Saint Paul University Dumaguete

Graduate School Nursing

Comprehensive Examination Pointers

Critical Thinking

1. Critical thinking and creative thinking

Critical thinking is reasoning that generates and examines

questions and problems and is central in making sound clinical
judgements. It is reflective intellectual process to identify and
challenge assumptions and explore and imagine alternatives. It
requires logic, breadth, depth, accuracy and relevance. It
includes questions such as Why.

Critical thinking is the disciplined, intellectual process of applying

skilful reasoning as a guide to belief or action (Paul, Ennis &
Norris). In nursing, critical thinking for clinical decision-making is
the ability to think in a systematic and logical manner with
openness to question and reflect on the reasoning process used
to ensure safe nursing practice and quality care (Heaslip).
Critical thinking when developed in the practitioner includes
adherence to intellectual standards, proficiency in using
reasoning, a commitment to develop and maintain intellectual
traits of the mind and habits of thought and the competent use
of thinking skills and abilities for sound clinical judgments and
safe decision-making.

Creative thinking- is essential to critical thinking. Creative

thinking as out of the box ideas that questions the ideology of
the art and science of nursing. Creativity is an important element
of human endeavour (Cohen, 2002), s described in current
literature as Problem Based Learning (Thomas, 2010).
Individuals need to be allowed to have creative thoughts
especially in an environment such as healthcare that is drenched
in bureaucracy (Smith, 2007). Creative thinking knows no
bounds and is not restricted by possibilities. creativity/creative
thinking as a complex personal trait as well as a cognitive
 process regarding problem solving. Managers refer to creative
problem solving in order to improve productivity or
organisational efficiency.

2. Importance of critical thinking in nursing

Critical thinking is important to be able to think through a patient

emergency or other patient-related problems. If a nurse has no critical
thinking abilities, chances are he might harm the patient rather than
healing it. Critical thinking is necessary because in this way, a nurse
can apply what he have learned appropriately because critical thinking
is not just knowing the facts but rather being able to apply them
accurately. It is to think beyond what is said, to consider options about
what they have heard and to evaluate and make decisions based on
the multiple sources that they have received. Therefore critical
thinking makes a nurse competent enough to care their patients.
Critical thinking also refers to thinking what crucial management must
be done to manage specific problems. It is necessary in identifying and
providing solutions to nursing problems.

It is also necessary to maintain a lifelong learning, healthy workplace,

and an organization culture thats more concern on reporting errors
and promoting safety than pointing fingers and blaming each other.

3. Clinical judgement, Clinical reasoning

Clinical judgment refers to the result (outcome) of critical thinking or

clinical reasoning, it is the conclusion, decision or opinion one makes
after thinking the issues and weighing it.

Clinical reasoning is a specific term, is the process you use to think

about issues at the point of care- example is deciding how to prevent
and manage patient problems.
4. Read critically, write critically, listen critically, speak critically

Read critically means that a person does not merely reads and accepts
immediately the facts and ideas presented to him while reading, but
rather the person or reader must understand it well and ask himself
the question why?. He must not believe on it immediately but rather
examine and validate such information whether such is true, effective,
whether its source is reliable or is it applicable. Meaning one processes
the information that is being read and look into its content and
application in the field of nursing.

Write critically- basic to critical thinking is the ability to speak ones

thoughts coherently, clearly and concisely. One should right and jot
things down with reasoning and understanding and capable of
communicating his thoughts to others.

Listen critically- this simply means listening and understanding.

Learning how to process and understand the things that are being
heard. This means focusing on what the speaker is saying and
listening to key points and identifying anything that is confusing.

Speak critically- this means clear, logical and accurate spoken

communication. Ambiguous statements that are misleading must be
avoided. Also personal biases influences what other persons hears.

5. Biological Psychologies relating to Critical thinking in nursing

ex. Locations of learning, Hemispheres of the brain,
intelligences and others. ( please correlate the information
here with your instructors discussions, this is not yet complete)

Locations of learning
a. Healthy workplace environment- healthy workplace standards form
the foundation for a climate that fosters critical thinking by
providing an atmosphere thats respectful, healing and humane.
b. Learning culture-

6. Blooms taxonomy (3 Domains)

 The cognitive, affective and psychomotor

The Three Domains of Learning

The committee identified three domains of educational activities

or learning (Bloom, et al. 1956):

1. Cognitive: mental skills (knowledge)

The cognitive domain involves knowledge and the development

of intellectual skills (Bloom, 1956). This includes the recall or
recognition of specific facts, procedural patterns, and concepts
that serve in the development of intellectual abilities and skills.
There are six major categories of cognitive an processes, starting
from the simplest to the most complex (see the table below for
an in-depth coverage of each category):

able of the Revised Cognitive Domain

Examples, key words (verbs), and

Category
technologies for learning (activities)

Examples: Recite a policy. Quote prices

from memory to a customer. Recite the
safety rules.

Key Words: defines, describes,

Remembering: Recall or
identifies, knows, labels, lists, matches,
retrieve previous learned
names, outlines, recalls, recognizes,
information.
reproduces, selects, states

Technologies: book marking, flash

cards, rote learning based on repetition,
reading

Understanding: Examples: Rewrite the principles of test

 writing. Explain in one's own words the
steps for performing a complex task.
Translate an equation into a computer
spreadsheet.
Comprehending the
meaning, translation, Key Words: comprehends, converts,
interpolation, and defends, distinguishes, estimates,
interpretation of explains, extends, generalizes, gives an
instructions and example, infers, interprets, paraphrases,
problems. State a predicts, rewrites, summarizes,
problem in one's own translates
words.
Technologies: create an analogy,
participating in cooperative learning ,
taking notes, storytelling, Internet
search

Examples: Use a manual to calculate an

employee's vacation time. Apply laws of
Applying: Use a concept statistics to evaluate the reliability of a
in a new situation or written test.
unprompted use of an
Key Words: applies, changes,
abstraction. Applies what
computes, constructs, demonstrates,
was learned in the
discovers, manipulates, modifies,
classroom into novel
operates, predicts, prepares, produces,
situations in the work
relates, shows, solves, uses
place.
Technologies: collaborative learning ,
create a process, blog, practice

Analyzing: Separates Examples: Troubleshoot a piece of

material or concepts into equipment by using logical deduction.
component parts so that Recognize logical fallacies in
its organizational reasoning. Gathers information from a
 department and selects the required
tasks for training.

Key Words: analyzes, breaks down,

structure may be compares, contrasts, diagrams,
understood. Distinguishes deconstructs, differentiates,
between facts and discriminates, distinguishes, identifies,
inferences. illustrates, infers, outlines, relates,
selects, separates

Technologies: Fishbowls , debating,

questioning what happened, run a test

Examples: Select the most effective

solution. Hire the most qualified
candidate. Explain and justify a new
budget.
Evaluating: Make
Key Words: appraises, compares,
judgments about the
concludes, contrasts, criticizes,
value of ideas or
critiques, defends, describes,
materials.
discriminates, evaluates, explains,
interprets, justifies, relates,
summarizes, supports

Technologies: survey, blogging

Creating: Builds a Examples: Write a company operations

structure or pattern from or process manual. Design a machine to
diverse elements. Put perform a specific task. Integrates
parts together to form a training from several sources to solve a
whole, with emphasis on problem. Revises and process to
creating a new meaning improve the outcome.
or structure.
Key Words: categorizes, combines,
compiles, composes, creates, devises,
 designs, explains, generates, modifies,
organizes, plans, rearranges,
reconstructs, relates, reorganizes,
revises, rewrites, summarizes, tells,
writes

Technologies: Create a new model,

write an essay, network with others

2. Affective: growth in feelings or emotional areas (attitude or

self)

The affective domain (Krathwohl, Bloom, Masia, 1973) includes

the manner in which we deal with things emotionally, such as
feelings, values , appreciation, enthusiasms, motivations ,
and attitudes . The five major categories are listed from the
simplest behavior to the most complex:

Example and Key Words

Category
(verbs)

Examples: Listen to others

with respect. Listen for and
remember the name of
newly introduced people.
Receiving Phenomena: Awareness,
willingness to hear, selected attention.
Key Words: acknowledge,
asks, attentive, courteous,
dutiful, follows, gives,
listens, understands

Responds to Phenomena: Active Examples: Participates in

participation on the part of the class discussions. Gives a

learners. Attend and react to a
particular phenomenon. Learning
outcomes may emphasize compliance
in responding, willingness to respond,
or satisfaction in responding
(motivation).
Valuing: The worth or value a person
attaches to a particular object,
phenomenon, or behavior. This ranges
from simple acceptance to the more
complex state of commitment. Valuing
is based on the internalization of a set
of specified values, while clues to
these values are expressed in the
learner's overt behavior and are often
identifiable.
Organization: Organizes values into
priorities by contrasting different
presentation. Questions new
ideals, concepts, models,
etc. in order to fully
understand them. Know the
safety rules and practice
them.
Key Words: answers,
assists, aids, complies,
conforms, discusses, greets,
helps, labels, performs,
presents, tells
Examples: Demonstrates
belief in the democratic
process. Is sensitive
towards individual and
cultural differences (value
diversity). Shows the ability
to solve problems. Proposes
a plan to social
improvement and follows
through with commitment.
Informs management on
matters that one feels
strongly about.
Key Words: appreciates,
cherish, treasure,
demonstrates, initiates,
invites, joins, justifies,
proposes, respect, shares
Examples: Recognizes the
need for balance between

values, resolving conflicts between
them, and creating an unique value
system. The emphasis is on
comparing, relating, and synthesizing
values.
Internalizes
Values (characterization): Has a
value system that controls their
behavior. The behavior is pervasive,
consistent, predictable, and most
important characteristic of the
learner. Instructional objectives are
concerned with the student's general
patterns of adjustment (personal,
social, emotional).
freedom and responsible
behavior. Explains the role
of systematic planning in
solving problems. Accepts
professional ethical
standards. Creates a life
plan in harmony with
abilities, interests, and
beliefs. Prioritizes time
effectively to meet the
needs of the organization,
family, and self.
Key Words: compares,
relates, synthesizes
Examples: Shows self-
reliance when working
independently. Cooperates
in group activities (displays
teamwork). Uses an
objective approach in
problem solving. Displays a
professional commitment to
ethical practice on a daily
basis. Revises judgments
and changes behavior in
light of new evidence.
Values people for what they
are, not how they look.
Key Words: acts,
discriminates, displays,
influences, modifies,
performs, qualifies,
questions, revises, serves,
 solves, verifies

3. Psychomotor: manual or physical skills (skills)

The psychomotor domain (Simpson, 1972) includes physical

movement, coordination, and use of the motor-skill areas.
Development of these skills requires practice and is measured in
terms of speed, precision, distance, procedures, or techniques in
execution. Thus, psychomotor skills rage from manual tasks,
such as digging a ditch or washing a car, to more complex tasks,
such as operating a complex piece of machinery or dancing.

The seven major categories are listed from the simplest behavior
to the most complex:

Category Example and Key Words (verbs)

Perception (awareness): The Examples: Detects non-verbal

ability to use sensory cues to
guide motor activity. This
ranges from sensory
stimulation, through cue
selection, to translation.
communication cues. Estimate
where a ball will land after it is
thrown and then moving to the
correct location to catch the ball.
Adjusts heat of stove to correct
temperature by smell and taste of
food. Adjusts the height of the
forks on a forklift by comparing
where the forks are in relation to
the pallet.

Key Words: chooses, describes,

detects, differentiates,

Set: Readiness to act. It
includes mental, physical, and
emotional sets. These three
sets are dispositions that
predetermine a person's
response to different situations
(sometimes called mindsets).
Guided Response: The early
stages in learning a complex
skill that includes imitation and
trial and error. Adequacy of
performance is achieved by
practicing.
Mechanism (basic
proficiency): This is the
intermediate stage in learning a
complex skill. Learned
distinguishes, identifies, isolates,
relates, selects.
Examples: Knows and acts upon
a sequence of steps in a
manufacturing process. Recognize
one's abilities and limitations.
Shows desire to learn a new
process (motivation). NOTE: This
subdivision of Psychomotor is
closely related with the
Responding to phenomena
subdivision of the Affective
domain.
Key Words: begins, displays,
explains, moves, proceeds, reacts,
shows, states, volunteers.
Examples: Performs a
mathematical equation as
demonstrated. Follows instructions
to build a model. Responds hand-
signals of instructor while learning
to operate a forklift.
Key Words: copies, traces,
follows, react, reproduce,
responds
Examples: Use a personal
computer. Repair a leaking faucet.
Drive a car.

responses have become
habitual and the movements
can be performed with some
confidence and proficiency.
Complex Overt Response
(Expert): The skillful
performance of motor acts that
involve complex movement
patterns. Proficiency is
indicated by a quick, accurate,
and highly coordinated
performance, requiring a
minimum of energy. This
category includes performing
without hesitation, and
automatic performance. For
example, players are often
utter sounds of satisfaction or
expletives as soon as they hit a
tennis ball or throw a football,
because they can tell by the
feel of the act what the result
will produce.
Adaptation: Skills are well
developed and the individual
can modify movement patterns
to fit special requirements.
Key Words: assembles,
calibrates, constructs, dismantles,
displays, fastens, fixes, grinds,
heats, manipulates, measures,
mends, mixes, organizes,
sketches.
Examples: Maneuvers a car into
a tight parallel parking spot.
Operates a computer quickly and
accurately. Displays competence
while playing the piano.
Key Words: assembles, builds,
calibrates, constructs, dismantles,
displays, fastens, fixes, grinds,
heats, manipulates, measures,
mends, mixes, organizes,
sketches.
NOTE: The Key Words are the
same as Mechanism, but will have
adverbs or adjectives that indicate
that the performance is quicker,
better, more accurate, etc.
Examples: Responds effectively
to unexpected experiences.
Modifies instruction to meet the
needs of the learners. Perform a
task with a machine that it was
not originally intended to do
(machine is not damaged and
there is no danger in performing
 the new task).

Key Words: adapts, alters,

changes, rearranges, reorganizes,
revises, varies.

Examples: Constructs a new

Origination: Creating new
movement patterns to fit a
particular situation or specific
problem. Learning outcomes
emphasize creativity based
upon highly developed skills.
theory. Develops a new and
comprehensive training
programming. Creates a new
gymnastic routine.
Key Words: arranges, builds,
combines, composes, constructs,
creates, designs, initiate, makes,
originates.

4. Factors that may hinder critical thinking (How to improve

critical thinking)

a. Cultural Conditioning and Egocentric Thinking or self focusing

Cultural conditioning refers to the process by which societys attitudes and
values are passed on to its members. Although the precise nature of cultural
conditioning, including how it operates and what lasting effects it has is
uncertain, cultures unquestionably condition their members. In other words,
you and I are to a large degree the products of the particular place and time
in which we were raised. We have been significantly shaped by the
customary beliefs, social forms, and material traits of that setting. The
assumptions derived from this conditioning are so embedded in our view of
things that we probably arent even aware of much of it.
 Egocentric thinking comes from the unfortunate fact that
humans do not naturally consider the rights and needs of others,
nor do we naturally appreciate the point of view of others or the
limitations of our own point of view. We become explicitly aware of
our egocentric thinking only if trained to do so. We do not naturally
recognize our egocentric assumptions, the egocentric way we use
information, the egocentric way we interpret data, the source of our
egocentric concepts and ideas, the implications of our egocentric
thought. We do not naturally recognize our self-serving perspective.

b. My way is better

c. Tunnel vision

d. Choosing only one

e. Face saving

f. Reliance on Authority

Authority is an expert outside ourselves. The expert can be a single

individual (a parent, a teacher, a celebrity, a clergy member, the
President), a group of individuals (doctors, educators, a peer group,
a national consensus), or even an institution (a religion, a
government agency, an educational establishment). Whatever its
form, authority is a common source of belief and knowledge.

Just think about everything you claim to know that is based on

authority. Examples might include facts and opinion about world
history, the state of your health, the direction of the economy, the
events of the day, the existence of God and an afterlife --- the list
seems endless, the topics unbounded. In fact, without relying on
authority, we would know very little of what we ordinarily take for
granted.

But theres a danger. We can so rely on authority that we stop

thinking for ourselves. Puzzled about something, we might invoke
some authority to decide the answer for us. When dealing with a
 controversial issue, we might find out what the majority thinks and,
looking no further, adopt the same position. Following authority
blindly is a block to critical thinking as well as an evasion of
autonomy.

g. Resistance to change

We all tend to resist change. Too often change is considered

guilty until proved innocent. Overcoming this barrier doesnt
mean embracing every new change uncritically. It means being
willing to suspend judgment long enough to make an informed
decision on whether the change is worthwhile.

h. Conformity

Although some conformity- like following policies and procedures

is good, there is harmful conformity. Harmful conformity is
when we conform to group thinking just to avoid being viewed
as different. Conforming without thought stifles the ability to be
creative and improve. Example of this is following policies blindly
even if there are clear indications that such does not apply to a
specific situation.

i. Stereotyping

We stereotype when we make fixed and unbending

overgeneralizations about others (eg. Homeless people are not
very bright). When our minds are fixed and unbending, were
unlikely to see whats really before us. By recognizing our
tendency to stereotype, we can make a conscious effort to
overcome this habit.

j. Self-deception

This is the subconscious forgetting of things about ourselves we

dont particularly feel good about. An example of this is experienced
nurses who believe that they never made learning errors or were
shy, nervous, or insecure when they were beginning nurses.
 5. 10 ways to develop creative thinking ( I suggest to look at
the reference of your instructor on this matter)

1. Re-define it more broadly so you have more of it!

2. Observe nature and look for consistent operating principles and
important truths that can be applied in your daily life.
3. Observe children at play and appreciate their ingenuity, awe,
inventiveness, spontaneity, innovation, and natural creativity.
4. Look for ways that seemingly opposite things are really two sides
of the same coin, i.e.,male and female being human.
5. Experiment in changing little routinesthe words you use, your
dress and grooming habits, furniture placement, etc. (shock your brain
a little).
6. Suspend judgments about the quality of a creative product you or
others produce.
7. Learn something positive from the next failure or bad event you
experience.
8. Brainstorm solutions to complex problems with others.
9. Look for a truth you firmly believe and then add something else to it
to make it even more truthful.
10. Start noticing the connection between where you are standing and
what you are seeing; change viewpoints.

6. Art and dynamics of questioning (Socratic questioning)

It is a disciplined questioning that can be used to pursue thought in

many directions and for many purposes, including: to explore complex ideas,
to get to the truth of things, to open up issues and problems, to uncover
assumptions, to analyze concepts, to distinguish what we know from what
we don't know, to follow out logical implications of thought or to control the
discussion. The key to distinguishing Socratic questioning from
questioning per se is that Socratic questioning is systematic, disciplined, and
deep and usually focuses on fundamental concepts, principles, theories,
issues or problems.
 It teaches us to dig beneath the surface of our ideas. It teaches us the
value of developing questioning minds in cultivating deep learning.
Integrating Socratic questions in the following manner in the classroom
helps develop active, independent learners
1. Getting to clarify their thinking/ Explore the origin of their thinking
e.g., Why do you say that?, Could you explain further?
2. Challenging about assumptions
e.g., Is this always the case?, Why do you think that this assumption
holds here?
3. Evidence as a basis for argument
e.g., Why do you say that?, Is there reason to doubt this evidence?
4. Alternative viewpoints and perspectives/ conflict with other thoughts
e.g., What is the counter-argument?, Can/did anyone see this
another way?
5. Implications and consequences
e.g., But if...happened, what else would result?, How
does...affect...?
6. Question the question
e.g., Why do you think that I asked that question?, Why was that
question important?, Which of your questions turned out to be the
most useful?
The art of Socratic questioning is intimately connected with critical
thinking because the art of questioning is important to excellence of thought.
What the word "Socratic" adds to the art of questioning is systematicity,
depth, and an abiding interest in assessing the truth or plausibility of things.
Critical thinking and Socratic questioning both seek meaning and truth.
Critical thinking provides the rational tools to monitor, assess, and perhaps
reconstitute or re-direct our thinking and action. This is what educational
reformer John Dewey described as Reflective Inquiry: "in which the
thinker turns a subject over in the mind, giving it serious and consecutive
consideration."[4] Socratic questioning is an explicit focus on framing self-
directed, disciplined questions to achieve that goal.
The technique of questioning or leading discussion is spontaneous,
exploratory, and issue-specific.[5] The Socratic educator listens to the
viewpoints of the student and considers the alternative points of view. [5] It is
necessary to teach students to sift through all the information, form a
connection to prior knowledge, and transform the data to new knowledge in
a thoughtful way.

7. Metacognition, IQ, EQ

Metacognition- is "cognition about cognition", "thinking about thinking",

"knowing about knowing", becoming "aware of one's awareness" and
higher-order thinking skills.
It is the body of knowledge and understanding that reflects on cognition
itself. It is a central way in which learners are able to apply, consider,
modify and reflect upon cognitive activity across varying tasks.

IQ (intelligence quotient) - is a total score derived from

several standardized tests designed to assess human intelligence. The
abbreviation "IQ" was coined by the psychologist William Stern for
the German term Intelligenzquotient, his term for a scoring method for
intelligence tests at University of Wrocaw he advocated in a 1912
book.
It is used by psychologists and educators to predict an individuals
academic performance and career success, as well as diagnose mental
retardation and learning disabilities

EQ (Emotional quotient) the ability to recognize and manage your own

emotions and help others do the same- is as important to critical thinking
as the intelligence quotient (IQ).