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Critical thinking models: definition, benefits, and skills

In the age of memes and misinformation, critical thinking is a must. It's a crucial skill to differentiate between what may be true or false and develop (and explain) reasons for your beliefs.

The hardest part of critical thinking is knowing when to do it. Most of the time, it's easier to accept things as fact rather than to dig deeper to reach a conscious conclusion. This happens for various reasons. The most common being the ease of following the crowd and the fact it would be rather cumbersome to think critically about every single thing in the world!

How then do we know what to think critically about? How do we get the right answers, and how do we know they're correct? This is where a critical thinking model comes in. In this article, we’ll share three critical thinking models, essential critical reasoning skills, and why improving your critical thinking process is a good idea.

What Is Critical Thinking?

"Critical thinking is reasonable and reflective thinking focused on deciding what to believe or do.” This is how renowned professor and author Robert Hugh Ennis defines it. Put another way, the definition of critical thinking is careful consideration and analysis of information to reach a rational conclusion or decision. We practice critical thinking to inform—and own—our beliefs and actions and ensure they truly align with our values and intentions.

That said, critical thinking is not our natural way of thinking . Most of us are never aware of our brain's metacognitive actions, conceptualizations, or synthesis. Instead, we rely on habits, patterns, and competencies from past experiences to understand and interact with the world. While this may save us time and effort, it doesn’t always provide the best results—and often results in fallacies.

What Are Critical Thinking Models?

A critical thinking model provides the structure for practicing this type of thinking. It helps us notice our own thinking biases and allows us to try viewing the world objectively all while providing guidelines for asking the right questions, reaching logical conclusions, and explaining how we did it.

3 Critical Thinking Models That Are Useful in Everyday Life

There are thousands of critical thinking models for almost any subject or discipline. Let’s take a look at three models of critical thinking we find useful in everyday life.

Proximate vs. Root Cause

The proximate vs. root cause critical thinking model encourages people to discover the primary cause of an event. A proximate cause is closest to the observed result or immediately responsible for it. In contrast, the root cause is the actual cause of the result. Both are causes of the event, but the root cause is the main cause, while the proximate cause is the immediate next cause.

This mental model forces you to look beyond obvious reasons to determine the core reason for impact. It helps with innovative problem-solving, so instead of relying on “Band-Aid solutions” or improving currently-existing solutions, you uncover the root of the matter and create something altogether new.

Example: You've gained a lot of weight since March 2021. Upon investigation, you may draw the following inferences:

• Proximate cause: You burn fewer calories than you consume (moving less and eating more due to boredom or food accessibility), thus the weight gain.
• Root cause: Your habits changed because of the lifestyle change from working at the office to working from home.

When you know the root cause of an issue, you can begin to deal with it to reduce the odds of recurrence. In this case, change your habits to fit the work-from-home lifestyle better. The proximate vs. root cause model improves your critical thinking ability and helps formulate a proper understanding of issues before working on them.

Cognitive Bias

Cognitive bias is a tendency to think in ways that can lead to deviations from rationality and objectivity. We all have cognitive biases. This error in thinking happens because of our tendency to process and interpret information swiftly, which can affect our decision-making and the eventual outcome of a situation.

Example: A soccer player scores a goal. In his mind, that means he's a great player. But if he had missed, he would reason that it was because the grass was wet. In self-serving bias, the tendency is to claim more responsibility for successes than failures. In other words: if there's a success, it's because I did something right. If there's a failure, it's something else's fault, not mine.

When you only pay attention or engage with news sources, stories, and conversations that confirm your worldview, you limit yourself from other perspectives and opinions that may be good for you without realizing it. Being aware of your own cognitive bias allows you to create some distance between how you expect the world to be and become more open to how it actually is on any given day.

The human brain is a powerful machine, but it has its limitations. One of them is neglecting facts and evidence to make sense of the world quickly and easily. This habit of mind may allow us to make faster decisions, but it doesn't serve us optimally. When unchecked, cognitive biases hinder fair-mindedness, inclusion, and impartiality.

Hanlon's Razor

"Never attribute to malice that which is adequately explained by incompetence."

Hanlon's Razor promotes good thinking and teaches us not to assume the worst intentions about people's actions without investigation. It helps regulate our emotions and improve relationships and decision-making. It also helps us develop empathy by giving others the benefit of the doubt and not assuming negative intent with evidence.

Example: You get to work earlier than usual on a Monday morning and notice your things scattered around. This must mean someone used your office! You immediately think a certain coworker did this to annoy you. But when you pause and consider, you realize that a coworker may have used your office during the weekend because it was vacant and they forgot their keys at home.

The stories we tell ourselves about why things happen the way they do are rarely true. It's worth spending some time to objectively view situations and choose a positive narrative that leads to better outcomes in our mental and emotional health and relationships.

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Critical Thinking Skills and Their Benefits

Critical thinking skills are useful for everyone. They help us think coherently and make advancements with our personal and professional goals. Some of the benefits you can gain from critical thinking are:

• Greater reflective thinking and self-awareness
• Ability to audit new information
• Better interpersonal relationships
• More creative thinking and problem-solving skills
• Expanded open-mindedness
• Improved communication and presentation skills
• Freedom from past experiences and attachments

To gain these types of benefits, it’s important to practice the critical thinking skills listed below.

1. Observation

Observation is the foundation for critical thinking. It’s the ability to notice and predict opportunities, problems, and solutions. Taking the time to observe helps you process information better. Positive habits like meditating, journaling, and active listening will help you improve your observation skills.

2. Analysis

After observing, it's time to analyze the information. Analyzing helps you gain a clearer grasp of the situation at hand. Ask questions that help you get a clearer picture of the subject and get to the root cause or reason. For example, if you’re analyzing a controversial tweet you read, you may ask questions such as:

• Who wrote this?
• What is it about?
• When was it written?
• Why did they write it? Do they have a hidden agenda?
• How sound is the premise?
• What if this tweet was altered to send a misleading message?

These questions help you break your subject into rational bits and consider the relationship between each one and the whole.

3. Inference

Inference is the ability to draw conclusions from the information you've analyzed and other relevant data. It's a higher-level critical thinking skill that helps you reach careful decisions rather than hastily drawn (and likely biased) conclusions.

4. Communication

Once you have a solid foundation for your beliefs, communicating your theory is the next essential part of critical thinking. Share your point of view and get feedback from others to know if it holds up. You can improve your communication skills by participating in thematic forum discussions and sharing your research and insights with others in your community, both online and offline.

5. Problem-solving

Problem-solving is one of the main reasons for critical thinking. The end goal of critical thinking is using your new conclusion to close gaps and solve problems. You start by identifying your viewpoint, analyzing relevant information, and deciding on the right solution for a particular scenario. You can improve your problem-solving skills by self-learning the subject at hand and considering hidden, alternative outcomes.

Tap Into the Power of Critical Thinking

Becoming a critical thinker is challenging but oh-so worth it. It leads to continuous growth in all areas of your life: better relationships, confidence, and problem-solving skills. Critical thinking helps us overcome familiar patterns and ways of thinking, opening us to new perspectives.

To improve your critical thinking, spend time honing the five crucial critical thinking skills: observation, analysis, inference, communication, and problem-solving. Have fun with the process as you pay more attention to your beliefs and experiences and other people's perspectives and experiences as well.

You can use critical thinking models to guide your critical thinking journey, prompting you to realize when to pause and ask questions and when to accept the answers you have and move on. For example, in today’s age of misinformation, you may learn that it’s almost always counterproductive to engage with news and information from unknown sources.

Critical thinking is needed to remove scales from our eyes and improve our knowledge and experience of the world, but it’s also important to know when to turn our attention to focus on a new subject and move on.

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What Are Critical Thinking Indicators (CTIs) In Nursing?

In this article, we will explore key critical thinking indicators in nursing and provide examples of how these indicators manifest in real-world situations.

What are Critical Thinking Indicators?

Critical Thinking Indicators (CTIs) are traits or skills that demonstrate a person’s ability to think critically and analytically.

They provide insights into how someone approaches complex problems, evaluates information, and makes well-reasoned decisions.

15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

• What is Critical Thinking in Nursing? (Explained W/ Examples)

How to Improve Critical Thinking Skills in Nursing? (24 Strategies W/ Examples)

What are critical thinking indicators (ctis) in nursing, definition of critical thinking indicators (ctis) in nursing.

Critical thinking indicators in nursing can be defined as the skills, traits, and behaviors that demonstrate a nurse’s ability to analyze complex situations, make informed decisions, and provide high-quality patient care.

CTIs are critical in the healthcare field, where nurses frequently face diverse and often urgent challenges that necessitate thoughtful and well-reasoned responses.

CTIs help nurses navigate the complexities of healthcare, adapt to changing circumstances, and ensure the best possible outcomes for their patients.

Related: What is the 4-Circle CT Model?

Critical thinking indicators (ctis) in nursing.

Here are a few critical thinking indicators; take a moment to reflect on how many of these attributes manifest in your own behavior.

1. Self-Awareness:

Nurses who are self-aware acknowledge their biases and limitations, enabling them to provide objective care.

For example, a nurse might recognize their discomfort with a certain medical procedure and actively seek guidance from a colleague to ensure patient safety.

2. Genuine/Authentic:

Authentic nurses align their actions with their values, fostering trust and rapport with patients.

By demonstrating empathy and compassion, a nurse establishes a genuine connection with patients, which can significantly enhance the healing process.

3. Effective Communicator:

Effective communication is essential for nurses to understand patient needs and relay critical information.

A nurse who actively listens to a patient’s concerns and articulates medical instructions clearly ensures that patients are well-informed and empowered to manage their health.

4. Curious and Inquisitive:

Curiosity drives nurses to seek deeper understanding. When faced with a new treatment approach, a curious nurse might research alternative methods and consult with colleagues to explore innovative solutions for patient care.

5. Alert to Context:

Being attentive to changes in a patient’s condition is crucial. A nurse who notices a sudden change in a patient’s vital signs may investigate further to identify potential complications and take swift action.

6. Reflective and Self-Corrective:

Nurses who reflect on their actions and interactions can identify areas for improvement.

After a challenging shift, a nurse might review their decisions and consider seeking feedback from peers to enhance future performance.

7. Analytical and Insightful:

Analytical nurses identify patterns in patient data that might go unnoticed by others.

By recognizing a recurring symptom, a nurse can contribute to an accurate diagnosis and tailored treatment plan.

8. Logical and Intuitive:

Balancing logic and intuition is key. A nurse who uses both logical reasoning and intuition may suspect an adverse reaction to medication based on a patient’s sudden change in behavior, prompting timely intervention.

9. Confident and Resilient:

Confident nurses trust their abilities even in challenging situations. When a complex case arises, a nurse’s confidence can drive them to collaborate with the medical team to devise an effective care strategy.

10. Honest and Upright:

Honesty and integrity guide ethical decision-making. A nurse who acknowledges their own mistakes and takes responsibility fosters an environment of trust within the healthcare team.

• Nursing Concept Map (FREE Template)
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• 8 Stages Of The Clinical Reasoning Cycle
• How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples
• What is the “5 Whys” Technique?
• What Are Socratic Questions?

Adopting these critical thinking indicators (CTIs) in nursing practice is essential for improving patient care and fostering transformative changes in the healthcare setting.

Recommended Readings

Critical Thinking Indicators (CTIs)

Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach

Applying Nursing Process: The Foundation for Clinical Reasoning

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For more than 40 years, our goal has been to promote essential change in education and society by cultivating fairminded critical thinking — thinking which embodies intellectual empathy, intellectual humility, intellectual perseverance, intellectual integrity, and intellectual responsibility.

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How to think effectively: Six stages of critical thinking

Credit: Elder / Paul

• Researchers propose six levels of critical thinkers: Unreflective thinkers, Challenged thinkers, Beginning thinkers, Practicing thinkers, Advanced thinkers, and Master thinkers.
• The framework comes from educational psychologists Linda Elder and Richard Paul.
• Teaching critical thinking skills is a crucial challenge in our times.

The coronavirus has not only decimated our populations, its spread has also attacked the very nature of truth and stoked inherent tensions between many different groups of people, both at local and international levels. Spawning widespread conspiracy theories and obfuscation by governments, the virus has also been a vivid demonstration of the need for teaching critical thinking skills necessary to survive in the 21st century. The stage theory of critical thinking development, devised by psychologists Linda Elder and Richard Paul , can help us gauge the sophistication of our current mental approaches and provides a roadmap to the thinking of others.

The researchers identified six predictable levels of critical thinkers, from ones lower in depth and effort to the advanced mind-masters, who are always steps ahead.

As the scientists write , moving up on this pyramid of thinking “is dependent upon a necessary level of commitment on the part of an individual to develop as a critical thinker.” Using your mind more effectively is not automatic and “is unlikely to take place “subconsciously.” In other words – you have to put in the work and keep doing it, or you’ll lose the faculty.

Here’s how the stages of intellectual development break down:

Unreflective thinker

These are people who don’t reflect about thinking and the effect it has on their lives. As such, they form opinions and make decisions based on prejudices and misconceptions while their thinking doesn’t improve.

Unreflective thinkers lack crucial skills that would allow them to parse their thought processes. They also do not apply standards like accuracy, relevance, precision, and logic in a consistent fashion.

How many such people are out there? You probably can guess based on social media comments. As Elder and Paul write , “it is perfectly possible for students to graduate from high school, or even college, and still be largely unreflective thinkers.”

Challenged thinker

This next level up thinker has awareness of the importance of thinking on their existence and knows that deficiencies in thinking can bring about major issues. As the psychologists explain, to solve a problem, you must first admit you have one.

People at this intellectual stage begin to understand that “high quality thinking requires deliberate reflective thinking about thinking”, and can acknowledge that their own mental processes might have many flaws. They might not be able to identify all the flaws, however.

A challenged thinker may have a sense that solid thinking involves navigating assumptions, inferences, and points of view, but only on an initial level. They may also be able to spot some instances of their own self-deception. The true difficulty for thinkers of this category is in not “believing that their thinking is better than it actually is, making it more difficult to recognize the problems inherent in poor thinking,” explain the researchers.

Thinkers at this level can go beyond the nascent intellectual humility and actively look to take control of their thinking across areas of their lives. They know that their own thinking can have blind spots and other problems and take steps to address those, but in a limited capacity.

Beginning thinker

Beginning thinkers place more value in reason, becoming self-aware in their thoughts. They may also be able to start looking at the concepts and biases underlying their ideas. Additionally, such thinkers develop higher internal standards of clarity, accuracy and logic, realizing that their ego plays a key role in their decisions.

Another big aspect that differentiates this stronger thinker – some ability to take criticism of their mental approach, even though they still have work to do and might lack clear enough solutions to the issues they spot.

Practicing thinker

This more experienced kind of thinker not only appreciates their own deficiencies, but has skills to deal with them. A thinker of this level will practice better thinking habits and will analyze their mental processes with regularity.

While they might be able to express their mind’s strengths and weaknesses, as a negative, practicing thinkers might still not have a systematic way of gaining insight into their thoughts and can fall prey to egocentric and self-deceptive reasoning.

How do you get to this stage? An important trait to gain, say the psychologists, is “intellectual perseverance.” This quality can provide “the impetus for developing a realistic plan for systematic practice (with a view to taking greater command of one’s thinking).”

“We must teach in such a way that students come to understand the power in knowing that whenever humans reason, they have no choice but to use certain predictable structures of thought: that thinking is inevitably driven by the questions, that we seek answers to questions for some purpose, that to answer questions, we need information, that to use information we must interpret it (i.e., by making inferences), and that our inferences, in turn, are based on assumptions, and have implications, all of which involves ideas or concepts within some point of view,” explain Elder and Paul.

One doesn’t typically get to this stage until college and beyond, estimate the scientists. This higher-level thinker would have strong habits that would allow them to analyze their thinking with insight about different areas of life. They would be fair-minded and able to spot the prejudicial aspects in the points of view of others and their own understanding.

While they’d have a good handle on the role of their ego in the idea flow, such thinkers might still not be able to grasp all the influences that affect their mentality.

Advanced thinker

The advanced thinker is at ease with self-critique and does so systematically, looking to improve. Among key traits required for this level are “intellectual insight” to develop new thought habits, “ intellectual integrity” to “recognize areas of inconsistency and contradiction in one’s life,” intellectual empathy ” to put oneself in the place of others in order to genuinely understand them, and the “ intellectual courage” to confront ideas and beliefs they don’t necessarily believe in and have negative emotions towards.

Master thinker

This is the super-thinker, the one who is totally in control of how they process information and make decisions. Such people constantly seek to improve their thought skills, and through experience “regularly raise their thinking to the level of conscious realization.”

A master thinker achieves great insights into deep mental levels, strongly committed to being fair and gaining control over their own egocentrism.

Such a high-level thinker also exhibits superior practical knowledge and insight, always re-examining their assumptions for weaknesses, logic, and biases.

And, of course, a master thinker wouldn’t get upset with being intellectually confronted and spends a considerable amount of time analyzing their own responses.

“Why is this so important? Precisely because the human mind, left to its own, pursues that which is immediately easy, that which is comfortable, and that which serves its selfish interests. At the same time, it naturally resists that which is difficult to understand, that which involves complexity, that which requires entering the thinking and predicaments of others,” write the researchers.

So how do you become a master thinker? The psychologists think most students will never get there. But a lifetime of practicing the best intellectual traits can get you to that point when “people of good sense seek out master thinkers, for they recognize and value the ability of master thinkers to think through complex issues with judgment and insight.”

The significance of critical thinking in our daily lives, especially in these confusing times, so rife with quick and often-misleading information, cannot be overstated. The decisions we make today can truly be life and death.

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• Analyze the logic of a problem or issue
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• Analyze the logic of a character in a novel
• Analyze the logic of a profession, subject, or discipline
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• Distinguishing Inferences and Assumptions
• Thinking Through Conflicting Ideas

• Could you elaborate further?
• Could you give me an example?
• Could you illustrate what you mean?
• How could we check on that?
• How could we find out if that is true?
• How could we verify or test that?
• Could you be more specific?
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• What factors make this a difficult problem?
• What are some of the complexities of this question?
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• Do we need to look at this from another perspective?
• Do we need to consider another point of view?
• Do we need to look at this in other ways?
• Does all this make sense together?
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• Is this the most important problem to consider?
• Is this the central idea to focus on?
• Which of these facts are most important?
• Do I have any vested interest in this issue?
• Am I sympathetically representing the viewpoints of others?

Everyone thinks; it is our nature to do so. But much of our thinking, left to itself, is biased, distorted, partial, uninformed, or downright prejudiced. If we want to think well, we must understand at least the udiments of thought, the most basic structures out of which all thinking is made. We must learn how to take thinking apart.

All Thinking Is Defined by the Eight Elements That Make It Up. Eight basic structures are present in all thinking: Whenever we think, we think for a purpose within a point of view based on assumptions leading to implications and consequences. We use concepts, ideas and theories to interpret data, facts, and experiences in order to answer questions, solve problems, and resolve issues.

• generates purposes
• raises questions
• uses information
• utilizes concepts
• makes inferences
• makes assumptions
• generates implications
• embodies a point of view
• What is your, my, their purpose in doing________?
• What is the objective of this assignment (task, job, experiment, policy, strategy, etc.)?
• Should we question, refine, modify our purpose (goal, objective, etc.)?
• What is the purpose of this meeting (chapter, relationship, action)?
• What is your central aim in this line of thought?
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• Why did you say…?
• Take time to state your purpose clearly.
• Distinguish your purpose from related purposes.
• Check periodically to be sure you are still on target.
• Choose significant and realistic purposes.
• What is the question I am trying to answer?
• What important questions are embedded in the issue?
• Is there a better way to put the question?
• Is this question clear? Is it complex?
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• The question in my mind is this: How do you see the question?
• What kind of question is this? Historical? Scientific? Ethical? Political? Economic? Or…?
• What would we have to do to settle this question?
• State the question at issue clearly and precisely.
• Express the question in several ways to clarify its meaning.
• Break the question into sub-questions.
• Distinguish questions that have definitive answers from those that are a matter of opinion or that require multiple viewpoints.
• What information do I need to answer this question?
• What data are relevant to this problem?
• Do we need to gather more information?
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• On what information are you basing that comment?
• What experience convinced you of this? Could your experience be distorted?
• How do we know this information (data, testimony) is accurate?
• Have we left out any important information that we need to consider?
• Restrict your claims to those supported by the data you have.
• Search for information that opposes your position as well as information that supports it.
• Make sure that all information used is clear, accurate and relevant.
• Make sure you have gathered sufficient information.
• What conclusions am I coming to?
• Is my inference logical?
• Are there other conclusions I should consider?
• Does this interpretation make sense?
• Does our solution necessarily follow from our data?
• How did you reach that conclusion?
• What are you basing your reasoning on?
• Is there an alternative plausible conclusion?
• Given all the facts what is the best possible conclusion?
• How shall we interpret these data?
• Infer only what the evidence implies.
• Check inferences for their consistency with each other.
• Identify assumptions underlying your inferences.
• What idea am I using in my thinking? Is this idea causing problems for me or for others?
• I think this is a good theory, but could you explain it more fully?
• What is the main hypothesis you are using in your reasoning?
• Are you using this term in keeping with established usage?
• What main distinctions should we draw in reasoning through this problem?
• What idea is this author using in his or her thinking? Is there a problem with it?
• Identify key concepts and explain them clearly.
• Consider alternative concepts or alternative definitions of concepts.
• Make sure you are using concepts with precision.
• What am I assuming or taking for granted?
• Am I assuming something I shouldn’t?
• What assumption is leading me to this conclusion?
• What is… (this policy, strategy, explanation) assuming?
• What exactly do sociologists (historians, mathematicians, etc.) take for granted?
• What is being presupposed in this theory?
• What are some important assumptions I make about my roommate, my friends, my parents, my instructors, my country?
• Clearly identify your assumptions and determine whether they are justifiable.
• Consider how your assumptions are shaping your point of view.
• If I decide to do “X”, what things might happen?
• If I decide not to do “X”, what things might happen?
• What are you implying when you say that?
• What is likely to happen if we do this versus that?
• Are you implying that…?
• How significant are the implications of this decision?
• What, if anything, is implied by the fact that a much higher percentage of poor people are in jail than wealthy people?
• Trace the implications and consequences that follow from your reasoning.
• Search for negative as well as positive implications.
• Consider all possible consequences.
• How am I looking at this situation? Is there another way to look at it that I should consider?
• What exactly am I focused on? And how am I seeing it?
• Is my view the only reasonable view? What does my point of view ignore?
• Have you ever considered the way ____(Japanese, Muslims, South Americans, etc.) view this?
• Which of these possible viewpoints makes the most sense given the situation?
• Am I having difficulty looking at this situation from a viewpoint with which I disagree?
• What is the point of view of the author of this story?
• Do I study viewpoints that challenge my personal beliefs?
• Identify your point of view.
• Seek other points of view and identify their strengths as well as weaknesses.
• Strive to be fairminded in evaluating all points of view.

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Identifying Critical Thinking Indicators and Critical Thinker Attributes in Nursing Practice

Chao, Shu-Yuan 1* ; Liu, Hsing-Yuan 2 ; Wu, Ming-Chang 3 ; Clark, Mary Jo 4 ; Tan, Jung-Ying 5

1 DNSc, RN, Professor, Department of Nursing, Hungkuang University

2 PhD, RN, Associate Professor, Department of Nursing, Chang Gung Technology University

3 PhD, Professor, Graduate School of Technological and Vocational Education, National Yunlin University of Science and Technology

4 PhD, RN, Professor, Hahn School of Nursing and Health Science, University of San Diego

5 PhD, RN, Assistant Professor, Department of Nursing, Hungkuang University.

Accepted for publication: March 1, 2013

*Address correspondence to: Shu-Yuan Chao, No. 34, Chungchi Rd. Shalu District, Taichung City, 433 Taiwan, ROC. Tel: +886 (4) 2631-8652 ext. 3013; E-mail: [email protected]

Background: 

Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process.

Purpose: 

This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students’ critical thinking skills.

Methods: 

The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1.

Results: 

We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect.

Conclusion/Implications for Practice: 

The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.

Introduction

Nursing students must have critical thinking abilities to respond constructively to diverse healthcare environments ( Brunt, 2005a ; Yuan, Willams, & Fan, 2008 ). Both the National League for Nursing Accrediting Commission (2007) and the American Association of Colleges of Nursing et al. (2011) have identified critical thinking as an essential element of the nursing curricula. In addition, the Joint Commission on Accreditation of Healthcare Organizations (2005) highlighted critical thinking as a key nursing skill and included it in their accreditation standards.

Critical thinking has been defined from multiple perspectives, with various definitions presenting the concepts of cognition, attitude, process, and skill. In nursing practice, critical thinking is usually defined as a skill, with a focus on solving practical problems ( Brunt, 2005a ; Staib, 2003 ). The nursing process provides nursing professionals the means to resolve patient problems. The several steps in the nursing process include collecting data systematically from the patient or family during the assessment phase, making a nursing diagnosis, formulating a plan to resolve the patient’s problems, initiating the plan to implement solutions, and evaluating the effectiveness of these solutions ( Su & Huang, 2000 ). Nursing is a challenging profession that requires astute clinical judgment, decision-making, and problem-solving skills. Critical thinking is required at each phase of the nursing process ( Chabeli, 2007 ; Huckabay, 2009 ).

Assessing nurses’ critical thinking abilities should be addressed in the context of the five stages of the nursing process. However, little information has been published to date on the measurement of critical thinking skills in professional nurses ( Mundy & Denham, 2008 ). Although several standardized tests have been developed to evaluate the critical thinking skills of college and university students in general, none specifically assesses critical thinking in nursing practice. Twibell, Ryan, and Hermiz (2005) proposed that the nature of nursing practice justifies a specialized assessment of critical thinking in this field. Brunt (2005b) noted that measures that are not discipline-specific may fail to capture the context-dependent aspects of critical thinking vital to a discipline, Shirrell (2008) questioned the appropriateness of current tests to measure critical thinking in clinical practice, and Mundy and Denham criticized standardized critical thinking assessment tools for their lack of relevance to clinical decision making in nursing settings.

Chabeli (2007) identified and integrated critical thinking concepts and core cognitive skills into the five-stage nursing process mentioned. However, assessing how effectively learned skills are transferred into practice is difficult to assess ( Marchigiano, Eduljee, & Harvey, 2011 ). Lunney (2010) presented a case study to show the use of critical thinking in formulating nursing diagnoses. However, critical thinking is also required in the other four stages. Critical thinking should influence nurse workplace performance and reflect his or her ability to resolve patients’ health-related problems using relevant contextual factors. Unfortunately, consensus is lacking regarding suitable methods to recognize or evaluate critical thinking in the clinical nursing context.

This study was designed to identify the attributes of critical thinkers and indicators of critical thinking from a nursing perspective. We thus tried to capture the essence of critical thinking as it is applied to clinical practice. Knowledge of these attributes and indicators can facilitate the development of tools to assess nursing students’ critical thinking skills. Furthermore, such knowledge may foster the development of teaching strategies that promote critical thinking and its application in nursing practice. This study asked the following questions:

• What indicators identify the effective use of critical thinking skills in clinical practice?
• What are the attributes of critical thinkers in the context of professional nursing?

Design and Procedure

This study was conducted in two phases from September 2009 to August 2010. In phase 1, we reviewed the literature to identify published indicators of critical thinking. The key words “critical thinking and nursing” were used to search full-text articles published from 1990 through 2009 and indexed in the CINAHL and CEPS (Chinese) databases. This step identified indicators of critical thinking in standardized inventories and framed these indicators in the context of the nursing process. In total, the indicators included 21 that indicate critical thinking skills in each phase of the nursing process and seven that are attributes of critical thinkers. Four focus groups were then assembled to validate and enrich the indicators of critical thinking and the attributes of critical thinkers in nursing. In phase 2, we used a modified two-round Delphi study to determine the appropriateness and explicitness of the indicators and attributes derived in phase 1. Finally, 37 items of critical thinking indicators and 10 attributes of critical thinkers were identified.

Respondent Groups

Each of the four focus groups comprised six experienced clinical nursing instructors from the fields of medicine and surgery, psychiatry, obstetrics and gynecology, pediatrics, and community health nursing. Because the indicators were expected to reflect critical thinking in clinical settings, consulting experts in the field was appropriate to identify these indicators as well as the personal attributes of critical thinkers in the discipline.

Members of the expert group for the Delphi study were drawn from the same clinical specialty areas. Thirty expert nurses were invited to participate, including six nursing faculty members, 10 hospital administrators, six head nurses, three nursing staff members, and five senior clinical instructors.

Data Collection and Analysis

In the focus group, the instructors were asked to provide their perspectives on indicators of critical thinking and the attributes of critical thinkers. The data were recorded and transcribed within 48 hours. The contents of the transcriptions were validated by the group members. Responses were used to create a questionnaire related to the identified indicators and attributes.

During the modified Delphi survey, each expert in the group was asked to independently evaluate and score each item in the first version of the questionnaire using a 5-point Likert scale. These evaluations rated the importance and appropriateness of each item, and space was provided for suggestions for revisions and additions. Items with a mean score above 3.5 and a standard deviation ( SD ) of less than 1 were retained in the second round of the Delphi as suggested by Chiou and Tsai (1996) . In this round, the indicators and attributes were reviewed by the same 30 people. Descriptive statistics were calculated using SPSS version 17.0 to determine the level of importance and appropriateness for each item.

Ethical Considerations

The study was approved by the institutional review board of the university. All participants in this study completed a written consent form.

The literature review showed critical thinking in the field of nursing to be defined as the ability to collect and analyze data, reflect and make decisions based on those data, and resolve clients’ problems in the context of specific situations. Critical thinking is an integral part of clinical decision making within the context of the nursing process ( Su, 2002 ). On the basis of relevance, each indicator was assigned to one of five dimensions. The eight indicators related to analyze and interpret data were assigned to the assessment phase, the three indicators related to clinical data integration and conjecture regarding problem cause were assigned to the diagnosis phase, the three indicators related to problem resolution strategies were assigned to the planning phase, the three indicators related to problem resolution strategy implementation were assigned to the implementation phase, and the four indicators related to results evaluation were assigned to the evaluation phase. As shown in Table 1 , seven attributes of critical thinkers were also identified, including “inquisitive,” “open-minded,” “analytical,” “systematic,” “self-confident,” “truth-seeking,” and “flexible.”

Instructors in the focus groups proposed several additional indicators of critical thinking in clinical settings and identified additional attributes of critical thinkers. These indicators and attributes were confirmed by the focus groups and modified by the experts during the two rounds of the Delphi review. This process is shown in Tables 2 and 3 .

In the first round, the average score for each item was greater than 3.5 ( SD < 1); thus, no items were deleted. The result was a list of 36 items across the five stages of the nursing process: assessment, 15 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect.

However, 10 items were revised based on the experts’ input to more explicitly express their intended meaning. Because the expert group suggested that critical thinking should be based on a client’s individual needs, an additional item was included in the third subdomain of the assessment stage. The item “using appropriate interview, observation, and physical assessment methods to collect information” was suggested by one expert and supported in the second Delphi round. Thus, the final instrument included 37 indicators: assessment, 16 indicators; diagnosis, five indicators; planning, five indicators; implementation, five indicators; and evaluation, six indicators. The mean score and SD for each item and category are shown in Table 4 .

Focus group participants identified 10 major attributes of critical thinkers in nursing. These were reviewed and modified by the experts in the Delphi survey to reflect appropriate behaviors for clinical practice. The resulting attributes were “has an open mind,” “actively pursues truth,” “exhibits patience and confidence,” “engages in self-reflection,” “shows the courage to acknowledge and correct errors,” “exhibits a neutral perspective,” “possesses keen observation skills,” “accepts criticism,” “displays good communication skills,” and “accurately documents findings and actions.” These attributes are presented in Table 3 .

Competence in critical thinking is a priority for practicing nurses. Nurse educators are faced with the challenge of developing strategies to inculcate critical thinking skills in their students and enhance the use of clinical reasoning to solve clients’ health problems in a manner that accounts for diverse contextual factors. Nurse educators lack an appropriate tool to measure critical thinking skills in nursing. The instrument developed in this study had a two-fold purpose: (a) to assist the faculty in providing instruction on clinical problem solving and (b) to identify students’ difficulties with the clinical problem resolution process.

The critical thinking indicators and attributes derived in this study shared similarities and dissimilarities with other published studies. The “determination” indicator in the Cornell Critical Thinking Test ( Ennis & Millman, 1985a , 1985b ) is comparable with the “problem identification” indicator in our findings. However, no other studies incorporate a similar variable. The California Critical Thinking Skills Test ( Facione & Facione, 1992 ) and Collegiate Assessment of Academic Proficiency ( American College Testing, 2011 ) use a “data analysis” indicator that is comparable with the assessment-phase data analysis indicator in this study. Furthermore, several previously published measures incorporate “deduction,” an indicator that the current study includes under “problem identification.” Our indicators related specifically to the nursing process and were thus categorized into domains not evident in most standardized measures. The stages of planning and implementation in our assessment instrument were not included in other tools.

As noted, prior studies have used diverse definitions of critical thinking. The “skills” perspective describes critical thinking as the ability to seek information, discriminate, and analyze ( Cruze, Pimenta, & Lunney, 2009 ). The same approach incorporates processes of reflection, verification, hypothesis investigation, explanation, analysis, inference, and judgment ( Riddell, 2007 ). The “attitude” perspective defines critical thinking as a trait, disposition, or affective aspect. Our study identified critical thinking as both a skill and an attitude. The term “indicator” reflects a skill, whereas “attribute” reflects an attitude. Items used in previous inventories to measure critical thinking ability such as “systematic analysis” and “synthesis skill” were classified in our study as skills, because our focus was on resolving patients’ problems within the nursing context only.

Although past studies have identified the concept of critical thinking, little information exists on the transferability of critical thinking to clinical practice. The concept of critical thinking tended to be quite abstract in most early studies. Thus, Su (2002) suggested developing concrete behavioral indicators of critical thinking to facilitate an understanding of this concept among faculty, staff, and students. For this reason, we described the indicators in terms of measurable behaviors, which allows their use to assess critical thinking in clinical settings. In this context, critical thinking focuses on problem solving and decision making ( Cruze et al., 2009 ; Huckabay, 2009 ; Lee, 2011 ; Staib, 2003 ). The indicators identified in our study reflect the “action” decisions that are derived from critical thinking and necessary in clinical nursing practice. Thus, our instrument may offer a guide to nursing students or novice nurses.

The Taiwanese Critical Thinking Disposition Inventory has been widely used and modified for specific applications. For example, Scheffer and Rubenfeld (2000) added “creativity” and “intuition,” because these two items were considered necessary for problem solving in the field of nursing. Using similar words, Profetto-McGrath (2003) proposed the qualities of being “tolerant of divergent views” and “able to suspend judgment pending additional evidence.” Forneris and Peden-McAlpine (2007) added to the definition with “perseverance, flexibility, contextual perspective, and confidence.” Similarly, Paul and Elder (2004) stated that critical thinkers possess curiosity and the willingness to learn autonomously. The Taiwanese Critical Thinking Disposition Inventory ( Feng, Chen, Chen, & Pai, 2010 ) included the categories of inquisitiveness, system activity and analyticity, open-mindedness, and reflective thinking.

Furthermore, several theorists emphasized that communication skill reflects critical thinking ability ( Forneris & Peden-McAlpine, 2009 ; Lunney, 2010 ; Zygmont & Schaefer, 2006 ). Thus, this study defined the attributes of critical thinkers based on the abilities already described with the addition of the indicator “displays good communication skills.”

Although the experts consulted in our study reached a high level of consensus on the appropriateness of the indicators and attributes, further studies are needed to refine the descriptions. These descriptions pertain to behavioral indicators of critical thinking that were identified for clinical settings. The skills and subskills derived in this study are incorporated across the nursing process. Further research is required to show the use of critical thinking skills in resolving problems in the nursing context.

As Mundy and Denham (2008) indicated, gaps may exist between teaching faculty knowledge and the ability of faculty to incorporate critical thinking into curricula. The indicators and attributes identified in this study provide new information to assist faculty to better guide their students in clinical practice to resolve patient problems. Study results provide guidelines for developing critical thinking in nursing students and novice nurses.

Acknowledgments

This study was supported by a research grant from the National Science Council, Taiwan, ROC (NSC98-2511-S-241-001-MY2). We thank all participants who helped with this research.

indicator; attribute; critical thinking; nursing education; Delphi research

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The Four-Circle Model

View this edition in our enhanced digital edition format with supporting visual insight and information.

Thanks to this week’s contributor and FFI Fellow, Dean Fowler, for providing an overview of his Four-Circle Model. In the article, Dean explains how his model builds upon the Three-Circle Model and can be utilized by advisors to help understand and map the role of individuals in the system and their relationship to their family.

Over the past forty years, two themes have been critical for shaping consulting with family businesses: first, a systemic approach, and second – in more recent years – the inclusion of the next generation in transition planning. In this article, I discuss my Four-Circle Model for consulting with family enterprises that is both systemic and honors the next generation as individuated adults. My purpose is not to critique the more well-known Three-Circle Model, but rather to offer a proposed enhancement to the systemic approach for understanding families in business and families of wealth.

Prof. John Davis is a pioneer in the field of family business. The main purpose for developing his original Three-Circle Model was to identify the distinct roles held in the family business and how those roles shape individual perspectives . For more than 40 years, numerous consultants and researchers have used the systemic approach described by the Davis-Taguri model to explore a broad range of other topics as well.

The celebration of the 40 th anniversary of the Three-Circle Model was explored in depth in two issues of the FFI Practitioner (see the sidebar for the two interviews with John Davis).

On the one hand, models, theories, and paradigms are powerful tools to focus our attention when studying a given discipline. On the other hand, models may also limit the questions we ask, the topics we explore, and our understanding of critical issues. 1 My Four-Circle Model focuses attention on the role of individual adults in relationship to their own family of origin and broadens the systemic approach to working with and studying business families.

In the 1980s, when FFI was first holding national conferences, I presented my Four-Circle Model for studying families in business at several workshops. After discussing my model and research ideas with the Psycho-Dynamic Family Business group (PDFB) in 1993, I was encouraged to complete research to determine how the Four-Circle Model could be used to identify the most critical competencies that business families had to master for success. That research was published in the proceedings at the 1999 FFI conference.

The Four-Circle Model is different from the Three-Circle Model in four significant ways:

• The addition of the “individual circle” is critical, because in a family-owned business, advisors are often dealing with a family of adults, and healthy adults have typically individuated themselves from their family of origin. Healthy adult families are intentional. In my judgment, intergenerational family therapies, such as those developed by Murray Bowen 2 and James Framo, 3 are well suited to examine the systemic relationships between adults and their families of origin.
• The model focuses attention on competencies, particularly the competencies that must be mastered at each of the four intersection areas illustrated in the diagram.
• Individuals and/or individual beneficiaries, not families, own family businesses.
• Individuals such as board members and advisors who are not family members fit into the model in Sector 8.

Based on my research, twelve statistically reliable “factors” were identified that represent the competencies that must be mastered by individuals and their families for success:

Competencies of Intersection 1: Between adult individuals and their family of origin

• Maturity – Individuals must separate both emotionally and financially from their family of origin and develop a strong sense of their own self-esteem.
• Purpose – Adults must determine their own purpose by developing and pursuing passions either inside or outside the family business.
• Communication – Families must listen for understanding as well as to be understood and develop strong communication skills.

Competencies of Intersection 2: Between the family and the business

• Roles – Clear guidelines should be established concerning appropriate boundaries between the business and the family, so that roles can be differentiated.
• Business Competency – Business competency deals with developing a broad-based knowledge of the business.
• Compensation – Families must determine how to balance family fairness with the best business practices, based on national and regional compensation plans.

Competencies of Intersection 3: Between the business and ownership

• Strategy – For long-term success across generations, the owners and the business must develop a clear and comprehensive strategy with a mission, vision, and goals for growth.
• Structure – The organizational structure of the business must support the strategy. This requires having the right people in the right roles.
• Leadership – Professionalization of the business may be necessary, perhaps by having qualified family members coupled with a capable non-family executive leadership team.

Competencies of Intersection 4: Between ownership and adult individuals

• Succession – Based on the strategy and structure of the business, the transition of management from one generation to the next is critical. This succession may include next-gen family leaders, or a non-family president/CEO.
• Governance – Either an advisory board or a fiduciary board of directors should be in place for the long-term success of the business.
• Estate Planning – Estate, financial, and tax planning should support rather than drive the other competencies. The ownership transition plan should capture the voice, vision, and values of both the current and next generation shareholders.

The Four-Circle Model and the related twelve competencies from my research have shaped my consulting practice for decades. With an emphasis on adult individuals, and the individuation process, my primary client is the next generation–individuals, siblings, and/or cousins.

The senior generation gives legal permission to their advisors including the attorneys, accountants, insurance, and financial planning professionals to work directly with the successor generation. The next generation of adults then would design the optimal structure for the transition of the business and ownership, so that the business and the family will be setup to thrive in the future. In addition to planning with a team of advisors, the next generation also works on mastering the twelve competencies for future success and the implementation of the recommended structures and policies for the intergenerational transition. The process often takes several years, working interactively through a family or owners council, through which the next generation makes their recommendations to the senior generation, who controls the voting shares for their approval.

Based on my research using the Four-Circle Model, I developed an online assessment process with a questionnaire and report that benchmark how family members, non-family executives, and advisors–from the perspective of different sub-groups (roles ala Davis) –assess how the family is mastering these twelve competencies. 4

1 In his seminal work The Structure of Scientific Revolutions (1970) , Thomas Kuhn demonstrated that scientific theories are in fact “paradigms.” From the perspective of the sociology of knowledge, Kuhn argued that scientific communities share a common set of theories and ideas that are excellent tools to explore problems. However, in the history of science, there is a paradigm shift through which new theories emerge – for example from Newtonian physics to Einstein’s theory of relativity. Kuhn’s position contrasts with classical rationalism put forth by Karl Popper.

2 For key principles regarding Bowen read The Eight Concepts of Bowen Theory First Edition by  Dr. Roberta M Gilbert  or see the website https://www.thebowencenter.org/

3 Family-Of-Origin Therapy: An Intergenerational Approach by  James L. Framo

4 This online assessment and questionnaire can be found at ( https://www.deanfowler.com )

About the Contributor

Dean R. Fowler, PhD, FFI Fellow has advised business families for 38 years as well as facilitating Forums for Family Business TM – peer advisory boards – that specialize in personal and professional development through diversified experiences and accountability, while focusing on successful intergenerational transitions. He is the author of several books, including Love, Power and Money: Family Business between Generations . He can be reached at [email protected] .

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Critical thinking is that mode of thinking – about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. (Paul and Elder, 2001). The Paul-Elder framework has three components:

• The elements of thought (reasoning)
• The  intellectual standards that should be applied to the elements of reasoning
• The intellectual traits associated with a cultivated critical thinker that result from the consistent and disciplined application of the intellectual standards to the elements of thought

According to Paul and Elder (1997), there are two essential dimensions of thinking that students need to master in order to learn how to upgrade their thinking. They need to be able to identify the "parts" of their thinking, and they need to be able to assess their use of these parts of thinking.

Elements of Thought (reasoning)

The "parts" or elements of thinking are as follows:

• All reasoning has a purpose
• All reasoning is an attempt to figure something out, to settle some question, to solve some problem
• All reasoning is based on assumptions
• All reasoning is done from some point of view
• All reasoning is based on data, information and evidence
• All reasoning is expressed through, and shaped by, concepts and ideas
• All reasoning contains inferences or interpretations by which we draw conclusions and give meaning to data
• All reasoning leads somewhere or has implications and consequences

Universal Intellectual Standards

The intellectual standards that are to these elements are used to determine the quality of reasoning. Good critical thinking requires having a command of these standards. According to Paul and Elder (1997 ,2006), the ultimate goal is for the standards of reasoning to become infused in all thinking so as to become the guide to better and better reasoning. The intellectual standards include:

Intellectual Traits

Consistent application of the standards of thinking to the elements of thinking result in the development of intellectual traits of:

• Intellectual Humility
• Intellectual Courage
• Intellectual Empathy
• Intellectual Autonomy
• Intellectual Integrity
• Intellectual Perseverance
• Confidence in Reason
• Fair-mindedness

Characteristics of a Well-Cultivated Critical Thinker

Habitual utilization of the intellectual traits produce a well-cultivated critical thinker who is able to:

• Raise vital questions and problems, formulating them clearly and precisely
• Gather and assess relevant information, using abstract ideas to interpret it effectively
• Come to well-reasoned conclusions and solutions, testing them against relevant criteria and standards;
• Think open-mindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences; and
• Communicate effectively with others in figuring out solutions to complex problems

Paul, R. and Elder, L. (2010). The Miniature Guide to Critical Thinking Concepts and Tools. Dillon Beach: Foundation for Critical Thinking Press.

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Diane halpern’s four-part model.

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Halpern extensively describes the model in Thought and Knowledge: An Introduction to Critical Thinking , a text popular for use in stand-alone critical thinking courses at colleges and currently in its fifth edition.  Halpern embeds the four parts of the model within the definition she provides for critical thinking. Halpern defines critical thinking as “the use of those cognitive skills or strategies that increase the probability of a desirable outcome” and further labels critical thinking as “purposeful, reasoned…goal-directed” and “involved in solving problems, formulating inferences, calculating likelihoods, and making decisions” (8). The definition also stipulates that the thinker must be using appropriate skills for a particular “context” and “type of thinking task” (8). The four-part model then aligns with these definition components and elaborates upon them.

The model’s first part is the overt teaching and learning of specific critical thinking skills and is also delineated in the book’s appendix (Halpern 563-92).

The model’s part two, that “develop[ing] the disposition” of a critical thinker relates to essential “attitudes” such as the “willingness to plan…flexibility…persistence… [and] admit[ting] errors,” as well as “chang[ing] your mind when the evidence changes.” Halpern indicates these attitudes undergird all thinking that raises the chances of attaining goals and solving problems (18-25).

Halpern’s part three centers on student transfer of the critical skills. Along with teaching students specific critical thinking skills, instructors also need to teach students to identify circumstances that require those skills and which skills are necessary in a particular circumstance (Halpern 25-6). To transfer skills, Halpern argues that students must move past “the domain-specific surface characteristics” to identify the “structural aspects of the problem or argument” that “trigger the recall of the thinking skill” (25).

Finally, the fourth part requires students to use metacognition to track the effectiveness of their thinking (Halpern 27). Decisions, goals, and problem solving feature significantly in Halpern’s definition and model. Both the definition and model account for uncertainty in the decision-making process because the result of critical thinking skills need not be “a desirable outcome” but instead a higher chance of such an outcome (8).

Works Cited

Halpern, diane f.  thought and knowledge: an introduction to critical thinking.  5th edition, psychology press, 2014..

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On the one hand, models, theories, and paradigms are powerful tools to focus our attention when studying a given discipline. On the other hand, models may also limit the questions we ask, the topics we explore, and our understanding of critical issues. 1 My Four-Circle Model focuses attention on the role of individual adults in relationship to their own family of origin and broadens the systemic approach to working with and studying business families. “My Four-Circle Model focuses attention on the role of individual adults in relationship to their own family of origin and broadens the systemic approach to working with and studying business families.” In the 1980s, when FFI was first holding national conferences, I presented my Four-Circle Model for studying families in business at several workshops. After discussing my model and research ideas with the Psycho-Dynamic Family Business group (PDFB) in 1993, I was encouraged to complete research to determine how the Four-Circle Model could be used to identify the most critical competencies that business families had to master for success. That research was published in the proceedings at the 1999 FFI conference.

• The addition of the “individual circle” is critical, because in a family-owned business, advisors are often dealing with a family of adults, and healthy adults have typically individuated themselves from their family of origin. Healthy adult families are intentional. In my judgment, intergenerational family therapies, such as those developed by Murray Bowen 2 and James Framo, 3 are well suited to examine the systemic relationships between adults and their families of origin.
• The model focuses attention on competencies, particularly the competencies that must be mastered at each of the four intersection areas illustrated in the diagram.
• Individuals and/or individual beneficiaries, not families, own family businesses.
• Individuals such as board members and advisors who are not family members fit into the model in Sector 8.

Competencies of Intersection 3: Between the business and ownership

• Strategy – For long-term success across generations, the owners and the business must develop a clear and comprehensive strategy with a mission, vision, and goals for growth.
• Structure – The organizational structure of the business must support the strategy. This requires having the right people in the right roles.
• Leadership – Professionalization of the business may be necessary, perhaps by having qualified family members coupled with a capable non-family executive leadership team.

Competencies of Intersection 4: Between ownership and adult individuals

• Succession – Based on the strategy and structure of the business, the transition of management from one generation to the next is critical. This succession may include next-gen family leaders, or a non-family president/CEO.
• Governance – Either an advisory board or a fiduciary board of directors should be in place for the long-term success of the business.
• Estate Planning – Estate, financial, and tax planning should support rather than drive the other competencies. The ownership transition plan should capture the voice, vision, and values of both the current and next generation shareholders.

1 In his seminal work The Structure of Scientific Revolutions (1970) , Thomas Kuhn demonstrated that scientific theories are in fact “paradigms.” From the perspective of the sociology of knowledge, Kuhn argued that scientific communities share a common set of theories and ideas that are excellent tools to explore problems. However, in the history of science, there is a paradigm shift through which new theories emerge – for example from Newtonian physics to Einstein’s theory of relativity. Kuhn’s position contrasts with classical rationalism put forth by Karl Popper.

2 For key principles regarding Bowen read The Eight Concepts of Bowen Theory First Edition by  Dr. Roberta M Gilbert  or see the website https://www.thebowencenter.org/

3 Family-Of-Origin Therapy: An Intergenerational Approach by  James L. Framo

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Does self-directed learning with simulation improve critical thinking and motivation of nursing students a pre-post intervention study with the maes© methodology.

1. Introduction

• To evaluate the learning motivation strategies of nursing students before and after the self-directed simulation training program (MAES©).
• To analyze the critical thinking of nursing students before and after the self-directed simulation training program (MAES©).

2. Materials and Methods

2.1. design, 2.2. participants, 2.3. study variables, 2.4. instruments, 2.5. procedure, 2.6. data analysis, 2.7. ethical considerations, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Arizo-Luque, V.; Ramirez-Baena, L.; Pujalte-Jesús, M.J.; Rodríguez-Herrera, M.Á.; Lozano-Molina, A.; Arrogante, O.; Díaz-Agea, J.L. Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology. Healthcare 2022 , 10 , 927. https://doi.org/10.3390/healthcare10050927

Arizo-Luque V, Ramirez-Baena L, Pujalte-Jesús MJ, Rodríguez-Herrera MÁ, Lozano-Molina A, Arrogante O, Díaz-Agea JL. Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology. Healthcare . 2022; 10(5):927. https://doi.org/10.3390/healthcare10050927

Arizo-Luque, Vanessa, Lucía Ramirez-Baena, María José Pujalte-Jesús, María Ángeles Rodríguez-Herrera, Ainhoa Lozano-Molina, Oscar Arrogante, and José Luis Díaz-Agea. 2022. "Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology" Healthcare 10, no. 5: 927. https://doi.org/10.3390/healthcare10050927

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