2 Critical Thinking and Evidence-Based Practice 19
The JHNEBP model broadly categorizes evidence as either research or non-
research. Scientific (empirical) findings comprise research evidence, whereas non-
research evidence includes ethical, personal, and aesthetic evidence. It is the
compilation and critical appraisal of all types of evidence, alone and as they re-
late to each other, that results in the nurse’s decision to adopt or reject evidence
for use in the care of the individual patient.
Critical Thinking, Reasoning, Reflection, and Judgment
Contemporary nurses are at risk of becoming increasingly task-focused as a re-
sult of multiple new technologies, task shifting (Cornell, Riordan, Townsend-
Gervis, & Mobley, 2011), and the widespread adoption of electronic health
records (EHRs). Time-limited task-focused practice is expected for newly gradu-
ated nurses. However, this focus precludes their reflection on the who, what,
where, when, and why of care. Even experienced nurses may fail to ask why as
they become immersed in managing the diverse and now ever-present technology.
EBP not only directs nurses to ask why but also guides them in answering ques-
tions and making patient-care decisions.
The growing complexity and intensity of patient care demands multiple higher
order thinking strategies that include not only critical thinking but also criti-
cal reasoning, reflection, and judgment (Benner, Hughes, & Sutphen, 2008, pp.
1–88). Each of these concepts and its applicability to EBP is discussed in Box 2.1.
Whereas critical thinkers strive to develop the ability to make their inferences
explicit, along with the assumptions or premises on which those inferences are
based, nurses who employ reasoning draw conclusions or inferences from obser-
vations, facts, or hypotheses. All reasoning has a purpose: It attempts to figure
something out, settle a question, or solve a problem. Reasoning is based on as-
sumptions from a specific point of view and on data, information, and evidence
expressed through, and shaped by, concepts and ideas. The inferences or interpre-
tations by which one draws conclusions and gives meaning to data have implica-
tions and consequences (Paul & Elder, 2005).
