of you, and move on from there with
use such a valuable resource. renewed understanding.
4. The faculty person teaches you about PRACTICE TOLERANCE
turning sheets, back supports, and the
power of a well-positioned pillow. You You have opinions about many things. Some of
also are cautioned about the fragility of your opinions are strong, and others could easily
Mr. Carrigan’s leg and how important it is be swayed. Would you cheat on a test to pass a
to have enough people to turn him so class, work in an AIDS clinic, or participate in
that someone holds and supports his leg euthanasia? Other highly charged opinions tend
at all times. to be formed around freedom and democracy,
parenthood, and religious beliefs. Although you
5. You now need to gather your supplies: may have strong opinions about these and other
four people (because this is the first time issues, a critical thinker practices tolerance of
Mr. Carrigan is being turned, you want other people’s opinions.
enough people to keep him safe and to Throughout U.S. history, society has been
prevent additional pain), four to six pillows intolerant of various ethnic and racial groups—
for support, a back support obtained from African Americans, Chinese, Irish, Germans,
central supply, and a turning sheet and other Italians, Jews, Hispanics, and so on. Yet, it is ob-
clean linens because this is the opportune vious that slavery and all racism and prejudice
time to change the bedding. are appalling errors in human behavior. The
Saying “I don’t know” means you don’t have world is a place of exciting diversity, and as a
the knowledge, information, or experience critical thinker, you would do well to learn to
needed to respond to the question or request, but embrace diversity and practice tolerance. How
it also means you will find the answer. else are you going to learn about other cultures?
Remember our discussion about the courage of
DEFINE YOUR TERMS Christopher Columbus to sail on a world that
Any interaction has the potential for miscommu- everyone else thought was flat? His crew had
nication. When you are interacting with someone tolerance for a new idea and look what hap-
and things seem to get uncomfortable or tense, pened! It is a challenge to value diverse people
one practical thing to do is to make sure you are and ideas, and it is a crucial aspect of critical
talking about the same thing or that you are defin- thinking.
ing your terms in the same way. As an educated
person, you do not want tense conversations to UNDERSTAND BEFORE CRITICIZING
turn into arguments. You want to examine criti- The phrase “there is a reason for every behav-
cally what is going on and do something produc- ior” fits well under this topic. Someone may be
tive with the interaction. Defining your terms is holding you at gunpoint. Even in such a terrify-
helpful in this type of situation. ing event, you must understand there is a reason
When things are tense, take a deep breath for what the person is doing. As a critical
to allow yourself to get enough oxygen in your thinker you need to understand that the behavior
system so you can relax, and sit down, if stand- of the person holding you hostage makes sense
ing, and invite the person with whom you are for that person.
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106 CHAPTER 7 | The Importance of Critical Thinking

of your own issues. Take some time to identify

REFLECTIVE THINKING
them and think of strategies for not reacting to
You do not need to record this assignment, people or situations that are evocative. If someone
but it is important for you to do it thought- has identified your buttons and keeps pushing
fully. Take some time and determine if you
them (children are famous for this) to get a reac-
have feelings of intolerance for an individual
tion, you need to practice tolerance and under-
or group. If you do, consider how to change
your thinking. Do you need to get more standing of the person and avoid being critical.
information about the person or group so If you learn to recognize your issues and
that you can understand them better? strengthen yourself so that you do not respond
Do you need to talk to the individual or to them, you can improve your life immensely.
a member of the group? Do you need to Think of the reactive arguments you would not
evaluate thoughtfully why you have feelings participate in, the patient families you would
of intolerance? You cannot have feelings of learn to value and support, and the angry and the
intolerance and be a successful nurse. The defensive interactions you would never engage
two simply are incompatible. I suggest you in again because you have learned to control
take some time now and work through
your “buttons.”
any feelings you may have. Your faculty
person may be a good resource as well. CONSIDER THE SOURCE
Best wishes!
I feel uncomfortable when my sister brings me
the latest fad for losing weight and says, “The
How do people come to develop the “reason” research says this is true.” She never looks at the
for the behavior they exhibit? It is what makes source of the research, however. Her assumption
each of us an individual. We are products of our is if it’s printed, it must be true. Never just accept
parents’ gene pool, culture, environment, expe- what you are told or what you read, whether in
riences, and thinking. A person who thinks print or on the Internet. Consider the source care-
critically needs to understand some of that indi- fully, especially if you are thinking about chang-
viduality before being able to act as an informed ing your opinion or activity (such as eating)
person. For example, a nurse assesses and talks based on the information. Who wrote or said
to a patient before giving a treatment or even what you are interested in exploring? Is the
ambulating. By talking to the patient and listen- individual a respected person in the field? Is the
ing with an open mind, the nurse can learn about research legitimate? Do you need to explore
the uniqueness of the patient, and quality care further and determine who else has something to
can be given. A teacher takes time to get to know say about the topic?
his or her students. Based on initial information Critical thinkers think about things rather than
and additional experiences and time with the simply accept them as truth. Why are you read-
class, the teacher decides on the best teaching ing a textbook written by me? Who am I? What
approach for that unique group of people. is my background and educational level? Have
Physicians diagnose before they prescribe. I had experience teaching LPNs? You need to
Lawyers brief themselves on an opponent’s case determine if I am worth reading by considering,
before going to trial. Open-minded listening is among other things, my credentials.
how you understand before criticizing.
If you are defensive or angry, you are not ASK QUESTIONS
being open-minded. Open-minded listening calls The essence of critical thinking is to ask ques-
for your energy to be focused on the other tions. Don’t accept the information that is given
person, not you. You should not be having to you without exploring it. Get more informa-
feelings that are in any way critical. tion. First, discipline yourself to think in terms
of questions. As you sit in class, consider what
WHAT PUSHES YOUR BUTTONS? questions you would like answered. The second
Every person I know has issues that “push their step is to have the courage to ask the questions.
buttons” or can cause a powerful negative reac- I delight in the critical thinkers I have in class.
tion. As a critical thinker, you need to be aware They are full of questions and often ask things
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CHAPTER 7 | The Importance of Critical Thinking 107

that I would never have thought about myself. It because someone in power (e.g., teacher, police
is exciting to see what comes from their minds. officer) told you to change it. I am talking about
“Don’t waste a question” is my motto. If you the entire process discussed in this chapter that
practice thinking about and asking questions, you allows you freedom of thought and the truest
will get better at asking meaningful questions form of empowerment. It all ties together. If you
that pertain to a specific situation. When that can think critically and act on those thoughts,
happens, you will know you are a critical thinker. you are empowered. You are able to contribute
To become a critical thinker, you need to con- significantly to a study group, your family, and
sider what has been said: Is it true, and if so, what the nursing team.
does it mean to you? The challenge is to be open- I suggest you take a break now (subcon-
minded enough to change your opinion or thinking scious time) and go to a movie, play basketball,
based on what you have heard or read, once you’ve or take a nap. Then come back to this chapter
established its validity. Critical thinkers always and read it again. You have just read a formula
reserve the right to reject what they hear as well. for critical thinking that calls for a new way of
thinking. It is important to your life’s success.
LOOK FOR AT LEAST THREE So rest or play, reread the chapter, and then go
ANSWERS try it out. It takes practice and time to change
Now that you have thoroughly explored a ques- your paradigm of thinking, but people do it
tion and have an answer with which you are com- every day. Your goal is to be an effective critical
fortable, you may think you are done. Whoops! thinker when you graduate.
Sorry! You need three answers. By looking at Critical thinking is the way educated, profes-
more than one solution to the question, you are sional people think. It is a challenging way to
able to fuel your own creativity and stimulate consider life and generally needs to be learned.
your mental energy. Never give up on the quest It is not intuitive. To be a critical thinker, a
for the truth to any question. In other words, don’t person must be a creative thinker as well. This
settle early, and don’t close your mind to other is a challenging prestep to critical thinking and
possibilities. is not a stage in the development that can
be skipped.
BE WILLING TO CHANGE YOUR MIND In light of today’s downsizing and lower
Being willing to change your mind is the highest LPN-to-patient ratios in many healthcare orga-
level of critical thinking. Have you thought nizations, the need to be a critical thinker is
through a situation or problem to the point that much more significant than ever before for
you can change your mind? Have you listened to nursing. As a LPN, you need to develop this skill
the other person without being judgmental or over the academic year. Being a critical thinker
defensive and, after personal consideration, is where you want to be when you graduate
determined the other person’s idea was a great because of the power and ability it will give
one? I am not talking about changing your mind you as a practicing nurse.
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108 CHAPTER 7 | The Importance of Critical Thinking

CASE STUDY
You enter a patient’s room to answer a call light and are surprised to walk in on a physician who
put on the call light because he needed help. The physician is doing a procedure unknown to
you that involves IV solutions and medications. You are a new LPN graduate and have not yet
been certified in IV therapy. There is a LPN student in the room looking frustrated and possibly
frightened. The patient appears to be in pain and looks at you as though she hopes to be rescued.
The physician seems frustrated and is tense and raising his voice. He appears to be unable to
complete the procedure he has undertaken because both of his hands are full, and he needs
one more thing done. You wonder if he asked the student to assist with the IV medications and
became frustrated when she said she couldn’t. All of these observations and considerations race
through your mind in seconds. In addition, your blood pressure and heart rate increase because
of the adrenaline release caused by the situation. Then the physician says to you, “Finally, a nurse!
Grab that medication (a syringe filled with ‘something’ sitting on the over bed table) and give it in
the second IV port.”
What do you do, and, more importantly, how do you think it through? Write the solution to the
case study in your class notebook and be prepared to share it in class.

INTERNET RESOURCES
Foundation for Critical Thinking http://www.criticalthinking.org/pages/our-concept-of-critical-thinking/411

REFERENCES
Finkelman, A., & Kenner, C. (2010). Professional nursing concepts: Competencies for quality leadership. Sudbury,
Mass: Jones & Bartlett.
Tait, F. E. (1985). How rational thinking affects student success. In J. Gardner and J. Jewler (Eds.), College is only the
beginning (pp. 75–86). Belmont, Calif: Wadsworth.
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CHAPTER 7 | The Importance of Critical Thinking 109

CASE STUDY ANSWERS

What a potentially traumatic situation! This situation happened to one of my students, so don’t dis-
count it as something that would never happen. What would you do? A possible course of action
follows. You may have other ideas that are just as valid. List them in your class notebook and come
to class prepared to share your thinking.
Do not give the medication just because the physician told you to give it. You have visually evalu-
ated the situation, and except for the patient’s apparent mental stress, you determine the patient is
not in any danger; there is a brief amount of time to get more information.
Before asking any questions, ask the student to go find a RN. Whatever the outcome, a RN is
needed because of the IV medication. The RN should make the necessary decisions and administer
the medication if it is deemed appropriate.
Ask questions! What is the procedure? What is the medication? What is the overall purpose for
what is being done? While you are asking the questions, move in close to the frightened patient and
touch her, give her some comfort and a feeling of security rather than the negative feelings coming
from the physician’s anxiety. This is caring.
It is possible that the physician is going to raise his voice at you in stress and frustration. He is in
a less than ideal situation. Because you are a critical thinker, you can listen to his anxiety without be-
coming defensive. At this point, your concern is the patient. Is she safe? Is she anxious? Is she in
need of medical attention other than what she is receiving?
When the RN arrives, he or she can determine a solution to the problem with the physician. You
have gathered information and should share it with the nurse. With the RN on the scene, you should
focus all of your attention on the patient, who is probably concerned. There is a temptation for peo-
ple to gather around what is exciting. In this case, it could be the interaction between the nurse and
the physician or the procedure that is being done. Where you are needed is with the patient, not the
procedure, unless you are doing it.
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