Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

2 Critical Thinking and Evidence-Based Practice 17

Paul and Elder (2005) define critical thinking as a skill that enables a person to
think regularly at a higher level. It transforms thinking in two directions, increas-
ing it systematically and comprehensively. In nursing, Heaslip (2008) views criti-
cal thinking for clinical decision-making as the ability to “think in a systematic
and logical manner with openness to question and reflect on the reasoning pro-
cess used to ensure safe nursing practice and quality care. Critical thinking when
developed in the practitioner includes adherence to intellectual standards, pro-
ficiency 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. To think like
a nurse requires that we learn the content of nursing: the ideas, concepts, and
theories of nursing and develop our intellectual capacities and skills so that we
become disciplined, self-directed, critical thinkers” (p. 1).

Scheffer and Rubenfeld (2000), in their landmark Delphi study of 55 nurse ex-
perts in practice, education, administration, and research roles from nine coun-
tries, established a consensus definition of critical thinking for nursing:

Critical thinking in nursing is an essential component of

professional accountability and quality nursing care. Criti-

cal thinkers in nursing exhibit these habits of mind: confi-

dence, contextual perspective, creativity, flexibility, inquisi-

tiveness, intellectual integrity, intuition, open mindedness,

perseverance, and reflection. Critical thinkers in nursing

practice the cognitive skills of analyzing, applying stan-

dards, predicting and transforming knowledge. (p. 357)

The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model’s PET
process structures the activities of EBP. The nurse asks a focused practice
question (P), searches for and appraises relevant evidence (E), and translates the
evidence in patient care, evaluating the outcome (T). Each phase requires an anal-
ogous set of critical thinking skills including questioning, information seeking,
synthesizing, logical reasoning, and transforming knowledge (see Table 2.1).