critical thinking activities in the assessment phase

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A Short Guide to Building Your Team’s Critical Thinking Skills

• Matt Plummer

Critical thinking isn’t an innate skill. It can be learned.

Most employers lack an effective way to objectively assess critical thinking skills and most managers don’t know how to provide specific instruction to team members in need of becoming better thinkers. Instead, most managers employ a sink-or-swim approach, ultimately creating work-arounds to keep those who can’t figure out how to “swim” from making important decisions. But it doesn’t have to be this way. To demystify what critical thinking is and how it is developed, the author’s team turned to three research-backed models: The Halpern Critical Thinking Assessment, Pearson’s RED Critical Thinking Model, and Bloom’s Taxonomy. Using these models, they developed the Critical Thinking Roadmap, a framework that breaks critical thinking down into four measurable phases: the ability to execute, synthesize, recommend, and generate.

With critical thinking ranking among the most in-demand skills for job candidates , you would think that educational institutions would prepare candidates well to be exceptional thinkers, and employers would be adept at developing such skills in existing employees. Unfortunately, both are largely untrue.

• Matt Plummer (@mtplummer) is the founder of Zarvana, which offers online programs and coaching services to help working professionals become more productive by developing time-saving habits. Before starting Zarvana, Matt spent six years at Bain & Company spin-out, The Bridgespan Group, a strategy and management consulting firm for nonprofits, foundations, and philanthropists.  

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ADPIE – The Five Stages of The Nursing Process

ADPIE is an acronym for assessment, diagnosis, planning, implementation, and evaluation.

The ADPIE process helps medical professionals remember the process and order of the steps they need to take to provide proper care for the individuals they are treating.

This process is essential as it provides a practical and thorough framework for patient care.

It also helps medical professionals develop critical thinking and problem-solving skills.

By following the ADPIE process, medical professionals can improve their work efficiency and promptly develop more accurate decisions.

Process Overview

The purpose of ADPIE is to help improve an individual’s mental, emotional, and physical health through analysis, diagnosis, and treatment.

The ADPIE process allows medical professionals to identify potential problems, develop solutions, and monitor the results individually.

Nurses must reevaluate, adjust and correct the process if it does not improve the patient’s condition.

Here is an explanation detailing each step of the process:

Assessment is the first step of the ADPIE process.

During the assessment phase, medical professionals will attempt to identify the problem and establish a database.

Interviewing the patient and family members, observing behavior, and performing examinations help with the assessment.

This step focuses heavily on collecting/recording data, validating information, and listing any abnormalities in the data.

Nurses collect assessment data in one of two ways, subjective or objective.

You cannot measure subjective data directly.

It includes verbal information like asking questions, obtaining verbal feedback, interviewing people, and collecting/gathering a patient’s health history data.

Subjective data is symptomatic because nurses cannot measure or observe it directly.

Objective data is measurable because nurses can see, hear, feel, or smell it.

It includes measuring a patient’s weight, blood pressure, heart rate, and body temperature.

Because objective data is measurable, nurses refer to it as signs.

Gathering as much data as possible during the assessment phase is essential.

While gathering data, Identify if the data is accurate, concise, consistent, and straightforward.

Once you’ve gathered enough accurate data, you can form a conclusion about the patient’s condition.

After that, move on to the next phase of the ADPIE process, diagnosis.

The process’s diagnosis phase is where the medical professional develops a theory or hypothesis about the individual’s situation based on the information collected while performing an assessment.

Although registered nurses cannot form a professional diagnosis, they can develop critical thinking and communicate their clinical judgments to their team members.

Nurses have a standardized language for communicating their clinical judgments, which comes from NANDA international .

That said, certified nurse practitioners can diagnose medical conditions and act as primary care providers for their patients.

Examples of Medical Language Nurse Use Include:

• Activity intolerance
• Constipation
• Decreased cardiac output
• Fluid volume deficit
• Hypothermia
• Sleep deficit

The diagnostic process allows medical professionals to decide on the individual they treat.

That determination determines whether the patient is dealing with a physiological, mental, or emotional condition.

And while nurses cannot give a professional diagnosis , they can identify actual or potential medical /health risks.

After performing a diagnosis, nurses must place risks that can cause complications or harm in order.

Organize the highest risks as the top priority (life-threatening).

Accordingly, nurses should label lower risks in descending order (non-life-threatening/minor/future well-being).

Nurses must identify, address and correct new problems that affect other priorities.

Therefore, nurses must perform assessments regularly to approach patient problems adequately.

After identifying and prioritizing the concerns, the next phase of the process is planning.

Planning involves developing a plan and establishing SMART goals to achieve the desired outcome.

For example, adequate planning helps reduce a patient’s pain or improve cardiovascular function.

SMART goals are specific, measurable, attainable, realistic/relevant, and time-restricted.

SMART goals provide the individual with focused activities designed to improve their condition.

They also provide medical professionals with a plan to measure and evaluate the individual’s improvements.

Goals may be short-term or long-term, singular in nature, and focus on the individual outcome.

Nurses must determine whether the SMART goals benefit the patient.

They must also make sure that the SMART goals are attainable.

In addition to SMART goals, nurses must develop and communicate a care plan and intervention strategies to the team.

It helps maximize the success of the goals.

The care plan involves the steps and strategies needed to achieve the desired goal.

Along with the care plan, developing intervention strategies keeps the individual on track.

Nurses communicate the care plan and intervention strategies to the patient and medical team as part of the treatment.

After nurses establish the care plan, interventions, and SMART goals, they must implement them into patient care.

Implementation

The implementation phase is the actionable part of the process.

It’s where the medical team implements the care plan, SMART goals, and interventions to achieve their goals.

Accordingly, nurses can evaluate and measure this process.

The implementation phase uses a combination of direct care and indirect care.

Direct care involves giving patients physical or verbal aid.

Direct care includes assisting the patient with mobility, performing physical maintenance, range of motion exercises, and assisting with daily living activities.

It may also include coaching, counseling, and providing feedback to the individual.

Indirect care involves actions performed while away from the patient.

Indirect care may include monitoring/supervising the medical staff, delegating responsibilities, and advocating on behalf of the patients.

While implementing the care plan, the nurse/team needs to use critical judgment.

They must also question care plan procedures to ensure it meets the demands/concerns of the people receiving the care.

Steps or procedures that appear inappropriate, non-actionable, or questionable should be questioned and reevaluated with the medical staff. 

Moreover, nurses must communicate with those receiving the care plan to ensure it is safe and aligns with the medical teams/individuals’ goals.

The last phase of the process is the evaluation phase.

It’s where the medical professionals assess and evaluate the success of the planning and implementation processes.

This phase ensures that the individual is making progress towards their goals and is achieving the desired outcome.

Healthcare professionals must evaluate if the process works and identify what brings the individual closer to their goals.

Nurses must reassess the problem if it isn’t working and determine whether it needs to be modified or eliminated.

Nurses must regularly perform evaluations during the ADPIE process to assess the plan and make adjustments.

By performing regular evaluations, medical professionals can determine the appropriate course of action, identify potential errors, and ensure that the process works as smoothly as possible.

ADPIE Recap

The ADPIE process assists medical professionals in identifying and addressing potential medical concerns.

By implementing the process, medical professionals can assess the patient’s condition and ensure they receive adequate care.

The assessment process begins through the collection of subjective and objective data.

This data allows medical to develop a diagnosis based on the collected information.

With the diagnosis, nurses can create a plan with interventions and SMART goals for the patient to follow.

The process is then implemented into action to achieve the plan’s goals.

Nurses must evaluate the process during and after implementation to ensure the individual achieves their goals.

ADPIE is an excellent way to improve critical thinking.

It helps nurses create, evaluate, and reevaluate procedures.

It also helps them implement and modify processes until they reach the desired outcome.

What Are The Five Stages of The Nursing Process?

The five stages of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.

In other words, the five stages of the nursing process are ADPIE, which I explained earlier in this article.

Nurses follow these five stages to ensure proper patient care from the beginning of treatment until the end.

Consequently, It allows nurses to utilize a systematic approach to observing, analyzing, taking action, and reevaluating goals, strategies, and outcomes.

Overall this helps nurses perform their best and account for potential mistakes and errors throughout patient treatment.

The ADPIE nursing process is an essential component of clinical care.

It improves critical thinking and decision-making by breaking down processes into simplified and organized steps.

Each concurrent step builds upon the previous one throughout the process until nurses develop and implement a good approach.

With that said, numerous nurses lack experience applying the ADPIE nursing process.

It’s partially due to a shortage of information/resources and busy work schedules making it difficult to implement.

However, new processes are continually developing, allowing current/future nurses to incorporate these processes into their daily work.

Without processes like ADPIE and others, nurses would have more difficulty approaching complex patient care scenarios.

ADPIE isn’t well known among some nurses.

However, there are many well-known, and implemented processes nurses utilize.

• Learning to analyze and critically evaluate ideas, arguments, and points of view

Series Editor : Michael Theall, Youngstown State University Authors: Patricia Armstrong, Vanderbilt University; Sonja Moyer, US Army Command and General Staff College; Katherine Stanton, Princeton University

The critical evaluation of ideas, arguments, and points of view is important for the development of students as autonomous thinkers (1, 2). It is only through this critical evaluation that students can distinguish among competing claims for truth and determine which arguments and points of views they can trust and those of which they should be skeptical. This work lays the foundation for students’ progressing to staking their own claims in an intellectually rigorous fashion. Learning how to analyze and critically evaluate arguments thus helps them to develop a sound framework to test their own arguments and advance their own points of view.Objective 11 reflects an important component of the educational process – training students in the habits of thought in our disciplines. IDEA research has found that it is related to Objectives #6 through #10 and Objective #12, which all address activities at the upper levels of cognitive taxonomies, activities requiring application and frequent synthesis and evaluation of ideas and events (3). Active processing is critical to our students’ long-term retention of ideas and concepts and their ability to transfer those ideas and concepts to other contexts (4).

There is a link between this objective and developing deeper understandings of the self and the world. By encouraging our students to adopt a critical framework, we prepare them not only to engage in scholarly conversation and debate in our disciplines, but also to be engaged citizens in a democratic society. As Patricia King points out,

a student who appreciates why people approach controversial issues in her discipline from different perspectives is more likely to see and appreciate the reasons people approach social controversies from different perspectives. By the same token, a student who evaluates knowledge claims in his major by reference to the strength of the evidence in support of conflicting hypotheses would also be more inclined to evaluate contradictory claims about current moral issues by reference to the weight of available evidence (5, p. 23).

The ability to weigh alternatives, make decisions, and evaluate contradictory evidence is crucial to scholastic endeavors and adult life more generally—to personal happiness, professional success, and civic engagement.

To achieve this and related objectives, instruction must incorporate intellectual challenge and activity; opportunities for creative or original work; finding and using information and translating that information into coherent communication; and opportunities to produce original work rather than simply recalling information. This is supported by IDEA research finding that instructors stressing this objective frequently stimulate students to intellectual effort (#8), introduce stimulating ideas about the subject (#13), ask students to share ideas (#16), and assign work that requires original or creative thinking (#19). For additional information about this objective, see IDEA Paper #37 Helping Your Students Develop Critical Thinking Skills. [PDF]

Helpful Hints

Teaching students “how to think” may begin by alerting them to the kinds of questions and problems that interest scholars or professionals in your field. So you may consider organizing your courses around such questions and problems to stimulate your students’ intellectual interest. Rather than simply presenting information, be explicit with your students about how you approach such questions, defining critical thinking in your field and modeling disciplinary ways of thought. Engage students in activities that require sophisticated thinking and design assessments that call on students to demonstrate thinking skills. Below, we provide specific ideas for how to teach students to analyze and critically evaluate ideas and assess their abilities to do so. These activities and assessments require students to identify assumptions, weigh competing evidence, make decisions, imagine alternatives, and build arguments.

John Bean writes that once professors decide to focus on developing critical thinking skills, “much of their classroom preparation time shifts from planning and preparing lectures to planning and preparing critical thinking problems for students to wrestle with” (6, p. 122). Below, we suggest a series of what he might call “critical thinking tasks” that give students practice—and the opportunity to receive feedback on—analyzing and critically evaluating ideas, arguments, and points of view.

• In humanities and social science courses, keep the reading load manageable and model for students how to read critically and to evaluate arguments in your field (see IDEA Paper #40 Getting Students to Read: Fourteen Tips [PDF]).
• In math, sciences, and engineering courses, encourage students participating in study groups not only to share ideas for solving problems but also to provide reasons for the problem solving ideas they advance.
• Have students respond to an editorial in a newspaper or to a review essay in a scholarly journal. For that response, ask students to identify unstated assumptions, biases, and points of views and show how they undermine the argument the author is making.
• Teach students to use a pro and con grid to analyze ideas and points of view (7, see pages 168-171).
• Take time in science and engineering classes to explore the ethical considerations of research questions and experimental design.
• In organized class debates, ask students to argue for a point of view counter to their own.
• Give students “ill-structured problems” in class to work through. Such problems have no known answer or solution and cannot be solved with formal rules of logic or mathematical formulas. Ask students to come up with multiple solutions for each problem and rank the viability of each solution.
• Teach students the “believing and doubting game” (Elbow, cited in 6, p.142), which asks them to be both sympathetic and skeptical readers.
• Help students develop strategies for systematically gathering data according to methodologies in your discipline, assessing the quality and relevance of the data, evaluating sources, and interpreting the data (5, p. 24).
• Encourage students to enter into dialogue with the sources they read; encourage them to ask questions, give assent, or protest in the margins of what they read.
• Train students to identify the author’s audience and purpose when they read.
• Encourage students to engage their critical reasoning skills outside of the classroom (5, p. 24).

Assessment Issues

To teach critical evaluation, we must define critical thinking in general and in the discipline, model habits of disciplinary thought, engage students in activities that require sophisticated thinking, and design assessments that call on students to demonstrate thinking skills. Instructional assignments and activities that promote critical thinking have to do more than present information and ask for recall. Rather, they must ask students to demonstrate their thinking, including their analysis and critical evaluation of ideas, arguments, and points of view. These assignments ask students to do more than reproduce what they know; they ask them to produce new knowledge.

Angelo and Cross (7) offer many techniques for assessing critical thinking, problem solving, analysis, and related skills. Echoing and expanding on their ideas, we make the following suggestions:

• Design a writing assignment that asks students to test a critic’s ideas (or an everyday assumption) against a primary text or texts.
• Ask students to apply a theory they’ve learned in a social science class by designing an experiment to test the theory. Have them carry out the experiment and document the results.
• Design a writing assignment that prompts students to position themselves within a scholarly or real-life debate.
• Ask students to review a scientific paper, assessing the evidence the authors use and how they use it.
• Allow students to choose a current political issue relevant to a community to which they are attached. Have them research both major parties’ point of view on this issue and critically analyze them. As a writing assignment or project, ask students to agree with one major party’s stand on this issue and justify their choice.
• Have students use a double-entry journal for reflection and self-assessment of this learning objective, using guided questioning. The journal helps faculty to assess the affective domain, and helps students through possible “road blocks” in the process of learning to analyze and critically evaluate ideas, arguments, and points of view. It also reinforces that this process is ongoing, not just an assignment for a class. Sample guided questions include: What happened (when you analyzed and critically evaluated ideas, arguments, and points of view)? What was your reaction as you went through this process? What did you learn about yourself? How can you apply what you learned to your education or your life?
• Construct a rubric (i.e. scoring guide) to provide guidelines for critical analysis and evaluation so students know what to expect when they are assessed. The criteria and standards for this rubric may include the Elements of Reasoning and Intellectual Standards in Paul and Elder’s Critical Thinking (8).

References and Resources

• Perry, W. G. (1999). Forms of ethical and intellectual development in the college years. San Francisco: Jossey-Bass.
• Brookfield, S. D. (1987). Developing critical thinkers. San Francisco: Jossey-Bass.
• Bloom, B. (Ed.). (1984). Taxonomy of educational objectives : Book 1, Cognitive Domain (2nd ed.). New York, Longman. See pp. 120-121, 162-163, 185-187.
• Halpern, D. F., & Hakel, M. D. (2003). Applying the science of learning to the university and beyond. Change , 35 (4).
• King, P. (2000). Learning to make reflective judgments. In Baxter-Magolda, M. B. Ed.), “Teaching to promote intellectual and personal maturity.” New Directions for Teaching and Learning, 82. San Francisco: Jossey-Bass.
• Bean, J. C. (1996). Engaging ideas: The professor’s guide to integrating writing, critical thinking, and active learning in the classroom . San Francisco: Jossey-Bass.
• Angelo, T., & Cross, P. (1993). Classroom assessment techniques (2nd ed.). San Francisco: Jossey-Bass.
• Paul, R., & Elder, L. (2002). Critical thinking: Tools for taking charge of your learning and your life. Instructor’s Manual . NJ: Prentice Hall.

Related POD-IDEA Center Notes

• IDEA Item #8 “Stimulated students to intellectual effort beyond that required by most courses,” Nancy McClure
• IDEA Item #13 “Introduced stimulating ideas about the subject,” Michael Theall
• IDEA Item #16 “Asked students to share ideas and experiences with others whose backgrounds and viewpoints differ from their own,” Jeff King
• IDEA Item #19 “Gave projects, tests, or assignments that required original or creative thinking,” Cynthia Desrochers

Additional Resources

• IDEA Paper No. 38 Enhancing Learning – and More! – Through Cooperative Learning , Millis
• IDEA Paper No. 37 Helping Your Students Develop Critical Thinking Skills, Lynch and Wolcott
• IDEA Paper No. 40 Getting Students to Read: Fourteen Tips, Hobson
• IDEA Paper No. 42 Integrated Course Design , Fink
• Gaining A Basic Understanding of the Subject
• Developing knowledge and understanding of diverse perspectives, global awareness, or other cultures
• Learning to apply course material
• Developing specific skills, competencies, and points of view needed by professionals in the field most closely related to this course
• Acquiring skills in working with others as a member of a team
• Developing creative capacities
• Gaining a broader understanding and appreciation of intellectual/cultural activity
• Developing skill in expressing myself orally or in writing
• Learning how to find, evaluate, and use resources to explore a topic in depth
• Developing ethical reasoning and/or ethical decision making
• Learning to apply knowledge and skills to benefit others or serve the public good
• Learning appropriate methods for collecting, analyzing, and interpreting numerical information

• A Model for the National Assessment of Higher Order Thinking
• International Critical Thinking Essay Test
• Online Critical Thinking Basic Concepts Test
• Online Critical Thinking Basic Concepts Sample Test

Consequential Validity: Using Assessment to Drive Instruction

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Critical Thinking Testing and Assessment

The purpose of assessment in instruction is improvement. The purpose of assessing instruction for critical thinking is improving the teaching of discipline-based thinking (historical, biological, sociological, mathematical, etc.) It is to improve students’ abilities to think their way through content using disciplined skill in reasoning. The more particular we can be about what we want students to learn about critical thinking, the better we can devise instruction with that particular end in view.

The Foundation for Critical Thinking offers assessment instruments which share in the same general goal: to enable educators to gather evidence relevant to determining the extent to which instruction is teaching students to think critically (in the process of learning content). To this end, the Fellows of the Foundation recommend:

that academic institutions and units establish an oversight committee for critical thinking, and

that this oversight committee utilizes a combination of assessment instruments (the more the better) to generate incentives for faculty, by providing them with as much evidence as feasible of the actual state of instruction for critical thinking.

The following instruments are available to generate evidence relevant to critical thinking teaching and learning:

Course Evaluation Form : Provides evidence of whether, and to what extent, students perceive faculty as fostering critical thinking in instruction (course by course). Machine-scoreable.

Online Critical Thinking Basic Concepts Test : Provides evidence of whether, and to what extent, students understand the fundamental concepts embedded in critical thinking (and hence tests student readiness to think critically). Machine-scoreable.

Critical Thinking Reading and Writing Test : Provides evidence of whether, and to what extent, students can read closely and write substantively (and hence tests students' abilities to read and write critically). Short-answer.

International Critical Thinking Essay Test : Provides evidence of whether, and to what extent, students are able to analyze and assess excerpts from textbooks or professional writing. Short-answer.

Commission Study Protocol for Interviewing Faculty Regarding Critical Thinking : Provides evidence of whether, and to what extent, critical thinking is being taught at a college or university. Can be adapted for high school. Based on the California Commission Study . Short-answer.

Protocol for Interviewing Faculty Regarding Critical Thinking : Provides evidence of whether, and to what extent, critical thinking is being taught at a college or university. Can be adapted for high school. Short-answer.

Protocol for Interviewing Students Regarding Critical Thinking : Provides evidence of whether, and to what extent, students are learning to think critically at a college or university. Can be adapted for high school). Short-answer. 

Criteria for Critical Thinking Assignments : Can be used by faculty in designing classroom assignments, or by administrators in assessing the extent to which faculty are fostering critical thinking.

Rubrics for Assessing Student Reasoning Abilities : A useful tool in assessing the extent to which students are reasoning well through course content.  

All of the above assessment instruments can be used as part of pre- and post-assessment strategies to gauge development over various time periods.

Consequential Validity

All of the above assessment instruments, when used appropriately and graded accurately, should lead to a high degree of consequential validity. In other words, the use of the instruments should cause teachers to teach in such a way as to foster critical thinking in their various subjects. In this light, for students to perform well on the various instruments, teachers will need to design instruction so that students can perform well on them. Students cannot become skilled in critical thinking without learning (first) the concepts and principles that underlie critical thinking and (second) applying them in a variety of forms of thinking: historical thinking, sociological thinking, biological thinking, etc. Students cannot become skilled in analyzing and assessing reasoning without practicing it. However, when they have routine practice in paraphrasing, summariz­ing, analyzing, and assessing, they will develop skills of mind requisite to the art of thinking well within any subject or discipline, not to mention thinking well within the various domains of human life.

For full copies of this and many other critical thinking articles, books, videos, and more, join us at the Center for Critical Thinking Community Online - the world's leading online community dedicated to critical thinking!   Also featuring interactive learning activities, study groups, and even a social media component, this learning platform will change your conception of intellectual development.

Engagement Activities

Assessing Critical Thinking Skills

Using essays, discussions and project work (group and individual) to assess student learning in your course are excellent strategies to evaluate critical thinking, problem solving and analysis skills, while also assessing student knowledge of the content. Using a well structured project, discussion or essay question you can easily determine how well students know the content and whether or not they have developed the skills to synthesize course material and apply it to new situations.

Your course assessment strategy will be more robust if you include a variety of elements, such as:

• computer marked quizzes to assess knowledge and comprehension
• essays and discussions to assess critical thinking, analysis and evaluation
• project work to assess synthesis and application of knowledge to new situations (creation)

Discussion Questions

Discussion questions in online and blended learning promote reflexion and critical thinking about the course material. Effective online instructors ask stimulating and thought provoking questions that will engage students in active learning by having them brainstorm ideas and compare them with their peers' before linking those ideas to the context of the course content.

Crafting Good Discussion Questions

Much like good essay questions, good discussion questions avoid asking about factual information, such as ' What are the steps involved in soldering two metals together ?' or ' What are the characteristics of diesel engines? '

If you needed to have a discussion about diesel engines in an automotive course, a more appropriate question might be:

Compare and contrast the differences between diesel and gas engines by analysing elements of efficiency in fuel consumption, environmental sustainability and maintenance safety in different physical environments.

To craft a good discussion question, make sure that you consider the learning objectives, the question type most appropriate to the learning situation and the scope of the question so that learners are able to meet the learning objectives. Too broad a question is bound to not zone in on what you need.

Watch the videos about creating forums in Moodle and then work on the Create a Discussion Question assignment.

Project Work

Including project work in your assessment strategy is one of the best ways to assess application of knowledge and knowledge creation.Giving learners projects to work on as part of the learning process, not necessarily only as part of the assessment process, provides many opportunities for active learning and deeper learner engagement.

Project work can be performed individually and in groups. Regardless of whether the intention is to have learners work individually or as part of a team, project assignments or tasks need to be clearly structured so that learners know exactly what is expected of them. A good strategy is to:

• State the objective(s) for the project in a quantifiable manner.
• Describe the deliverable for the project in clear and concise words. If possible provide examples of the deliverable.
• When possible, structure the project in several phases, and invite learners to submit their work for each phase so that you can provide continuous guidance in a timely fashion.
• Provide clear instructions for project tasks, ideally in the order that they are to be performed.
• Use active verbs for the instructions.
• Provide a rubric with the assessment criteria and the grading scheme, if applicable.

• Our Mission

3 Simple Ways to Use Pre-Unit Assessments to Promote Critical Thinking

Teachers can tweak popular strategies to assess students’ prior knowledge in order to encourage critical thinking at the same time.

Pre-unit assessment is an integral part of comprehensive assessment; however, these activities often miss easy and effective opportunities to increase students’ critical thinking abilities while gathering data for future instruction. Additionally, students can feel called out in situations where they lack the schema to complete what is supposed to be a low-risk assessment, leaving them with feelings of defeat before the unit has even begun. Tried-and-true preassessments can be adjusted to promote critical thinking while also sending positive messages to students.

Try OWL Instead of KWL

KWL (a graphic organizer recording students’ Knowledge, Wonders, and Learning over time) can be an effective strategy to measure schema and new learning throughout a unit. However, for a student who’s never heard of quadrilaterals, Cro-Magnon humans, or soil, this can be an intimidating task when a teacher says to fill a graphic organizer with background knowledge. You don’t know what you don’t know. Instead, teachers can tweak this process so that it’s a win for them as well as their students.

OWL ( Observe, Wonder, Learn ) is a small variation that can increase higher-order thinking by introducing a topic through a shared observation. A teacher could display a collage of rectangles, rhombuses, parallelograms, etc., and ask students to use comparison skills to write down everything they notice and wonder about these shapes.

Another teacher could play a short clip from a documentary about Cro-Magnon humans with muted volume so that the students engage in inference while formulating their responses. Still another teacher could have students use magnifying glasses and analysis skills to observe a bucket of topsoil and then write their connections.

These teachers will still be able to gather actionable data regarding vocabulary, previous exposure, connections to real-life examples, etc., and will most likely be pleased with the higher-order thinking that they observe. Varied levels of schema on the topic will be evident, but the difference is that in this type of activity all students are entering into an equitable experience. Everyone will have something to say/write.

What KWL might suggest:

• You should already know something about this.
• You are already behind to be successful in this unit.

What OWL suggests:

• You are in an equitable situation with everyone else.
• Everyone’s map to learning about this is unique.

Try Anticipation Guides Instead of Pretests

Simply stated, pretests collect a unit’s big takeaways and gauge students’ previous exposure and readiness to learn. Anticipation guides are a unique spin on pretests that require some of the most complex higher-order thinking skills: evaluation, synthesis, analysis, judgment, and justification, while still making it possible to glean student schema. They are popular in English language arts but often fall out of favor in other subjects where the teacher needs to determine if students know the right answer, not just have opinions.

Consider how a slight change in language opens the doors for better thinking. For example, instead of asking, “T or F: Fungi can be helpful to humans,” try asking students to provide scientific evidence to support their responses to the prompt—for example: “Some of the best things are found by accident” or “In most cases, help outweighs hurt.”

Instead of asking students which equation from a list is not correct, have them provide mathematical examples to support if they agree or disagree with   “There’s one best way to solve a problem.” Anticipation guides require metacognition and often get students emotionally engaged with the topic before content delivery. Best of all, students practice the life skill of using evidence to justify their beliefs.

What pretests might suggest:

• There is one right or wrong answer.

What anticipation guides suggest:

• Your viewpoint is valued and will make your learning stronger.
• As long as you can justify your answer and/or provide evidence, you aren’t wrong.

Try Narrative and Demonstration Instead of Quick Writes

Quick writes are a powerful tool that all teachers, regardless of their subject or grade level, can use. By having students process their thoughts, feelings, ideas, and information into quick, low-stakes writing moments, teachers aren’t only gathering data regarding learning but also are using brain-based strategies to increase student memory and understanding.

While a quick write is good on its own, teachers can increase creativity and synthesis, as well as honor differences in expressive skills, with a slight addition to this process. Rather than having students only write on a topic, the allotted time can be broken into two equal parts: narrative writing and demonstration .

On one side of paper, students write everything they know (or don’t know) about a topic. On the reverse, they demonstrate their knowledge in visual form. This might look like students’ drawing clock faces, doodling World War II symbols, or labeling the parts of the digestive system. This variation works well for all students and also empowers those with language barriers and/or delays to show off what they know, while not obsessing with filling the page or how much time on the clock is left to fill.

What quick writes might suggest:

• Quantity is more important than quality in response.

What narrative and demonstration suggests:

• You may be able to share/connect this information in a better way than just words.
• Depth of response is most important.

3 Activities to Enhance Your Evaluation in Critical Thinking

This set of exercises may help enhance critical thinking..

Posted July 9, 2021 | Reviewed by Devon Frye

Back in January, I posted a piece on this blog asking if any readers wanted to develop their critical thinking as a kind of New Year’s Resolution. Following some rather positive feedback, I added a second set of exercises on "analysis."

The third set of exercises in this sequence, regarding "evaluation," can be found below. If you’re interested in enhancing your critical thinking skills, please start with the first set of exercises and then the second, before jumping into this next set. Remember, when we are given opportunities to think about our thinking, we are engaging our metacognitive processes; and that’s a foundational part of critical thinking!

Evaluate arguments on a topic from articles online regarding a current social problem.

Exercise 1:

Find two examples of each type of evidence from the articles you’ve read and evaluate the credibility of the proposition. That is, is the source reliable? Can it be trusted? If not, why? Remember, personal experience and "common belief" statements are among the worst sources for credible information, so be on the lookout for those!

Assess the evidence based on the following factors:

• Anecdotal Evidence/Personal Experience
• Common Belief/Sense Statements
• Expert Opinion
• Statistical Evidence
• Research Data

Exercise 2:

Of course, there is more to "evaluation" than an assessment of credibility. In critical thinking, we must also evaluate the relevance, logic, balance, and bias among the propositions of support and refutation. Think about the articles you read and try answering the following questions in light of your reading:

• Is there any information presented that is irrelevant to the central claim that the article is trying to make?
• Is the overall argument imbalanced in any way?
• Is the overall argument biased in any way?
• Does the argument exclude important arguments?
• Are there hidden assumptions that need to be made more explicit?

Exercise 3:

Finally, consider whether the reasoning presented within these articles is strong enough, in light of your evaluations, to support the conclusion(s) drawn. Are there other reasonable conclusions possible? Again, consider the credibility, relevance, bias, balance, and logic of the information presented in the articles in the context of your consideration.

These activities are a great way to start working on the critical thinking skill of evaluation, as they help you to assess the strength and weaknesses of an argument through each proposition. Depending on how thorough your evaluation was, considering the credibility, relevance, logical strength and both balance and bias of the network of proposition within an argument should give you confidence when inferring a conclusion. In Exercise 4, we will delve further into the skill of inference.

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

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Learning Interventions: Collaborative Learning, Critical Thinking and Assessing Participation Real-Time

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This chapter focuses on the authentic learning interventions for team-based and flipped classroom collaborative learning that assesses real-time class participation which develops competency and employability skills set. The discussions address the process in achieving the intended learning outcomes with the adoption of these learning interventions. It provides evidence-based results in terms of how these learning interventions facilitate effective learning in terms of higher-order critical thinking (refers to the process of thinking is made intensive through scaffolding approach that potentially enables learners to question and reflect deeply), deeper engagement amongst students (refers to the ability for students to be motivated and their involvement through listening and/or participation is much more spontaneous) and higher level of collaboration at inter- and intra-group levels (refers to much more interactivity, team-based involvement in engaging within the team members and/or across members of another group). Collaborative learning is generally defined as a situation in which two or more people learn or attempt to learn something together (Dillenbourg in Collaborative Learning: Cognitive and Computational Approaches 1:1–15, 1999), whereas in a cooperative learning context, individuals work together to optimize, maximize their own and each other’s learning to attain shared goals. Largely, there are three categories of cooperative learning namely informal cooperative learning groups, formal cooperative learning groups and cooperative base groups. In our context, informal cooperative learning was focused on. In accordance with research scholars (Johnson et al. in Change: The Magazine of Higher Learning 30(4):26–35, 1998a; Johnson et al. in Cooperation in the classroom , Interaction Book Company, Edina, MN, 1998b), informal cooperative learning entails students working together to achieve common learning goal in temporary, ad-hoc groups that last from a few minutes to one class period. In a meta-analysis performed by Johnson et al. (Johnson et al. in Change: The Magazine of Higher Learning 30(4):26–35, 1998a), studies since 1924 were reviewed and it was found that when students learn together, academic achievement is enhanced. Moreover, students were found to have higher self-esteem and better quality of relationships (Johnson et al. in Change: The Magazine of Higher Learning 30(4):26–35, 1998a). The functionalities offered within the learning interventions and support systems fundamentally promote collaboration. Student engagement is correlated with participation in public service, self-reported learning gains, increased student achievement (Carini et al. in Research in Higher Education 47:1–32, 2006) and job engagement (Busteed & Seymour in Gallup Business Journal 19, 2015). The goal of the learning interventions is to maximize student engagement in meaningful learning activities within classroom settings. When students engage in more meaningful learning activities, they are actively learning. DeLozier and Rhodes (DeLozier & Rhodes in Educational Psychology Review 29:141–151, 2017) believed that it is the active learning in class that is responsible for the enhancement in learning performances. The use of learning interventions also increases the number of students participating in meaningful learning activities through providing the quieter students in class an alternative avenue of input other than speaking up in front of the class. Cain and Klein ( Independent School 75(1):64–71, 2015) found in their study that quiet students indeed feel more comfortable sharing their ideas online. Moreover, shy and quiet students contribute more through synchronous online discussion than in regular classroom discussion (Warschauer in CALICO Journal , 7–26, 2015). Lastly, with the synchronous online discussion feature of the activity support system and the organized class activity sequences, it is expected that there will be a reduction in time used for transitions between activities, introductions to activities, and disruptions within activities. Both collaborative learning, through “discussion, clarification of ideas, and evaluation of others’ ideas” (Gokhale in Journal of Technology Education 7:22–30, 1995), and high student engagement (Carini et al. in Research in Higher Education 47:1–32, 2006) enhance the development of critical thinking. It was also argued that critical thinking can be learnt through every interaction (MacKnight in Educause Quarterly 23:38–41, 2000) provided the interaction is supported with specific critical thinking activities (Astleitner in Journal of Instructional Psychology 29:53, 2002; Kim in Interactive Learning Environments 22:467–484, 2014; Weltzer-Ward & Carmona in International Journal of Emerging Technologies in Learning 3:86–88, 2008). Therefore, our learning interventions and supports systems, which enhances students’ engagement and collaborative learning, would also lead to a desirable development of students’ critical thinking ability. The chapter will also describe the varying functionalities and the process of how the learning interventions enable the intended learning outcomes to be achieved. This chapter also furnishes the relevant video and training resources that are developed for the learning interventions. The findings from the surveys and interviews serve as evidence based to validate the discussions that emerge from the analysis.

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Acknowledgements

The above two research studies were funded by Nanyang Technological University (NTU) through the NTU Educational Excellence Grants. The author would also like to thank the anonymous reviewers and editors for providing valuable feedback and guidance.

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Appendix A: Post-Survey (After the Intervention of the Learning Support System)

3.1.1 survey questions.

The experience of using “K^mAlive” in this class is ___________________.

Very Positive

Somewhat Positive

Very Negative

What are your thoughts and feelings about your contributions in class being captured?

____________________________________________________________

The use of “K^mAlive” in this class is a/an _________ way to encourage my participation in class.

Very Effective

Somewhat Effective

Ineffective

Very Ineffective

What are your thoughts in terms of the impact of class participation through the adoption of K^mAlive?

The use of “K^mAlive” in this class motivates me to listen more attentively to my classmates’ contributions in class.

Strongly Agree

Strongly Disagree

The use of “K^mAlive” in this class developed my critical thinking abilities.

If you have answered “Strongly Agree/Agree” to question 5, can you explain how the use of “K^mAlive” has enhanced your critical thinking skills?

I believe the use of “K^mAlive” in this course gives a fair assessment of my participation in class.

What are your thoughts and feelings regarding the grading of your participation in class using “K^mAlive”?

What do you like the best about the experience of using “K^mAlive” in class? Please explain why.

What would you like to change about the experience of the usage of “K^mAlive” in class? Please explain why.

Any other comments?

Appendix B: Interview Questions

What are your experiences of using this real-time learning support system—K^mAlive?

How does it explicitly enhance (a) higher levels of class participation; (b) make you think more critically; (c) better engagement with your peers in your group and others in the class

What are your overall perspectives of the features offered in this learning intervention—K^mAlive on how it supports your learning process and how do you learn?

Appendix C: Video Resources

Value Proposition of Learning Support System: K^mAlive (5 min)

https://www.youtube.com/watch?v=NZOpR4fWL0s

Value Proposition of Learning Support System: K^mAlive (20 min)

https://www.youtube.com/watch?v=fjDQcbq84V4

Operational Guide: K^mAlive

https://www.youtube.com/watch?v=O0Iv0q1IdiM

The video trailers with supporting illustrations could also be viewed in the furnished links:

K^mAlive Learning Blog Site: https://blogs.ntu.edu.sg/learning-innovations/kumalive/

Research Lab for Learning Innovation and Culture of Learning: https://learningintervention.wixsite.com/researchlab/klive

Appendix D: Screen Shot of K^mAlive Feature Embedded with NTULearn (Blackboard)

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Rajaram, K. (2021). Learning Interventions: Collaborative Learning, Critical Thinking and Assessing Participation Real-Time. In: Evidence-Based Teaching for the 21st Century Classroom and Beyond. Springer, Singapore. https://doi.org/10.1007/978-981-33-6804-0_3

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• Grades 6-12
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100 Last-Day-of-School Activities Your Students Will Love!

5 Critical Thinking Activities That Get Students Up and Moving

More movement means better learning.

It’s easy to resort to having kids be seated during most of the school day. But learning can (and should) be an active process. Incorporating movement into your instruction has incredible benefits—from deepening student understanding to improving concentration to enhancing performance. Check out these critical thinking activities, adapted from Critical Thinking in the Classroom , a book with over 100 practical tools and strategies for teaching critical thinking in K-12 classrooms.

Four Corners

In this activity, students move to a corner of the classroom based on their responses to a question with four answer choices. Once they’ve moved, they can break into smaller groups to explain their choices. Call on students to share to the entire group. If students are persuaded to a different answer, they can switch corners and further discuss. 

Question ideas:

• Which president was most influential: George Washington, Thomas Jefferson, John Adams, or Abraham Lincoln?
• Is Holden Caulfield a hero: Strongly Agree, Agree, Disagree, or Strongly Disagree?

Gallery Walk

This strategy encourages students to move around the classroom in groups to respond to questions, documents, images, or situations posted on chart paper. Each group gets a different colored marker to record their responses and a set amount of time at each station. When groups move, they can add their own ideas and/or respond to what prior groups have written.

Gallery ideas:

• Political cartoons

Stations are a great way to chunk instruction and present information to the class without a “sit and get.” Group desks around the room or create centers, each with a different concept and task. There should be enough stations for three to five students to work for a set time before rotating.

Station ideas:

• Types of rocks
• Story elements
• Literary genres

Silent Sticky-Note Storm

In this brainstorming activity, students gather in groups of three to five. Each group has a piece of chart paper with a question at the top and a stack of sticky notes. Working in silence, students record as many ideas or answers as possible, one answer per sticky note. When time is up, they post the sticky notes on the paper and then silently categorize them.

• How can you exercise your First Amendment rights?
• What are all the ways you can divide a square into eighths?

Mingle, Pair, Share

Take your Think, Pair, Share to the next level. Instead of having students turn and talk, invite them to stand and interact. Play music while they’re moving around the classroom. When the music stops, each student finds a partner. Pose a question and invite students to silently think about their answer. Then, partners take turns sharing their thoughts.

• How do organisms modify their environments?
• What is the theme of Romeo and Juliet ?

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11 Activities That Promote Critical Thinking In The Class

52 Critical Thinking Flashcards for Problem Solving

Critical thinking activities encourage individuals to analyze, evaluate, and synthesize information to develop informed opinions and make reasoned decisions. Engaging in such exercises cultivates intellectual agility, fostering a deeper understanding of complex issues and honing problem-solving skills for navigating an increasingly intricate world. Through critical thinking, individuals empower themselves to challenge assumptions, uncover biases, and constructively contribute to discourse, thereby enriching both personal growth and societal progress.

Critical thinking serves as the cornerstone of effective problem-solving, enabling individuals to dissect challenges, explore diverse perspectives, and devise innovative solutions grounded in logic and evidence. For engaging problem solving activities, read our article problem solving activities that enhance student’s interest.

What is Critical Thinking?

Critical thinking is a 21st-century skill that enables a person to think rationally and logically in order to reach a plausible conclusion. A critical thinker assesses facts and figures and data objectively and determines what to believe and what not to believe. Critical thinking skills empower a person to decipher complex problems and make impartial and better decisions based on effective information.

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Critical thinking skills cultivate habits of mind such as strategic thinking, skepticism, discerning fallacy from the facts, asking good questions and probing deep into the issues to find the truth.

Importance of Acquiring Critical Thinking Skills

Acquiring critical thinking skills was never as valuable as it is today because of the prevalence of the modern knowledge economy. Today, information and technology are the driving forces behind the global economy. To keep pace with ever-changing technology and new inventions, one has to be flexible enough to embrace changes swiftly.

Read our article: How to Foster Critical Thinking Skills in Students? Creative Strategies and Real-World Examples

Today critical thinking skills are one of the most sought-after skills by the companies. In fact, critical thinking skills are paramount not only for active learning and academic achievement but also for the professional career of the students. The lack of critical thinking skills catalyzes memorization of the topics without a deeper insight, egocentrism, closed-mindedness, reduced student interest in the classroom and not being able to make timely and better decisions.

Benefits of Critical Thinking Skills in Education

Certain strategies are more eloquent than others in teaching students how to think critically. Encouraging critical thinking in the class is indispensable for the learning and growth of the students. In this way, we can raise a generation of innovators and thinkers rather than followers. Some of the benefits offered by thinking critically in the classroom are given below:

• It allows a student to decipher problems and think through the situations in a disciplined and systematic manner
• Through a critical thinking ability, a student can comprehend the logical correlation between distinct ideas
• The student is able to rethink and re-justify his beliefs and ideas based on facts and figures
• Critical thinking skills make the students curious about things around them
• A student who is a critical thinker is creative and always strives to come up with out of the box solutions to intricate problems
• Critical thinking skills assist in the enhanced student learning experience in the classroom and prepares the students for lifelong learning and success
• The critical thinking process is the foundation of new discoveries and inventions in the world of science and technology
• The ability to think critically allows the students to think intellectually and enhances their presentation skills, hence they can convey their ideas and thoughts in a logical and convincing manner
• Critical thinking skills make students a terrific communicator because they have logical reasons behind their ideas

Critical Thinking Lessons and Activities

11 Activities that Promote Critical Thinking in the Class

We have compiled a list of 11 activities that will facilitate you to promote critical thinking abilities in the students. We have also covered problem solving activities that enhance student’s interest in our another article. Click here to read it.

1. Worst Case Scenario

Divide students into teams and introduce each team with a hypothetical challenging scenario. Allocate minimum resources and time to each team and ask them to reach a viable conclusion using those resources. The scenarios can include situations like stranded on an island or stuck in a forest. Students will come up with creative solutions to come out from the imaginary problematic situation they are encountering. Besides encouraging students to think critically, this activity will enhance teamwork, communication and problem-solving skills of the students.

Read our article: 10 Innovative Strategies for Promoting Critical Thinking in the Classroom

2. If You Build It

It is a very flexible game that allows students to think creatively. To start this activity, divide students into groups. Give each group a limited amount of resources such as pipe cleaners, blocks, and marshmallows etc. Every group is supposed to use these resources and construct a certain item such as building, tower or a bridge in a limited time. You can use a variety of materials in the classroom to challenge the students. This activity is helpful in promoting teamwork and creative skills among the students.

It is also one of the classics which can be used in the classroom to encourage critical thinking. Print pictures of objects, animals or concepts and start by telling a unique story about the printed picture. The next student is supposed to continue the story and pass the picture to the other student and so on.

4. Keeping it Real

In this activity, you can ask students to identify a real-world problem in their schools, community or city. After the problem is recognized, students should work in teams to come up with the best possible outcome of that problem.

5. Save the Egg

Make groups of three or four in the class. Ask them to drop an egg from a certain height and think of creative ideas to save the egg from breaking. Students can come up with diverse ideas to conserve the egg like a soft-landing material or any other device. Remember that this activity can get chaotic, so select the area in the school that can be cleaned easily afterward and where there are no chances of damaging the school property.

6. Start a Debate

In this activity, the teacher can act as a facilitator and spark an interesting conversation in the class on any given topic. Give a small introductory speech on an open-ended topic. The topic can be related to current affairs, technological development or a new discovery in the field of science. Encourage students to participate in the debate by expressing their views and ideas on the topic. Conclude the debate with a viable solution or fresh ideas generated during the activity through brainstorming.

7. Create and Invent

This project-based learning activity is best for teaching in the engineering class. Divide students into groups. Present a problem to the students and ask them to build a model or simulate a product using computer animations or graphics that will solve the problem. After students are done with building models, each group is supposed to explain their proposed product to the rest of the class. The primary objective of this activity is to promote creative thinking and problem-solving skills among the students.

8. Select from Alternatives

This activity can be used in computer science, engineering or any of the STEM (Science, Technology, Engineering, Mathematics) classes. Introduce a variety of alternatives such as different formulas for solving the same problem, different computer codes, product designs or distinct explanations of the same topic.

Form groups in the class and ask them to select the best alternative. Each group will then explain its chosen alternative to the rest of the class with reasonable justification of its preference. During the process, the rest of the class can participate by asking questions from the group. This activity is very helpful in nurturing logical thinking and analytical skills among the students.

9. Reading and Critiquing

Present an article from a journal related to any topic that you are teaching. Ask the students to read the article critically and evaluate strengths and weaknesses in the article. Students can write about what they think about the article, any misleading statement or biases of the author and critique it by using their own judgments.

In this way, students can challenge the fallacies and rationality of judgments in the article. Hence, they can use their own thinking to come up with novel ideas pertaining to the topic.

10. Think Pair Share

In this activity, students will come up with their own questions. Make pairs or groups in the class and ask the students to discuss the questions together. The activity will be useful if the teacher gives students a topic on which the question should be based.

For example, if the teacher is teaching biology, the questions of the students can be based on reverse osmosis, human heart, respiratory system and so on. This activity drives student engagement and supports higher-order thinking skills among students.

11. Big Paper – Silent Conversation

Silence is a great way to slow down thinking and promote deep reflection on any subject. Present a driving question to the students and divide them into groups. The students will discuss the question with their teammates and brainstorm their ideas on a big paper. After reflection and discussion, students can write their findings in silence. This is a great learning activity for students who are introverts and love to ruminate silently rather than thinking aloud.

Finally, for students with critical thinking, you can go to GS-JJ.co m to customize exclusive rewards, which not only enlivens the classroom, but also promotes the development and training of students for critical thinking.

Read our next article: 10 Innovative Strategies for Promoting Critical Thinking in the Classroom

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Thanks for the great article! Especially with the post-pandemic learning gap, these critical thinking skills are essential! It’s also important to teach them a growth mindset. If you are interested in that, please check out The Teachers’ Blog!

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• v.22(4); 2014 Aug

Critical Thinking: The Development of an Essential Skill for Nursing Students

Ioanna v. papathanasiou.

1 Nursing Department, Technological Educational Institute of Thessaly, Greece

Christos F. Kleisiaris

2 Nursing Department, Technological Educational Institute of Crete, Greece

Evangelos C. Fradelos

3 State Mental Hospital of Attica “Daphne”, Greece

Katerina Kakou

Lambrini kourkouta.

4 Nursing Department, Alexander Technological Educational Institute of Thessaloniki, Greece

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

1. INTRODUCTION

Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis, synthesis and evaluation of information collected or derived from observation, experience, reflection, reasoning or the communication leading to conviction for action ( 1 ).

So, nurses must adopt positions that promote critical thinking and refine skills of critical reasoning in order a meaningful assessment of both the previous and the new information and decisions taken daily on hospitalization and use of limited resources, forces you to think and act in cases where there are neither clear answers nor specific procedures and where opposing forces transform decision making in a complex process ( 2 ).

Critical thinking applies to nurses as they have diverse multifaceted knowledge to handle the various situations encountered during their shifts still face constant changes in an environment with constant stress of changing conditions and make important decisions using critical thinking to collect and interpret information that are necessary for making a decision ( 3 ).

Critical thinking, combined with creativity, refine the result as nurses can find specific solutions to specific problems with creativity taking place where traditional interventions are not effective. Even with creativity, nurses generate new ideas quickly, get flexible and natural, create original solutions to problems, act independently and with confidence, even under pressure, and demonstrate originality ( 4 ).

The aim of the study is to present the basic skills of critical thinking, to highlight critical thinking as a essential skill for nursing education and a fundamental skill for decision making in nursing practice. Moreover to indicate the positive effect and relation that critical thinking has on professional outcomes.

2. CRITICAL THINKING SKILLS

Nurses in their efforts to implement critical thinking should develop some methods as well as cognitive skills required in analysis, problem solving and decision making ( 5 ). These skills include critical analysis, introductory and concluding justification, valid conclusion, distinguishing facts and opinions to assess the credibility of sources of information, clarification of concepts, and recognition conditions ( 6 , 7 ).

Critical analysis is applied to a set of questions that relate to the event or concept for the determination of important information and ideas and discarding the unnecessary ones. It is, thus, a set of criteria to rationalize an idea where one must know all the questions but to use the appropriate one in this case ( 8 ).

The Socratic Method, where the question and the answer are sought, is a technique in which one can investigate below the surface, recognize and examine the condition, look for the consequences, investigate the multiple data views and distinguish between what one knows and what he simply believes. This method should be implemented by nurses at the end of their shifts, when reviewing patient history and progress, planning the nursing plan or discussing the treatment of a patient with colleagues ( 9 ).

The Inference and Concluding justification are two other critical thinking skills, where the justification for inductive generalizations formed from a set of data and observations, which when considered together, specific pieces of information constitute a special interpretation ( 10 ). In contrast, the justification is deduced from the general to the specific. According to this, nurse starts from a conceptual framework–for example, the prioritization of needs by Maslow or a context–evident and gives descriptive interpretation of the patient’s condition with respect to this framework. So, the nurse who uses drawing needs categorizes information and defines the problem of the patient based on eradication, nutrition or need protection.

In critical thinking, the nurses still distinguish claims based on facts, conclusions, judgments and opinions. The assessment of the reliability of information is an important stage of critical thinking, where the nurse needs to confirm the accuracy of this information by checking other evidence and informants ( 10 ).

The concepts are ideas and opinions that represent objects in the real world and the importance of them. Each person has developed its own concepts, where they are nested by others, either based on personal experience or study or other activities. For a clear understanding of the situation of the patient, the nurse and the patient should be in agreement with the importance of concepts.

People also live under certain assumptions. Many believe that people generally have a generous nature, while others believe that it is a human tendency to act in its own interest. The nurse must believe that life should be considered as invaluable regardless of the condition of the patient, with the patient often believing that quality of life is more important than duration. Nurse and patient, realizing that they can make choices based on these assumptions, can work together for a common acceptable nursing plan ( 11 ).

3. CRITICAL THINKING ENHANCEMENT BEHAVIORS

The person applying critical thinking works to develop the following attitudes and characteristics independence of thought, fairness, insight into the personal and public level, humble intellect and postpone the crisis, spiritual courage, integrity, perseverance, self-confidence, research interest considerations not only behind the feelings and emotions but also behind the thoughts and curiosity ( 12 ).

Independence of Thought

Individuals who apply critical thinking as they mature acquire knowledge and experiences and examine their beliefs under new evidence. The nurses do not remain to what they were taught in school, but are “open-minded” in terms of different intervention methods technical skills.

Impartiality

Those who apply critical thinking are independent in different ways, based on evidence and not panic or personal and group biases. The nurse takes into account the views of both the younger and older family members.

Perspicacity into Personal and Social Factors

Those who are using critical thinking and accept the possibility that their personal prejudices, social pressures and habits could affect their judgment greatly. So, they try to actively interpret their prejudices whenever they think and decide.

Humble Cerebration and Deferral Crisis

Humble intellect means to have someone aware of the limits of his own knowledge. So, those who apply critical thinking are willing to admit they do not know something and believe that what we all consider rectum cannot always be true, because new evidence may emerge.

Spiritual Courage

The values and beliefs are not always obtained by rationality, meaning opinions that have been researched and proven that are supported by reasons and information. The courage should be true to their new ground in situations where social penalties for incompatibility are strict. In many cases the nurses who supported an attitude according to which if investigations are proved wrong, they are canceled.

Use of critical thinking to mentally intact individuals question their knowledge and beliefs quickly and thoroughly and cause the knowledge of others so that they are willing to admit and appreciate inconsistencies of both their own beliefs and the beliefs of the others.

Perseverance

The perseverance shown by nurses in exploring effective solutions for patient problems and nursing each determination helps to clarify concepts and to distinguish related issues despite the difficulties and failures. Using critical thinking they resist the temptation to find a quick and simple answer to avoid uncomfortable situations such as confusion and frustration.

Confidence in the Justification

According to critical thinking through well motivated reasoning leads to reliable conclusions. Using critical thinking nurses develop both the inductive and the deductive reasoning. The nurse gaining more experience of mental process and improvement, does not hesitate to disagree and be troubled thereby acting as a role model to colleagues, inspiring them to develop critical thinking.

Interesting Thoughts and Feelings for Research

Nurses need to recognize, examine and inspect or modify the emotions involved with critical thinking. So, if they feel anger, guilt and frustration for some event in their work, they should follow some steps: To restrict the operations for a while to avoid hasty conclusions and impulsive decisions, discuss negative feelings with a trusted, consume some of the energy produced by emotion, for example, doing calisthenics or walking, ponder over the situation and determine whether the emotional response is appropriate. After intense feelings abate, the nurse will be able to proceed objectively to necessary conclusions and to take the necessary decisions.

The internal debate, that has constantly in mind that the use of critical thinking is full of questions. So, a research nurse calculates traditions but does not hesitate to challenge them if you do not confirm their validity and reliability.

4. IMPLEMENTATION OF CRITICAL THINKING IN NURSING PRACTICE

In their shifts nurses act effectively without using critical thinking as many decisions are mainly based on habit and have a minimum reflection. Thus, higher critical thinking skills are put into operation, when some new ideas or needs are displayed to take a decision beyond routine. The nursing process is a systematic, rational method of planning and providing specialized nursing ( 13 ). The steps of the nursing process are assessment, diagnosis, planning, implementation, evaluation. The health care is setting the priorities of the day to apply critical thinking ( 14 ). Each nurse seeks awareness of reasoning as he/she applies the criteria and considerations and as thinking evolves ( 15 ).

Problem Solving

Problem solving helps to acquire knowledge as nurse obtains information explaining the nature of the problem and recommends possible solutions which evaluate and select the application of the best without rejecting them in a possible appeal of the original. Also, it approaches issues when solving problems that are often used is the empirical method, intuition, research process and the scientific method modified ( 16 ).

Experiential Method

This method is mainly used in home care nursing interventions where they cannot function properly because of the tools and equipment that are incomplete ( 17 ).

Intuition is the perception and understanding of concepts without the conscious use of reasoning. As a problem solving approach, as it is considered by many, is a form of guessing and therefore is characterized as an inappropriate basis for nursing decisions. But others see it as important and legitimate aspect of the crisis gained through knowledge and experience. The clinical experience allows the practitioner to recognize items and standards and approach the right conclusions. Many nurses are sensing the evolution of the patient’s condition which helps them to act sooner although the limited information. Despite the fact that the intuitive method of solving problems is recognized as part of nursing practice, it is not recommended for beginners or students because the cognitive level and the clinical experience is incomplete and does not allow a valid decision ( 16 ).

Research Process / Scientifically Modified Method

The research method is a worded, rational and systematic approach to problem solving. Health professionals working in uncontrolled situations need to implement a modified approach of the scientific method of problem solving. With critical thinking being important in all processes of problem solving, the nurse considers all possible solutions and decides on the choice of the most appropriate solution for each case ( 18 ).

The Decision

The decision is the selection of appropriate actions to fulfill the desired objective through critical thinking. Decisions should be taken when several exclusive options are available or when there is a choice of action or not. The nurse when facing multiple needs of patients, should set priorities and decide the order in which they help their patients. They should therefore: a) examine the advantages and disadvantages of each option, b) implement prioritization needs by Maslow, c) assess what actions can be delegated to others, and d) use any framework implementation priorities. Even nurses make decisions about their personal and professional lives. The successive stages of decision making are the Recognition of Objective or Purpose, Definition of criteria, Calculation Criteria, Exploration of Alternative Solutions, Consideration of Alternative Solutions, Design, Implementation, Evaluation result ( 16 ).

The contribution of critical thinking in decision making

Acquiring critical thinking and opinion is a question of practice. Critical thinking is not a phenomenon and we should all try to achieve some level of critical thinking to solve problems and make decisions successfully ( 19 - 21 ).

It is vital that the alteration of growing research or application of the Socratic Method or other technique since nurses revise the evaluation criteria of thinking and apply their own reasoning. So when they have knowledge of their own reasoning-as they apply critical thinking-they can detect syllogistic errors ( 22 – 26 ).

5. CONCLUSION

In responsible positions nurses should be especially aware of the climate of thought that is implemented and actively create an environment that stimulates and encourages diversity of opinion and research ideas ( 27 ). The nurses will also be applied to investigate the views of people from different cultures, religions, social and economic levels, family structures and different ages. Managing nurses should encourage colleagues to scrutinize the data prior to draw conclusions and to avoid “group thinking” which tends to vary without thinking of the will of the group. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

CONFLICT OF INTEREST: NONE DECLARED.

The Nursing Process: A Comprehensive Guide

In 1958, Ida Jean Orlando began developing the nursing process still evident in nursing care today. According to Orlando’s theory, the patient’s behavior sets the nursing process in motion. Through the nurse ‘s knowledge to analyze and diagnose the behavior to determine the patient’s needs.

Application of the fundamental principles of critical thinking , client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EBP) recommendations, and nursing intuition, the nursing process functions as a systematic guide to client-centered care with five subsequent steps. These are assessment , diagnosis, planning, implementation, and evaluation ( ADPIE ).

Table of Contents

What is the nursing process.

• What is the purpose of the nursing process? 

Characteristics of the nursing process

Nursing process steps, collecting data, objective data or signs, subjective data or symptoms, verbal data, nonverbal data, primary source, secondary source, tertiary source, health interview, physical examination, observation, validating data, documenting data.

• 2. Diagnosis: “What is the problem?” 

Initial Planning

Ongoing planning, discharge planning, developing a nursing care plan, behavioral nursing interventions, community nursing interventions, family nursing interventions, health system nursing interventions, physiological nursing interventions, safety nursing interventions, skills used in implementing nursing care, 1. reassessing the client, 2. determining the nurse’s need for assistance, nursing intervention categories, independent nursing interventions, dependent nursing interventions, interdependent nursing interventions, 4. supervising the delegated care, 5. documenting nursing activities, 1. collecting data, 2. comparing data with desired outcomes, 3. analyzing client’s response relating to nursing activities, 4. identifying factors contributing to success or failure, 5. continuing, modifying, or terminating the nursing care plan, 6. discharge planning.

The nursing process is defined as a systematic, rational method of planning that guides all nursing actions in delivering holistic and patient-focused care. The nursing process is a form of scientific reasoning and requires the nurse’s critical thinking to provide the best care possible to the client.

What is the purpose of the nursing process?

The following are the purposes of the nursing process:

• To identify the client’s health status and actual or potential health care problems or needs (through assessment).
• To establish plans to meet the identified needs.
• To deliver specific nursing interventions to meet those needs.
• To apply the best available caregiving evidence and promote human functions and responses to health and illness (ANA, 2010).
• To protect nurses against legal problems related to nursing care when the standards of the nursing process are followed correctly.
• To help the nurse perform in a systematically organized way their practice.
• To establish a database about the client’s health status, health concerns, response to illness, and the ability to manage health care needs.

The following are the unique characteristics of the nursing process: 

• Patient-centered . The unique approach of the nursing process requires care respectful of and responsive to the individual patient’s needs, preferences, and values. The nurse functions as a patient advocate by keeping the patient’s right to practice informed decision-making and maintaining patient-centered engagement in the health care setting.
• Interpersonal . The nursing process provides the basis for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing due to the interaction. It involves the interaction between the nurse and the patient with a common goal.
• Collaborative . The nursing process functions effectively in nursing and inter-professional teams, promoting open communication, mutual respect, and shared decision-making to achieve quality patient care .
• Dynamic and cyclical .The nursing process is a dynamic, cyclical process in which each phase interacts with and is influenced by the other phases.
• Requires critical thinking . The use of the nursing process requires critical thinking which is a vital skill required for nurses in identifying client problems and implementing interventions to promote effective care outcomes.

The nursing process consists of five steps: assessment, diagnosis, planning, implementation, and evaluation . The acronym ADPIE is an easy way to remember the components of the nursing process. Nurses need to learn how to apply the process step-by-step. However, as critical thinking develops through experience, they learn how to move back and forth among the steps of the nursing process.

The steps of the nursing process are not separate entities but overlapping, continuing subprocesses. Apart from understanding nursing diagnoses and their definitions, the nurse promotes awareness of defining characteristics and behaviors of the diagnoses, related factors to the selected nursing diagnoses, and the interventions suited for treating the diagnoses.

The steps of the nursing process are detailed below:

1. Assessment: “What data is collected?”

The first phase of the nursing process is assessment . It involves collecting, organizing, validating, and documenting the clients’ health status. This data can be obtained in a variety of ways. Usually, when the nurse first encounters a patient, the nurse is expected to assess to identify the patient’s health problems as well as the physiological, psychological, and emotional state and to establish a database about the client’s response to health concerns or illness and the ability to manage health care needs. Critical thinking skills are essential to the assessment, thus requiring concept-based curriculum changes.

Data collection is the process of gathering information regarding a client’s health status. The process must be systematic and continuous in collecting data to prevent the omission of important information concerning the client.

The best way to collect data is through head-to-toe assessment. Learn more about it at our guide: Head to Toe Assessment: Complete Physical Assessment Guide

Types of Data

Data collected about a client generally falls into objective or subjective categories, but data can also be verbal and nonverbal. 

Objective data are overt, measurable, tangible data collected via the senses, such as sight, touch , smell , or hearing , and compared to an accepted standard, such as vital signs, intake and output , height and weight, body temperature, pulse, and respiratory rates, blood pressure , vomiting , distended abdomen, presence of edema , lung sounds, crying, skin color, and presence of diaphoresis.

Subjective data involve covert information, such as feelings, perceptions, thoughts, sensations, or concerns that are shared by the patient and can be verified only by the patient, such as nausea , pain , numbness, pruritus, attitudes, beliefs, values, and perceptions of the health concern and life events.

Verbal data are spoken or written data such as statements made by the client or by a secondary source. Verbal data requires the listening skills of the nurse to assess difficulties such as slurring, tone of voice, assertiveness, anxiety , difficulty in finding the desired word, and flight of ideas.

Nonverbal data are observable behavior transmitting a message without words, such as the patient’s body language, general appearance , facial expressions, gestures, eye contact, proxemics (distance), body language, touch, posture, clothing. Nonverbal data obtained can sometimes be more powerful than verbal data, as the client’s body language may not be congruent with what they really think or feel. Obtaining and analyzing nonverbal data can help reinforce other forms of data and understand what the patient really feels.

Sources of Data

Sources of data can be primary, secondary, and tertiary . The client is the primary source of data, while family members , support persons, records and reports, other health professionals, laboratory and diagnostics fall under secondary sources.

The client is the only primary source of data and the only one who can provide subjective data. Anything the client says or reports to the members of the healthcare team is considered primary.

A source is considered secondary data if it is provided from someone else other than the client but within the client’s frame of reference. Information provided by the client’s family or significant others are considered secondary sources of data if the client cannot speak for themselves, is lacking facts and understanding, or is a child. Additionally, the client’s records and assessment data from other nurses or other members of the healthcare team are considered secondary sources of data.

Sources from outside the client’s frame of reference are considered tertiary sources of data . Examples of tertiary data include information from textbooks, medical and nursing journals, drug handbooks, surveys, and policy and procedural manuals.

Methods of Data Collection

The main methods used to collect data are health interviews, physical examination, and observation.

The most common approach to gathering important information is through an interview. An interview is an intended communication or a conversation with a purpose, for example, to obtain or provide information, identify problems of mutual concern, evaluate change, teach, provide support, or provide counseling or therapy. One example of the interview is the nursing health history , which is a part of the nursing admission assessment. Patient interaction is generally the heaviest during the assessment phase of the nursing process so rapport must be established during this step.

Aside from conducting interviews, nurses will perform physical examinations, referencing a patient’s health history, obtaining a patient’s family history, and general observation can also be used to gather assessment data. Establishing a good physical assessment would, later on, provide a more accurate diagnosis, planning, and better interventions and evaluation .

Observation is an assessment tool that depends on the use of the five senses (sight, touch, hearing, smell, and taste ) to learn information about the client. This information relates to characteristics of the client’s appearance, functioning, primary relationships, and environment. Although nurses observe mainly through sight, most of the senses are engaged during careful observations such as smelling foul odors, hearing or auscultating lung and heart sounds and feeling the pulse rate and other palpable skin deformations.

Validation is the process of verifying the data to ensure that it is accurate and factual. One way to validate observations is through “double-checking,” and it allows the nurse to complete the following tasks:

• Ensures that assessment information is double-checked, verified, and complete. For example, during routine assessment, the nurse obtains a reading of 210/96 mm Hg of a client with no history of hypertension . To validate the data, the nurse should retake the blood pressure and if necessary, use another equipment to confirm the measurement or ask someone else to perform the assessment.
• Ensure that objective and related subjective data are valid and accurate. For example, the client’s perceptions of “feeling hot” need to be compared with the measurement of the body temperature.
• Ensure that the nurse does not come to a conclusion without adequate data to support the conclusion. A nurse assumes tiny purple or bluish-black swollen areas under the tongue of an older adult client to be abnormal until reading about physical changes of aging.
• Ensure that any ambiguous or vague statements are clarified. For example, a 86-year-old female client who is not a native English speaker says that “I am in pain on and off for 4 weeks,” would require verification for clarity from the nurse by asking “Can you describe what your pain is like? What do you mean by on and off?”
• Acquire additional details that may have been overlooked. For example, the nurse is asking a 32-year-old client if he is allergic to any prescription or non-prescription medications. And what would happen if he takes these medications.
• Distinguish between cues and inferences. Cues are subjective or objective data that can be directly observed by the nurse; that is, what the client says or what the nurse can see, hear, feel, smell, or measure. On the other hand, inferences are the nurse’s interpretation or conclusions made based on the cues. For example, the nurse observes the cues that the incision is red, hot, and swollen and makes an inference that the incision is infected.

Once all the information has been collected, data can be recorded and sorted. Excellent record-keeping is fundamental so that all the data gathered is documented and explained in a way that is accessible to the whole health care team and can be referenced during evaluation. 

2. Diagnosis: “What is the problem?”

The second step of the nursing process is the nursing diagnosis . The nurse will analyze all the gathered information and diagnose the client’s condition and needs. Diagnosing involves analyzing data, identifying health problems, risks, and strengths, and formulating diagnostic statements about a patient’s potential or actual health problem. More than one diagnosis is sometimes made for a single patient. Formulating a nursing diagnosis by employing clinical judgment assists in the planning and implementation of patient care .

The types, components, processes, examples, and writing nursing diagnosis are discussed more in detail here “ Nursing Diagnosis Guide: All You Need To Know To Master Diagnosing ”

3. Planning: “How to manage the problem?”

Planning is the third step of the nursing process. It provides direction for nursing interventions . When the nurse, any supervising medical staff, and the patient agree on the diagnosis, the nurse will plan a course of treatment that takes into account short and long-term goals. Each problem is committed to a clear, measurable goal for the expected beneficial outcome. 

The planning phase is where goals and outcomes are formulated that directly impact patient care based on evidence-based practice (EBP) guidelines. These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing care plans are essential in this phase of goal setting. Care plans provide a course of direction for personalized care tailored to an individual’s unique needs. Overall condition and comorbid conditions play a role in the construction of a care plan. Care plans enhance communication, documentation, reimbursement , and continuity of care across the healthcare continuum.

Types of Planning

Planning starts with the first client contact and resumes until the nurse-client relationship ends, preferably when the client is discharged from the health care facility.

Initial planning is done by the nurse who conducts the admission assessment. Usually, the same nurse would be the one to create the initial comprehensive plan of care.

Ongoing planning is done by all the nurses who work with the client. As a nurse obtain new information and evaluate the client’s responses to care, they can individualize the initial care plan further. An ongoing care plan also occurs at the beginning of a shift. Ongoing planning allows the nurse to:

• determine if the client’s health status has changed
• set priorities for the client during the shift
• decide which problem to focus on during the shift
• coordinate with nurses to ensure that more than one problem can be addressed at each client contact

Discharge planning is the process of anticipating and planning for needs after discharge. To provide continuity of care, nurses need to accomplish the following:

• Start discharge planning for all clients when they are admitted to any health care setting.
• Involve the client and the client’s family or support persons in the planning process.
• Collaborate with other health care professionals as needed to ensure that biopsychosocial, cultural, and spiritual needs are met.

A nursing care plan (NCP) is a formal process that correctly identifies existing needs and recognizes potential needs or risks. Care plans provide communication among nurses, their patients, and other healthcare providers to achieve health care outcomes. Without the nursing care planning process, the quality and consistency of patient care would be lost.

The planning step of the nursing process is discussed in detail in Nursing Care Plans (NCP): Ultimate Guide and Database .

4. Implementation: “Putting the plan into action!”

The implementation phase of the nursing process is when the nurse puts the treatment plan into effect. It involves action or doing and the actual carrying out of nursing interventions outlined in the plan of care. This typically begins with the medical staff conducting any needed medical interventions. 

Interventions should be specific to each patient and focus on achievable outcomes. Actions associated with a nursing care plan include monitoring the patient for signs of change or improvement, directly caring for the patient or conducting important medical tasks such as medication administration, educating and guiding the patient about further health management, and referring or contacting the patient for a follow-up.

A taxonomy of nursing interventions referred to as the Nursing Interventions Classification (NIC) taxonomy, was developed by the Iowa Intervention Project. The nurse can look up a client’s nursing diagnosis to see which nursing interventions are recommended. 

Nursing Interventions Classification (NIC) System

There are more than 550 nursing intervention labels that nurses can use to provide the proper care to their patients. These interventions are categorized into seven fields or classes of interventions according to the Nursing Interventions Classification system.

These are interventions designed to help a patient change their behavior. With behavioral interventions, in contrast, patient behavior is the key and the goal is to modify it. The following measures are examples of behavioral nursing interventions:

• Encouraging stress and relaxation techniques
• Providing support to quit smoking
• Engaging the patient in some form of physical activity , like walking , to reduce the patient’s anxiety , anger, and hostility

These are interventions that refer to the community-wide approach to health behavior change. Instead of focusing mainly on the individual as a change agent, community interventionists recognize a host of other factors that contribute to an individual’s capacity to achieve optimal health, such as:

• Implementing an education program for first-time mothers
• Promoting diet and physical activities
• Initiating HIV awareness and violence-prevention programs
• Organizing a fun run to raise money for breast cancer research 

These are interventions that influence a patient’s entire family.

• Implementing a family-centered approach in reducing the threat of illness spreading when one family member is diagnosed with a communicable disease
• Providing a nursing woman support in breastfeeding her new baby
• Educating family members about caring for the patient

These are interventions that designed to maintain a safe medical facility for all patients and staff, such as:

• Following procedures to reduce the risk of infection for patients during hospital stays.
• Ensuring that the patient’s environment is safe and comfortable, such as repositioning them to avoid pressure ulcers in bed

These are interventions related to a patient’s physical health to make sure that any physical needs are being met and that the patient is in a healthy condition. These nursing interventions are classified into two types: basic and complex.

• Basic. Basic interventions regarding the patient’s physical health include hands-on procedures ranging from feeding to hygiene assistance.
• Complex. Some physiological nursing interventions are more complex, such as the insertion of an IV line to administer fluids to a dehydrated patient.

These are interventions that maintain a patient’s safety and prevent injuries, such as:

• Educating a patient about how to call for assistance if they are not able to safely move around on their own
• Providing instructions for using assistive devices such as walkers or canes, or how to take a shower safely.

When implementing care, nurses need cognitive, interpersonal, and technical skills to perform the care plan successfully.

• Cognitive Skills are also known as Intellectual Skills are skills involve learning and understanding fundamental knowledge including basic sciences, nursing procedures, and their underlying rationale before caring for clients. Cognitive skills also include problem-solving, decision-making, critical thinking, clinical reasoning, and creativity.
• Interpersonal Skills are skills that involve believing, behaving, and relating to others. The effectiveness of a nursing action usually leans mainly on the nurse’s ability to communicate with the patient and the members of the health care team.
• Technical Skills are purposeful “hands-on” skills such as changing a sterile dressing , administering an injection, manipulating equipment, bandaging, moving , lifting, and repositioning clients. All of these activities require safe and competent performance.

Process of Implementing

The process of implementing typically includes the following:

Prior to implementing an intervention, the nurse must reassess the client to make sure the intervention is still needed. Even if an order is written on the care plan, the client’s condition may have changed.

Other nursing tasks or activities may also be performed by non- RN members of the healthcare team. Members of this team may include unlicensed assistive personnel (UAP) and caregivers , as well as other licensed healthcare workers, such as licensed practical nurses/licensed vocational nurses (LPNs/LVNs). The nurse may need assistance when implementing some nursing intervention, such as ambulating an unsteady obese client, repositioning a client, or when a nurse is not familiar with a particular model of traction equipment needs assistance the first time it is applied.

3. Implementing the nursing interventions

Nurses must not only have a substantial knowledge base of the sciences, nursing theory, nursing practice , and legal parameters of nursing interventions but also must have the psychomotor skills to implement procedures safely. It is necessary for nurses to describe, explain, and clarify to the client what interventions will be done, what sensations to anticipate, what the client is expected to do, and what the expected outcome is. When implementing care, nurses perform activities that may be independent, dependent, or interdependent.

Nursing interventions are grouped into three categories according to the role of the healthcare professional involved in the patient’s care:

A registered nurse can perform independent interventions on their own without the help or assistance from other medical personnel, such as: 

• routine nursing tasks such as checking vital signs
• educating a patient on the importance of their medication so they can administer it as prescribed

A nurse cannot initiate dependent interventions alone. Some actions require guidance or supervision from a physician or other medical professional, such as:

• prescribing new medication
• inserting and removing a urinary catheter
• providing diet
• Implementing wound or bladder irrigations

A nurse performs as part of collaborative or interdependent interventions that involve team members across disciplines.

• In some cases, such as post- surgery , the patient’s recovery plan may require prescription medication from a physician, feeding assistance from a nurse, and treatment by a physical therapist or occupational therapist.
• The physician may prescribe a specific diet to a patient. The nurse includes diet counseling in the patient care plan. To aid the patient, even more, the nurse enlists the help of the dietician that is available in the facility.

Delegate specific nursing interventions to other members of the nursing team as appropriate. Consider the capabilities and limitations of the members of the nursing team and supervise the performance of the nursing interventions. Deciding whether delegation is indicated is another activity that arises during the nursing process.

The American Nurses Association and the National Council of State Boards of Nursing (2006) define delegation as “the process for a nurse to direct another person to perform nursing tasks and activities.” It generally concerns the appointment of the performance of activities or tasks associated with patient care to unlicensed assistive personnel while retaining accountability for the outcome.

Nevertheless, registered nurses cannot delegate responsibilities related to making nursing judgments. Examples of nursing activities that cannot be delegated to unlicensed assistive personnel include assessment and evaluation of the impact of interventions on care provided to the patient.

Record what has been done as well as the patient’s responses to nursing interventions precisely and concisely.

5. Evaluation: “Did the plan work?”

Evaluating is the fifth step of the nursing process. This final phase of the nursing process is vital to a positive patient outcome. Once all nursing intervention actions have taken place, the team now learns what works and what doesn’t by evaluating what was done beforehand. Whenever a healthcare provider intervenes or implements care, they must reassess or evaluate to ensure the desired outcome has been met. The possible patient outcomes are generally explained under three terms: the patient’s condition improved, the patient’s condition stabilized, and the patient’s condition worsened.

Steps in Evaluation

Nursing evaluation includes (1) collecting data, (2) comparing collected data with desired outcomes, (3) analyzing client’s response relating to nursing activities, (4) identifying factors that contributed to the success or failure of the care plan, (5) continuing, modifying, or terminating the nursing care plan , and (6) planning for future nursing care.

The nurse recollects data so that conclusions can be drawn about whether goals have been fulfilled. It is usually vital to collect both objective and subjective data. Data must be documented concisely and accurately to facilitate the next part of the evaluating process.

The documented goals and objectives of the nursing care plan become the standards or criteria by which to measure the client’s progress whether the desired outcome has been met, partially met, or not met.

• The goal was met , when the client response is the same as the desired outcome.
• The goal was partially met , when either a short-term outcome was achieved but the long-term goal was not, or the desired goal was incompletely attained.
• The goal was not met.

It is also very important to determine whether the nursing activities had any relation to the outcomes whether it was successfully accomplished or not.

It is required to collect more data to confirm if the plan was successful or a failure. Different factors may contribute to the achievement of goals. For example, the client’s family may or may not be supportive, or the client may be uncooperative to perform such activities. 

The nursing process is dynamic and cyclical. If goals were not sufficed, the nursing process begins again from the first step. Reassessment and modification may continually be needed to keep them current and relevant depending upon general patient condition. The plan of care may be adjusted based on new assessment data. Problems may arise or change accordingly. As clients complete their goals, new goals are set. If goals remain unmet, nurses must evaluate the reasons these goals are not being achieved and recommend revisions to the nursing care plan .

Discharge planning is the process of transitioning a patient from one level of care to the next. Discharge plans are individualized instructions provided as the client is prepared for continued care outside the healthcare facility or for independent living at home. The main purpose of a discharge plan is to improve the client’s quality of life by ensuring continuity of care together with the client’s family or other healthcare workers providing continuing care.

The following are the key elements of IDEAL discharge planning according to the Agency for Healthcare Research and Quality:

• I nclude the patient and family as full partners in the discharge planning process.
• Describe what life at home will be like
• Review medications
• Highlight warning signs and problems
• Explain test results
• Schedule follow-up appointments
• E ducate the patient and family in plain language about the patient’s condition, the discharge process, and next steps throughout the hospital stay.
• A ssess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient’s care to the patient and family and use teach back.
• L isten to and honor the patient’s and family’s goals, preferences, observations, and concerns. 

A discharge plan includes specific components of client teaching with documentation such as:

• Equipment needed at home. Coordinate home-based care and special equipment needed.
• Dietary needs or special diet . Discuss what the patient can or cannot eat at home.
• Medications to be taken at home. List the patient’s medications and discuss the purpose of each medicine, how much to take, how to take it, and potential side effects.
• Resources such as contact numbers and addresses of important people. Write down the name and contact information of someone to call if there is a problem.
• Emergency response: Danger signs. Identify and educate patients and families about warning signs or potential problems.
• Home care activities. Educate patient on what activities to do or avoid at home.
• Summary. Discuss with the patient and family about the patient’s condition, the discharge process, and follow-up checkups.

39 thoughts on “The Nursing Process: A Comprehensive Guide”

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Is the nursing process the same as “critical thinking”?

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Excellent job. A great help to all nursing students. Thank you for sharing. God bless you.

Hi Joycelyn, Thank you so much for your kind words! It’s really rewarding to hear that it’s helping nursing students out there. We’re all about sharing knowledge and making things a bit easier. 😊 If there’s anything else you’d like to see or know, just let me know. And blessings right back at you!

Thank you so much…It’s a very comprehensive reference.

You’re very welcome, A.C! I’m glad you found the nursing process reference comprehensive and useful. Just out of curiosity, is there a particular step in the nursing process you’d like to explore more deeply, or do you have any specific areas where you’d like more detailed information?

I am a nursing student and I see this as a helpful tool, very detailed and easy to understand thanks for sharing

Hi Mawuli, I’m delighted to know that you’re finding our resources helpful! If you have any specific questions or if there’s a particular topic you’d like more information on, please feel free to ask. I’m here to assist you with any nursing-related inquiries you may have. Keep up the great work in your studies! 🩺📚🌟

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Hey Mokete, Thank you so much for the kind words! We’re thrilled to hear that you’re finding our nursing resources helpful. We’ll do our best to keep you updated with more valuable nursing PDFs and information. If there’s anything specific you’d like to see or if you have any questions, feel free to let us know. Keep up the great work in your nursing journey! 👩‍⚕️📚🌟

Thanks it really helps alot

Glad to be of help! Thank you!

This guideline very useful for Nurses building their competency and practice quality of care of Nursing to use as reference please allow to download free especially to Nurses who live in developing countries since it is not affordable to buy it

You can download the articles by printing them as PDF :) You can use a service called printfriendly (google it) to make PDFs of our webpages.

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Thank you so much…It’s a very comprehensive reference. God bless you

Hello Theophilus, You’re very welcome, and thank you for the blessings! 😊 I’m glad you found the reference on the nursing process comprehensive. Just out of curiosity, is there a particular part of the nursing process you’re most interested in, or any aspect you’d like to explore more deeply?

God bless you too, and if you have any more questions, feel free to ask!

Very helpful information. Thank you.

Thank you so much, Alisa. If you need more information or help regarding this, let us know.

You’re doing a great job here. Please can you do it in such a way for us to download it as a pdf?

Hi Millicent, Thank you so much for the kind words! 😊 I’m really glad you’re finding the site useful.

Regarding your request to download content as a PDF, a neat trick you can use is the “print” function in your web browser. Here’s how you can do it:

Open the page you want to save as a PDF. -Go to the “File” menu in your browser and select “Print,” or simply press Ctrl+P (Cmd+P on Mac). -In the print window, look for a destination option and select “Save as PDF” or something similar. -Adjust any settings as needed, then click “Save” or “Print,” and choose where you want to save the file on your computer.

This way, you can turn any page into a PDF for your personal use. If you have any more questions or need further assistance, feel free to ask. Always here to help!

Very helpful Thank you

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15 Assessment Activities That Are Fast, Fun, and Formative

Assessment activities should be quick, enjoyable, and versatile. That’s because formative assessment is best when it’s ongoing and consistent. You can’t go wrong with these assessment activities that are perfect for formative evaluations on the go.

Teachers use it in their classrooms to provide critical feedback to learners. It helps them to monitor and modify their instruction methods and lesson plans to improve learning outcomes. That’s why we must use a variety of assessment activities and change them up frequently to stimulate both students and themselves.

Formative assessment is an assessment that’s both for learning and as learning. This continual cycle of feedback and improvement makes learning useful and effective. Try these assessment activities with your learners and see the results for yourself.

15 Formative Assessment Activities You’ll Love Using

1. Peer Quizzes:  Learners can write their own questions about the content and then quiz each other. They would also spend time going through the incorrect answers with each other to heighten their understanding.

2. 5x5 Journal:  Journaling has been proven to be one of the best reflection tools around for learning. Have learners journal about the five most interesting ideas they discovered during a lesson. Next, they identify five things that resonate with them about each one and explain why.

3. Past Postcards:  Have learners adopt the personality of a historical figure and write a postcard to another historical figure from the same era. They can discuss a significant event from history that has just occurred.

4. Cool Collages:  Ask learners to make a collage or poster from magazine photos for demonstrating their understanding of a concept. They can use standard art materials or use apps designed for drawing.

5. Talk it Out:  Learners can host their own talk show and discuss the important points of any lesson. They write their own questions and answers, and can even play characters of their own creation.

6. Daring Doodles:  Challenge learners to use a drawing rather than words to show understanding of a concept. This is the perfect exercise for those who have difficulty speaking out in class.

7. Exploration Table:  At the end of class, each learner answers the following questions presented to them on index cards:

What did we do in class?

Why did we do it?

What did I learn today?

How can I apply it?

What questions do I have about it?

8. 3-2-1:  Have learners write or talk about 3 things they learned, 2 things they still want to learn, and 1 question they have. These values are interchangeable and can be used in different combinations, or with different questions altogether.

9. Four Corners:  This is a great way to encourage dynamic movement while learning multiple-choice questions. Designate each corner of the classroom to represent A, B, C, and D. Learners go to the corner that they believe corresponds with the correct answer.

10. Traffic Cards:  Learners create index cards with a large green marker circle on one side and red on the other. If they are following along and understanding the lesson, the green side of their card is upright and visible to you. When they do not understand something and need clarification, they flip the card to show you the red side. Here is an alternative method that can be downloaded for free and printed on coloured card stock for quick use.

11. Twitter Board:  Learners summarize what was learned in a lesson using 140 characters. Pin small strips of paper to a poster or cork board to resemble a Twitter feed.

12. Top Ten Lists:  Learners can write out their ten most important takeaways from a lesson plan or a class discussion. Encourage them to create lists that are humorous and fun.

13. Roll the Dice:  Put a 6-sided dice at each desk. At the end of class, each learner rolls and briefly answers aloud a question based on the number rolled:

I want to remember …

Something I learned today

One word to sum up what I learned

Something I already knew

I’m still confused about …

An “aha” moment that I had today

14. Enthusiasm Example Chart: Learners rank what they learned that day and how much they enjoyed the lessons. They then elaborate by offering details about what they found helpful to them in having a successful learning day. They can also share what prevented them from having a fulfilling day. Compile the data and discuss it in class the next day.

15. Quick Quotable:  Have learners create two columns on a piece of paper. On one side have them write 5 or 6 of their most favourite quotes from people they admire. In the adjoining column, have them write their own interpretation of what the quote means to them and why it appeals to them. If they’re feeling good about it, have them consider what makes a great quote as they write their own ideas that are important to them.

Give Them a Shot

These are awesome formative assessments that we like because they’re creative, low-tech, fun, and best of all, engaging for learners. They’re also easy for a teacher to implement on an ongoing basis anytime. Try them out in your classroom anytime and watch the learning happen.

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