Research Article| Volume 53, ISSUE 2, P59-65, March 2005

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Critical thinking and patient outcomes: A review

      There has been a multidisciplinary plethora of critical thinking definitions stemming from educators in 1912
      • Thorndike E.L.
      through and inclusive of today. As nurses’ roles change in response to the dynamics of managed care and an increase in use of biotechnology in health care, more is expected of them both in terms of psychomotor and cognitive skills. The American Association for Colleges of Nursing requires that critical thinking be reflected within academic nursing programs as a core competency for program accreditation.
      American Association of Colleges of Nursing
      Although critical thinking has been associated with and evaluated in regard to learning outcomes, little information exists which links critical thinking to patient outcomes. The purpose of this article is to provide a literature review of critical thinking and to explore a possible link between nurses’ critical thinking and patient outcomes.
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        • Thorndike E.L.
        Education. Macmillan, New York, NY1912
        • American Association of Colleges of Nursing
        The essentials of Baccalaureate education for professional nursing practice. 1998
      1. Reilly D, Oermann M. Clinical teaching in nursing, second ed New York, NY: NLN 55.

      2. Ibid.

        • King P.
        The development of reflective judgment and formal operational thinking in adolescents and young adults (PhD thesis). University of Minnesota, Minneapolis, Minnesota1977: 199
      3. King, 1977,14.

        • Gordon M.
        Nursing diagnosis process and application. McGraw-Hill, New York, NY1989: 22
      4. McPeck J. Critical thinking and education. California:St Martin’s Press.

        • Cook P.
        • Johnson R.
        • Moore P.
        Critical thinking assessment: measuring a moving target. Report and recommendations of the South Carolina Higher Education Assessment Network Critical Thinking Task Force. South Carolina Higher Education Assessment Network, Rock Hill, SC1966
      5. Reilly and Oermann 1992.

      6. Thorndike 1912, 42.

        • Dewey J.
        Experience and education. Macmillan, New York, NY1938
        • Logan R.
        Teaching critical thinking using the scientific process as a model system. Santa Monica College, Santa Monica, CA1987
        • Paul R.W.
        Critical thinking. Foundation for Critical Thinking, Dillon Beach, CA1993
        • Facione P.
        Critical thinking. California Academic Press, Millbrae, CA1992
      7. Gordon, 1987.

        • Jones S.A.
        • Brown L.N.
        Alternative views on defining critical thinking through the nursing process.
        Holistic Nurs Practitioner. 1993; 7: 71-76
        • Grant G.E.
        Teaching critical thinking. Praeger, New York, NY1988
      8. Ibid.

        • Olson I.
        The arts and critical thinking in American education. Bergin and Garvey, Stamford, CT2000
      9. Siegel H. Critical thinking as an educational ideal. Educational Forum, (Nov. 1980) 7-21.

        • American Philosophical Association
        Critical thinking: a statement of expert consensus for purposes of educational assessment and instruction. The Delphi report: research findings and recommendations prepared for the committee on pre-college philosophy. 1990 (ERIC Document Reproduction Service No. ED315-423)
        • Ennis R.
        A concept of critical thinking.
        Harvard Educat Review. 1962; 32: 81-109
        • Bandman E.
        • Bandman E.
        Critical thinking in nursing. Appleton and Lange, Norwalk, CT1988
        • Alfaro-LeFevere R.
        Critical thinking in nursing. Saunders, Philadelphia, PA1995
        • Gendrop S.
        • Eisenhauer L.
        A transactional perspective on critical thinking.
        Scholarly Inquiry Nurs Practice. 1996; 10: 329-342
      10. Alfaro-LeFevere, 1995.

        • Scheffer B.K.
        • Rubenfeld M.G.
        A consensus statement on critical thinking in nursing.
        J Nurs Ed. 2000; 39: 357
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        Critical thinking skills and dispositions of baccalauereate nursing students - conceptual model for evaluation.
        J Professional Nurs. 1997; 13: 236-245
      11. Gendrop and Eisenhauer, 1996.

      12. Ibid.

        • O’Halloran V.E.
        • Frederickson K.
        Response to “A transactional perspective on critical thinking”.
        Scholarly Inquiry Nurs Pract. 1996; 10: 347-350
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        • Saylor C.
        A critical thinking model for nursing judgment.
        J Nurs Ed. 1995; 33: 351-356
      13. Ibid.

      14. Paul. 1993.

        • Facione N.C.
        • Facione P.A.
        Assessment design issues for evaluating critical thinking in nursing.
        Holistic Nurs Practitioner. 1996; 10: 41-53
      15. Jones and Brown, 1993.

        • Lohr K.
        Outcome measurement.
        Inquiry. 1988; 25: 37-50
        • Mark B.A.
        The black box of patient outcomes research.
        Image. 1995; 27: 42
      16. Ibid.

        • Miller M.A.
        • Malcolm N.S.
        Critical thinking in the nursing curriculum.
        Nurs Hlth Care. 1990; 11: 67-73
        • Claytor K.L.
        The development and validation of an adult medical nursing critical thinking instrument. 1997 (Doctoral Dissertation Indiana University, 58-08A)
      17. Ibid.

      18. D Fesler “Assessment of critical thinking in perioperative nurses,” Instrument undergoing testing, unpublished.

      19. McPeck, 1981.

        • Ennis R.H.
        The extent to which critical thinking is subject-specific.
        Educational Researcher. 1990; 19: 13-16
      20. Ibid.

      21. Gendrop and Eisenhauer, 1996.

      22. Cook, Johnson, Moore, et. al. 1966.

        • Koch F.T.
        • Speers A.T.
        It is time to move from the nursing process to critical thinking.
        AORN. 1997; 66: 318-320
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        J Professional Nurs. 1992; 8: 26-34
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        Doing the right thing.
        Nurse Educator. 1983; 8: 7-11
        • Kemp V.H.
        Concept analysis as a strategy for promoting critical thinking.
        J Nurs Education. 1985; 24: 382
      23. Ibid., 383

        • Free K.
        Teaching tools what if? What else? What then? A critical thinking game.
        Nurse Educator. 1997; 22: 9-11
        • Oermann M.H.
        Evaluating critical thinking in clinical practice.
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        Development of clinical reasoning exercises in a problem-based curriculum.
        Academic Med Supplement. 1996; 71: S105-S107
      24. J Kurfiss Critical thinking. Theory, research, practice, and possibilities, ASHE-ERIC Higher Education Report 2, (Washington:Association for the Study of Higher Education, 1988).

      25. Logan, 1987.

      26. del Bueno, 1983.

      27. Brookfield, 1997.

      28. Ibid., 18.

      29. Ennis, 1962.

      30. McPeck, 1981.

      31. Ibid.

      32. L S Cromwell “Assessing critical thinking,” New Directions for Community Colleges, 77 (Spring, 1992).

      33. Sormunen and Chalupa, 1994.

        • Halonen J.S.
        Demystifying critical thinking.
        Teaching Psychology. 1995; 22: 75-80
      34. Oermann, 1997.

      35. Gendrop and Eisenhauer, 1996.

        • Carpenter C.B.
        • Doig J.C.
        Assessing critical thinking across the curriculum.
        New Directions Teaching Learning. 1988; 34: 33-45
      36. Cromwell, 1992.

      37. Facione and Facione, 1996.

      38. Sormunen and Chalupa, 1994.

      39. Lohr, 1993.

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      40. Collier, 1997.

      41. Weingarten, Riedinger, and Sandhu, 1998.

        • Dunstan J.L.
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        Rapid recovery management.
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      42. Facione and Facione, 1996.

      43. Jones and Brown, 1993.

      44. Collier, 1997.

        • Facione N.C.
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      45. Ibid.

      46. Kurfiss, 1988.

      47. Oermann, 1997.


      Dr. Diane Fesler-Birch is the Vice President of Nursing and Clinical Services at Physicians Hospital, Portland, OR.