Critical Thinking for Nurse Preceptors

Critical Thinking from Three Perspectives

Thinking ahead is the ability to be proactive. Help your preceptee to think ahead by asking, “What complications might arise for this patient? What are some of the difficulties we have to manage? What supplies will we need?”

Thinking in action is the ability to think on your feet. To prepare preceptees for this, give them hands-on, low-risk experiences to build their skills and confidence. For example, have them gather all the supplies that are needed for a procedure. Then, they also must observe and assist you when you are thinking in action. Tell them what you’re doing and why. Teach them.

Thinking back is the ability to recall and analyze the reasoning process to gain a better understanding. Facilitate reflective thinking by asking questions and allowing your preceptee to ask questions. Ask questions to help your preceptee understand relevance, significance and clarity. “How does that relate to the problem? What was the most important problem to consider? Which of the facts are the most important? Could you elaborate or give me an example of why?”

Critical Thinking: What Does It Look Like?

According to Alfaro-Lefevre (2008), critical thinking is the ability to focus your thinking to get the results you need. It is outcome-focused. It is purposeful. Critical thinking is always driven by the patient’s needs and the nurse’s desire to meet those needs. Critical thinkers are constantly re-evaluating, self-correcting and striving to improve. So, how do you know if your preceptees are thinking critically? You must ask them questions and observe their behavior.

Critical thinking indicators can help you assess your preceptees’ critical thinking skills. CTIs “are evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote CT in clinical practice.” (www.AlfaroTeachSmart.com). CTIs are most effective when they are incorporated into your evaluation tools. The following are examples of CTI behavior questions, with examples of CTIs in italics. If you answer yes to these, you are observing critical thinking.

 Are your preceptees curious and inquisitive?
 Do they ask you, physicians or others questions to learn more? Do they delve into the resources for answers?
 Do your preceptees communicate effectively?
 Are they open and fair-minded? Do they listen to other views?
 Are they analytical and insightful?
 Do they recognize cause and effects of interventions? Can they tell you the reasons for their interventions?
 Can your preceptees identify any opportunities for improvement?
 Do they verbalize an understanding of complex situations or pathophysiology and act accordingly?
 Do they demonstrate their knowledge by distinguishing normal from abnormal symptomatology?
 Do your preceptees question inconsistencies?
 Do they consider multiple explanations and solutions?
 Do they assess their patients systematically and comprehensively and demonstrate the use of the nursing process by assessing, planning and implementing care effectively?
 Do your preceptees apply standards and ethics codes when caring for their patients?
 Are they able to set priorities as they provide care?
 Can they make decisions appropriately?

Share these CTI questions with your preceptees. Together, you can focus on improving their ability to think critically, and you will both gain from the experience. More important, your patients will benefit when both of you think critically while providing quality care.

Resources Alfaro Lefevre (2008). Critical Thinking Indicators: 2007-2008 Evidence-Based Version. www.alfaroteachsmart.com
Elder and Paul (2008). Miniature Guide to Critical Thinking. www.criticalthinking.org