Universidad de Costa Rica - Sede de Occidente
Revista Pensamiento Actual - Vol 20 - No. 34 2020
ISSN Impreso: 1409-0112 ISSN Electrónico 2215-3586
Salud y Medio Ambiente
Período Junio - Noviembre 2020
- 137.
DOI 10.15517/PA.V20I34.41880
Fernando Riegel -Maria da Graça Oliveira Crossetti
A Theoretical Model to Measure Holistic Critical Thinking in the Teaching of Diagnosis
Process in Nursing
Modelo teórico para la medición del pensamiento crítico holístico en el proceso de diagnóstico de
Fernando Riegel1
Maria da Graça Oliveira Crossetti2
Fecha de recepción: 23-7-2019
Fecha de aprobación: 19-12-2019
Objective: describe a theoretical model built to measure holistic critical thinking in the teaching of nursing using the Holistic
Critical Thinking Scoring Rubric. The instrument was originally written in English and then translated into Portuguese. This
is a descriptive-exploratory study with a qualitative approach conducted at a higher education institution in South Brazil, after
getting consent by the Committee for Ethics in Research, CAEE No. 72294917.7.0000.5347. Five nursing students and four teachers
participated in the study through focus group sessions. For data analysis, the technique of content analysis was used. Results
indicate that metaconcepts and conceptual elements were registered, which gave support to the construction of the theoretical
model of holistic critical thinking measurement in nursing teaching. The theoretical model built has shown to contribute and
guide accurate clinical decision making by nursing students.
Keywords: critical thinking, evaluation, theoretical models, education, nursing.
Objetivo: describir el modelo teórico creado para medir el pensamiento crítico holístico en la enseñanza de enfermería utilizando
la Rúbrica de puntuación de pensamiento crítico holístico. Se diseñó originalmente em inglés y se tradujo al portugués. El estudio
se classifica como descriptivo-exploratorio con enfoque cualitativo. El estudio se realizó en una institución de educación superior
en el sur de Brasil, luego de la aprobación del Comité de Ética en Investigación, CAEE No. 72294917.7.0000.5347. Cinco estudiantes
de enfermería y cuatro maestros participaron en el estudio a través de sesiones de grupos focales. Para el análisis de datos, se
utilizó la técnica de análisis de contenido. Los hallazgos indican que se registraron metaconceptos y elementos conceptuales, los
cuales apoyan la construcción del modelo teórico de medición holística del pensamiento crítico en la enseñanza de enfermería. El
modelo teórico construido contribuye con la toma de decisiones clínicas precisas por parte de estudiantes de enfermería.
Palabras clave: pensamiento crítico, evaluación, modelos teóricos, educación, enfermería.
Doctorado en Enfermería (UFRGS). Máster en Educación (UNISINOS). Profesor del Curso de Enfermería en la Universidad Federal de
Mato Grosso (UFMT) - Campus de la Universidad de Araguaia. Brasil. Correo electrónico: fernandoriegel85@gmail.com
Doctorado en Filosofía de Enfermería (UFSC). Profesor titular del Departamento de Enfermería Médico-Quirúrgica de la Escuela de
Enfermería de la Universidad Federal de Rio Grande do Sul (UFRGS). Brasil Correo electrónico: mgcrossetti@gmail.com
Salud y Medio Ambiente
I. Introduction
think exercise their profession critically and holistically
is also to be attentive to a need imposed by the current
The current global scenario demands from nurses a
demands of society (Paul, 2014). Within this context,
new mindset to meet the challenges of our society.
students and health professionals need to develop skills
These professionals, therefore, need to foster greater
to foster critical thinking to obtain the best results in
responsibility and autonomous judgment and decision-
nursing and advance in nursing diagnoses, patients
making as key characteristics for a qualified professional
planning and evaluation steps (Herdman; Kamitsuru,
praxis. Along with this, they requires knowledge,
2018). Facione defines holistic critical thinking (HCT)
experience and critical thinking, in addition to traits
as thinking with quality, i.e., the trial process centred
such as creativity, empathy and compassion, and a host
on deciding what to believe or what to do. The critical
of other emotional and interpersonal skills; the profession
thinker should not be negative or cynical, but thoughtful
requires thinking about the unified whole and/or to think
or reflective and balanced, demanding people to express
with quality (Facione; Gittens, 2016). More often than not,
some kind of reason or basis for what they are saying
in everyday practice in hospitals, patients are treated for
(Facione; Gittens, 2016). Holistic critical thinking in
body part injury organ sickness. Unfortunately, they are
nursing allows nurses to act in scenarios of diversity and
seen -albeit unintentionally- as an “object” or part of a
adversity. The holistic approach includes the participation
body in need of cure.
of individuals in its totality, brain and spirit, body and
mind, with reason and emotion interacting in a dynamic
The above implies that training for professionals in
and interconnected whole, present in the process of caring
nursing needs to be reoriented to emphasize treatment
for and with another human being (Facione; Crossetti;
and care approaches focused on the patients’ needs on
Riegel, 2017).
multiple levels. This requires for nurses to think in terms
of clinical decision-making in addition to the evidence
The HCT involves the cognitive abilities set, supported
they gather from diagnoses (Crossetti; Góes, 2016). It is
by specific habits of mind, to arrive to a selective and
necessary to teach the nursing healthcare professional
purposeful judgment (Facione; Facione, 2009). To teach
to think with a holistic focus, i.e., the sum of all parties,
to think holistically, it is necessary to measure the HCT,
understanding patient care in a broad sense, encouraging
determining whether a general opinion on the quality of
dialogue, active listening, openness, interest, translation,
critical thinking of the patient assessed. It will be possible
negotiation, interaction and bond. The holistic approach
to interact with students or nursing professionals in the
ensures the interventions must be drawn to the individual
development of this way of thinking, identifying those
and not just on the basis of disease treatment (Alfaro-
who already have developed skills and those whose skills
Lefevre, 2014). This concern backed up by recent scientific
should be reinforced, in the context of care.
evidences. According to recent findings, patients cared
for holistically get discharged from hospital sooner,
According to research, it is known that the development of
responding better to treatment and reducing hospital
theories, theoretical models and care models contributes
costs. In this context, the complexity of health care should
to the explanation of phenomena in nursing area. In
also be considered, which requires nurses training with
nursing clinical practice, they contribute to highlight
thinking teaching. Nonetheless these findings, the current
different processes and technologies used, such as clinical
model of training is still influenced by a biomedical model,
research processes, care planning, implementation of
which is biologicist and stereotyped, making the care
patient classification systems, programs of care quality
centred in totality difficult (Crossetti; Góes, 2016).
and nursing practice standards (Mcewen; Willis, 2016).
The need of think critically is vital since critical thinking
promotes better performance in clinical practice
(Vandenhouten; Peterson, 2012). To educate nurses to
Revista Pensamiento Actual - Vol 20 - No. 34 2020 - Universidad de Costa Rica - Sede de Occidente
All things considered, the aim of this study was to
Four teachers of the IES were also selected, by indication
describe the theoretical model built to measure holistic
of the referred nursing course coordination. The invitation
critical thinking in the teaching of nursing, using the
to participate in the study was formalized via electronic
instrument Holistic Critical Thinking Scoring Rubric,
mail and personally by the researcher. The time, date
which evaluates critical thinking holistically.
and place of meetings were agreed. Inclusion criteria:
teachers acting in different semesters of Undergraduate
II. Method
Nursing Course with minimum grade Nursing specialist
and 2 years minimum working on nursing care applying
This was a descriptive-exploratory study with a qualitative
NDP. As an exclusion criterion, the fact of being a teacher
approach, developed to construct a theoretical model of
of other undergraduate courses was considered.
holistic critical thinking measurement in the teaching
of nursing diagnosis process. The study was approved
The teachers-evaluators were specified by the codes P1,
by the Research Ethics Committee at the Universidade
P2, P3, and P4. At the time of the study, teacher P1 was a
Federal do Rio Grande do Sul, authorization No. CAEE:
28-year-old female holding a Master’s degree with two
years of teaching practice and 6 years of professional
practice in nursing; teacher P2 was a 37-year-old female
Five nursing students regularly enrolled in the 8th to
holding a Master’s degree with more than 5 years of
10th semesters at the university and four nurse teachers
teaching practice and 14 years of professional practice in
participated in the study. The sample was purposefully
nursing; teacher P3 was 43 years old, also female, holding
selected and obtained under the approval of the higher
a Master’s degree with more than 5 years of teaching
education institution Course Coordinator. The students
practice and 21 years of professional practice in nursing;
were invited through electronic correspondence and
and teacher P4 was 51 years old, female, holding a Doctor’s
personally by the researcher to explain the research
degree with more than 5 years of teaching experience and
objectives and time, date, and place of meetings.
8 years of professional practice in nursing.
The inclusion criteria were as follows: nursing course
Data collection comprised two meetings with four focus
academics, regularly enrolled in the 8th to 10th semesters
group sessions, recorded in MP3 format, on the premises
who agreed to participate in the research. The exclusion
of the institution of higher education with the 5 nursing
criteria comprised these: not attending the 8th to the
students, previously selected by convenience and who had
10th semesters of the nursing course or other academic
not participated in the step of validation of the holistic
degree courses.
critical thinking scoring rubric (HCTSR), and 4 teachers-
evaluators. After the focus groups, a content analysis of
The academic participants were specified by codes as A1,
the discourse of the participants was conducted and used
A2, A3, A4, and A5. At the time of the study, academic A1
as the basis for the measurement of HCT through the
was a 23 year-old female and enrolled in 10th semester;
academic A2 was a 40-years-old female enrolled in
the 10th semester and had 22 years of experience and
At the beginning of the focus groups, the setting was
technical nursing education; academic A3 was 39 years
performed with the participants. It is a contract group
old, also female, was attending the 9th semester and
to establish the sessions duration, objectives and themes
had 8 years of experience as a caregiver for the elderly;
addressed, in addition to the general guidelines to
A4 was 23, female, and was on the 9th semester; and
participants. In each session of the focus group, a voluntary
academic A5 was a 30-year-old female attending her 8th
observer participated. This observer was previously
semester and had 9 years of experience and technical
invited by the researcher, who has a Humanities’, Master’s
nursing education.
and Doctor’s degree in Education from Universidade
Católica de Brasília. He observed the sessions of focus
Salud y Medio Ambiente
groups making notes about the interaction of participants
male patient, 83 years old, with a diagnosis of tumor in
during the sessions, as well as in other meetings. The
the clavicular region, with loss of voice, hospitalized in
purpose of such notes was subsidizing the data analysis
palliative care unit about a month before his death. He
performed by the researcher. This observer has consented
could no longer live alone and needed complete healthcare.
to his participation by signing the Informed Consent Form
This case was used for the implementation of the NDP
(survey of relevant data - list of problems, nursing
The focus groups aimed, in their subjective essence,
diagnostic hypotheses) with a Check List of HCT abilities
to identify what the participants think and how they
for the activity; they could select the skills of HCT needed
think, recognizing participants’ perceptions about the
in the implementation of the NDP, taking as a basis the
phenomenon studied (Dall’agnol, Trench, 1999). Focus
steps of the NDP, after the identification of the priority
groups sessions were recorded with an MP3 recorder. The
diagnosis, justifying the choice. To the resolution of
recordings were transcribed by the researcher for further
the clinical case, participants used as support material
data analysis; the estimated time was 2 hours with a
to the book NANDA, 11th edition for consulting the
twenty-minutes pause. At the pause, a snack was offered.
priority nursing diagnoses based on NANDA-I Taxonomy
(Herdman, Kamitsuru, 2018).
In the first meeting of the focus group, the following
trigger questions was discussed with the academic
The third session of the focus group took place with
participants: “What do you understand by critical
teachers-evaluators. They were part of the evaluation
thinking?”; “What do you understand by holistic critical
board of the HCT and applied the HCTSR instrument
thinking?”; “What do you understand by NDP?”, “Which
with preparation for the clinical cases writing evaluation
holistic critical thinking skills you deem necessary in the
analysis, by 5 nursing students. In this session, the
development of NDP?”, “In your opinion, how should be
researcher explained the thesis project and the HCT
the teaching of holistic critical thinking to instrumentalize
in the teaching of NDP. The aim of the meeting was to
the academics for this way of thinking in NDP?”. The
identify the perception and understanding they had about
questions also intended to identify, based on the discourse
critical thinking, HCT, NDP and HCT skills necessary
of the academics, the understanding about the CT and
for the development of NDP, as well as to identify, in the
the HCT.
view of the teachers, how should be HCT teaching, to
instrumentalize the academics in the implementation
The second session of the focus group also took place with
of the NDP.
5 nursing students and aimed to identify, based on their
perception, the metaconcepts and conceptual elements
Due to the above, a prior teachers knowledge measuring
originated from the theoretical model for measurement of
was applied, followed by the discussion of trigger questions
HCT in the NDP. Initially, a word Brainstorming was made
(the same questions used in the first session of the focus
to identify the understanding of academics about the HCT
group with students), so they could report, during the
and the NDP. The following questions were used: “In
meeting, the individual and/or collective understanding
your understanding, what are the definitions of HCT and
on HCT, in order to identify the teachers’ understanding
NDP?”. The students also mentioned, randomly and in
about the theme.
different words, besides their use for conceptual elements
and metaconcepts identification, were used to subsidize
On this occasion, the teachers were trained by the
the analysis of clinical case done after that.
researcher to use the HCTSR instrument by presenting
the theme and with a practical example of the instrument
Also, the implementation of a clinical case (Lunney, 2011)
HCTSR application, demonstrating the assessment with
for analysis of the HCT was made at the second session
the instrument use in preparation for the fourth session
of the focus group. This clinical case revels the story of a
of the focus group.
Revista Pensamiento Actual - Vol 20 - No. 34 2020 - Universidad de Costa Rica - Sede de Occidente
In the fourth session of the focus group, teachers carried
students from the 8th to the 10th semesters, and four
out the instrument implementation in the clinical case
nurses-teachers of Nursing course. The theoretical model
analysis, performed by 5 nursing students in the second
metaconcepts of holistic critical thinking measurement in
session of the focus group. This assessment was performed
the Nursing Diagnosis Process teaching were: research,
blind by four teachers-evaluators, followed by a debate
nursing diagnoses, NANDA-I, Holistic Critical Thinking
about the positive and negative points of HCTSR use.
(HCT), cognitive abilities, behavioural skills, mind
For it, following driving questions were used: “Describe
habits, teaching methodologies, evaluation methods,
your perceptions about the evaluative process using the
Holistic Critical Thinking Scoring Rubric (HCTSR) and
HCT measurement rubric in the NDP”; “What are the
strengths or positive points using the HCTSR?”; “What
are the weaknesses or negative points using the HCTSR?”;
The conceptual elements of the theoretical model
“In your understanding, what contributions the use of
identified by the participants in the study are: analysis,
this measurement instrument for the evaluation of the
knowledge, search for information, observation, logical
HCT can do to NDP teaching?”; “In your opinion, what
reasoning, comprehension, knowledge transformation,
are the prospects related to holistic critical thinking in
interpretation, self-confidence, research, analytical mind,
Nursing area?”
reflection, confidence, creativity, curiosity, open mind,
intuition, flexibility, perseverance, contextual perspective,
The teachers were also asked to demonstrate the
clinical experience. Figure 1 below shows the graphical
instrument’s contributions for the evaluation of the HCT
representation of the theoretical model metaconcepts
and the teaching of the NDP. The session ended with the
for measurement of HCT in NDP teaching (Riegel, 2018):
following question: “Would you use this instrument in
your teaching practices? Why?”, including a discussion of
the strong and weak points and future perspectives for
NDP teaching qualification from this method.
The analysis of the collected data was performed
applying the proposed content analysis by Bardin with
the steps of a) organization of the analysis; b) coding; c)
categorization; and d) treatment of results, inference, and
interpretation of results. The following analysis categories
were originated: Critical Thinking and Holistic Critical
Thinking under the perspective of nursing academics
and professors; meaning of nursing diagnostic process
(NDP) in clinical practice: identification of the holistic
critical thinking skills; teachers understanding about the
assessment process of Holistic Critical Thinking using the
The HCT Theoretical Model in the NDP teaching
HCTSR instrument; teachers and students defining how
allows to observe, measure, and interpret the HCT of
to teach to think holistically: prospects in nursing area.
nursing students in decision-making NDP teaching. This
theoretical model represents the dynamic stages and their
III. Results
inter-relation with a process intended to guide the HCT
and the decision-making process of the nurse applying
For the construction of the theoretical model, the
NDP to understand human responses in the health-illness
metaconcepts and conceptual elements were extracted
from the statements of the categories analyzed and
originated by the focus groups sessions with five nursing
Salud y Medio Ambiente
The HCT was defined by the participants of the study as “a
A theoretical model can be defined as a combination of
way of thinking about individual as a whole, considering
abstract concepts and associated by propositions, such
the patients’ spirituality and beliefs”. Also, it considers the
statements describe or connect integrated concepts
human being in its existential dimension. For this reason,
in an important configuration (Christensen, Kenney,
nurses must put themselves in the place of another
1995). The HCT, made of skills used by nurses in the
person, thinking holistically. The HCT, when applied to
NDP implementation. But to identify or discuss it, it is
nursing professional practice, requires critical-thinking
necessary observation (Bittencourt, 2011).
skills to make informed decisions and habits of mind to
apply these skills in practical scenarios. If a person has
From the results obtained in the second moment,
the skills but does not have the habit of applying the skills,
metaconcepts and conceptual elements of the theoretical
the individual will not think well in a professional setting.
model. With this, it was possible organize theoretical model
Many times, the culture of the professional environment
metaconcepts for critical thinking measurement in nursing
can stimulate or discourage the good thinking. The same
education. It will fill the gaps in knowledge and contribute
proposition applies to educational contexts. Students, even
to the advancement of nursing education in Brazil.
when they are very young, can be encouraged to think
(habits of mind) and taught how to think through the
IV Discussion
abilities of HCT (Facione, Gittens, 2016).
4.1. Putting the Theoretical model for
In nursing, the theoretical foundations are inherent
HCT Measurement in NDP Teaching into
to the profession. In different contexts, they help the
identification and demonstration of the phenomena
of nursing domain, subsidize the conceptualization
The theoretical model of HCT measurement in NDP
of research order issues, seeking a meaning at the
teaching demonstrates, in its 1st step, the nursing student
phenomena from clinical practice. Based on this attention
being taught to think holistically through the learning of
to theoretical foundations guiding HCT and NDP, the aim
theoretical bases of HCT and their skills. It is possible to
was to make the theoretical model for critical thinking
motivate a person internally and consistently apply the
measurement in NDP teaching.
skills in others. In the 2nd step, the analysis’ strategies
for clinical cases, seminars, simulations, Problem Based
The language of theoretical thinking is expressed through
Learning (PBL) and NDP implementation (research and
concepts. They are understood as basic units of thinking
nursing diagnoses) will be proposed. At this moment,
and defined as mental representations of an object by
the student must apply the HCTS for basic human needs
formulating ideas described by words, definitions and
identification and priority issues to be addressed. In the
characteristics (Dictionary Cambridge, 2020).
3rd step of the model, the student must submit the work
or proposed project in written, oral, or simulated way.
The concepts are words describing mental plans of
phenomena idealizing the reality, which, in a certain way,
In 4th Step, the performance of the student will be assessed,
provide the ability for communication about this same
using the HCTSR instrument. According to the score
reality. The concepts can be classified into empirical and
obtained, the student will be able to follow one of two paths
abstract, which will depend on the capacity of observation
for the development of the HCT: If the score is between
in the real world. They are considered empirical when
HCTSR= 3 and 4, the student will go to the 5th step A
they can be observed by the senses and can be touched;
level. At this stage, the student is already applying the HCT
the abstract exists in terms of ideas and not on the
successfully and will need to carry out educational activities
material plane; as example, behaviour, care and ethics
focused on evidence interpretation, conclusions drawing,
(Lima, 2015, Meleis, 2018).
results justification, pros and cons identification in taking
decisions, following, with impartiality, evidence, analysis
Revista Pensamiento Actual - Vol 20 - No. 34 2020 - Universidad de Costa Rica - Sede de Occidente
and evaluation of points of view in a unique situation. At
activities focused on each of the B levels, which are:
this level, for students who are achieving high scores, it is
B1=Identify misinterpretations of evidence, declarations
possible to say they are strong or holistic critical thinkers.
or graphs; B2=Identify strong and relevant reposts to
arguments; B3=Identify alternative points of view; B4=
On the 5th step, the student who achieve scores of
draw conclusions and justify them; B5=Explain reasons
HCTSR= 2 and 1, characterized as a weak critical
and justify results and procedures; B6= Evaluate evidence
thinker who needs improvement, should be allocated by
and reasons, points of view without bias or self-interest.
teachers in the 5th step B level and propose individualized
Figure 2 - Theoretical Model for Holistic Critical Thinking to Measure the Teaching of Nursing Diagnosis
The theoretical model presented in this study, the
perceptions and abilities of HCT were identified, which
complexity of the HCT is demonstrated, and that the
also favored the evidence of elements structuring the HCT
NDP and the abilities of HCT, presented at this step, are
for accurate clinical decision making in the NDP. HCT
related to the teaching and application of NDP. In addition,
is considered a quality thinking and, therefore, can be
the theoretical model can guide the teaching practices
learned and improved from different teaching strategies.
of those teachers who choose to teach their students to
Different strategies to teach how to think critically are
think holistically to the advancement of science and the
available, but the emphasis of education must be in global
teaching of nursing.
thinking and mental habits, in addition to the internal
motivation to apply the skills in everyday life. It is believed
This model represents the dynamic and inter-related steps
a theoretical model, as proposed here, can be used as a
to a process intended to guide the HCT of future nurses
reference for HCT teaching and evaluation (Lima, 2015,
in search of understanding an existential and singular
Bittencourt, 2011).
human being in situations of health-disease. Different
Salud y Medio Ambiente
The Holistic Critical Thinking Scoring Rubric is an
As limitations, this study presented the achievement in
instrument structured in four levels. It enables the
a single search field, for this, it is impossible to make
students HCT measurement in different levels of training,
comparisons in different institutions of higher education.
in nursing and other areas of knowledge. It is found along
As future forwarding, the instrument can be applied in
the various stages in which the instrument was applied, its
different populations, proving to be useful in distinct
relevance to the teaching and learning processes find new
contexts of professional training, qualifying the varied
directions, taking the formative plot to new and effective
formative processes and interaction. The suggestion
configurations. It was evidenced, along the discussion
is further studies to validate the theoretical model for
with students and teachers, that the HCTSR can be used
measurement of the holistic critical thinking in the
as a rich tool for the diagnosis and the verification of
teaching nursing diagnosis process developed.
advances achieved in the thinking process during the
management of knowledge acquired on education, and
V. Final Considerations
also for the survey of prior knowledge of students. The
conclusion was the validity of the instrument for initial,
This study aimed to construct a theoretical model to
intermediate, and conclusive moments of the various
measure the HCT and focused on the perspective that
formation ways of students (Facione and Facione; 2009,
such theoretical model should assess the teaching of
Facione, Gittens, 2016).
NDP. This also evaluates the clinical decision-making, so
future nursing professionals can, in clinical practice, go
From this perspective, future professionals may exercise
beyond the observation of evidence, seeking to apply the
their clinical practice accurately, considering the totality
nursing diagnosis process of critical and reflexive manner.
and uniqueness of human beings under their care.
They will seek, in the subjectivity of each patient, unique
However, for maximum potentiality of the instrument,
information, permeated by the own life trajectory of each
teachers need to be trained as evaluators, trained in this
individual-target of the care process. This model purports
critical and holistic perspective to have enough capacity to
to guide the teaching endeavor, given the complexity of care
mobilize the HCT skills in themselves, in order to provide
and changes in the epidemiological profile of the disease.
evaluation with more precision of their students. The
versatility of the instrument application makes its practice
A theoretical model can contribute as a reference for
possible in different contexts and teaching strategies, not
observation, study, or analysis of certain abstract
limiting it to only one way of teaching. We suggest the
phenomena which are not perceptible in professional
use of strategies such as clinical case studies, seminars,
practice and teaching. At the end of the investigation,
conceptual maps, realistic simulations for application of
it was possible to measure the HCT of nursing students
NDP in the teaching of the HCT (Lima, 2015, Bittencourt,
from different semesters of training, which confirmed the
2011). According to the theoretical model, the first step
applicability of the HCTSR to different levels of training
is to teach the academics the definition of HCT and NDP
successfully. To the teacher, this showed the real way
to move forward in the model implementation in all its
of thinking of their different students, facilitating the
development of educational activities of the nursing
process with focus on the individual needs of their
Thus, the study contributed to reaffirming the importance
students. Thus, the instrument becomes an ally for the
of the NDP to the practices of the nurse to guide the
construction of a curriculum and a practice considering
nursing professional towards interpreting human
the potential of each student, as well their weaknesses,
responses to health and disease processes, as well as
which may be worked throughout the formative process.
to stimulate the search for evidence and its meaning
through the survey of inferences about the process of
The study helped to reaffirm the importance of the PDE
clinical decisions.
for the nurses’ practices, aiming to guide the nursing
professional in the interpretation of the human responses
Revista Pensamiento Actual - Vol 20 - No. 34 2020 - Universidad de Costa Rica - Sede de Occidente
to health and disease processes, besides stimulating the
Christensen PJ; Kenney JW (1995). Nursing process:
search for evidence and its meaning by raising inferences
application of conceptual models. Saint Louis:
about the decision process clinics. For this reason,
practices that lead the student to experience the theory
and bring it to the center of the formation process can be
Crossetti MGO; Góes MGO (2016). Habilidades de
used, in a constant integrate construction of knowledge
pensamento crítico no processo diagnóstico em
with the teacher and with their peers.
enfermagem [Critical thinking skills at nursing
diagnostic process]. In Herdman, TH. et al.
As limitations, this study presented the realization in a
(Orgs.). PRONANDA: programa de atualização
single research field, the which did not allow comparisons
em diagnósticos de enfermagem, Ciclo 4, v. 1.
in different higher education institutions. As a future
Porto Alegre: Artmed Panamericana..
referral, the instrument can be applied to different
populations, proving useful in different contexts of
Dall’agnol CM;Trench MH (1999). Grupos focais como
vocational training, qualifying the various training and
estratégia metodológica em pesquisas na
interaction processes. Further studies are suggested to
enfermagem [Focus groups as methodological
validate the theoretical model of measurement of the SHP
strategies at nursing research]. Rev Gaucha de
in the teaching of the PDE developed.
Enfermagem. 20 (1): 5-25.
VI. References
Facione PA; Gittens CA (2016). Think Critically. Califórnia:
Pearson Education.
Alfaro-Lefevre R (2014). Aplicação do processo de
enfermagem: fundamentos para o raciocínio
Facione PA, Crossetti MGO, Riegel F.(2017). Pensamento
clínico [Nursing process application: essentials
Crítico Holístico no Processo Diagnóstico
for clinic reasoning. 8 ed. Porto Alegre: Artmed.
de Enfermagem [Editorial] [Holistic Critical
Thinking at Nursing Diagnostic Process
Almeida MA; Lucena AF (2011). O processo de enfermagem
- Editorial]. Rev Gaúcha Enferm. 38(3):
e as classificações NANDA-I, NIC e NOC [Nursing
e75576. doi: http://dx.doi.org/10.1590/1983-
process and classifications NANDA-I, NIC and
NOC]. In Almeida, MA et al. (Orgs.), Processo de
enfermagem na prática clínica: estudos realizados
Facione PA; Facione NC (2009). Holistic critical thinking
no Hospital de Clínicas de Porto Alegre. Porto
scoring rubric. California: Academic Pres.
Alegre: Artmed.
Facione PA (1990). Critical Thinking: a Statement of Expert
Bittencourt GKGD (2011). Modelo teórico de pensamento
Consensus for Proposes of Educational Assessment
crítico no processo diagnóstico de enfermagem
and Instruction. California: Academic Press.
[Critical thinking theoretical model at nursing
diagnostic process]. 2011. Thesis (Nursing
Facione PA (1995). Critical Thinking & Clinical Judgment:
Doctorate). Universidade Federal do Rio Grande
Goals 2000 for Nursing Science. In Annual
do Sul, Porto Alegre.
Meeting of the Western Institute of Nursing.
San Diego.
Chinn PL; Kramer, MK (2011). Integrated theory and
knowledge development in nursing. St. Louis:
Ferreira ABH (2009). Mini-Aurélio: o dicionário da língua
portuguesa. Curitiba: Positivo.
Salud y Medio Ambiente
Herdman TH; Kamitsuru S (2018). Da coleta de dados ao
Vandenhouten C; Peterson M (2012). Watson’s Theory of
diagnóstico [From data collect to diagnosis]. In
Transpersonal Caring: factors impacting Nurses
Herdman TH; Kamitsuru S. (Orgs) Diagnósticos
Professional Caring. Holist Nurs Pract. 26(6):
de Enfermagem da NANDA: definições e
326-34. doi: 10.1097 / HNP.0b013e31826ed0e8.
classificação 2018-2020. Porto Alegre: Artmed.
Lima AAA.(2015). Modelo teórico de pensamento crítico
no processo diagnóstico de enfermagem: análise
à luz do modelo de avaliação de Meleis [Critical
thinking theoretical model at nursing diagnosis
process: analysis based con Meleis evaluation].
[Thesis] Porto Alegre: Escola de Enfermagem,
Universidade Federal do Rio Grande do Sul.
Lunney M et al (2011). Pensamento crítico para o alcance
de resultados positivos em saúde: análises
e estudos de caso em enfermagem [Critical
thinking to reach positive results in health area:
nursing analyses and case studies]. Porto Alegre:
Mcewen M; Willis EM (2016). Bases teóricas de
Enfermagem [Nursing theoretical bases]. Porto
Alegre: Artmed.
Meleis AI (1997). Theoretical nursing: development and
progress. Philadelphia: Lippincont.
Paul SA (2014) Assessment of critical thinking: a Delphi
study. In Nurse Educ. Today; 34 (11): 1357-60. doi:
10.1016 / j.nedt.2014.03.008
Riegel, F (2018). Modelo teórico para mensuração do
pensamento crítico holístico no ensino do
processo diagnóstico de enfermagem [Theoretical
model to holistic critical thinking measurement
at nursing diagnostic process teaching].
[Thesis]. Porto Alegre: Escola de Enfermagem,
Universidade Federal do Rio Grande do Sul.
Streubert HJ; Carpenter DR (2011). Qualitative Research
in nursing: advancing the humanistic imperative.
Philadelphia: Lippincott Williams & Wilkins.