critical thinking and problem solving examples in nursing

The Value of Critical Thinking in Nursing

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

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

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

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

How Do Nurses Use Critical Thinking?

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

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

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

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

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

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

Top 5 Ways Nurses Can Improve Critical Thinking Skills

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

Case-Based Approach

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

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

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

Practice Self-Reflection

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

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

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

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

Develop a Questioning Mind

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

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

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

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

Practice Self-Awareness in the Moment

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

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

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

Use a Process

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

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

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

Common Critical Thinking Pitfalls in Nursing

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

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

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

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

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

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

An Essential Skill for All Nurses

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

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

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

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

How does nursing school develop critical thinking skills?

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

Do only nurse managers use critical thinking?

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

Meet Our Contributors

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

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

Jenna Liphart Rhoads, Ph.D., RN

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

Nicholas McGowan, BSN, RN, CCRN

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

What is Problem-Solving in Nursing? (With Examples, Importance, & Tips to Improve)

Whether you have been a nurse for many years or you are just beginning your nursing career, chances are, you know that problem-solving skills are essential to your success. With all the skills you are expected to develop and hone as a nurse, you may wonder, “Exactly what is problem solving in nursing?” or “Why is it so important?” In this article, I will share some insight into problem-solving in nursing from my experience as a nurse. I will also tell you why I believe problem-solving skills are important and share some tips on how to improve your problem-solving skills.

What Exactly Is Problem-Solving In Nursing?

5 reasons why problem-solving is important in nursing, reason #1: good problem-solving skills reflect effective clinical judgement and critical thinking skills, reason #2: improved patient outcomes, reason #3: problem-solving skills are essential for interdisciplinary collaboration, reason #4: problem-solving skills help promote preventative care measures, reason #5: fosters opportunities for improvement, 5 steps to effective problem-solving in nursing, step #1: gather information (assessment), step #2: identify the problem (diagnosis), step #3: collaborate with your team (planning), step #4: putting your plan into action (implementation), step #5: decide if your plan was effective (evaluation), what are the most common examples of problem-solving in nursing, example #1: what to do when a medication error occurs, how to solve:, example #2: delegating tasks when shifts are short-staffed, example #3: resolving conflicts between team members, example #4: dealing with communication barriers/lack of communication, example #5: lack of essential supplies, example #6: prioritizing care to facilitate time management, example #7: preventing ethical dilemmas from hindering patient care, example #8: finding ways to reduce risks to patient safety, bonus 7 tips to improve your problem-solving skills in nursing, tip #1: enhance your clinical knowledge by becoming a lifelong learner, tip #2: practice effective communication, tip #3: encourage creative thinking and team participation, tip #4: be open-minded, tip #5: utilize your critical thinking skills, tip #6: use evidence-based practices to guide decision-making, tip #7: set a good example for other nurses to follow, my final thoughts, list of sources used for this article.

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Problem Solving in Nursing: Strategies for Your Staff

4 min read • September, 15 2023

Problem solving is in a nurse manager’s DNA. As leaders, nurse managers solve problems every day on an individual level and with their teams. Effective leaders find innovative solutions to problems and encourage their staff to nurture their own critical thinking skills and see problems as opportunities rather than obstacles.

Health care constantly evolves, so problem solving and ingenuity are skills often used out of necessity. Tackling a problem requires considering multiple options to develop a solution. Problem solving in nursing requires a solid strategy.

Nurse problem solving

Nurse managers face challenges ranging from patient care matters to maintaining staff satisfaction. Encourage your staff to develop problem-solving nursing skills to cultivate new methods of improving patient care and to promote  nurse-led innovation .

Critical thinking skills are fostered throughout a nurse’s education, training, and career. These skills help nurses make informed decisions based on facts, data, and evidence to determine the best solution to a problem.

Problem-Solving Examples in Nursing

To solve a problem, begin by identifying it. Then analyze the problem, formulate possible solutions, and determine the best course of action. Remind staff that nurses have been solving problems since Florence Nightingale invented the nurse call system.

Nurses can implement the  original nursing process  to guide patient care for problem solving in nursing. These steps include:

• Assessment . Use critical thinking skills to brainstorm and gather information.
• Diagnosis . Identify the problem and any triggers or obstacles.
• Planning . Collaborate to formulate the desired outcome based on proven methods and resources.
• Implementation . Carry out the actions identified to resolve the problem.
• Evaluation . Reflect on the results and determine if the issue was resolved.

How to Develop Problem-Solving Strategies

Staff look to nurse managers to solve a problem, even when there’s not always an obvious solution. Leaders focused on problem solving encourage their team to work collaboratively to find an answer. Core leadership skills are a good way to nurture a health care environment that supports sharing concerns and  innovation .

Here are some essentials for building a culture of innovation that encourages problem solving:

• Present problems as opportunities instead of obstacles.
• Strive to be a positive role model. Support creative thinking and staff collaboration.
• Encourage feedback and embrace new ideas.
• Respect staff knowledge and abilities.
• Match competencies with specific needs and inspire effective decision-making.
• Offer opportunities for  continual learning and career growth.
• Promote research and analysis opportunities.
• Provide support and necessary resources.
• Recognize contributions and reward efforts .

Embrace Innovation to Find Solutions

Try this exercise:

Consider an ongoing departmental issue and encourage everyone to participate in brainstorming a solution. The team will:

• Define the problem, including triggers or obstacles.
• Determine methods that worked in the past to resolve similar issues.
• Explore innovative solutions.
• Develop a plan to implement a solution and monitor and evaluate results.

Problems arise unexpectedly in the fast-paced health care environment. Nurses must be able to react using critical thinking and quick decision-making skills to implement practical solutions. By employing problem-solving strategies, nurse leaders and their staff can  improve patient outcomes  and refine their nursing skills.

Images sourced from Getty Images

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Critical Thinking in Nursing

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Critical thinking is an integral part of nursing, especially in terms of professionalization and independent clinical decision-making. It is necessary to think critically to provide adequate, creative, and effective nursing care when making the right decisions for practices and care in the clinical setting and solving various ethical issues encountered. Nurses should develop their critical thinking skills so that they can analyze the problems of the current century, keep up with new developments and changes, cope with nursing problems they encounter, identify more complex patient care needs, provide more systematic care, give the most appropriate patient care in line with the education they have received, and make clinical decisions. The present chapter briefly examines critical thinking, how it relates to nursing, and which skills nurses need to develop as critical thinkers.

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Critical thinking in nursing.

This painting shows a nurse and how she is thinking critically. On the right side are the stages of critical thinking and on the left side, there are challenges that a nurse might face. The entire background is also painted in several colors to represent a kind of intellectual puzzle. It is made using colored pencils and markers.

(Adapted with permission from the Association of Science and Art (ASA), Universal Scientific Education and Research Network (USERN); Painting by Mahshad Naserpour).

Unless the individuals of a nation thinkers, the masses can be drawn in any direction. Mustafa Kemal Atatürk

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A guide to critical thinking: implications for dental education

Bilgiç Ş, Kurtuluş Tosun Z (2016) Birinci ve son sınıf hemşirelik öğrencilerinde eleştirel düşünme ve etkileyen faktörler. Sağlık Bilimleri ve Meslekleri Dergisi 3(1):39–47

Article   Google Scholar  

Kantek F, Yıldırım N (2019) The effects of nursing education on critical thinking of students: a meta-analysis. Florence Nightingale Hemşirelik Dergisi 27(1):17–25

Ennis R (1996) Critical thinking dispositions: their nature and assessability. Informal Logic 18(2):165–182

Riddell T (2007) Critical assumptions: thinking critically about critical thinking. J Nurs Educ 46(3):121–126

Cüceloğlu D (2001) İyi düşün doğru karar ver. Remzi Kitabevi, pp 242–284

Google Scholar  

Kurnaz A (2019) Eleştirel düşünme öğretimi etkinlikleri Planlama-Uygulama ve Değerlendirme. Eğitim yayın evi, p 27

Doğanay A, Ünal F (2006) Eleştirel düşünmenin öğretimi. In: İçerik Türlerine Dayalı Öğretim. Ankara Nobel Yayınevi, pp 209–261

Scheffer B-K, Rubenfeld M-G (2000) A consensus statement on critical thinking in nursing. J Nurs Educ 39(8):352–359

Article   CAS   Google Scholar  

Rubenfeld M-G, Scheffer B (2014) Critical thinking tactics for nurses. Jones & Bartlett Publishers, pp 5–6, 7, 19–20

Gobet F (2005) Chunking models of expertise: implications for education. Appl Cogn Psychol 19:183–204

Ay F-A (2008) Mesleki temel kavramlar. In: Temel hemşirelik: Kavramlar, ilkeler, uygulamalar. İstanbul Medikal Yayıncılık, pp 205–220

Birol L (2010) Hemşirelik bakımında sistematik yaklaşım. In: Hemşirelik süreci. Berke Ofset Matbaacılık, pp 35–45

Twibell R, Ryan M, Hermiz M (2005) Faculty perceptions of critical thinking in student clinical experiences. J Nurs Educ 44(2):71–79

The Importance of Critical Thinking in Nursing. 19 November 2018 by Carson-Newman University Online. https://onlinenursing.cn.edu/news/value-critical-thinking-nursing

Suzanne C, Smeltzer Brenda G, Bare Janice L, Cheever HK (2010) Definition of critical thinking, critical thinking process. Medical surgical nursing. Lippincott, Williams & Wilkins, pp 27–28

Profetto-McGrath J (2003) The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students. J Adv Nurs 43(6):569–577

Elaine S, Mary C (2002) Critical thinking in nursing education: literature review. Int J Nurs Pract 8(2):89–98

Brunt B-A (2005) Critical thinking in nursing: an integrated review. J Continuing Educ Nurs 36(2):60–67

Carter L-M, Rukholm E (2008) A study of critical thinking, teacher–student interaction, and discipline-specific writing in an online educational setting for registered nurses. J Continuing Educ Nurs 39(3):133–138

Daly W-M (2001) The development of an alternative method in the assessment of critical thinking as an outcome of nursing education. J Adv Nurs 36(1):120–130

Edwards S-L (2007) Critical thinking: a two-phase framework. Nurse Educ Pract 7(5):303–314

Rogal S-M, Young J (2008) Exploring critical thinking in critical care nursing education: a pilot study. J Continuing Educ Nurs 39(1):28–33

Worrell J-A, Profetto-McGrath J (2007) Critical thinking as an outcome of context-based learning among post RN students: a literature review. Nurse Educ Today 27(5):420–426

Morrall P, Goodman B (2013) Critical thinking, nurse education and universities: some thoughts on current issues and implications for nursing practice. Nurse Educ Today 33(9):935–937

Raymond-Seniuk C, Profetto-McGrath J (2011) Can one learn to think critically?—a philosophical exploration. Open Nurs J 5:45–51

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Güven, Ş.D. (2023). Critical Thinking in Nursing. In: Rezaei, N. (eds) Brain, Decision Making and Mental Health. Integrated Science, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-031-15959-6_10

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How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples

Last updated on August 19th, 2023

Nurses play a critical role in making critical decisions that directly impact patient outcomes in the dynamic field of healthcare. Developing strong critical thinking skills is essential for success in this role.

In this article, we present a comprehensive list of 23 nursing-specific strategies aimed at improving critical thinking and improve the quality of patient care.

24 Strategies to improve critical thinking skills in nursing

You may also want to check out: 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

1. Reflective Journaling: Delving into Deeper Understanding

Reflective journaling is a potent tool for nurses to explore their experiences, actions, and decisions.

By regularly pondering over situations and analyzing their thought processes, nurses can identify strengths and areas for improvement.

This practice encourages the conscious development of critical thinking by comparing past experiences with current knowledge and exploring alternative solutions.

After a particularly challenging case, a nurse reflects on their decision-making process, exploring what worked well and what could have been done differently.

2. Meeting with Colleagues: Collaborative Learning for Critical Thinking

Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills .

Colleagues’ insights can challenge assumptions and broaden perspectives, ultimately leading to more well-rounded clinical judgments.

A nursing team gathers to discuss a recent complex case, sharing their perspectives, insights, and lessons learned to collectively improve patient care strategies.

3. Concept Mapping: Visualizing Complexity

Concept mapping is an excellent technique to synthesize intricate patient information. By creating visual representations of patient problems and interventions, nurses can identify relationships and patterns that might not be apparent otherwise.

This strategy aids in comprehensive care planning and encourages nurses to think holistically about patient care.

Creating a concept map to connect patient symptoms, diagnostics, and interventions reveals patterns that help the nurse formulate a comprehensive care plan.

4. Socratic Questioning: Digging Deeper into Situations

The art of Socratic questioning involves asking probing questions that lead to deeper understanding.

Applying this technique allows nurses to uncover assumptions, examine inconsistencies, and explore multiple viewpoints.

This approach is especially valuable when reviewing patient history, discussing conditions, and planning care strategies.

When assessing a patient’s deteriorating condition, a nurse asks probing questions to uncover potential underlying causes and prioritize appropriate interventions.

5. Inductive and Deductive Reasoning: From Specifics to Generalizations

Developing skills in both inductive and deductive reasoning equips nurses to analyze situations from different angles.

Inductive reasoning involves drawing conclusions from specific observations, while deductive reasoning starts with general premises to arrive at specific conclusions.

Proficient use of these methods enhances nurses’ ability to make accurate clinical judgments.

When encountering a series of patients with similar symptoms, a nurse uses inductive reasoning to identify a common pattern and deduce potential causes.

6. Distinguishing Statements: Fact, Inference, Judgment, and Opinion

Clear thinking demands the ability to differentiate between statements of fact, inference, judgment, and opinion.

Nurses must critically evaluate information sources, ensuring they rely on evidence-based practice.

This skill safeguards against misinformation and supports informed decision-making.

While reviewing a patient’s history, a nurse differentiates factual medical information from inferences and subjective judgments made by different healthcare professionals.

7. Clarifying Assumptions: Promoting Effective Communication

Recognizing assumptions and clarifying their underlying principles is vital for effective communication. Nurses often hold differing assumptions, which can impact patient care.

By acknowledging these assumptions and encouraging open discussions, nursing teams can collaboratively create care plans that align with patients’ best interests.

Before suggesting a treatment plan, a nurse engages in a conversation with a patient to understand their cultural beliefs and preferences, ensuring assumptions are not made.

8. Clinical Simulations: Learning through Virtual Scenarios

Clinical simulations provide nurses with a risk-free environment to practice decision-making and problem-solving skills.

These virtual scenarios mimic real-life patient situations and allow nurses to test different approaches, assess outcomes, and reflect on their choices.

By engaging in simulations, nurses can refine their critical thinking abilities, learn from mistakes, and gain confidence in their clinical judgment.

Engaging in a simulated scenario where a patient’s condition rapidly changes challenges a nurse’s decision-making skills in a controlled environment.

9. Case Studies and Grand Rounds: Analyzing Complex Cases

Engaging in case studies and participating in grand rounds exposes nurses to complex patient cases that require in-depth analysis.

Working through these scenarios encourages nurses to consider various factors, potential interventions, and their rationale.

Discussing these cases with colleagues and experts fosters collaborative critical thinking and widens the spectrum of possible solutions.

Nurses participate in grand rounds, discussing a challenging case involving multiple medical specialties, encouraging a holistic approach to patient care.

10. Continuing Education and Lifelong Learning: Expanding Knowledge

Staying up-to-date with the latest advancements in nursing and healthcare is crucial for effective critical thinking.

Pursuing continuing education opportunities, attending conferences, and engaging in self-directed learning keeps nurses informed about new research, technologies, and best practices.

This continuous learning enriches their knowledge base, enabling them to approach patient care with a well-rounded perspective.

Attending a nursing conference on the latest advancements in wound care equips a nurse with evidence-based techniques to improve patient outcomes.

11. Debates and Discussions: Encouraging Thoughtful Dialogue

Organizing debates or participating in structured discussions on healthcare topics stimulates critical thinking.

Engaging in debates requires researching and presenting evidence-based arguments, promoting the evaluation of different perspectives.

Nurses can exchange insights, challenge assumptions, and refine their ability to defend their viewpoints logically.

Engaging in a debate on the pros and cons of a new treatment method encourages nurses to critically analyze different viewpoints and strengthen their own understanding.

12. Multidisciplinary Collaboration: Gaining Insights from Various Disciplines

Collaborating with professionals from diverse healthcare disciplines enriches nurses’ critical thinking.

Interacting with doctors, pharmacists, therapists, and other experts allows nurses to benefit from different viewpoints and approaches.

This cross-disciplinary collaboration broadens their understanding and encourages innovative problem-solving.

Collaborating with physical therapists, nutritionists, and pharmacists helps a nurse develop a holistic care plan that addresses all aspects of a patient’s recovery.

13. Ethical Dilemma Analysis: Balancing Patient Autonomy and Best Practice

Ethical dilemmas are common in nursing practice. Analyzing these situations requires nurses to weigh the principles of beneficence, non-maleficence, autonomy, and justice.

By critically examining ethical scenarios, nurses develop the capacity to navigate morally complex situations, prioritize patient welfare, and make ethically sound decisions.

When faced with a patient’s refusal of treatment due to religious beliefs, a nurse evaluates the ethical considerations, respects autonomy, and seeks alternatives.

14. Root Cause Analysis: Investigating Adverse Events

When adverse events occur, performing a root cause analysis helps identify the underlying causes and contributing factors.

Nurses engage in a systematic process of analyzing events, exploring the “5 Whys” technique , and developing strategies to prevent similar occurrences in the future.

This approach cultivates a thorough and analytical approach to problem-solving.

After a medication error, a nurse leads a root cause analysis to identify system failures and implement preventive measures to enhance patient safety.

15. Creative Thinking Exercises: Expanding Solution Repertoire

Encouraging creative thinking through brainstorming sessions or scenario-based exercises widens the range of possible solutions nurses consider.

By thinking outside the box and exploring innovative approaches, nurses develop adaptable problem-solving skills that can be applied to complex patient care challenges.

Brainstorming creative approaches to comfort a distressed pediatric patient empowers a nurse to find innovative methods beyond routine interventions.

16. Journal Clubs: Fostering Evidence-Based Discussion

Participating in journal clubs involves healthcare professionals coming together to dissect recent research articles.

This practice ignites critical thinking by allowing nurses to evaluate study methodologies, scrutinize findings, and consider the implications for their practice.

Engaging in evidence-based discussions not only cultivates a culture of critical inquiry but also reinforces continuous learning.

At the monthly journal club meeting, Nurse Mark engages in a discussion on a recent research article focusing on pain management strategies for post-operative patients.

The group analyzes the study design, scrutinizes the findings, and considers the potential implications for their practice.

During the discussion, Mark raises thought-provoking questions about the study’s methodology and suggests potential applications in their hospital’s patient care protocols.

This active participation in journal clubs not only refines Mark’s critical thinking but also instills evidence-based practices into his nursing approach.

17. Critical Reflection Groups: Collaborative Learning and Analysis

Similarly, establishing critical reflection groups, where nurses meet regularly to discuss experiences, cases, and challenges, fosters collective learning.

These sessions encourage the exchange of diverse perspectives, enriching the analysis process and ultimately enhancing patient care strategies.

Through shared insights and discussions, nurses can refine their clinical reasoning and broaden their problem-solving capabilities.

Nurse Emma actively participates in critical reflection groups in order to broaden her clinical knowledge. During a recent meeting, the group tackled a difficult patient case with complicated symptomatology.

Emma suggests alternative diagnostic pathways based on her own experiences. Emma’s critical thinking skills are honed as a result of the group’s dynamic interaction, which also emphasizes the importance of collaborative decision-making in complex scenarios.

18. Mindfulness and Reflection Practices: Enhancing Self-Awareness

Mindfulness techniques, such as meditation and deep breathing, encourage self-awareness and a clear mind.

Engaging in these practices helps nurses become more attuned to their thoughts and emotions, leading to better self-regulation and improved decision-making during high-pressure situations.

Engaging in mindfulness exercises before a demanding shift helps a nurse maintain focus, manage stress, and make clear-headed decisions.

19. Problem-Based Learning: Applying Knowledge in Real Scenarios

Problem-based learning involves presenting nurses with real-world patient cases and encouraging them to collaboratively solve the problems.

This approach bridges the gap between theoretical knowledge and practical application, fostering critical thinking through active problem-solving.

Working through a simulated patient case challenges nurses to apply theoretical knowledge to practical situations, refining their clinical reasoning.

20. Self-Assessment and Feedback: Evaluating Decision-Making Skills

Regularly assessing one’s own decision-making process and seeking feedback from peers and mentors is essential for improvement.

Reflecting on past decisions, considering alternative approaches, and understanding the rationale behind them contribute to the refinement of critical thinking skills.

A nurse evaluates their performance after a patient’s unexpected complication, seeking feedback from peers and mentors to identify areas for improvement.

21. Cultural Competence Training: Navigating Diverse Perspectives

Cultural competence training enhances critical thinking by enabling nurses to understand the diverse cultural beliefs and practices of patients.

This knowledge is vital for providing patient-centered care, as it encourages nurses to think critically about the unique needs of each individual.

A nurse attends cultural competence training to understand the dietary preferences of a diverse patient population, ensuring respectful and patient-centered care.

22. Active Listening and Empathetic Communication: Gathering Insights

Active listening and empathetic communication with patients and their families enable nurses to gather comprehensive information about their conditions, concerns, and preferences.

This data forms the basis for critical analysis and informed decision-making in patient care.

Through attentive listening, a nurse uncovers a patient’s underlying concerns, leading to an informed care plan that addresses both medical needs and emotional well-being.

23. Mentorship and Preceptorship: Learning from Experienced Professionals

Having a mentor or preceptor provides novice nurses with the opportunity to learn from experienced professionals.

Mentors guide critical thinking by sharing their insights, challenging assumptions, and offering guidance in complex situations. This relationship fosters growth and expertise development.

A novice nurse gains valuable insight from a mentor, who guides them through complex cases, offering real-world wisdom and refining critical thinking skills.

24. Self-Assessment and Feedback: Evaluating Decision-Making Skills

Reflecting on past decisions, considering alternative approaches, and understanding the rationale behind them contribute to the refinement of critical thinking skills .

Nurse Sarah regularly takes time to assess her decision-making skills by reviewing past patient cases. After a challenging case involving conflicting symptoms, she reflects on her initial approach, the outcomes, and what she could have done differently.

She seeks feedback from her senior colleague, who provides insights on alternative diagnostic paths. Sarah’s self-assessment and feedback-seeking process enable her to identify areas for improvement and refine her critical thinking in similar situations.

• Clinical Reasoning In Nursing (Explained W/ Example)
• 8 Stages Of The Clinical Reasoning Cycle
• What is Critical Thinking in Nursing? (Explained W/ Examples)

Enhancing critical thinking skills is an ongoing journey that transforms nursing practice.

Reflective journaling, collaborative learning, concept mapping, Socratic questioning , reasoning techniques, distinguishing statements, and clarifying assumptions all play integral roles in nurturing these skills.

By incorporating these strategies into their daily routines, nurses can improve their critical thinking skills.

Additionally, this will help nurses in navigating the complexities of the healthcare field with confidence, expertise, and the ability to make well-informed decisions that improve patient outcomes.

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Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Affiliations.

• 1 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group Quantitative Psychology (2017-SGR-269), University of Barcelona, Barcelona, Spain.
• 2 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group on Gender, Identity and Diversity (2017-SGR-1091), University of Barcelona, Barcelona, Spain.
• 3 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.
• 4 Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain.
• PMID: 33029860
• DOI: 10.1111/nup.12332

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.

© 2020 John Wiley & Sons Ltd.

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Nurses are critical thinkers

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Margaret McCartney: Nurses must be allowed to exercise professional judgment

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The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.

The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.

As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier

The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report

Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.

NMC (2010) New Standards for Pre-Registration Nursing. London: Nursing and Midwifery Council.

Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465

Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)

Competing interests: No competing interests

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

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Critical Thinking on the Nursing Floor

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

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

Critical Thinking in Nursing: Example 1

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

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

I looked at his history. Congestive heart failure.

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

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

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

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

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

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

Badda Bing Bada Boom!

Critical Thinking in Nursing: Example 2

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

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

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

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

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

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

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

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

And that we did!

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

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

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

by Ashely Adkins RN BSN

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

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

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

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

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

My professor was absolutely right.

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

You may ask…how?

Well, let me tell you…

• Questioning

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

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

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

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

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

“Why is this happening?”

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

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

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

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

YOU KNOW MORE THAN YOU THINK YOU KNOW.

In case you did not catch it the first time…

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

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

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

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

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

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

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

That is critical thinking.

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

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• Research article
• Open access
• Published: 07 October 2020

Impact of social problem-solving training on critical thinking and decision making of nursing students

• Soleiman Ahmady 1 &
• Sara Shahbazi   ORCID: orcid.org/0000-0001-8397-6233 2 , 3  

BMC Nursing volume  19 , Article number:  94 ( 2020 ) Cite this article

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The complex health system and challenging patient care environment require experienced nurses, especially those with high cognitive skills such as problem-solving, decision- making and critical thinking. Therefore, this study investigated the impact of social problem-solving training on nursing students’ critical thinking and decision-making.

This study was quasi-experimental research and pre-test and post-test design and performed on 40 undergraduate/four-year students of nursing in Borujen Nursing School/Iran that was randomly divided into 2 groups; experimental ( n  = 20) and control (n = 20). Then, a social problem-solving course was held for the experimental group. A demographic questionnaire, social problem-solving inventory-revised, California critical thinking test, and decision-making questionnaire was used to collect the information. The reliability and validity of all of them were confirmed. Data analysis was performed using SPSS software and independent sampled T-test, paired T-test, square chi, and Pearson correlation coefficient.

The finding indicated that the social problem-solving course positively affected the student’ social problem-solving and decision-making and critical thinking skills after the instructional course in the experimental group ( P  < 0.05), but this result was not observed in the control group ( P  > 0.05).

Conclusions

The results showed that structured social problem-solving training could improve cognitive problem-solving, critical thinking, and decision-making skills. Considering this result, nursing education should be presented using new strategies and creative and different ways from traditional education methods. Cognitive skills training should be integrated in the nursing curriculum. Therefore, training cognitive skills such as problem- solving to nursing students is recommended.

Peer Review reports

Continuous monitoring and providing high-quality care to patients is one of the main tasks of nurses. Nurses’ roles are diverse and include care, educational, supportive, and interventional roles when dealing with patients’ clinical problems [ 1 , 2 ].

Providing professional nursing services requires the cognitive skills such as problem-solving, decision-making and critical thinking, and information synthesis [ 3 ].

Problem-solving is an essential skill in nursing. Improving this skill is very important for nurses because it is an intellectual process which requires the reflection and creative thinking [ 4 ].

Problem-solving skill means acquiring knowledge to reach a solution, and a person’s ability to use this knowledge to find a solution requires critical thinking. The promotion of these skills is considered a necessary condition for nurses’ performance in the nursing profession [ 5 , 6 ].

Managing the complexities and challenges of health systems requires competent nurses with high levels of critical thinking skills. A nurse’s critical thinking skills can affect patient safety because it enables nurses to correctly diagnose the patient’s initial problem and take the right action for the right reason [ 4 , 7 , 8 ].

Problem-solving and decision-making are complex and difficult processes for nurses, because they have to care for multiple patients with different problems in complex and unpredictable treatment environments [ 9 , 10 ].

Clinical decision making is an important element of professional nursing care; nurses’ ability to form effective clinical decisions is the most significant issue affecting the care standard. Nurses build 2 kinds of choices associated with the practice: patient care decisions that affect direct patient care and occupational decisions that affect the work context or teams [ 11 , 12 , 13 , 14 , 15 , 16 ].

The utilization of nursing process guarantees the provision of professional and effective care. The nursing process provides nurses with the chance to learn problem-solving skills through teamwork, health management, and patient care. Problem-solving is at the heart of nursing process which is why this skill underlies all nursing practices. Therefore, proper training of this skill in an undergraduate nursing program is essential [ 17 ].

Nursing students face unique problems which are specific to the clinical and therapeutic environment, causing a lot of stresses during clinical education. This stress can affect their problem- solving skills [ 18 , 19 , 20 , 21 ]. They need to promote their problem-solving and critical thinking skills to meet the complex needs of current healthcare settings and should be able to respond to changing circumstances and apply knowledge and skills in different clinical situations [ 22 ]. Institutions should provide this important opportunity for them.

Despite, the results of studies in nursing students show the weakness of their problem-solving skills, while in complex health environments and exposure to emerging diseases, nurses need to diagnose problems and solve them rapidly accurately. The teaching of these skills should begin in college and continue in health care environments [ 5 , 23 , 24 ].

It should not be forgotten that in addition to the problems caused by the patients’ disease, a large proportion of the problems facing nurses are related to the procedures of the natural life of their patients and their families, the majority of nurses with the rest of health team and the various roles defined for nurses [ 25 ].

Therefore, in addition to above- mentioned issues, other ability is required to deal with common problems in the working environment for nurses, the skill is “social problem solving”, because the term social problem-solving includes a method of problem-solving in the “natural context” or the “real world” [ 26 , 27 ]. In reviewing the existing research literature on the competencies and skills required by nursing students, what attracts a lot of attention is the weakness of basic skills and the lack of formal and systematic training of these skills in the nursing curriculum, it indicates a gap in this area [ 5 , 24 , 25 ]. In this regard, the researchers tried to reduce this significant gap by holding a formal problem-solving skills training course, emphasizing the common social issues in the real world of work. Therefore, this study was conducted to investigate the impact of social problem-solving skills training on nursing students’ critical thinking and decision-making.

Setting and sample

This quasi-experimental study with pretest and post-test design was performed on 40 undergraduate/four-year nursing students in Borujen nursing school in Shahrekord University of Medical Sciences. The periods of data collection were 4 months.

According to the fact that senior students of nursing have passed clinical training and internship programs, they have more familiarity with wards and treatment areas, patients and issues in treatment areas and also they have faced the problems which the nurses have with other health team personnel and patients and their families, they have been chosen for this study. Therefore, this study’s sampling method was based on the purpose, and the sample size was equal to the total population. The whole of four-year nursing students participated in this study and the sample size was 40 members. Participants was randomly divided in 2 groups; experimental ( n  = 20) and control (n = 20).

The inclusion criteria to take part in the present research were students’ willingness to take part, studying in the four-year nursing, not having the record of psychological sickness or using the related drugs (all based on their self-utterance).

Intervention

At the beginning of study, all students completed the demographic information’ questionnaire. The study’s intervening variables were controlled between the two groups [such as age, marital status, work experience, training courses, psychological illness, psychiatric medication use and improving cognitive skills courses (critical thinking, problem- solving, and decision making in the last 6 months)]. Both groups were homogeneous in terms of demographic variables ( P  > 0.05). Decision making and critical thinking skills and social problem solving of participants in 2 groups was evaluated before and 1 month after the intervention.

All questionnaires were anonymous and had an identification code which carefully distributed by the researcher.

To control the transfer of information among the students of two groups, the classification list of students for internships, provided by the head of nursing department at the beginning of semester, was used.

Furthermore, the groups with the odd number of experimental group and the groups with the even number formed the control group and thus were less in contact with each other.

The importance of not transferring information among groups was fully described to the experimental group. They were asked not to provide any information about the course to the students of the control group.

Then, training a course of social problem-solving skills for the experimental group, given in a separate course and the period from the nursing curriculum and was held in 8 sessions during 2 months, using small group discussion, brainstorming, case-based discussion, and reaching the solution in small 4 member groups, taking results of the social problem-solving model as mentioned by D-zurilla and gold fried [ 26 ]. The instructor was an assistant professor of university and had a history of teaching problem-solving courses. This model’ stages are explained in Table  1 .

All training sessions were performed due to the model, and one step of the model was implemented in each session. In each session, the teacher stated the educational objectives and asked the students to share their experiences in dealing to various workplace problems, home and community due to the topic of session. Besides, in each session, a case-based scenario was presented and thoroughly analyzed, and students discussed it.

Instruments

In this study, the data were collected using demographic variables questionnaire and social problem- solving inventory – revised (SPSI-R) developed by D’zurilla and Nezu (2002) [ 26 ], California critical thinking skills test- form B (CCTST; 1994) [ 27 , 28 ] and decision-making questionnaire.

SPSI-R is a self - reporting tool with 52 questions ranging from a Likert scale (1: Absolutely not – 5: very much).

The minimum score maybe 25 and at a maximum of 125, therefore:

The score 25 and 50: weak social problem-solving skills.

The score 50–75: moderate social problem-solving skills.

The score higher of 75: strong social problem-solving skills.

The reliability assessed by repeated tests is between 0.68 and 0.91, and its alpha coefficient between 0.69 and 0.95 was reported [ 26 ]. The structural validity of questionnaire has also been confirmed. All validity analyses have confirmed SPSI as a social problem - solving scale.

In Iran, the alpha coefficient of 0.85 is measured for five factors, and the retest reliability coefficient was obtained 0.88. All of the narratives analyzes confirmed SPSI as a social problem- solving scale [ 29 ].

California critical thinking skills test- form B(CCTST; 1994): This test is a standard tool for assessing the basic skills of critical thinking at the high school and higher education levels (Facione & Facione, 1992, 1998) [ 27 ].

This tool has 34 multiple-choice questions which assessed analysis, inference, and argument evaluation. Facione and Facione (1993) reported that a KR-20 range of 0.65 to 0.75 for this tool is acceptable [ 27 ].

In Iran, the KR-20 for the total scale was 0.62. This coefficient is acceptable for questionnaires that measure the level of thinking ability of individuals.

After changing the English names of this questionnaire to Persian, its content validity was approved by the Board of Experts.

The subscale analysis of Persian version of CCTST showed a positive high level of correlation between total test score and the components (analysis, r = 0.61; evaluation, r = 0.71; inference, r = 0.88; inductive reasoning, r = 0.73; and deductive reasoning, r = 0.74) [ 28 ].

A decision-making questionnaire with 20 questions was used to measure decision-making skills. This questionnaire was made by a researcher and was prepared under the supervision of a professor with psychometric expertise. Five professors confirmed the face and content validity of this questionnaire. The reliability was obtained at 0.87 which confirmed for 30 students using the test-retest method at a time interval of 2 weeks. Each question had four levels and a score from 0.25 to 1. The minimum score of this questionnaire was 5, and the maximum score was 20 [ 30 ].

Statistical analysis

For analyzing the applied data, the SPSS Version 16, and descriptive statistics tests, independent sample T-test, paired T-test, Pearson correlation coefficient, and square chi were used. The significant level was taken P  < 0.05.

The average age of students was 21.7 ± 1.34, and the academic average total score was 16.32 ± 2.83. Other demographic characteristics are presented in Table  2 .

None of the students had a history of psychiatric illness or psychiatric drug use. Findings obtained from the chi-square test showed that there is not any significant difference between the two groups statistically in terms of demographic variables.

The mean scores in social decision making, critical thinking, and decision-making in whole samples before intervention showed no significant difference between the two groups statistically ( P  > 0.05), but showed a significant difference after the intervention ( P  < 0.05) (Table  3 ).

Scores in Table  4 showed a significant positive difference before and after intervention in the “experimental” group ( P  < 0.05), but this difference was not seen in the control group ( P  > 0.05).

Among the demographic variables, only a positive relationship was seen between marital status and decision-making skills (r = 0.72, P  < 0.05).

Also, the scores of critical thinking skill’ subgroups and social problem solving’ subgroups are presented in Tables  5 and 6 which showed a significant positive difference before and after intervention in the “experimental” group (P < 0.05), but this difference was not seen in the control group ( P  > 0.05).

In the present study conducted by some studies, problem-solving and critical thinking and decision-making scores of nursing students are moderate [ 5 , 24 , 31 ].

The results showed that problem-solving skills, critical thinking, and decision-making in nursing students were promoted through a social problem-solving training course. Unfortunately, no study has examined the effect of teaching social problem-solving skills on nursing students’ critical thinking and decision-making skills.

Altun (2018) believes that if the values of truth and human dignity are promoted in students, it will help them acquire problem-solving skills. Free discussion between students and faculty on value topics can lead to the development of students’ information processing in values. Developing self-awareness increases students’ impartiality and problem-solving ability [ 5 ]. The results of this study are consistent to the results of present study.

Erozkan (2017), in his study, reported there is a significant relationship between social problem solving and social self-efficacy and the sub-dimensions of social problem solving [ 32 ]. In the present study, social problem -solving skills training has improved problem -solving skills and its subdivisions.

The results of study by Moshirabadi (2015) showed that the mean score of total problem-solving skills was 89.52 ± 21.58 and this average was lower in fourth-year students than other students. He explained that education should improve students’ problem-solving skills. Because nursing students with advanced problem-solving skills are vital to today’s evolving society [ 22 ]. In the present study, the results showed students’ weakness in the skills in question, and holding a social problem-solving skills training course could increase the level of these skills.

Çinar (2010) reported midwives and nurses are expected to use problem-solving strategies and effective decision-making in their work, using rich basic knowledge.

These skills should be developed throughout one’s profession. The results of this study showed that academic education could increase problem-solving skills of nursing and midwifery students, and final year students have higher skill levels [ 23 ].

Bayani (2012) reported that the ability to solve social problems has a determining role in mental health. Problem-solving training can lead to a level upgrade of mental health and quality of life [ 33 ]; These results agree with the results obtained in our study.

Conducted by this study, Kocoglu (2016) reported nurses’ understanding of their problem-solving skills is moderate. Receiving advice and support from qualified nursing managers and educators can enhance this skill and positively impact their behavior [ 31 ].

Kashaninia (2015), in her study, reported teaching critical thinking skills can promote critical thinking and the application of rational decision-making styles by nurses.

One of the main components of sound performance in nursing is nurses’ ability to process information and make good decisions; these abilities themselves require critical thinking. Therefore, universities should envisage educational and supportive programs emphasizing critical thinking to cultivate their students’ professional competencies, decision-making, problem-solving, and self-efficacy [ 34 ].

The study results of Kirmizi (2015) also showed a moderate positive relationship between critical thinking and problem-solving skills [ 35 ].

Hong (2015) reported that using continuing PBL training promotes reflection and critical thinking in clinical nurses. Applying brainstorming in PBL increases the motivation to participate collaboratively and encourages teamwork. Learners become familiar with different perspectives on patients’ problems and gain a more comprehensive understanding. Achieving these competencies is the basis of clinical decision-making in nursing. The dynamic and ongoing involvement of clinical staff can bridge the gap between theory and practice [ 36 ].

Ancel (2016) emphasizes that structured and managed problem-solving training can increase students’ confidence in applying problem-solving skills and help them achieve self-confidence. He reported that nursing students want to be taught in more innovative ways than traditional teaching methods which cognitive skills training should be included in their curriculum. To this end, university faculties and lecturers should believe in the importance of strategies used in teaching and the richness of educational content offered to students [ 17 ].

The results of these recent studies are adjusted with the finding of recent research and emphasize the importance of structured teaching cognitive skills to nurses and nursing students.

Based on the results of this study on improving critical thinking and decision-making skills in the intervention group, researchers guess the reasons to achieve the results of study in the following cases:

In nursing internationally, problem-solving skills (PS) have been introduced as a key strategy for better patient care [ 17 ]. Problem-solving can be defined as a self-oriented cognitive-behavioral process used to identify or discover effective solutions to a special problem in everyday life. In particular, the application of this cognitive-behavioral methodology identifies a wide range of possible effective solutions to a particular problem and enhancement the likelihood of selecting the most effective solution from among the various options [ 27 ].

In social problem-solving theory, there is a difference among the concepts of problem-solving and solution implementation, because the concepts of these two processes are different, and in practice, they require different skills.

In the problem-solving process, we seek to find solutions to specific problems, while in the implementation of solution, the process of implementing those solutions in the real problematic situation is considered [ 25 , 26 ].

The use of D’zurilla and Goldfride’s social problem-solving model was effective in achieving the study results because of its theoretical foundations and the usage of the principles of cognitive reinforcement skills. Social problem solving is considered an intellectual, logical, effort-based, and deliberate activity [ 26 , 32 ]; therefore, using this model can also affect other skills that need recognition.

In this study, problem-solving training from case studies and group discussion methods, brainstorming, and activity in small groups, was used.

There are significant educational achievements in using small- group learning strategies. The limited number of learners in each group increases the interaction between learners, instructors, and content. In this way, the teacher will be able to predict activities and apply techniques that will lead students to achieve high cognitive taxonomy levels. That is, confront students with assignments and activities that force them to use cognitive processes such as analysis, reasoning, evaluation, and criticism.

In small groups, students are given the opportunity to the enquiry, discuss differences of opinion, and come up with solutions. This method creates a comprehensive understanding of the subject for the student [ 36 ].

According to the results, social problem solving increases the nurses’ decision-making ability and critical thinking regarding identifying the patient’s needs and choosing the best nursing procedures. According to what was discussed, the implementation of this intervention in larger groups and in different levels of education by teaching other cognitive skills and examining their impact on other cognitive skills of nursing students, in the future, is recommended.

Social problem- solving training by affecting critical thinking skills and decision-making of nursing students increases patient safety. It improves the quality of care because patients’ needs are better identified and analyzed, and the best solutions are adopted to solve the problem.

In the end, the implementation of this intervention in larger groups in different levels of education by teaching other cognitive skills and examining their impact on other cognitive skills of nursing students in the future is recommended.

Study limitations

This study was performed on fourth-year nursing students, but the students of other levels should be studied during a cohort from the beginning to the end of course to monitor the cognitive skills improvement.

The promotion of high-level cognitive skills is one of the main goals of higher education. It is very necessary to adopt appropriate approaches to improve the level of thinking. According to this study results, the teachers and planners are expected to use effective approaches and models such as D’zurilla and Goldfride social problem solving to improve problem-solving, critical thinking, and decision-making skills. What has been confirmed in this study is that the routine training in the control group should, as it should, has not been able to improve the students’ critical thinking skills, and the traditional educational system needs to be transformed and reviewed to achieve this goal.

Availability of data and materials

The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.

Abbreviations

California critical thinking skills test

Social problem-solving inventory – revised

Pesudovs L. Medical/surgical nursing in the home. Aust Nurs Midwifery J. 2014;22(3):24.

PubMed   Google Scholar  

Szeri C, et al. Problem solving skills of the nursing and midwifery students and influential factors. Revista Eletrônica de Enfermagem. 2010;12(4).

Friese CR, et al. Pod nursing on a medical/surgical unit: implementation and outcomes evaluation. J Nurs Adm. 2014;44(4):207–11.

Article   Google Scholar  

Lyneham J. A conceptual model for medical-surgical nursing: moving toward an international clinical specialty. Medsurg Nurs. 2013;22(4):215–20 263.

Altun I. The perceived problem solving ability and values of student nurses and midwives. Nurse Educ Today. 2003;23(8):575–84.

Deniz Kocoglu R, et al. Problem solving training for first line nurse managers. Int J Caring Sci. 2016;9(3):955.

Google Scholar  

Mahoney C, et al. Implementing an 'arts in nursing' program on a medical-surgical unit. Medsurg Nurs. 2011;20(5):273–4.

Pardue SF. Decision-making skills and critical thinking ability among associate degree, diploma, baccalaureate, and master's-prepared nurses. J Nurs Educ. 1987;26(9):354–61.

Article   CAS   Google Scholar  

Kozlowski D, et al. The role of emotion in clinical decision making: an integrative literature review. BMC Med Educ. 2017;17(1):255.

Kuiper RA, Pesut DJ. Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory. J Adv Nurs. 2004;45(4):381–91.

Huitzi-Egilegor JX, et al. Implementation of the nursing process in a health area: models and assessment structures used. Rev Lat Am Enfermagem. 2014;22(5):772–7.

Lauri S. Development of the nursing process through action research. J Adv Nurs. 1982;7(4):301–7.

Muller-Staub M, de Graaf-Waar H, Paans W. An internationally consented standard for nursing process-clinical decision support Systems in Electronic Health Records. Comput Inform Nurs. 2016;34(11):493–502.

Neville K, Roan N. Challenges in nursing practice: nurses' perceptions in caring for hospitalized medical-surgical patients with substance abuse/dependence. J Nurs Adm. 2014;44(6):339–46.

Rabelo-Silva ER, et al. Advanced nursing process quality: comparing the international classification for nursing practice (ICNP) with the NANDA-international (NANDA-I) and nursing interventions classification (NIC). J Clin Nurs. 2017;26(3–4):379–87.

Varcoe C. Disparagement of the nursing process: the new dogma? J Adv Nurs. 1996;23(1):120–5.

Ancel G. Problem-solving training: effects on the problem-solving skills and self-efficacy of nursing students. Eurasian J Educ Res. 2016;64:231–46.

Fang J, et al. Social problem-solving in Chinese baccalaureate nursing students. J Evid Based Med. 2016;9(4):181–7.

Kanbay Y, Okanli A. The effect of critical thinking education on nursing students' problem-solving skills. Contemp Nurse. 2017;53(3):313–21.

Lau Y. Factors affecting the social problem-solving ability of baccalaureate nursing students. Nurse Educ Today. 2014;34(1):121–6.

Terzioglu F. The perceived problem-solving ability of nurse managers. J Nurs Manag. 2006;14(5):340–7.

Moshirabadi, Z., et al., The perceived problem solving skill of Iranian nursing students . 2015.

Cinar N. Problem solving skills of the nursing and midwifery students and influential factors. Revista Eletrônica de Enfermagem. 2010;12(4):601–6.

Moattari M, et al. Clinical concept mapping: does it improve discipline-based critical thinking of nursing students? Iran J Nurs Midwifery Res. 2014;19(1):70–6.

PubMed   PubMed Central   Google Scholar  

Elliott TR, Grant JS, Miller DM. Social Problem-Solving Abilities and Behavioral Health. In Chang EC, D'Zurilla TJ, Sanna LJ, editors. Social problem solving: Theory, research, and training. American Psychological Association; 2004. p. 117–33.

D'Zurilla TJ, Maydeu-Olivares A. Conceptual and methodological issues in social problem-solving assessment. Behav Ther. 1995;26(3):409–32.

Facione PA. The California Critical Thinking Skills Test--College Level. Technical Report# 1. Experimental Validation and Content Validity; 1990.

Khalili H, Zadeh MH. Investigation of reliability, validity and normality Persian version of the California Critical Thinking Skills Test; Form B (CCTST). J Med Educ. 2003;3(1).

Mokhberi A. Questionnaire, psychometrics, and standardization of indicators of social problem solving ability. Educ Measurement. 2011;1(4):1–21.

Heidari M, Shahbazi S. Effect of training problem-solving skill on decision-making and critical thinking of personnel at medical emergencies. Int J Crit Illn Inj Sci. 2016;6(4):182–7.

Kocoglu D, Duygulu S, Abaan S, Akin B. Problem Solving Training for First Line Nurse Managers. Int J Caring Sci. 2016;9(13):955–65.

Erozkan A. Analysis of social problem solving and social self-efficacy in prospective teachers. Educational Sciences: Theory and Practice. 2014;14(2):447–55.

Bayani AA, Ranjbar M, Bayani A. The study of relationship between social problem-solving and depression and social phobia among students. J Mazandaran Univ Med Sci. 2012;22(94):91–8.

Kashaninia Z, et al. The effect of teaching critical thinking skills on the decision making style of nursing managers. J Client-Centered Nurs Care. 2015;1(4):197–204.

Kirmizi FS, Saygi C, Yurdakal IH. Determine the relationship between the disposition of critical thinking and the perception about problem solving skills. Procedia Soc Behav Sci. 2015;191:657–61.

Hung CH, Lin CY. Using concept mapping to evaluate knowledge structure in problem-based learning. BMC Med Educ. 2015;15:212.

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Acknowledgments

This article results from research project No. 980 approved by the Research and Technology Department of Shahrekord University of Medical Sciences. We would like to appreciate to all personnel and students of the Borujen Nursing School. The efforts of all those who assisted us throughout this research.

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SA and SSH conceptualized the study, developed the proposal, coordinated the project, completed initial data entry and analysis, and wrote the report. SSH conducted the statistical analyses. SA and SSH assisted in writing and editing the final report. All authors read and approved the final manuscript.

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This study was reviewed and given exempt status by the Institutional Review Board of the research and technology department of Shahrekord University of Medical Sciences (IRB No. 08–2017-109). Before the survey, students completed a research consent form and were assured that their information would remain confidential. After the end of the study, a training course for the control group students was held.

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Ahmady, S., Shahbazi, S. Impact of social problem-solving training on critical thinking and decision making of nursing students. BMC Nurs 19 , 94 (2020). https://doi.org/10.1186/s12912-020-00487-x

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Factors Influencing Problem-Solving Competence of Nursing Students: A Cross-Sectional Study

Eunhee choi.

1 Department of Nursing, Korean Bible University, 32 Dongil-ro(st) 214-gil, Nowon-gu, Seoul 01757, Korea; moc.revan@1029iohci

Jaehee Jeon

2 Department of Nursing, Gangneung-Wonju National University, Gangneung-si 26403, Korea

Associated Data

Not applicable.

Problem-solving ability is an important competency for nursing students to enable them to solve various problems that occur in dynamic clinical settings. The purpose of this cross-sectional study was to identify the factors that affect the problem-solving ability of nursing students. The subjects of this study were 192 nursing college students in their second year or beyond. The research tool consisted of an online questionnaire, with a total of 91 items regarding general characteristics, metacognition, and communication competence. Data collection was conducted from 10 to 30 March 2022. An online survey link was uploaded to the student group of a social network service from two nursing colleges that permitted data collection. Subjects who agreed to participate directly accessed and responded to the online survey. The collected data were analyzed using descriptive statistics, and the factors associated with the problem-solving ability of nursing students were examined using hierarchical multiple regression analysis. The subjects’ mean problem-solving ability score was 3.63 out of 5. Factors affecting problem-solving ability were age, communication competence, and metacognition, among which metacognition had the greatest influence. These variables explained 51.2% of the problem-solving ability of nursing students. Thus, it is necessary to provide guidance to improve metacognition and to develop educational methods to improve communication competence in curricular and non-curricular courses to improve the problem-solving ability of nursing students.

1. Introduction

Nurses must have the ability to develop individual problem-solving methods to satisfy their patients’ diverse and high-level health needs [ 1 ]. However, the medical field is characterized by uncertainty, instability, and unpredictability; thus, it is not easy for nurses to apply or utilize the knowledge learned within controlled situations in schools, and therefore, it is often difficult for nurses to address the health needs of patients [ 2 ]. The problem-solving ability required in such situations is an essential skill that college students majoring in nursing must have in order to effectively perform their assigned nursing tasks after graduation, while successfully adapting in order to practice in a rapidly changing medical field [ 3 ]. Therefore, strategies to improve the problem-solving ability of nursing students should be applied in their education.

This study aimed to examine the relationship between metacognition, communication competency, and the problem-solving ability of nursing students, and to identify factors that affect nursing students’ problem-solving ability. The results represent basic data that could help inform the development of educational strategies to improve the communication skills of nursing students.

Problem solving involves recognizing the difference between the problem solver’s current state and the goal state to be reached, and resolving the obstacles that prevent them from achieving the goal [ 4 ]. Acquiring problem-solving ability based on judgment and critical thinking is an important element of nursing education [ 5 ]. Furthermore, the use of effective problem-solving strategies based on professional knowledge is a competency that a professional nurse should possess [ 3 ].

Recently, metacognition has been recognized in psychology and pedagogy as a central element of the understanding, self-learning, communication, and problem-solving processes. Metacognition is the ability to think about one’s own thinking [ 6 ], as expressed by the individual knowing and controlling their thought processes and applying previously acquired knowledge, skills, and experiences using appropriate strategies [ 7 ]. In particular, metacognition is an important variable for learning and problem-solving. It is the knowledge related to the selection of an appropriate strategy for the task; the establishment, selection, and application of problem-solving measures; evaluation of the effectiveness of the applied measures; and checking and adjusting the performance process [ 6 , 7 ]. Accordingly, interest in metacognition is increasing in the field of nursing, with emphasis on the problem-solving ability of nursing students [ 8 ].

Metacognition affects problem solving by cultivating the learner’s active attitude, linking existing knowledge with new knowledge, and fostering the development of practical cognitive strategies that can be used for problem solving [ 7 ]. Previous studies on learners’ metacognition have observed that a higher level of metacognition leads to an improvement in the problem-solving process, as metacognition has a significant effect on goal setting and problem-solving performance [ 9 ]. Thus, metacognition and problem-solving ability are closely related; furthermore, metacognition is a key strategic aspect in the problem-solving process [ 10 ]. Although metacognition is a powerful predictor of learning outcomes and problem-solving success, it is not clear how metacognition works regarding cognitive strategies and learning outcomes [ 11 ]. A study of adolescent metacognition-related cognition (learning strategies and problem-solving strategies) and how metacognition affects various types of learning performance confirmed that problem solving is the only mediator between general metacognition and learning performance [ 11 ]. Metacognition plays a major role in improving learning and work ability, and the appropriate use of metacognition when performing nursing tasks can improve the personal lives of nurses [ 12 ]. Therefore, it is necessary to assess the influence of metacognition and problem-solving ability on nursing education.

Communication competence is a major factor that affects problem-solving ability [ 13 ]. It is essential for smoothly maintaining professional relationships with medical personnel, patients, and guardians in diverse and complex medical environments [ 14 ]. Since communication competence is an important aspect of problem solving, it can affect the quality of nursing and the satisfaction of the patient [ 15 ]. There is an urgent need to improve communication competence, as various issues that arise during the clinical process can be solved through communication between medical staff and patients, and nurses are responsible for much of the continuous communication with patients and their guardians [ 16 ]. However, a lack of communication competence among nurses may lead to miscommunication, and thereby, poor outcomes, even if nurses possess good problem-solving methods [ 13 ].

While previous studies have revealed the relationship between communication competence and the problem-solving ability of nursing students [ 13 , 17 ], there is a lack of research regarding the relationship between metacognition, communication competence, and problem-solving ability. Through this research, we confirmed the relationship between the metacognition and problem-solving ability of nursing college students, the relationship between communication ability and problem-solving ability, and finally, examined the factors that affect variables associated with problem-solving ability, including metacognition.

2. Materials and Methods

2.1. design.

This study used quantitative methods to investigate the relationship between the metacognition, communication ability, and problem-solving ability of nursing students and to identify factors that affect problem-solving ability.

2.2. Participants and Procedures

The subjects of this study were nursing students enrolled in two nursing colleges in the same city and region. Since data collection was conducted in March, second-year, third-year, and fourth-year students, with college life experience, were targeted. The required number of study subjects was calculated using the G-Power 3.1.9.7 program, which determined a significance level of 0.05, an effect size of 0.15, a power of 0.90, and 11 predictors, for multiple regression analysis. The minimum sample size was 152. In consideration of the dropout rate, 170 was set as the target number of subjects.

Data collection was conducted from 10 to 30 March 2022. The survey was conducted online. Consent for participation in the study was obtained by the individual reading the explanation of the purpose of the study and checking a consent box, which was displayed on the first screen of the online survey. The study subjects were redirected to the questionnaire completion page after providing their consent. It required approximately 10 min to complete the questionnaire. A total of 200 participants accessed and completed the questionnaire; 192 questionnaires were used for analysis after excluding 8 questionnaires that were determined to have been completedinccurately.

2.3. Instruments

The tools of this study consisted of a total of 91 items, including 9 items regarding general characteristics, 20 metacognition items, 15 items dealing with communication competencies, and 45 regarding problem-solving skills.

The items regarding the general characteristics of the subjects included age, sex, academic level, interpersonal relationships, satisfaction with major, problem based learning (PBL) experience, number of related experiences, clinical practice experience (yes or no), and number of weeks of clinical practice experience.

Metacognition was assessed using the state metacognitive inventory developed by O’Neil Jr et al. [ 18 ], as modified and supplemented by Joo [ 19 ]. It consists of a total of 20 items that assess the four sub-factors of metacognition: cognition, cognitive strategy, plan, and monitoring, using a 5-point Likert scale ranging from 1 point, for ‘not at all’, to 5 points, for ‘strongly agree’. The Cronbach’s α measure of the reliability of the tool was 0.86 at the time of development and 0.89 in the study of Joo [ 19 ]. The value in the current study was 0.91.

Communication competence was measured using a comprehensive interpersonal communication competence scale developed by Rubin [ 20 ], as modified and supplemented by Hur [ 21 ] to fit Korean culture. This tool consists of 15 items related to communication, such as self-exposure, cross-exposure, social tension relief, assertiveness, and concentration. Each item is assessed on a 5-point Likert scale ranging from 1 point, for ‘not at all’, to 5 points, for ‘strongly agree’. The Cronbach’ α reliability measure at the time of development was 0.72, and the value in this study was 0.84.

Problem-solving ability was assessed via a life-skills measurement tool developed by the Korea Educational Development Institute [ 22 ]. This tool considers 5 problem factors (clarification, cause analysis, alternative development, plan and implementation, and performance evaluation) and 9 sub-factors (problem recognition, information collection, analysis ability, divergent thinking, decision making, planning ability, execution and risk taking, evaluation, and feedback), and thus consists of 45 items in total. Each item is assessed on a 5-point Likert scale ranging from 1 point, for ‘very rarely’, to 5 points, for ‘very often’, with higher scores indicating better problem-solving skills. The reliability at the time of tool development was indicated by a Cronbach’s α value of 0.95, whereas in this study, the Cronbach’s α value was 0.90.

2.4. Statistical Analysis

Statistical analyses were performed using SPSS (ver. 25) statistical software (IBM). The subjects’ general characteristics, metacognition, communication competence, and problem-solving ability were analyzed by number and percentage, as well as mean and standard deviation. To test the normality of all variables, skewness and kurtosis were assessed. In general, when the absolute value of skewness is less than 2 or the absolute value of kurtosis is less than 7, there are no problems associated with deviations in the variable distributions from normality [ 23 ]. In this study, skewness ranged between −0.002 and 0.435, with absolute values less than 2, and kurtosis ranged between −0.204 to 1.580, with absolute values less than 7, thus indicating that the variables satisfied the assumption of univariate normality. Differences in metacognition, communication competence, and problem-solving ability according to the general characteristics of the subjects were analyzed by mean, standard deviation, independent t-test, and one-way ANOVA, followed by Scheffé’s post hoc analysis. The correlation between metacognition, communication competence, and problem-solving ability of the participants was analyzed using Pearson’s correlation coefficient. Factors affecting the subject’s problem-solving ability were analyzed using hierarchical multiple regression.

2.5. Ethical Considerations

Before the study was conducted, the research proposal and questionnaire were approved by the Institutional Review Board of Gangneung–Wonju National University (No: GWNUIRB-2022-1). The tools used in the study were used after obtaining the consent of the original author. When explaining the purpose of the study, it was emphasized that the participants had the right to withdraw from the study at any time, that the anonymity and confidentiality of the survey results were guaranteed, and that the study results would not be used for other purposes. Participants were provided with a small gift to motivate participation.

3.1. General Characteristics

Table 1 illustrates that the participants’ mean age was 21.56 ± 1.99. Most participants were women (81.3%).

General Characteristics of Participants (N = 192).

† SD, standard deviation; ‡ PBL, problem-based learning.

3.2. Scores for Metacognition, Communication Competence, and Problem-Solving Ability

Table 2 illustrates that the average score of the subjects’ metacognition was 3.86 ± 0.47 (out of 5). Among the sub-domains, cognitive strategy showed the highest score of 4.03 ± 0.45, followed by monitoring, with 3.90 ± 0.59. The average for communication competence was 3.92 ± 0.42 points (out of 5 points). The average for problem-solving ability was 3.63 ± 0.35 (out of 5), and among the sub-domains, problem clarification was the highest at 3.83 ± 0.52, and cause analysis was the lowest at 3.28 ± 0.36.

Scores for metacognition, communication competence, and problem-solving ability. (N = 192).

3.3. Differences in Problem-Solving Ability According to General Characteristics

The problem-solving ability according to the general characteristics of the subjects was as follows ( Table 3 ): age (F = 4.32, p = 0.015), academic level (F = 10.17, p < 0.001), interpersonal relationships (F = 9.47, p < 0.001), satisfaction with major (F = 3.73, p = 0.012), PBL experience (F = 3.73, p = 0.012), number of PBL experiences (F = 3.20, p = 0.025), and practical experience (F = 2.74, p = 0.007). There was a significant difference in problem-solving ability accorfing to the number of training weeks (F = 4.46, p = 0.013). Scheffé’s post hoc analysis indicated that participants older than 23 years old and younger than 20 years old, as well as fourth-year students, were more dissatisfied than were second-year students. In other cases, interpersonal relationships were very good. Additionally, satisfaction with the major was more than satisfactory. Problem-solving ability was statistically significantly higher for those with more than 7 weeks of practice, and there was no case of not having more than 7 weeks of practice.

Differences in metacognition, communication competence, and problem-solving ability according to nursing students’ general characteristics (N = 192).

† Scheffé test; ‡ PBL, problem based learning.

3.4. Relationship beetween Metacognition, Communication Competence, and Problem-Solving Ability

There was a strong, significantly positive correlation between metacognition and problem-solving ability (r = 0.672, p < 0.001), and communication competence and problem-solving ability (r = 0.542, p < 0.001). There was also a strong, significantly positive correlation between metacognition and communication competence (r = 0.557, p < 0.001; Table 4 ).

Relationships between metacognition, communication competence, and problem-solving ability (N = 192).

3.5. Factors Influencing Problem-Solving Ability

Among general characteristics, variables were converted into dummy variables as needed to confirm their effect on the problem-solving ability of nursing students (e.g., age, 23 years or older = 1; academic level, third year = 1; interpersonal relationships, very good = 1; satisfaction with major, more than satisfied = 1; the number of PBL experiences, 3–6 times = 1; and the number of training weeks, 7 weeks or more = 1). A hierarchical stepwise multiple regression analysis was then performed, inputting communication ability followed by metacognition, which were significantly correlated.

The Durbin–Watson value was 1.96 (close to 2), which confirmed that there was no autocorrelation between the independent variables. The variance inflation factor was 1.013 to 4.999; as all value were less than 10, there were no problems with multicollinearity between independent variables.

General characteristics that showed a significant difference with problem-solving ability in univariate analyses were first input to Model 1, namely age, academic level, interpersonal relationships, and satisfaction with major. This model explained 8.1% of the variance in problem-solving ability. When PBL experience and frequency, clinical practice, and number of weeks were added to Model 1 (Model 2), the variance explained was 12.5%, namely an increased of 4.4% compared to Model 1. When communication competence and metacognition were additionally added to Model 2 (Model 3), the variance explained was 51.2%, which is an increase of 38.7% compared to Model 2. Finally, age (β = 0.11, p = 0.048), communication competence (β = 0.24, p = 0.001), and metacognition (β = 0.52, p = 0.023) were significantly related to problem-solving ability. These variables exhibited an explanatory power of 51.2% (F = 21.01, p < 0.001) regarding job satisfaction; the most influential variable was metacognition ( Table 5 ).

Factors influencing problem-solving ability (N = 192).

† Dummy variables; ‡ Reference; ¶ PBL, problem-based learning; * p < 0.05.

4. Discussion

In this study, the mean problem-solving ability score of nursing students was 3.63 out of 5, which is similar to the 3.56 points reported in a study targeting third- and fourth- year students in the department of nursing [ 24 ]. However, the current value is higher than the 3.44 points reported in a study targeting first- and second-year students [ 13 ]. Participants in these studies were nursing students in the second, third, and fourth years of study in this paper, in the third and fourth years in the study done by Kim et al. [ 24 ]; and in the first and second grades in the study by Ji et al. [ 13 ]. Problem-solving ability can be developed under the influence of various factors; those identified in previous studies include communication ability [ 13 ], critical thinking ability [ 12 , 25 ], metacognition [ 11 ], and self-directed learning [ 2 ]. These factors are continuously improved through various interpersonal relationships formed while learning and studying liberal arts and other major subjects, rather than existing as innate abilities [ 26 ]. Therefore, the degree of problem-solving ability was rather high in the study targeting the upper grades. Problem-solving ability in various unexpected situations is essential for working as a nurse [ 27 ]. In the current study, the problem-solving ability score of nursing students approximated the 72.6 percentile of the full 100-point scale. Although this score is relatively high, it is nevertheless necessary to improve problem-solving ability; given the nature of the nurse’s job, this ability represents a very important competency. Therefore, it is necessary to improve the problem-solving ability level of nursing students in Korea. The results of this study showed that factors affecting nursing students’ problem-solving ability were metacognition, communication competence, and age. It is necessary to establish a strategy that considers these factors to improve the problem-solving ability of nursing students.

The participants’ average metacognitive score was 3.86 out of 5, which was slightly higher than the 3.61 observed in a study conducted using the same tools for second-year nursing students [ 12 ]. While direct comparison using other tools is difficult, the metacognitive level of 72.3 obtained by Kim [ 28 ] for all grades in the nursing department was lower than the 77.2 points (out of 100 points) obtained in this study. According to Sternberg and Sternberg [ 29 ], the problem-solving phase includes problem identification, problem expression, strategy formulation, information construction, resource allocation, supervision, and evaluation. For health science students, metacognitive instruction has been shown to have a positive effect on students’ problem-solving ability and in improving academic achievement [ 30 ]. That is, metacognition is a key factor in predicting learning outcomes in the problem-solving domain [ 31 ]. These results were replicated in this study, which showed that a higher metacognitive level of nursing students indicated a significantly higher problem-solving ability. The subjects of this study were second-, third-, and fourth-year nursing students, and it is thought that their metacognitive level was improved compared to students in earlier phases of education, as a result of the curriculum of the nursing department. Educational programs and strategies to improve metacognition will be needed to improve the problem-solving ability of nursing students. The components of metacognition are thinking deeply in the planning stage, establishing possible strategies, undertaking regulating and monitoring activities to carry out the strategy, and revising and regulating to ensure that the solution is progressing in an appropriate direction to achieve the goal [ 32 ]. Therefore, a professor who instructs and checks nursing students is necessary to enable them to set their own goals in the curricular and non-curricular programs as they advance through the course, plan and implement strategies to achieve their goals through deep thinking, and conduct their own monitoring and control processes.

The average communication competence score of the subjects was 3.92 out of 5. Previous studies targeting students in various years of the course at the department of nursing found that the communication competence of nursing students also improved as they progressed through the course, with values reported of 3.58 points [ 33 ] and 3.56 points [ 34 ].

In previous studies, communication competence was a factor affecting nursing students’ problem-solving ability [ 13 ]. However, the current study is valuable because it additionally revealed that the level of problem-solving ability significantly increased according to the level of communication competence. Case-based education is suggested as a strategy to simultaneously improve communication competence and problem-solving skills in nursing student education [ 17 ]. This is because it is difficult to solve problems through integrative thinking and effective communication in a clinical environment, such as a hospital, with only theoretical knowledge of nursing subjects. Thus, the PBL method is applied to theoretical education in nursing colleges [ 35 , 36 ]. The results of this study showed that the presence or absence of PBL education had a significant effect on the problem-solving ability of nursing students; this ability improved when the PBL factor was added to Model 2. Therefore, it is necessary for nursing professors to practice and improve the communication competence of their students through case-based education in various subjects beginning in the first year to improve the problem-solving abilities of the students.

Additionally, the age of the subjects was also a factor influencing the problem-solving ability. Stewart, Cooper, and Moulding [ 37 ] reported that metacognitive levels increase with age. The study revealed that the communication competence of nursing students improved through various experiences [ 38 ]. Age may have had a similar influence.

Previous studies identified critical thinking disposition, empathy, nursing professional intuition, self-leadership [ 24 ], learning motivation [ 17 ], and communication competence [ 13 ] as examples of factors that affect nursing students’ problem-solving ability. However, this study demonstrated that metacognition also significantly affects the problem-solving ability of nursing students. In particular, metacognition and communication competence are considered key concepts, as they explained 51.2% of nursing students’ problem-solving ability. Therefore, it is necessary to consider and continuously apply educational strategies to improve metacognition and communication competence in the education of nursing students in the future.

This study is limited by the small number of nursing colleges that were included in the sampling, as this hinders the generalizability of the results.

5. Conclusions

This was a descriptive research study that identified the degree of and correlations between metacognition, communication competence, and problem-solving ability of nursing students, and identified factors that affect problem-solving ability. The results demonstrated that age, communication competence, and metacognition were the factors that most significantly affected the problem-solving ability of nursing students. Among these factors, metacognition had the greatest influence. Therefore, to improve the problem-solving ability of nursing students, an educational strategy is needed to improve communication competence through case-based learning in the curriculum, and development and application of activities such as PBL. In addition, the guidance of professors is needed to enable nursing students to improve their metacognition.

Since this study revealed that metacognition is a factor that influences the problem-solving ability of nursing students, we recommend conducting a study to check whether it affects actual problem-solving by developing and applying a metacognitive improvement curriculum in the future.

Acknowledgments

We would like to thank the nursing students who participated in the study.

Funding Statement

This study was supported by the research fund of Korean Bible University in 2021.

Author Contributions

Conceptualization, E.C. and J.J.; methodology, E.C. and J.J.; validation, E.C.; formal analysis, E.C.; investigation, E.C. and J.J.; resources, E.C. and J.J.; data curation, E.C.; writing—original draft preparation, E.C.; writing—review and editing, J.J.; supervision, E.C.; project administration, E.C. and J.J.; funding acquisition, E.C. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Gangneung–Wonju National University (No. GWNUIRB-2022-1).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Critical Thinking

Ai generator.

In today’s dynamic and fast-paced world, critical thinking stands out as an essential competency, seamlessly bridging the gap between soft and hard skills . As we navigate complex challenges and make informed decisions, the ability to think critically enhances our overall skill set. Critical thinking stands at the core of effective decision-making and problem-solving in today’s complex world. It involves analyzing information, evaluating evidence, and considering multiple perspectives to make informed judgments. In a society flooded with information, the ability to think critically ensures that individuals can distinguish between credible sources and misinformation. It empowers people to approach challenges logically and creatively, fostering innovation and resilience. By honing critical thinking skills, individuals enhance their capacity to navigate personal and professional landscapes with clarity and confidence.

What is Critical Thinking?

Critical thinking is the process of actively and skillfully analyzing, evaluating, and synthesizing information gathered from various sources, including observations , experiences, and communication. It involves using logic and reasoning to identify connections, draw conclusions, and make informed decisions, while remaining open-minded and aware of potential biases.

Critical Thinking Examples

• Analyzing News Reports : Evaluating the credibility of sources, checking for biases, and verifying facts before accepting news stories as true.
• Problem-Solving in the Workplace : Identifying the root cause of a problem, considering multiple solutions, and weighing the pros and cons before deciding on the best course of action.
• Scientific Research : Formulating hypotheses, designing experiments to test them, analyzing data objectively, and drawing conclusions based on evidence.
• Budgeting : Assessing income and expenses, prioritizing spending, and making informed decisions to stay within budget while saving for future needs.
• Reading Literature : Interpreting themes, symbols, and character motivations in a novel or poem, and considering how they relate to broader societal issues.
• Debating : Constructing logical arguments, anticipating counterarguments, and using evidence to support one’s position while also listening to and understanding opposing views.
• Medical Diagnosis : Doctors evaluating symptoms, considering possible conditions, ordering tests, and interpreting results to make accurate diagnoses and treatment plans.
• Educational Assessment : Teachers designing fair and effective assessments that measure student understanding and skills, and using the results to improve teaching strategies.
• Ethical Decision-Making : Weighing the moral implications of actions, considering the impact on stakeholders, and making choices that align with ethical principles.
• Legal Analysis : Lawyers analyzing case law, statutes, and evidence to build strong legal arguments and anticipate the strategies of opposing counsel.
• Marketing Strategy : Analyzing market trends, customer needs, and competitor actions to develop effective marketing campaigns that resonate with target audiences.
• Programming : Writing efficient code by understanding the problem, breaking it into smaller parts, and testing and debugging to ensure it works correctly.
• Urban Planning : Evaluating the needs of a community, considering environmental impact, and planning sustainable and functional urban spaces.
• Historical Analysis : Examining historical events, considering the context, and understanding the causes and effects while avoiding presentism (judging the past by today’s standards).
• Personal Decision-Making : Weighing the benefits and drawbacks of significant life choices, such as career changes or moving to a new city, and making decisions based on careful consideration and long-term goals.

For Students

• Activity : Organize debates on current events or controversial topics.
• Example : Have students debate the pros and cons of renewable energy sources versus fossil fuels.
• Activity : Present students with complex problems to solve in groups.
• Example : Task students with designing a plan to reduce plastic waste in their school.
• Activity : Analyze case studies relevant to their subjects.
• Example : In a business class, analyze a company’s decision-making process during a crisis.
• Activity : Conduct Socratic seminars where students discuss philosophical or ethical questions.
• Example : Discuss the ethical implications of artificial intelligence in society.
• Activity : Facilitate brainstorming sessions to generate creative solutions to problems.
• Example : Brainstorm ideas for a community service project to help local residents.
• Activity : Assign research projects requiring critical analysis of sources.
• Example : Research the impact of social media on teenage mental health and present findings.
• Activity : Engage students in role-playing exercises to explore different perspectives.
• Example : Role-play a historical event, with each student taking on the role of a key figure.
• Activity : Use logic puzzles and games to develop reasoning skills.
• Example : Solve Sudoku puzzles or play strategy games like chess.
• Activity : Encourage students to write reflectively about their learning experiences.
• Example : Write an essay on how their views on a topic have changed after a class discussion.
• Activity : Analyze the techniques used in advertisements to influence consumers.
• Example : Evaluate an advertisement’s claims and discuss the strategies used to persuade the audience.

In the Workplace

• Problem Solving : Analyzing the root cause of a recurring issue in production and developing a sustainable solution.
• Decision Making : Evaluating the pros and cons of two potential suppliers based on cost, quality, and reliability.
• Strategic Planning : Assessing market trends to develop a new product line that meets future consumer demands.
• Conflict Resolution : Mediating a disagreement between team members by understanding both perspectives and finding common ground.
• Process Improvement : Reviewing workflow inefficiencies and implementing new procedures to increase productivity.
• Risk Management : Identifying potential risks in a project and devising strategies to mitigate them.
• Customer Service : Addressing a customer complaint by understanding the underlying issue and providing a satisfactory resolution.
• Innovation : Brainstorming and evaluating new ideas for improving a product or service.
• Performance Evaluation : Analyzing employee performance data to provide constructive feedback and development plans.
• Budgeting : Reviewing and adjusting the department budget to ensure financial efficiency without compromising quality.

In the Classroom

• Critical Reading : Analyzing a text to understand the author’s argument, purpose, and use of evidence.
• Scientific Inquiry : Designing and conducting experiments to test hypotheses and draw conclusions based on data.
• Mathematical Problem Solving : Applying logical reasoning to solve complex math problems and explaining the solution process.
• Historical Analysis : Evaluating historical events and their impact from multiple perspectives.
• Debate : Constructing and defending arguments on various topics using evidence and reasoning.
• Project-Based Learning : Developing a research project by identifying a problem, gathering information, and presenting findings.
• Creative Writing : Critiquing peers’ work to provide constructive feedback and suggestions for improvement.
• Ethical Dilemmas : Discussing moral questions and justifying decisions based on ethical principles.
• Literary Analysis : Interpreting themes, symbols, and character development in literature.
• Collaborative Learning : Working in groups to solve problems, share ideas, and reach consensus.

In Everyday Life

• Financial Planning : Creating a budget to manage expenses, savings, and investments.
• Nutrition and Health : Analyzing dietary choices to improve overall health and wellness.
• Time Management : Prioritizing tasks and activities to make efficient use of time.
• Consumer Decisions : Comparing product reviews and prices before making a purchase.
• Home Maintenance : Troubleshooting and fixing household issues, such as plumbing or electrical problems.
• Travel Planning : Researching destinations, comparing travel options, and creating itineraries.
• Parenting : Making informed decisions about children’s education, health, and activities.
• Conflict Resolution : Resolving disputes with family or friends by understanding different viewpoints and finding compromises.
• Personal Development : Setting and pursuing personal goals, such as learning a new skill or improving fitness.
• Community Involvement : Analyzing community issues and participating in local initiatives to address them.

In Healthcare

• Diagnosis : Interpreting patient symptoms and medical history to diagnose conditions accurately.
• Treatment Planning : Developing individualized treatment plans based on patient needs and evidence-based practices.
• Ethical Decision-Making : Addressing ethical dilemmas in patient care, such as end-of-life decisions.
• Patient Communication : Explaining complex medical information to patients and families clearly and compassionately.
• Interdisciplinary Collaboration : Working with other healthcare professionals to provide comprehensive care.
• Medical Research : Designing and conducting research studies to advance medical knowledge and treatments.
• Healthcare Policy Analysis : Evaluating healthcare policies and their impact on patient care and outcomes.
• Clinical Judgment : Assessing and prioritizing patient care needs in emergency situations.
• Quality Improvement : Implementing strategies to improve patient safety and care quality.
• Continuing Education : Staying updated on medical advancements and integrating new knowledge into practice.

In Business

• Market Analysis : Evaluating market trends and consumer behavior to make informed business decisions.
• Strategic Planning : Developing long-term goals and strategies to achieve business objectives.
• Financial Management : Analyzing financial statements to make sound investment and budgeting decisions.
• Risk Assessment : Identifying and mitigating potential business risks.
• Negotiation : Using persuasive arguments and data to negotiate contracts and deals.
• Product Development : Assessing customer needs and market gaps to create new products.
• Customer Feedback Analysis : Collecting and analyzing customer feedback to improve products and services.
• Supply Chain Management : Optimizing supply chain processes to reduce costs and increase efficiency.
• Leadership : Making decisions that motivate and guide employees toward achieving company goals.
• Corporate Social Responsibility : Evaluating the social and environmental impact of business practices and implementing sustainable strategies.
• Research Projects : Conducting independent research, analyzing data, and presenting findings.
• Critical Essays : Writing essays that critically analyze texts, arguments, and ideas.
• Group Projects : Collaborating with classmates to complete assignments and solve problems.
• Class Discussions : Participating in discussions by presenting well-reasoned arguments and listening to others.
• Case Studies : Analyzing real-world scenarios to understand complex issues and propose solutions.
• Exam Preparation : Developing study plans and strategies to prepare for exams effectively.
• Internships : Applying classroom knowledge to real-world situations during internships and reflecting on experiences.
• Time Management : Balancing academic, social, and personal responsibilities.
• Library Research : Using library resources to find credible sources for research papers.
• Extracurricular Activities : Engaging in activities that develop leadership, teamwork, and problem-solving skills.

Critical Thinking scenarios

Here are some critical thinking scenarios along with questions and answers to help you practice and enhance your critical thinking skills:

Scenario 1: Workplace Conflict

Scenario: You are a manager at a company. Two of your team members, John and Lisa, have been having frequent disagreements. These conflicts are starting to affect the team’s productivity and morale.

• What steps would you take to address the conflict between John and Lisa?
• How would you ensure that the resolution is fair and satisfactory for both parties?
• What strategies would you implement to prevent similar conflicts in the future?
• Schedule a private meeting with John and Lisa to discuss the issue.
• Listen to both sides without taking sides to understand the root cause of the conflict.
• Facilitate a mediation session where both parties can express their concerns and work towards a resolution.
• Agree on specific actions that both parties will take to avoid future conflicts.
• Ensure that both John and Lisa feel heard and respected during the mediation process.
• Identify common ground and mutual interests to build a foundation for resolution.
• Set clear expectations and follow-up actions for both parties.
• Monitor the situation and provide support to ensure the conflict does not resurface.
• Foster an open and inclusive team culture where concerns can be raised early.
• Provide regular team-building activities to strengthen relationships.
• Implement conflict resolution training for all team members.
• Establish clear communication channels and protocols for addressing grievances.

Scenario 2: Ethical Dilemma

Scenario: You are a journalist working on a high-profile story. You discover that one of your sources has provided you with information that could harm their reputation if published. However, this information is crucial to your story and serves the public interest.

• What factors would you consider before deciding whether to publish the information?
• How would you balance the public interest with the potential harm to your source?
• What steps would you take to verify the accuracy of the information before publication?
• The significance of the information to the public interest.
• The potential consequences for the source if the information is published.
• The ethical guidelines and professional standards of journalism.
• Any possible legal implications of publishing the information.
• Evaluate whether the public’s right to know outweighs the potential harm to the source.
• Consider anonymizing the source or redacting sensitive details to protect their identity.
• Seek advice from colleagues or an ethics committee to make an informed decision.
• Cross-check the information with other reliable sources.
• Review any documentation or evidence provided by the source.
• Conduct interviews with other individuals who can corroborate the information.
• Ensure that the information is presented in context to avoid misrepresentation.

Scenario 3: Environmental Impact

Scenario: Your company is planning to build a new factory in a rural area. This project promises economic growth and job creation but also raises concerns about environmental impact and the displacement of local wildlife.

• What are the potential environmental impacts of the new factory?
• How would you address the concerns of the local community and environmental groups?
• What measures would you implement to minimize the environmental impact of the factory?
• Air and water pollution from factory emissions and waste.
• Habitat destruction and displacement of local wildlife.
• Increased traffic and noise pollution in the area.
• Strain on local resources such as water and energy.
• Organize community meetings to discuss the project and listen to concerns.
• Collaborate with environmental groups to assess the impact and find solutions.
• Provide transparent information about the factory’s operations and mitigation plans.
• Offer compensation or relocation assistance to affected residents if necessary.
• Implement eco-friendly technologies and practices to reduce emissions and waste.
• Develop a comprehensive environmental management plan.
• Create buffer zones and wildlife corridors to protect local habitats.
• Invest in renewable energy sources to power the factory.
• Improved Problem Solving: Critical thinking helps in analyzing problems systematically and making better decisions.
• Enhanced Communication: It allows for clear expression and understanding of ideas.
• Better Decision Making: Critical thinking leads to more informed and logical choices.
• Adaptability: It enables individuals to adapt to new situations and challenges effectively.
• Informed Opinions: Critical thinkers can form well-grounded opinions and defend them logically.

What are the critical thinking skills?

• Analysis: Breaking down complex information into smaller parts to understand it better.
• Interpretation: Understanding and explaining the meaning of information or an event.
• Inference: Drawing logical conclusions from available information.
• Evaluation: Assessing the credibility and relevance of information and arguments.
• Explanation: Clearly and concisely articulating your reasoning and evidence.
• Self-Regulation: Reflecting on and adjusting one’s own thought processes and biases.

Concepts of critical thinking

• Clarity: Ensuring that the information and arguments are clear and understandable.
• Accuracy: Ensuring that information is true and free from errors.
• Precision: Providing enough detail to understand the specific context.
• Relevance: Ensuring that information and arguments are directly related to the issue at hand.
• Depth: Addressing the complexities and underlying factors of an issue.
• Breadth: Considering different perspectives and alternatives.
• Logic: Ensuring that the reasoning is coherent and follows a logical sequence.
• Fairness: Being open-minded and impartial in evaluating information and arguments.
• Identify the Problem or Question: Clearly define what you are trying to solve or understand.
• Gather Information: Collect relevant data, evidence, and viewpoints.
• Analyze the Information: Break down the information to understand the relationships and implications.
• Evaluate the Evidence: Assess the quality, credibility, and relevance of the evidence.
• Formulate Conclusions: Draw reasoned conclusions based on the analysis and evaluation.
• Communicate the Conclusion: Clearly express your findings and reasoning.
• Reflect and Reassess: Continuously reflect on the process and outcomes to improve your critical thinking skills.

Basics of critical thinking

• Open-Mindedness: Being willing to consider new ideas and perspectives.
• Curiosity: Having a strong desire to learn and understand.
• Skepticism: Questioning the validity of information and not taking things at face value.
• Objectivity: Striving to remain unbiased and impartial.
• Rationality: Basing decisions on logical reasoning rather than emotions.
• Socratic Questioning: Asking a series of probing questions to explore complex ideas and uncover underlying assumptions.
• Mind Mapping: Visually organizing information to see connections and relationships.
• Brainstorming: Generating a wide range of ideas and solutions without immediate judgment.
• Role Playing: Considering different perspectives by imagining oneself in another person’s position.
• SWOT Analysis: Evaluating the strengths, weaknesses, opportunities, and threats related to a particular situation or decision.
• Thought Experiments: Imagining hypothetical scenarios to explore potential outcomes and implications.

How to Practice and Use Critical Thinking

The critical thinking process incorporates various other logical soft skills that will help you analyze and interpret all the information to create an informed decision. These soft skills include observational skills, problem-solving, communication skills, and analytical thinking. If you sharpen all of these elements and characteristics you will inadvertently enhance your critical thinking.

Step 1: Practice One’s Observational and Perception Skills

We use our senses to perceive the world around us, whether it would be sight, smell, a, and sensations. One should practice utilizing these senses to create logical inferences and deductions that will help out brain unconsciously absorb and analyze these types of information. The more one practices their senses the better their thinking process will be.

Step 2: Enhance One’s Problem-Solving Skills

Logic and problem-solving allow the person to deduce and connect information that the environment or circumstance presents to the said person. You need to practice your problem-solving skills via puzzles, logical reasoning tests, and ethical dilemmas. Practicing one’s problem-solving skills will allow the person to efficiently establish cause-and-effect  reasoning or properly create logical decisions.

Step 3: Prepare and Practice One’s Communication Skills

Communication is a pivotal skill we often use when interacting with other people. This type of skill includes body language , assertive communication , concise language, and other communication skills. In critical thinking, a person must be able to properly communicate their thoughts and thinking process to other people, which will create a collaborative environment. Other times, the perfect solution might not be present without the need for communication.

Step 4: Practice Analysis of the Situation

One’s analytical thinking skills allow the person to take note of various elements and characteristics of the situation and analyze these elements’ contribution to the current situation or circumstance. You need to practice your analytical thinking to properly process the current situation or circumstance you find yourself in.

Why Do Employers Value Critical Thinking Skills?

Employers value critical thinking skills because they enable employees to analyze situations, make informed decisions, and solve problems effectively. Critical thinkers can evaluate information from various sources, identify logical connections, and foresee potential consequences, which leads to better strategic planning and innovation. These skills also enhance communication and collaboration, as critical thinkers can present their ideas clearly and consider different perspectives. Ultimately, critical thinking contributes to improved productivity, adaptability, and competitiveness in the workplace.

What is critical thinking?

Critical thinking involves analyzing and evaluating information to make reasoned, logical decisions, and judgments. It emphasizes evidence-based reasoning and problem-solving.

Why is critical thinking important?

Critical thinking enhances decision-making, problem-solving, and the ability to analyze complex situations. It is crucial for personal and professional growth.

How can I improve my critical thinking skills?

Improve critical thinking by questioning assumptions, seeking diverse perspectives, practicing problem-solving, and engaging in reflective thinking regularly.

What are the key components of critical thinking?

Key components include analysis, evaluation, inference, explanation, and self-regulation. These skills help in understanding and assessing arguments and evidence.

How does critical thinking benefit students?

Students benefit from critical thinking by improving academic performance, enhancing research skills, and fostering independent thinking and creativity.

What role does critical thinking play in the workplace?

In the workplace, critical thinking aids in decision-making, innovation, conflict resolution, and improving productivity and efficiency.

Can critical thinking be taught?

Yes, critical thinking can be taught through targeted educational programs, exercises, and practice that focus on developing analytical and evaluative skills.

What is an example of critical thinking in everyday life?

An example is evaluating news sources for credibility before accepting information as true. This involves analyzing evidence and assessing biases.

How does critical thinking relate to problem-solving?

Critical thinking is integral to problem-solving as it involves analyzing the problem, evaluating options, and making reasoned decisions based on evidence.

What are common barriers to critical thinking?

Common barriers include cognitive biases, emotional influences, lack of relevant information, and social pressures. Overcoming these requires awareness and deliberate practice.

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