CRITICAL THINKING

by; Eko Susilo,

S.Kep.,Ns.,M.Kep

???
Critical thinking is the process that
allows nurses to see the big picture
(envision the overall perspective)
instead of focusing only on details.
- Proses yang dapat dilakukan perawat
dalam melihat sebuah
gambaran/permasalahan tertentu
(focus) secara detail

Critical thinking is a skilled process

that conceptualizes and applies
information from ;
a) observation, (pengamatan)
b) experience, (pengalaman)
c) reflection, (cerminan)
d) inference, (simpulan)
e) communication(komunikasi)

 Critical thinking is the rational examination of ideas, assumptions,

principles,conclusions, beliefs, and actions (Bandman & Bandman,
1995/2011) adalah pengujian terhadap suatu ide,
pendapat,prinsip,simpulan,kepercayaan dan tindakan

Reasonable reflective thinking that focuses on decisions

about actions and beliefs (Ennis, 1989)cerminan kelayakan berfikir
fokus pada keputusan tentang tindakan dan kepercayaan
Purposeful, autonomous judgments that lead to interpretation,
analysis, inference, evaluation, and explanation (Facione,
1990)penuh arti,otonomi keputusan yang mengarahkan pada
pemahaman, analisis,kesimpulan,evaluasi,penjelasan
Self-directed rational thinking that validates what we
know and identifies what we do not know (Paul, 1992)kemandirian
berfikir rasional tentang kepastian terhadap apa yg kita ketahui
danidentifikasi apa yg kita tdk tahu

COMPONENTS OF CRITICAL THINKING

Critical thinking has several
components, including :
A. mental operations,
B. knowledge,
C. attitudes.

A. Mental Operations
Mental operations include :
a. activities such as decision making
b. reasoning that are used to find or create meaning.
Nurses engage in such activities whenever they search for
solutions based on rationale and develop outcomes accordingly.
perawat terlibat dalam beberapa aktivitas pencarian solusi dasar dan
rasional dan konsekuaensinya
Hasil dari mental operations adalah :
c. creative,
d. kemampuan problem solving.
Critical thinking enables nurses to make sound clinical
judgments by analyzing information and applying knowledge.

B. Knowledge
Critical thinking calls for a knowledge base
that includes declarative knowledge, which
is specific facts or information, and
operative knowledge, which is an
understanding of the nature of that
knowledge.
Nursing curricula assist the student in
learning specific facts about nursing and
the delivery of quality care.

 In order to think critically, to solve

problems, and to make decisions,
nurses must develop a broad base of
knowledge.

C. Attitudes
Some attitudes demonstrated by critical thinkers are:
a) Tolerance, open-mindedness, nonjudgmental mind-set
b) Curiosity (kecurigaan)
c) Persistence (tekun), intellectual courage(keberanian)
d) Respect for others perspectives
e) Comfort dealing with ambiguity, uncertainty (ketidak
pastian)
f) Intellectual humility (knowing that one does not have allthe
answers)
g) Self-confidence (percaya diri)
h) Flexibility
i) Organization (Alfaro-LeFevre, 2008; Forehand, 2005/2011)

Critical Thinking Skill

1.
2.
3.
4.
5.
6.

Interpretation
Analysis
Evaluation
Inference (simpulan)
Explanation (penjelasan)
Self-regulation

Levels of Critical thinking in NJursing

1. Basic
2. Complex
3. Commitment

Critical Thinking
Competencies
a. General critical thinking
b. Specifik critical thinking in clinical
situation
c. Specifik kritical thinking in nursing

Standars of Critical thinking

A. Intelektual
-. Clear
-. Precise (tepat)
-. Specific
-. Accurate
-. Relevant
-. Plausible (masuk akal)
-. Consistent
-. Logical
-. Deep
-. Broad (lebar)
-. Complete
-. Significant
-. Adequat
-. Fair (adil)

B. Proffesional Standards
- Etical criteria for nursing judgement
- Criteria for evaluation
- Professional responsibility

DEVELOPMENT OF CRITICAL
THINKING SKILLS
Following are some specific strategies that promote
the
development and application of critical thinking:
1. Identify goals
2. Determine what knowledge is required
3. Assess the margin for error
4. Determine the amount of time available for
decision making
5. Identify available resources
6. Recognize factors (i.e., biases, fatigue) that may
influence decision making (Alfaro-LeFevre, 2008)

Critical Thinking Skills

Interpretation = Categorize, decode sentences,
clarify meanings
Analysis
= Examine ideas, identify and
analyze arguments
Influence
= Query evidence(bukti), conjecture
(menduga)alternatives, draw conclusions
Explanation
= State results(menghasilkan),
justify procedures, present arguments
Evaluation
= Assess claims, assess arguments
Self-regulation = Self-examination, self-correction
(if ecessary)

Examples of Critical Thinking Questions

for Use with the Nursing Process

ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION

ASSESSMENT
Are the data complete?
What other data do I need?
What are some possible sources of
those data?
What assumptions or biases do I have
in this situation?
What is the clients point of view?
Are there other points of view?

DIAGNOSIS
What do these data mean?
What else could be happening?
Are there any gaps in the data?
How are these data similar and how are they
different?
What assumptions or biases do I have in this
situation?
Have my assumptions affected my interpretation of
the data?
If so, in what way?

OUTCOME IDENTIFICATION AND

PLANNINg
What are the goals for this client?
What do I want to accomplish(memenuhi)?
How are my goals related to what the client wants to
accomplish?
What are the expected outcomes for this client?
What interventions are to be used?
Who is the best-qualified person to perform
these interventions?
How much involvement (keterlibatan) can the client and family
or significant others have at this time?
How much involvement does the client wish to have at
this time?

IMPLEMENTATION
What is the clients current status?
What are the most critical steps in this
intervention?
How must I alter the intervention to best meet this
clients needs and maintain principles of safety?
What is the clients response during and after the
intervention?
Is there a need to alter the intervention in any way?
If so, why and how?

EVALUATION
Were the interventions successful in assisting
the client to achieve the desired goals?
How could things have been done differently?
What data do I need to make new decisions?
Where will I get the data?
Were there assumptions, biases, or points of
view
that I missed that affected the outcomes?
What can be done aboutthese assumptions,
biases, or points of view?

Critical Thinking in Long-Term Care Nursing

Determining the need
Two components: history and physical assessment
History
Be disciplined to be consistent and thorough. Consider using a mnemonic.
History of the chief complaint (Rutenberg, C. 2000. Telephone triage.
American
Journal of Nursing 100 (3): 7778, 8081.)
P Problem
O Onset
S Associated symptoms
H Previous history
P Precipitating factors
A Alleviating/aggravating factors
T Timing
E Etiology
Document key findings that allowed you to rule out the worst-case scenario or that
made you think there was a problem.
Compare to the residents normal, especially for a chronic or elderly condition.
(You look like you are having a little trouble breathing. Is that how you are feeling?)
Your concern should be heightened if the resident is concerned enough to complain
about an ordinary condition (e.g., headache).

 Assess before acting

Question: A resident is admitted to the nursing
home after a total left knee replacement.
The resident complains of pain. Nurses should
first:
a. Administer the PRN analgesic
b. Assess for bowel sounds
c. Obtain a description of the pain including location
d. Chart vital signs
Answer: C. Do not assume the pain is related
to the knee replacement. There could be a
pulmonary embolism or a deep-vein thrombosis.
Assess location for swelling and shortness of breath.