Spock (of Star Trek fame) was the model of rationality. He frequently admonished his humanoid shipmates to strive for emotional detachment, since humans could, at best, only recognize and set aside their emotions, minimizing but not eliminating their untoward influence on reason and logic. I don't think Spock ever wanted to be a nurse, and I think most of us would agree that although he was bright, he lacked the compassion and ability to fully understand the human condition that we deem so important in nursing. Yet we seem to be collectively taking up critical thinking, defining it and teaching it in ways that are reminiscent of Vulcan mores.
In this issue of JNE Videbeck reports her study of how nursing faculty in baccalaureate programs are responding to the 1992 NLN accreditation criteria related to critical thinking. Surveying a random sample of baccalaureate programs, Videbeck obtained and analyzed the portions of the self-study reports related to definitions and methods of evaluating critical thinking. Now I may be overinterpreting Videbeck's account, overgeneralizing from my many conversations with nursing faculty, and be dead wrong about what is being done in schools of nursing. But bear with me. Even if some of my premises are wrong, the possible issues are worth considering. First is the issue of vulcanizing critical thinking. Videbeck's survey suggests that a large proportion of nursing programs are defining critical thinking drawing on a host of definitions that have been in the literature. Virtually all of the definitions cited emphasize reason and logic, such as that offered by Bandman and Bandman (1995): "the rational explanation of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs and actions." Few programs included "affective components" in their definitions. Affective, of course, could mean anything from attitudes or dispositions toward critical thinking to emotions as distinct from or part of rationality. In any case, the affective component seems to be getting little attention, again possibly supporting Vulcan mores. The fact that programs have adopted some fairly widely accepted definitions of critical thinking is obviously not a problem in and of itself nor is the exclusion of affective components of critical thinking by itself a problem.
Videbeck's survey also shows that the many nursing programs in their primary outcomes and methods of measurement evidently equate critical thinking with nursing process, decision-making or problem-solving. This finding, by itself, may also be of little concern. Indeed, in several previous issues of JNE, and in this issue, we have at least implied parallels between critical thinking and decisionmaking by publishing articles on these topics in the same special issue. Several authors have argued convincingly on these pages, and elsewhere, that there are both general critical thinking skills, and discipline-specific critical thinking skills; nursing process (decision-making, problem-solving, etc.) are the discipline-specific versions of critical thinking (Facione, Facione, & Sanchez, 1994; Kataoka-Yahiro & Saylor, 1994; Kintgen-Andrews, 1991; Paul & Heaslip, 1995). Although the empirical evidence is inconclusive (see Kintgen-Andrews, 1991), one could argue that critical thinking and clinical decision-making are related sets of skills. But that does not mean they are the same.
These three findings, taken together, do raise concern. If critical thinking is in some way being equated with nursing process (or decision-making or problem-solving) and if affective components are not being included, what in the world is happening to the relational dimensions of nursing practice, to caring and caring practices that draw, at least to some extent, on emotional involvement? Virginia Henderson reminded us several years ago (1982) that "use of the term nursing process... is traced from the 1950s... as a way of describing client-nurse communication conducive to mutual understanding." Contemporary use of the term connotes a systematic approach to problemsolving, drawing on scientifically based knowledge. Recent research on clinical judgment should serve to remind us of the significance of the nurse-client relationship and the important role of the clinician's emotional responses in clinical decision-making (Benner, Tanner, & Chesla, 1996; Jenks, 1993; Jenny & Logan, 1992; MacLeod, 1993; Tanner, Benner, Chesla, & Gordon, 1993). On this view, although Spock may have been very good at critical thinking, he would have not been so great at clinical decision-making. There are two other important aspects of critical thinking that are likely to be obscured by the critical-thinking-as-nursing-process view, and which do not show up in a significant way in Videbeck's findings. Brookfield (1993) and Ford and ProfettoMcGrath (1994) argued for a conception of critical thinking as challenging taken-for-granted assumptions and practices, a critical thinking as praxis, requiring action, involvement, and risk-taking. This view fundamentally presupposes a moral basis of nursing in a nurse patient relationship, in the patient's expectations that he or she will receive compassionate and competent care and in society's expectations that the practice of nursing is guided by ethical ideals, virtues and standards (Bishop & Scudder, 1990). It is the kind of critical thinking that asks the key question: who benefits and whose ends are being met by the particular nursing actions (Liaschenko, 1995)? It is the kind of critical thinking that exposes the interconnections among health care policy and political and economic interests, and sets up the possibility for nurses to recognize when they themselves are being used to support the interests of "powerful others" (MacPherson, 1983). On this view, emotional involvement is central, as it calls our attention to moral issues, it impels the nurse to take personal risks involved with challenging the taken-for-granted, it motivates moral agency and perseverance in seeking solutions (Callahan, 1988).
I invite continued dialogue about our conception of critical thinking in nursing practice, about the intersection among moral agency, ethical practice, clinical judgment and critical thinking, about the consequences of adopting one view over others, and about pedagogical practices and cultures which will support faculty and students to develop as critical thinkers. If you are doing something different about critical thinking than what Videbeck's study, or my interpretation of it implies, let us hear about it!
- Bandman, E. L., & Bandman, B. (1995). Critical thinking in nursing. Norwalk, CT: Appleton & Lange.
- Benner, P., Tanner, C, & Chesla, C. (1996). Expertise in nursing practice: Caring, clinical judgment and ethics. New York, NY: Springer.
- Bishop, A.H., & Scudder, J.R. (1990). The practical, moral and personal sense of nursing. Albany, NY: State University of New York Press.
- Brookfield, S.D. (1993). On impostership, cultural suicide, and other dangers: How nurses learn critical thinking. The Journal of Continuing Education in Nursing, 24(5), 197-205.
- Callahan, S. (1988). The role of emotion in ethical decisionmaking. Hastings Center Report, 18(3), 9-14.
- Facione, N.C., Facione, P.A., & Sanchez, CA (1994). Critical thinking disposition as a measure of competent clinical judgment. The development of the California Critical Thinking Disposition Inventory. Journal of Nursing Education, 33(8), 345350.
- Ford, J.S., & Profetto-McGrath, J. (1994). A model for critical thinking within the context of curriculum as praxis. Journal of Nursing Education, 33(8), 341-344.
- Henderson, V. (1982). Nursing process- Is the title right? Journal of Advanced Nursing, 7, 103-109
- Jenks, J.M. (1993) The pattern of personal knowing in nurse decision making. Journal of Nursing Education, 32, 399-405.
- Jenny, J., & Logan, J. (1992). Knowing the patient: One aspect of clinical knowledge. Image: The Journal of Nursing Scholarship, 24(4), 254-258.
- Kataoka-Yahiro, M., & Saylor, C. (1994). A critical thinking model of nursing judgment. Journal of Nursing Education, 33(8), 351-356.
- Kintgen-Andrews, J. (1991). Critical thinking and nursing education: Perplexities and insights. Journal of Nursing Education, 30(4), 152-157.
- Liaschenko, J. (1995). Ethics in the work of acting for patients. Advances in Nursing Science, 18(2), 1-12.
- MacLeod, M. (1993). On knowing the patient: Experiences of nurses undertaking care. In A. Radley (Ed.), Worlds of illness: Biographical and cultural perspectives on health and disease (pp. 38-56). London: Routledge.
- MacPherson, KI. (1983). Health care policy, values and nursing. Advances in Nursing Science, 9(3), 1-11.
- Paul, R. W., & Heaslip, P. (1995). Critical thinking and intuitive nursing practice. Journal of Advanced Nursing, 22, 40-47.
- Tanner, CA., Benner, P., Chesla, C, & Gordon, D. (1993). The phenomenology of knowing a patient. Image: The Journal of Nursing Scholarship, 25, 273-280.