how do nurses demonstrate critical thinking

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What is Critical Thinking in Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

ANA Nursing Resources Hub

Search Resources Hub

A female nurse leans in closely as she checks on a young patient after surgery. The little girl is wearing a hospital gown and tucked into bed as she talks with her nurse.

Critical Thinking in Nursing: Tips to Develop the Skill

4 min read • February, 09 2024

Critical thinking in nursing helps caregivers make decisions that lead to optimal patient care. In school, educators and clinical instructors introduced you to critical-thinking examples in nursing. These educators encouraged using learning tools for assessment, diagnosis, planning, implementation, and evaluation.

Nurturing these invaluable skills continues once you begin practicing. Critical thinking is essential to providing quality patient care and should continue to grow throughout your nursing career until it becomes second nature. 

What Is Critical Thinking in Nursing?

Critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills.

Reflection comes next. Carefully consider whether your actions led to the right solution or if there may have been a better course of action.

Remember, there's no one-size-fits-all treatment method — you must determine what's best for each patient.

How Is Critical Thinking Important for Nurses? 

As a patient's primary contact, a nurse is typically the first to notice changes in their status. One example of critical thinking in nursing is interpreting these changes with an open mind. Make impartial decisions based on evidence rather than opinions. By applying critical-thinking skills to anticipate and understand your patients' needs, you can positively impact their quality of care and outcomes.

Elements of Critical Thinking in Nursing

To assess situations and make informed decisions, nurses must integrate these specific elements into their practice:

Clinical judgment. Prioritize a patient's care needs and make adjustments as changes occur. Gather the necessary information and determine what nursing intervention is needed. Keep in mind that there may be multiple options. Use your critical-thinking skills to interpret and understand the importance of test results and the patient’s clinical presentation, including their vital signs. Then prioritize interventions and anticipate potential complications. 
Patient safety. Recognize deviations from the norm and take action to prevent harm to the patient. Suppose you don't think a change in a patient's medication is appropriate for their treatment. Before giving the medication, question the physician's rationale for the modification to avoid a potential error. 
Communication and collaboration. Ask relevant questions and actively listen to others while avoiding judgment. Promoting a collaborative environment may lead to improved patient outcomes and interdisciplinary communication. 
Problem-solving skills. Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. Besides assessing patient conditions, you can apply these skills to other challenges, such as staffing issues .

A diverse group of three (3) nursing students working together on a group project. The female nursing student is seated in the middle and is pointing at the laptop screen while talking with her male classmates.

How to Develop and Apply Critical-Thinking Skills in Nursing

Critical-thinking skills develop as you gain experience and advance in your career. The ability to predict and respond to nursing challenges increases as you expand your knowledge and encounter real-life patient care scenarios outside of what you learned from a textbook. 

Here are five ways to nurture your critical-thinking skills:

Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice . That knowledge helps you make informed decisions in stressful moments.  
Practice reflection. Allow time each day to reflect on successes and areas for improvement. This self-awareness can help identify your strengths, weaknesses, and personal biases to guide your decision-making.
Open your mind. Don't assume you're right. Ask for opinions and consider the viewpoints of other nurses, mentors , and interdisciplinary team members.
Use critical-thinking tools. Structure your thinking by incorporating nursing process steps or a SWOT analysis (strengths, weaknesses, opportunities, and threats) to organize information, evaluate options, and identify underlying issues.
Be curious. Challenge assumptions by asking questions to ensure current care methods are valid, relevant, and supported by evidence-based practice .

Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills.

Images sourced from Getty Images

Related Resources

Smiling female medical practitioner attends to smiling patient in hospital bed

Item(s) added to cart

The Value of Critical Thinking in Nursing

How Nurses Use Critical Thinking
How to Improve Critical Thinking
Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

Ask questions.
Gather information.
Implement a strategy.
Evaluate the results.
Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

Learn from their mistakes and the mistakes of other nurses
Look forward to integrating changes that improve patient care
Treat each patient interaction as a part of a whole
Evaluate new events based on past knowledge and adjust decision-making as needed
Solve problems with their colleagues
Are self-confident
Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Affiliations.

1 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group Quantitative Psychology (2017-SGR-269), University of Barcelona, Barcelona, Spain.
2 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group on Gender, Identity and Diversity (2017-SGR-1091), University of Barcelona, Barcelona, Spain.
3 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.
4 Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain.
PMID: 33029860
DOI: 10.1111/nup.12332

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.

PubMed Disclaimer

Grants and funding

PREI-19-007-B/School of Nursing. Faculty of Medicine and Health Sciences. University of Barcelona

LinkOut - more resources

Full text sources.

Ovid Technologies, Inc.

Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Warning: The NCBI web site requires JavaScript to function. more...

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Chapter 6 clinical reasoning, decisionmaking, and action: thinking critically and clinically.

Patricia Benner ; Ronda G. Hughes ; Molly Sutphen .

Affiliations

This chapter examines multiple thinking strategies that are needed for high-quality clinical practice. Clinical reasoning and judgment are examined in relation to other modes of thinking used by clinical nurses in providing quality health care to patients that avoids adverse events and patient harm. The clinician’s ability to provide safe, high-quality care can be dependent upon their ability to reason, think, and judge, which can be limited by lack of experience. The expert performance of nurses is dependent upon continual learning and evaluation of performance.

Critical Thinking

Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years. 1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. The American Philosophical Association (APA) defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based. 2 A more expansive general definition of critical thinking is

. . . in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and a commitment to overcome our native egocentrism and sociocentrism. Every clinician must develop rigorous habits of critical thinking, but they cannot escape completely the situatedness and structures of the clinical traditions and practices in which they must make decisions and act quickly in specific clinical situations. 3

There are three key definitions for nursing, which differ slightly. Bittner and Tobin defined critical thinking as being “influenced by knowledge and experience, using strategies such as reflective thinking as a part of learning to identify the issues and opportunities, and holistically synthesize the information in nursing practice” 4 (p. 268). Scheffer and Rubenfeld 5 expanded on the APA definition for nurses through a consensus process, resulting in the following definition:

Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, openmindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge 6 (Scheffer & Rubenfeld, p. 357).

The National League for Nursing Accreditation Commission (NLNAC) defined critical thinking as:

the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research 7 (p. 8).

These concepts are furthered by the American Association of Colleges of Nurses’ definition of critical thinking in their Essentials of Baccalaureate Nursing :

Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity 8 (p. 9).

Course work or ethical experiences should provide the graduate with the knowledge and skills to:

Use nursing and other appropriate theories and models, and an appropriate ethical framework;
Apply research-based knowledge from nursing and the sciences as the basis for practice;
Use clinical judgment and decision-making skills;
Engage in self-reflective and collegial dialogue about professional practice;
Evaluate nursing care outcomes through the acquisition of data and the questioning of inconsistencies, allowing for the revision of actions and goals;
Engage in creative problem solving 8 (p. 10).

Taken together, these definitions of critical thinking set forth the scope and key elements of thought processes involved in providing clinical care. Exactly how critical thinking is defined will influence how it is taught and to what standard of care nurses will be held accountable.

Professional and regulatory bodies in nursing education have required that critical thinking be central to all nursing curricula, but they have not adequately distinguished critical reflection from ethical, clinical, or even creative thinking for decisionmaking or actions required by the clinician. Other essential modes of thought such as clinical reasoning, evaluation of evidence, creative thinking, or the application of well-established standards of practice—all distinct from critical reflection—have been subsumed under the rubric of critical thinking. In the nursing education literature, clinical reasoning and judgment are often conflated with critical thinking. The accrediting bodies and nursing scholars have included decisionmaking and action-oriented, practical, ethical, and clinical reasoning in the rubric of critical reflection and thinking. One might say that this harmless semantic confusion is corrected by actual practices, except that students need to understand the distinctions between critical reflection and clinical reasoning, and they need to learn to discern when each is better suited, just as students need to also engage in applying standards, evidence-based practices, and creative thinking.

The growing body of research, patient acuity, and complexity of care demand higher-order thinking skills. Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes. These skills can be cultivated by educators who display the virtues of critical thinking, including independence of thought, intellectual curiosity, courage, humility, empathy, integrity, perseverance, and fair-mindedness. 9

The process of critical thinking is stimulated by integrating the essential knowledge, experiences, and clinical reasoning that support professional practice. The emerging paradigm for clinical thinking and cognition is that it is social and dialogical rather than monological and individual. 10–12 Clinicians pool their wisdom and multiple perspectives, yet some clinical knowledge can be demonstrated only in the situation (e.g., how to suction an extremely fragile patient whose oxygen saturations sink too low). Early warnings of problematic situations are made possible by clinicians comparing their observations to that of other providers. Clinicians form practice communities that create styles of practice, including ways of doing things, communication styles and mechanisms, and shared expectations about performance and expertise of team members.

By holding up critical thinking as a large umbrella for different modes of thinking, students can easily misconstrue the logic and purposes of different modes of thinking. Clinicians and scientists alike need multiple thinking strategies, such as critical thinking, clinical judgment, diagnostic reasoning, deliberative rationality, scientific reasoning, dialogue, argument, creative thinking, and so on. In particular, clinicians need forethought and an ongoing grasp of a patient’s health status and care needs trajectory, which requires an assessment of their own clarity and understanding of the situation at hand, critical reflection, critical reasoning, and clinical judgment.

Critical Reflection, Critical Reasoning, and Judgment

Critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case. Critical reflective skills are essential for clinicians; however, these skills are not sufficient for the clinician who must decide how to act in particular situations and avoid patient injury. For example, in everyday practice, clinicians cannot afford to critically reflect on the well-established tenets of “normal” or “typical” human circulatory systems when trying to figure out a particular patient’s alterations from that typical, well-grounded understanding that has existed since Harvey’s work in 1628. 13 Yet critical reflection can generate new scientifically based ideas. For example, there is a lack of adequate research on the differences between women’s and men’s circulatory systems and the typical pathophysiology related to heart attacks. Available research is based upon multiple, taken-for-granted starting points about the general nature of the circulatory system. As such, critical reflection may not provide what is needed for a clinician to act in a situation. This idea can be considered reasonable since critical reflective thinking is not sufficient for good clinical reasoning and judgment. The clinician’s development of skillful critical reflection depends upon being taught what to pay attention to, and thus gaining a sense of salience that informs the powers of perceptual grasp. The powers of noticing or perceptual grasp depend upon noticing what is salient and the capacity to respond to the situation.

Critical reflection is a crucial professional skill, but it is not the only reasoning skill or logic clinicians require. The ability to think critically uses reflection, induction, deduction, analysis, challenging assumptions, and evaluation of data and information to guide decisionmaking. 9 , 14 , 15 Critical reasoning is a process whereby knowledge and experience are applied in considering multiple possibilities to achieve the desired goals, 16 while considering the patient’s situation. 14 It is a process where both inductive and deductive cognitive skills are used. 17 Sometimes clinical reasoning is presented as a form of evaluating scientific knowledge, sometimes even as a form of scientific reasoning. Critical thinking is inherent in making sound clinical reasoning. 18

An essential point of tension and confusion exists in practice traditions such as nursing and medicine when clinical reasoning and critical reflection become entangled, because the clinician must have some established bases that are not questioned when engaging in clinical decisions and actions, such as standing orders. The clinician must act in the particular situation and time with the best clinical and scientific knowledge available. The clinician cannot afford to indulge in either ritualistic unexamined knowledge or diagnostic or therapeutic nihilism caused by radical doubt, as in critical reflection, because they must find an intelligent and effective way to think and act in particular clinical situations. Critical reflection skills are essential to assist practitioners to rethink outmoded or even wrong-headed approaches to health care, health promotion, and prevention of illness and complications, especially when new evidence is available. Breakdowns in practice, high failure rates in particular therapies, new diseases, new scientific discoveries, and societal changes call for critical reflection about past assumptions and no-longer-tenable beliefs.

Clinical reasoning stands out as a situated, practice-based form of reasoning that requires a background of scientific and technological research-based knowledge about general cases, more so than any particular instance. It also requires practical ability to discern the relevance of the evidence behind general scientific and technical knowledge and how it applies to a particular patient. In dong so, the clinician considers the patient’s particular clinical trajectory, their concerns and preferences, and their particular vulnerabilities (e.g., having multiple comorbidities) and sensitivities to care interventions (e.g., known drug allergies, other conflicting comorbid conditions, incompatible therapies, and past responses to therapies) when forming clinical decisions or conclusions.

Situated in a practice setting, clinical reasoning occurs within social relationships or situations involving patient, family, community, and a team of health care providers. The expert clinician situates themselves within a nexus of relationships, with concerns that are bounded by the situation. Expert clinical reasoning is socially engaged with the relationships and concerns of those who are affected by the caregiving situation, and when certain circumstances are present, the adverse event. Halpern 19 has called excellent clinical ethical reasoning “emotional reasoning” in that the clinicians have emotional access to the patient/family concerns and their understanding of the particular care needs. Expert clinicians also seek an optimal perceptual grasp, one based on understanding and as undistorted as possible, based on an attuned emotional engagement and expert clinical knowledge. 19 , 20

Clergy educators 21 and nursing and medical educators have begun to recognize the wisdom of broadening their narrow vision of rationality beyond simple rational calculation (exemplified by cost-benefit analysis) to reconsider the need for character development—including emotional engagement, perception, habits of thought, and skill acquisition—as essential to the development of expert clinical reasoning, judgment, and action. 10 , 22–24 Practitioners of engineering, law, medicine, and nursing, like the clergy, have to develop a place to stand in their discipline’s tradition of knowledge and science in order to recognize and evaluate salient evidence in the moment. Diagnostic confusion and disciplinary nihilism are both threats to the clinician’s ability to act in particular situations. However, the practice and practitioners will not be self-improving and vital if they cannot engage in critical reflection on what is not of value, what is outmoded, and what does not work. As evidence evolves and expands, so too must clinical thought.

Clinical judgment requires clinical reasoning across time about the particular, and because of the relevance of this immediate historical unfolding, clinical reasoning can be very different from the scientific reasoning used to formulate, conduct, and assess clinical experiments. While scientific reasoning is also socially embedded in a nexus of social relationships and concerns, the goal of detached, critical objectivity used to conduct scientific experiments minimizes the interactive influence of the research on the experiment once it has begun. Scientific research in the natural and clinical sciences typically uses formal criteria to develop “yes” and “no” judgments at prespecified times. The scientist is always situated in past and immediate scientific history, preferring to evaluate static and predetermined points in time (e.g., snapshot reasoning), in contrast to a clinician who must always reason about transitions over time. 25 , 26

Techne and Phronesis

Distinctions between the mere scientific making of things and practice was first explored by Aristotle as distinctions between techne and phronesis. 27 Learning to be a good practitioner requires developing the requisite moral imagination for good practice. If, for example, patients exercise their rights and refuse treatments, practitioners are required to have the moral imagination to understand the probable basis for the patient’s refusal. For example, was the refusal based upon catastrophic thinking, unrealistic fears, misunderstanding, or even clinical depression?

Techne, as defined by Aristotle, encompasses the notion of formation of character and habitus 28 as embodied beings. In Aristotle’s terms, techne refers to the making of things or producing outcomes. 11 Joseph Dunne defines techne as “the activity of producing outcomes,” and it “is governed by a means-ends rationality where the maker or producer governs the thing or outcomes produced or made through gaining mastery over the means of producing the outcomes, to the point of being able to separate means and ends” 11 (p. 54). While some aspects of medical and nursing practice fall into the category of techne, much of nursing and medical practice falls outside means-ends rationality and must be governed by concern for doing good or what is best for the patient in particular circumstances, where being in a relationship and discerning particular human concerns at stake guide action.

Phronesis, in contrast to techne, includes reasoning about the particular, across time, through changes or transitions in the patient’s and/or the clinician’s understanding. As noted by Dunne, phronesis is “characterized at least as much by a perceptiveness with regard to concrete particulars as by a knowledge of universal principles” 11 (p. 273). This type of practical reasoning often takes the form of puzzle solving or the evaluation of immediate past “hot” history of the patient’s situation. Such a particular clinical situation is necessarily particular, even though many commonalities and similarities with other disease syndromes can be recognized through signs and symptoms and laboratory tests. 11 , 29 , 30 Pointing to knowledge embedded in a practice makes no claim for infallibility or “correctness.” Individual practitioners can be mistaken in their judgments because practices such as medicine and nursing are inherently underdetermined. 31

While phronetic knowledge must remain open to correction and improvement, real events, and consequences, it cannot consistently transcend the institutional setting’s capacities and supports for good practice. Phronesis is also dependent on ongoing experiential learning of the practitioner, where knowledge is refined, corrected, or refuted. The Western tradition, with the notable exception of Aristotle, valued knowledge that could be made universal and devalued practical know-how and experiential learning. Descartes codified this preference for formal logic and rational calculation.

Aristotle recognized that when knowledge is underdetermined, changeable, and particular, it cannot be turned into the universal or standardized. It must be perceived, discerned, and judged, all of which require experiential learning. In nursing and medicine, perceptual acuity in physical assessment and clinical judgment (i.e., reasoning across time about changes in the particular patient or the clinician’s understanding of the patient’s condition) fall into the Greek Aristotelian category of phronesis. Dewey 32 sought to rescue knowledge gained by practical activity in the world. He identified three flaws in the understanding of experience in Greek philosophy: (1) empirical knowing is the opposite of experience with science; (2) practice is reduced to techne or the application of rational thought or technique; and (3) action and skilled know-how are considered temporary and capricious as compared to reason, which the Greeks considered as ultimate reality.

In practice, nursing and medicine require both techne and phronesis. The clinician standardizes and routinizes what can be standardized and routinized, as exemplified by standardized blood pressure measurements, diagnoses, and even charting about the patient’s condition and treatment. 27 Procedural and scientific knowledge can often be formalized and standardized (e.g., practice guidelines), or at least made explicit and certain in practice, except for the necessary timing and adjustments made for particular patients. 11 , 22

Rational calculations available to techne—population trends and statistics, algorithms—are created as decision support structures and can improve accuracy when used as a stance of inquiry in making clinical judgments about particular patients. Aggregated evidence from clinical trials and ongoing working knowledge of pathophysiology, biochemistry, and genomics are essential. In addition, the skills of phronesis (clinical judgment that reasons across time, taking into account the transitions of the particular patient/family/community and transitions in the clinician’s understanding of the clinical situation) will be required for nursing, medicine, or any helping profession.

Thinking Critically

Being able to think critically enables nurses to meet the needs of patients within their context and considering their preferences; meet the needs of patients within the context of uncertainty; consider alternatives, resulting in higher-quality care; 33 and think reflectively, rather than simply accepting statements and performing tasks without significant understanding and evaluation. 34 Skillful practitioners can think critically because they have the following cognitive skills: information seeking, discriminating, analyzing, transforming knowledge, predicating, applying standards, and logical reasoning. 5 One’s ability to think critically can be affected by age, length of education (e.g., an associate vs. a baccalaureate decree in nursing), and completion of philosophy or logic subjects. 35–37 The skillful practitioner can think critically because of having the following characteristics: motivation, perseverance, fair-mindedness, and deliberate and careful attention to thinking. 5 , 9

Thinking critically implies that one has a knowledge base from which to reason and the ability to analyze and evaluate evidence. 38 Knowledge can be manifest by the logic and rational implications of decisionmaking. Clinical decisionmaking is particularly influenced by interpersonal relationships with colleagues, 39 patient conditions, availability of resources, 40 knowledge, and experience. 41 Of these, experience has been shown to enhance nurses’ abilities to make quick decisions 42 and fewer decision errors, 43 support the identification of salient cues, and foster the recognition and action on patterns of information. 44 , 45

Clinicians must develop the character and relational skills that enable them to perceive and understand their patient’s needs and concerns. This requires accurate interpretation of patient data that is relevant to the specific patient and situation. In nursing, this formation of moral agency focuses on learning to be responsible in particular ways demanded by the practice, and to pay attention and intelligently discern changes in patients’ concerns and/or clinical condition that require action on the part of the nurse or other health care workers to avert potential compromises to quality care.

Formation of the clinician’s character, skills, and habits are developed in schools and particular practice communities within a larger practice tradition. As Dunne notes,

A practice is not just a surface on which one can display instant virtuosity. It grounds one in a tradition that has been formed through an elaborate development and that exists at any juncture only in the dispositions (slowly and perhaps painfully acquired) of its recognized practitioners. The question may of course be asked whether there are any such practices in the contemporary world, whether the wholesale encroachment of Technique has not obliterated them—and whether this is not the whole point of MacIntyre’s recipe of withdrawal, as well as of the post-modern story of dispossession 11 (p. 378).

Clearly Dunne is engaging in critical reflection about the conditions for developing character, skills, and habits for skillful and ethical comportment of practitioners, as well as to act as moral agents for patients so that they and their families receive safe, effective, and compassionate care.

Professional socialization or professional values, while necessary, do not adequately address character and skill formation that transform the way the practitioner exists in his or her world, what the practitioner is capable of noticing and responding to, based upon well-established patterns of emotional responses, skills, dispositions to act, and the skills to respond, decide, and act. 46 The need for character and skill formation of the clinician is what makes a practice stand out from a mere technical, repetitious manufacturing process. 11 , 30 , 47

In nursing and medicine, many have questioned whether current health care institutions are designed to promote or hinder enlightened, compassionate practice, or whether they have deteriorated into commercial institutional models that focus primarily on efficiency and profit. MacIntyre points out the links between the ongoing development and improvement of practice traditions and the institutions that house them:

Lack of justice, lack of truthfulness, lack of courage, lack of the relevant intellectual virtues—these corrupt traditions, just as they do those institutions and practices which derive their life from the traditions of which they are the contemporary embodiments. To recognize this is of course also to recognize the existence of an additional virtue, one whose importance is perhaps most obvious when it is least present, the virtue of having an adequate sense of the traditions to which one belongs or which confront one. This virtue is not to be confused with any form of conservative antiquarianism; I am not praising those who choose the conventional conservative role of laudator temporis acti. It is rather the case that an adequate sense of tradition manifests itself in a grasp of those future possibilities which the past has made available to the present. Living traditions, just because they continue a not-yet-completed narrative, confront a future whose determinate and determinable character, so far as it possesses any, derives from the past 30 (p. 207).

It would be impossible to capture all the situated and distributed knowledge outside of actual practice situations and particular patients. Simulations are powerful as teaching tools to enable nurses’ ability to think critically because they give students the opportunity to practice in a simplified environment. However, students can be limited in their inability to convey underdetermined situations where much of the information is based on perceptions of many aspects of the patient and changes that have occurred over time. Simulations cannot have the sub-cultures formed in practice settings that set the social mood of trust, distrust, competency, limited resources, or other forms of situated possibilities.

One of the hallmark studies in nursing providing keen insight into understanding the influence of experience was a qualitative study of adult, pediatric, and neonatal intensive care unit (ICU) nurses, where the nurses were clustered into advanced beginner, intermediate, and expert level of practice categories. The advanced beginner (having up to 6 months of work experience) used procedures and protocols to determine which clinical actions were needed. When confronted with a complex patient situation, the advanced beginner felt their practice was unsafe because of a knowledge deficit or because of a knowledge application confusion. The transition from advanced beginners to competent practitioners began when they first had experience with actual clinical situations and could benefit from the knowledge gained from the mistakes of their colleagues. Competent nurses continuously questioned what they saw and heard, feeling an obligation to know more about clinical situations. In doing do, they moved from only using care plans and following the physicians’ orders to analyzing and interpreting patient situations. Beyond that, the proficient nurse acknowledged the changing relevance of clinical situations requiring action beyond what was planned or anticipated. The proficient nurse learned to acknowledge the changing needs of patient care and situation, and could organize interventions “by the situation as it unfolds rather than by preset goals 48 (p. 24). Both competent and proficient nurses (that is, intermediate level of practice) had at least two years of ICU experience. 48 Finally, the expert nurse had a more fully developed grasp of a clinical situation, a sense of confidence in what is known about the situation, and could differentiate the precise clinical problem in little time. 48

Expertise is acquired through professional experience and is indicative of a nurse who has moved beyond mere proficiency. As Gadamer 29 points out, experience involves a turning around of preconceived notions, preunderstandings, and extends or adds nuances to understanding. Dewey 49 notes that experience requires a prepared “creature” and an enriched environment. The opportunity to reflect and narrate one’s experiential learning can clarify, extend, or even refute experiential learning.

Experiential learning requires time and nurturing, but time alone does not ensure experiential learning. Aristotle linked experiential learning to the development of character and moral sensitivities of a person learning a practice. 50 New nurses/new graduates have limited work experience and must experience continuing learning until they have reached an acceptable level of performance. 51 After that, further improvements are not predictable, and years of experience are an inadequate predictor of expertise. 52

The most effective knower and developer of practical knowledge creates an ongoing dialogue and connection between lessons of the day and experiential learning over time. Gadamer, in a late life interview, highlighted the open-endedness and ongoing nature of experiential learning in the following interview response:

Being experienced does not mean that one now knows something once and for all and becomes rigid in this knowledge; rather, one becomes more open to new experiences. A person who is experienced is undogmatic. Experience has the effect of freeing one to be open to new experience … In our experience we bring nothing to a close; we are constantly learning new things from our experience … this I call the interminability of all experience 32 (p. 403).

Practical endeavor, supported by scientific knowledge, requires experiential learning, the development of skilled know-how, and perceptual acuity in order to make the scientific knowledge relevant to the situation. Clinical perceptual and skilled know-how helps the practitioner discern when particular scientific findings might be relevant. 53

Often experience and knowledge, confirmed by experimentation, are treated as oppositions, an either-or choice. However, in practice it is readily acknowledged that experiential knowledge fuels scientific investigation, and scientific investigation fuels further experiential learning. Experiential learning from particular clinical cases can help the clinician recognize future similar cases and fuel new scientific questions and study. For example, less experienced nurses—and it could be argued experienced as well—can use nursing diagnoses practice guidelines as part of their professional advancement. Guidelines are used to reflect their interpretation of patients’ needs, responses, and situation, 54 a process that requires critical thinking and decisionmaking. 55 , 56 Using guidelines also reflects one’s problem identification and problem-solving abilities. 56 Conversely, the ability to proficiently conduct a series of tasks without nursing diagnoses is the hallmark of expertise. 39 , 57

Experience precedes expertise. As expertise develops from experience and gaining knowledge and transitions to the proficiency stage, the nurses’ thinking moves from steps and procedures (i.e., task-oriented care) toward “chunks” or patterns 39 (i.e., patient-specific care). In doing so, the nurse thinks reflectively, rather than merely accepting statements and performing procedures without significant understanding and evaluation. 34 Expert nurses do not rely on rules and logical thought processes in problem-solving and decisionmaking. 39 Instead, they use abstract principles, can see the situation as a complex whole, perceive situations comprehensively, and can be fully involved in the situation. 48 Expert nurses can perform high-level care without conscious awareness of the knowledge they are using, 39 , 58 and they are able to provide that care with flexibility and speed. Through a combination of knowledge and skills gained from a range of theoretical and experiential sources, expert nurses also provide holistic care. 39 Thus, the best care comes from the combination of theoretical, tacit, and experiential knowledge. 59 , 60

Experts are thought to eventually develop the ability to intuitively know what to do and to quickly recognize critical aspects of the situation. 22 Some have proposed that expert nurses provide high-quality patient care, 61 , 62 but that is not consistently documented—particularly in consideration of patient outcomes—and a full understanding between the differential impact of care rendered by an “expert” nurse is not fully understood. In fact, several studies have found that length of professional experience is often unrelated and even negatively related to performance measures and outcomes. 63 , 64

In a review of the literature on expertise in nursing, Ericsson and colleagues 65 found that focusing on challenging, less-frequent situations would reveal individual performance differences on tasks that require speed and flexibility, such as that experienced during a code or an adverse event. Superior performance was associated with extensive training and immediate feedback about outcomes, which can be obtained through continual training, simulation, and processes such as root-cause analysis following an adverse event. Therefore, efforts to improve performance benefited from continual monitoring, planning, and retrospective evaluation. Even then, the nurse’s ability to perform as an expert is dependent upon their ability to use intuition or insights gained through interactions with patients. 39

Intuition and Perception

Intuition is the instant understanding of knowledge without evidence of sensible thought. 66 According to Young, 67 intuition in clinical practice is a process whereby the nurse recognizes something about a patient that is difficult to verbalize. Intuition is characterized by factual knowledge, “immediate possession of knowledge, and knowledge independent of the linear reasoning process” 68 (p. 23). When intuition is used, one filters information initially triggered by the imagination, leading to the integration of all knowledge and information to problem solve. 69 Clinicians use their interactions with patients and intuition, drawing on tacit or experiential knowledge, 70 , 71 to apply the correct knowledge to make the correct decisions to address patient needs. Yet there is a “conflated belief in the nurses’ ability to know what is best for the patient” 72 (p. 251) because the nurses’ and patients’ identification of the patients’ needs can vary. 73

A review of research and rhetoric involving intuition by King and Appleton 62 found that all nurses, including students, used intuition (i.e., gut feelings). They found evidence, predominately in critical care units, that intuition was triggered in response to knowledge and as a trigger for action and/or reflection with a direct bearing on the analytical process involved in patient care. The challenge for nurses was that rigid adherence to checklists, guidelines, and standardized documentation, 62 ignored the benefits of intuition. This view was furthered by Rew and Barrow 68 , 74 in their reviews of the literature, where they found that intuition was imperative to complex decisionmaking, 68 difficult to measure and assess in a quantitative manner, and was not linked to physiologic measures. 74

Intuition is a way of explaining professional expertise. 75 Expert nurses rely on their intuitive judgment that has been developed over time. 39 , 76 Intuition is an informal, nonanalytically based, unstructured, deliberate calculation that facilitates problem solving, 77 a process of arriving at salient conclusions based on relatively small amounts of knowledge and/or information. 78 Experts can have rapid insight into a situation by using intuition to recognize patterns and similarities, achieve commonsense understanding, and sense the salient information combined with deliberative rationality. 10 Intuitive recognition of similarities and commonalities between patients are often the first diagnostic clue or early warning, which must then be followed up with critical evaluation of evidence among the competing conditions. This situation calls for intuitive judgment that can distinguish “expert human judgment from the decisions” made by a novice 79 (p. 23).

Shaw 80 equates intuition with direct perception. Direct perception is dependent upon being able to detect complex patterns and relationships that one has learned through experience are important. Recognizing these patterns and relationships generally occurs rapidly and is complex, making it difficult to articulate or describe. Perceptual skills, like those of the expert nurse, are essential to recognizing current and changing clinical conditions. Perception requires attentiveness and the development of a sense of what is salient. Often in nursing and medicine, means and ends are fused, as is the case for a “good enough” birth experience and a peaceful death.

Applying Practice Evidence

Research continues to find that using evidence-based guidelines in practice, informed through research evidence, improves patients’ outcomes. 81–83 Research-based guidelines are intended to provide guidance for specific areas of health care delivery. 84 The clinician—both the novice and expert—is expected to use the best available evidence for the most efficacious therapies and interventions in particular instances, to ensure the highest-quality care, especially when deviations from the evidence-based norm may heighten risks to patient safety. Otherwise, if nursing and medicine were exact sciences, or consisted only of techne, then a 1:1 relationship could be established between results of aggregated evidence-based research and the best path for all patients.

Evaluating Evidence

Before research should be used in practice, it must be evaluated. There are many complexities and nuances in evaluating the research evidence for clinical practice. Evaluation of research behind evidence-based medicine requires critical thinking and good clinical judgment. Sometimes the research findings are mixed or even conflicting. As such, the validity, reliability, and generalizability of available research are fundamental to evaluating whether evidence can be applied in practice. To do so, clinicians must select the best scientific evidence relevant to particular patients—a complex process that involves intuition to apply the evidence. Critical thinking is required for evaluating the best available scientific evidence for the treatment and care of a particular patient.

Good clinical judgment is required to select the most relevant research evidence. The best clinical judgment, that is, reasoning across time about the particular patient through changes in the patient’s concerns and condition and/or the clinician’s understanding, are also required. This type of judgment requires clinicians to make careful observations and evaluations of the patient over time, as well as know the patient’s concerns and social circumstances. To evolve to this level of judgment, additional education beyond clinical preparation if often required.

Sources of Evidence

Evidence that can be used in clinical practice has different sources and can be derived from research, patient’s preferences, and work-related experience. 85 , 86 Nurses have been found to obtain evidence from experienced colleagues believed to have clinical expertise and research-based knowledge 87 as well as other sources.

For many years now, randomized controlled trials (RCTs) have often been considered the best standard for evaluating clinical practice. Yet, unless the common threats to the validity (e.g., representativeness of the study population) and reliability (e.g., consistency in interventions and responses of study participants) of RCTs are addressed, the meaningfulness and generalizability of the study outcomes are very limited. Relevant patient populations may be excluded, such as women, children, minorities, the elderly, and patients with multiple chronic illnesses. The dropout rate of the trial may confound the results. And it is easier to get positive results published than it is to get negative results published. Thus, RCTs are generalizable (i.e., applicable) only to the population studied—which may not reflect the needs of the patient under the clinicians care. In instances such as these, clinicians need to also consider applied research using prospective or retrospective populations with case control to guide decisionmaking, yet this too requires critical thinking and good clinical judgment.

Another source of available evidence may come from the gold standard of aggregated systematic evaluation of clinical trial outcomes for the therapy and clinical condition in question, be generated by basic and clinical science relevant to the patient’s particular pathophysiology or care need situation, or stem from personal clinical experience. The clinician then takes all of the available evidence and considers the particular patient’s known clinical responses to past therapies, their clinical condition and history, the progression or stages of the patient’s illness and recovery, and available resources.

In clinical practice, the particular is examined in relation to the established generalizations of science. With readily available summaries of scientific evidence (e.g., systematic reviews and practice guidelines) available to nurses and physicians, one might wonder whether deep background understanding is still advantageous. Might it not be expendable, since it is likely to be out of date given the current scientific evidence? But this assumption is a false opposition and false choice because without a deep background understanding, the clinician does not know how to best find and evaluate scientific evidence for the particular case in hand. The clinician’s sense of salience in any given situation depends on past clinical experience and current scientific evidence.

Evidence-Based Practice

The concept of evidence-based practice is dependent upon synthesizing evidence from the variety of sources and applying it appropriately to the care needs of populations and individuals. This implies that evidence-based practice, indicative of expertise in practice, appropriately applies evidence to the specific situations and unique needs of patients. 88 , 89 Unfortunately, even though providing evidence-based care is an essential component of health care quality, it is well known that evidence-based practices are not used consistently.

Conceptually, evidence used in practice advances clinical knowledge, and that knowledge supports independent clinical decisions in the best interest of the patient. 90 , 91 Decisions must prudently consider the factors not necessarily addressed in the guideline, such as the patient’s lifestyle, drug sensitivities and allergies, and comorbidities. Nurses who want to improve the quality and safety of care can do so though improving the consistency of data and information interpretation inherent in evidence-based practice.

Initially, before evidence-based practice can begin, there needs to be an accurate clinical judgment of patient responses and needs. In the course of providing care, with careful consideration of patient safety and quality care, clinicians must give attention to the patient’s condition, their responses to health care interventions, and potential adverse reactions or events that could harm the patient. Nonetheless, there is wide variation in the ability of nurses to accurately interpret patient responses 92 and their risks. 93 Even though variance in interpretation is expected, nurses are obligated to continually improve their skills to ensure that patients receive quality care safely. 94 Patients are vulnerable to the actions and experience of their clinicians, which are inextricably linked to the quality of care patients have access to and subsequently receive.

The judgment of the patient’s condition determines subsequent interventions and patient outcomes. Attaining accurate and consistent interpretations of patient data and information is difficult because each piece can have different meanings, and interpretations are influenced by previous experiences. 95 Nurses use knowledge from clinical experience 96 , 97 and—although infrequently—research. 98–100

Once a problem has been identified, using a process that utilizes critical thinking to recognize the problem, the clinician then searches for and evaluates the research evidence 101 and evaluates potential discrepancies. The process of using evidence in practice involves “a problem-solving approach that incorporates the best available scientific evidence, clinicians’ expertise, and patient’s preferences and values” 102 (p. 28). Yet many nurses do not perceive that they have the education, tools, or resources to use evidence appropriately in practice. 103

Reported barriers to using research in practice have included difficulty in understanding the applicability and the complexity of research findings, failure of researchers to put findings into the clinical context, lack of skills in how to use research in practice, 104 , 105 amount of time required to access information and determine practice implications, 105–107 lack of organizational support to make changes and/or use in practice, 104 , 97 , 105 , 107 and lack of confidence in one’s ability to critically evaluate clinical evidence. 108

When Evidence Is Missing

In many clinical situations, there may be no clear guidelines and few or even no relevant clinical trials to guide decisionmaking. In these cases, the latest basic science about cellular and genomic functioning may be the most relevant science, or by default, guestimation. Consequently, good patient care requires more than a straightforward, unequivocal application of scientific evidence. The clinician must be able to draw on a good understanding of basic sciences, as well as guidelines derived from aggregated data and information from research investigations.

Practical knowledge is shaped by one’s practice discipline and the science and technology relevant to the situation at hand. But scientific, formal, discipline-specific knowledge are not sufficient for good clinical practice, whether the discipline be law, medicine, nursing, teaching, or social work. Practitioners still have to learn how to discern generalizable scientific knowledge, know how to use scientific knowledge in practical situations, discern what scientific evidence/knowledge is relevant, assess how the particular patient’s situation differs from the general scientific understanding, and recognize the complexity of care delivery—a process that is complex, ongoing, and changing, as new evidence can overturn old.

Practice communities like individual practitioners may also be mistaken, as is illustrated by variability in practice styles and practice outcomes across hospitals and regions in the United States. This variability in practice is why practitioners must learn to critically evaluate their practice and continually improve their practice over time. The goal is to create a living self-improving tradition.

Within health care, students, scientists, and practitioners are challenged to learn and use different modes of thinking when they are conflated under one term or rubric, using the best-suited thinking strategies for taking into consideration the purposes and the ends of the reasoning. Learning to be an effective, safe nurse or physician requires not only technical expertise, but also the ability to form helping relationships and engage in practical ethical and clinical reasoning. 50 Good ethical comportment requires that both the clinician and the scientist take into account the notions of good inherent in clinical and scientific practices. The notions of good clinical practice must include the relevant significance and the human concerns involved in decisionmaking in particular situations, centered on clinical grasp and clinical forethought.

The Three Apprenticeships of Professional Education

We have much to learn in comparing the pedagogies of formation across the professions, such as is being done currently by the Carnegie Foundation for the Advancement of Teaching. The Carnegie Foundation’s broad research program on the educational preparation of the profession focuses on three essential apprenticeships:

To capture the full range of crucial dimensions in professional education, we developed the idea of a three-fold apprenticeship: (1) intellectual training to learn the academic knowledge base and the capacity to think in ways important to the profession; (2) a skill-based apprenticeship of practice; and (3) an apprenticeship to the ethical standards, social roles, and responsibilities of the profession, through which the novice is introduced to the meaning of an integrated practice of all dimensions of the profession, grounded in the profession’s fundamental purposes. 109

This framework has allowed the investigators to describe tensions and shortfalls as well as strengths of widespread teaching practices, especially at articulation points among these dimensions of professional training.

Research has demonstrated that these three apprenticeships are taught best when they are integrated so that the intellectual training includes skilled know-how, clinical judgment, and ethical comportment. In the study of nursing, exemplary classroom and clinical teachers were found who do integrate the three apprenticeships in all of their teaching, as exemplified by the following anonymous student’s comments:

With that as well, I enjoyed the class just because I do have clinical experience in my background and I enjoyed it because it took those practical applications and the knowledge from pathophysiology and pharmacology, and all the other classes, and it tied it into the actual aspects of like what is going to happen at work. For example, I work in the emergency room and question: Why am I doing this procedure for this particular patient? Beforehand, when I was just a tech and I wasn’t going to school, I’d be doing it because I was told to be doing it—or I’d be doing CPR because, you know, the doc said, start CPR. I really enjoy the Care and Illness because now I know the process, the pathophysiological process of why I’m doing it and the clinical reasons of why they’re making the decisions, and the prioritization that goes on behind it. I think that’s the biggest point. Clinical experience is good, but not everybody has it. Yet when these students transition from school and clinicals to their job as a nurse, they will understand what’s going on and why.

The three apprenticeships are equally relevant and intertwined. In the Carnegie National Study of Nursing Education and the companion study on medical education as well as in cross-professional comparisons, teaching that gives an integrated access to professional practice is being examined. Once the three apprenticeships are separated, it is difficult to reintegrate them. The investigators are encouraged by teaching strategies that integrate the latest scientific knowledge and relevant clinical evidence with clinical reasoning about particular patients in unfolding rather than static cases, while keeping the patient and family experience and concerns relevant to clinical concerns and reasoning.

Clinical judgment or phronesis is required to evaluate and integrate techne and scientific evidence.

Within nursing, professional practice is wise and effective usually to the extent that the professional creates relational and communication contexts where clients/patients can be open and trusting. Effectiveness depends upon mutual influence between patient and practitioner, student and learner. This is another way in which clinical knowledge is dialogical and socially distributed. The following articulation of practical reasoning in nursing illustrates the social, dialogical nature of clinical reasoning and addresses the centrality of perception and understanding to good clinical reasoning, judgment and intervention.

Clinical Grasp *

Clinical grasp describes clinical inquiry in action. Clinical grasp begins with perception and includes problem identification and clinical judgment across time about the particular transitions of particular patients. Garrett Chan 20 described the clinician’s attempt at finding an “optimal grasp” or vantage point of understanding. Four aspects of clinical grasp, which are described in the following paragraphs, include (1) making qualitative distinctions, (2) engaging in detective work, (3) recognizing changing relevance, and (4) developing clinical knowledge in specific patient populations.

Making Qualitative Distinctions

Qualitative distinctions refer to those distinctions that can be made only in a particular contextual or historical situation. The context and sequence of events are essential for making qualitative distinctions; therefore, the clinician must pay attention to transitions in the situation and judgment. Many qualitative distinctions can be made only by observing differences through touch, sound, or sight, such as the qualities of a wound, skin turgor, color, capillary refill, or the engagement and energy level of the patient. Another example is assessing whether the patient was more fatigued after ambulating to the bathroom or from lack of sleep. Likewise the quality of the clinician’s touch is distinct as in offering reassurance, putting pressure on a bleeding wound, and so on. 110

Engaging in Detective Work, Modus Operandi Thinking, and Clinical Puzzle Solving

Clinical situations are open ended and underdetermined. Modus operandi thinking keeps track of the particular patient, the way the illness unfolds, the meanings of the patient’s responses as they have occurred in the particular time sequence. Modus operandi thinking requires keeping track of what has been tried and what has or has not worked with the patient. In this kind of reasoning-in-transition, gains and losses of understanding are noticed and adjustments in the problem approach are made.

We found that teachers in a medical surgical unit at the University of Washington deliberately teach their students to engage in “detective work.” Students are given the daily clinical assignment of “sleuthing” for undetected drug incompatibilities, questionable drug dosages, and unnoticed signs and symptoms. For example, one student noted that an unusual dosage of a heart medication was being given to a patient who did not have heart disease. The student first asked her teacher about the unusually high dosage. The teacher, in turn, asked the student whether she had asked the nurse or the patient about the dosage. Upon the student’s questioning, the nurse did not know why the patient was receiving the high dosage and assumed the drug was for heart disease. The patient’s staff nurse had not questioned the order. When the student asked the patient, the student found that the medication was being given for tremors and that the patient and the doctor had titrated the dosage for control of the tremors. This deliberate approach to teaching detective work, or modus operandi thinking, has characteristics of “critical reflection,” but stays situated and engaged, ferreting out the immediate history and unfolding of events.

Recognizing Changing Clinical Relevance

The meanings of signs and symptoms are changed by sequencing and history. The patient’s mental status, color, or pain level may continue to deteriorate or get better. The direction, implication, and consequences for the changes alter the relevance of the particular facts in the situation. The changing relevance entailed in a patient transitioning from primarily curative care to primarily palliative care is a dramatic example, where symptoms literally take on new meanings and require new treatments.

Developing Clinical Knowledge in Specific Patient Populations

Extensive experience with a specific patient population or patients with particular injuries or diseases allows the clinician to develop comparisons, distinctions, and nuanced differences within the population. The comparisons between many specific patients create a matrix of comparisons for clinicians, as well as a tacit, background set of expectations that create population- and patient-specific detective work if a patient does not meet the usual, predictable transitions in recovery. What is in the background and foreground of the clinician’s attention shifts as predictable changes in the patient’s condition occurs, such as is seen in recovering from heart surgery or progressing through the predictable stages of labor and delivery. Over time, the clinician develops a deep background understanding that allows for expert diagnostic and interventions skills.

Clinical Forethought

Clinical forethought is intertwined with clinical grasp, but it is much more deliberate and even routinized than clinical grasp. Clinical forethought is a pervasive habit of thought and action in nursing practice, and also in medicine, as clinicians think about disease and recovery trajectories and the implications of these changes for treatment. Clinical forethought plays a role in clinical grasp because it structures the practical logic of clinicians. At least four habits of thought and action are evident in what we are calling clinical forethought: (1) future think, (2) clinical forethought about specific patient populations, (3) anticipation of risks for particular patients, and (4) seeing the unexpected.

Future think

Future think is the broadest category of this logic of practice. Anticipating likely immediate futures helps the clinician make good plans and decisions about preparing the environment so that responding rapidly to changes in the patient is possible. Without a sense of salience about anticipated signs and symptoms and preparing the environment, essential clinical judgments and timely interventions would be impossible in the typically fast pace of acute and intensive patient care. Future think governs the style and content of the nurse’s attentiveness to the patient. Whether in a fast-paced care environment or a slower-paced rehabilitation setting, thinking and acting with anticipated futures guide clinical thinking and judgment. Future think captures the way judgment is suspended in a predictive net of anticipation and preparing oneself and the environment for a range of potential events.

Clinical forethought about specific diagnoses and injuries

This habit of thought and action is so second nature to the experienced nurse that the new or inexperienced nurse may have difficulty finding out about what seems to other colleagues as “obvious” preparation for particular patients and situations. Clinical forethought involves much local specific knowledge about who is a good resource and how to marshal support services and equipment for particular patients.

Examples of preparing for specific patient populations are pervasive, such as anticipating the need for a pacemaker during surgery and having the equipment assembled ready for use to save essential time. Another example includes forecasting an accident victim’s potential injuries, and recognizing that intubation might be needed.

Anticipation of crises, risks, and vulnerabilities for particular patients

This aspect of clinical forethought is central to knowing the particular patient, family, or community. Nurses situate the patient’s problems almost like a topography of possibilities. This vital clinical knowledge needs to be communicated to other caregivers and across care borders. Clinical teaching could be improved by enriching curricula with narrative examples from actual practice, and by helping students recognize commonly occurring clinical situations in the simulation and clinical setting. For example, if a patient is hemodynamically unstable, then managing life-sustaining physiologic functions will be a main orienting goal. If the patient is agitated and uncomfortable, then attending to comfort needs in relation to hemodynamics will be a priority. Providing comfort measures turns out to be a central background practice for making clinical judgments and contains within it much judgment and experiential learning.

When clinical teaching is too removed from typical contingencies and strong clinical situations in practice, students will lack practice in active thinking-in-action in ambiguous clinical situations. In the following example, an anonymous student recounted her experiences of meeting a patient:

I was used to different equipment and didn’t know how things went, didn’t know their routine, really. You can explain all you want in class, this is how it’s going to be, but when you get there … . Kim was my first instructor and my patient that she assigned me to—I walked into the room and he had every tube imaginable. And so I was a little overwhelmed. It’s not necessarily even that he was that critical … . She asked what tubes here have you seen? Well, I know peripheral lines. You taught me PICC [peripherally inserted central catheter] lines, and we just had that, but I don’t really feel comfortable doing it by myself, without you watching to make sure that I’m flushing it right and how to assess it. He had a chest tube and I had seen chest tubes, but never really knew the depth of what you had to assess and how you make sure that it’s all kosher and whatever. So she went through the chest tube and explained, it’s just bubbling a little bit and that’s okay. The site, check the site. The site looked okay and that she’d say if it wasn’t okay, this is what it might look like … . He had a feeding tube. I had done feeding tubes but that was like a long time ago in my LPN experiences schooling. So I hadn’t really done too much with the feeding stuff either … . He had a [nasogastric] tube, and knew pretty much about that and I think at the time it was clamped. So there were no issues with the suction or whatever. He had a Foley catheter. He had a feeding tube, a chest tube. I can’t even remember but there were a lot.

As noted earlier, a central characteristic of a practice discipline is that a self-improving practice requires ongoing experiential learning. One way nurse educators can enhance clinical inquiry is by increasing pedagogies of experiential learning. Current pedagogies for experiential learning in nursing include extensive preclinical study, care planning, and shared postclinical debriefings where students share their experiential learning with their classmates. Experiential learning requires open learning climates where students can discuss and examine transitions in understanding, including their false starts, or their misconceptions in actual clinical situations. Nursing educators typically develop open and interactive clinical learning communities, so that students seem committed to helping their classmates learn from their experiences that may have been difficult or even unsafe. One anonymous nurse educator described how students extend their experiential learning to their classmates during a postclinical conference:

So for example, the patient had difficulty breathing and the student wanted to give the meds instead of addressing the difficulty of breathing. Well, while we were sharing information about their patients, what they did that day, I didn’t tell the student to say this, but she said, ‘I just want to tell you what I did today in clinical so you don’t do the same thing, and here’s what happened.’ Everybody’s listening very attentively and they were asking her some questions. But she shared that. She didn’t have to. I didn’t tell her, you must share that in postconference or anything like that, but she just went ahead and shared that, I guess, to reinforce what she had learned that day but also to benefit her fellow students in case that thing comes up with them.

The teacher’s response to this student’s honesty and generosity exemplifies her own approach to developing an open community of learning. Focusing only on performance and on “being correct” prevents learning from breakdown or error and can dampen students’ curiosity and courage to learn experientially.

Seeing the unexpected

One of the keys to becoming an expert practitioner lies in how the person holds past experiential learning and background habitual skills and practices. This is a skill of foregrounding attention accurately and effectively in response to the nature of situational demands. Bourdieu 29 calls the recognition of the situation central to practical reasoning. If nothing is routinized as a habitual response pattern, then practitioners will not function effectively in emergencies. Unexpected occurrences may be overlooked. However, if expectations are held rigidly, then subtle changes from the usual will be missed, and habitual, rote responses will inappropriately rule. The clinician must be flexible in shifting between what is in background and foreground. This is accomplished by staying curious and open. The clinical “certainty” associated with perceptual grasp is distinct from the kind of “certainty” achievable in scientific experiments and through measurements. Recognition of similar or paradigmatic clinical situations is similar to “face recognition” or recognition of “family resemblances.” This concept is subject to faulty memory, false associative memories, and mistaken identities; therefore, such perceptual grasp is the beginning of curiosity and inquiry and not the end. Assessment and validation are required. In rapidly moving clinical situations, perceptual grasp is the starting point for clarification, confirmation, and action. Having the clinician say out loud how he or she is understanding the situation gives an opportunity for confirmation and disconfirmation from other clinicians present. 111 The relationship between foreground and background of attention needs to be fluid, so that missed expectations allow the nurse to see the unexpected. For example, when the background rhythm of a cardiac monitor changes, the nurse notices, and what had been background tacit awareness becomes the foreground of attention. A hallmark of expertise is the ability to notice the unexpected. 20 Background expectations of usual patient trajectories form with experience. Tacit expectations for patient trajectories form that enable the nurse to notice subtle failed expectations and pay attention to early signs of unexpected changes in the patient's condition. Clinical expectations gained from caring for similar patient populations form a tacit clinical forethought that enable the experienced clinician to notice missed expectations. Alterations from implicit or explicit expectations set the stage for experiential learning, depending on the openness of the learner.

Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, and clinical judgment. The high-performance expectation of nurses is dependent upon the nurses’ continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities.

This section of the paper was condensed and paraphrased from Benner, Hooper-Kyriakidis, and Stannard. 23 Patricia Hooper-Kyriakidis wrote the section on clinical grasp, and Patricia Benner wrote the section on clinical forethought.

Cite this Page Benner P, Hughes RG, Sutphen M. Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 6.
PDF version of this page (147K)

In this Page

Clinical Grasp

Other titles in this collection

Advances in Patient Safety

Related information

PMC PubMed Central citations
PubMed Links to PubMed

Recent Activity

Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinical... Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically - Patient Safety and Quality

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Account Management

Download a Certificate of Insurance (COI) to provide to your employer.

Make a Payment

Make a one-time payment, set up autopay, or update your payment information.

Submit a notice of an incident or claim in just minutes.

Topics on this page:

Why Critical Thinking in Nursing Is Important

8 examples of critical thinking in nursing, improving the quality of patient care, the importance of critical thinking in nursing.

Jul 24, 2024

While not every decision is an immediate life-and-death situation, there are hundreds of decisions nurses must make every day that impact patient care in ways small and large.

“Being able to assess situations and make decisions can lead to life-or-death situations,” said nurse anesthetist Aisha Allen . “Critical thinking is a crucial and essential skill for nurses.”

The National League for Nursing Accreditation Commission (NLNAC) defines critical thinking in nursing this way: “the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief-based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research.”

An eight-year study by Johns Hopkins reports that 10% of deaths in the U.S. are due to medical error — the third-highest cause of death in the country.

“Diagnostic errors, medical mistakes, and the absence of safety nets could result in someone’s death,” wrote Dr. Martin Makary , professor of surgery at Johns Hopkins University School of Medicine.

Everyone makes mistakes — even doctors. Nurses applying critical thinking skills can help reduce errors.

“Question everything,” said pediatric nurse practitioner Ersilia Pompilio RN, MSN, PNP . “Especially doctor’s orders.” Nurses often spend more time with patients than doctors and may notice slight changes in conditions that may not be obvious. Resolving these observations with treatment plans can help lead to better care.

Key Nursing Critical Thinking Skills

Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation.

Interpretation: Understanding the meaning of information or events.
Analysis: Investigating a course of action based on objective and subjective data.
Evaluation: Assessing the value of information and its credibility.
Inference: Making logical deductions about the impact of care decisions.
Explanation: Translating complicated and often complex medical information to patients and families in a way they can understand to make decisions about patient care.
Self-Regulation: Avoiding the impact of unconscious bias with cognitive awareness.

These skills are used in conjunction with clinical reasoning. Based on training and experience, nurses use these skills and then have to make decisions affecting care.

It’s the ultimate test of a nurse’s ability to gather reliable data and solve complex problems. However, critical thinking goes beyond just solving problems. Critical thinking incorporates questioning and critiquing solutions to find the most effective one. For example, treating immediate symptoms may temporarily solve a problem, but determining the underlying cause of the symptoms is the key to effective long-term health.

Here are some real-life examples of how nurses apply critical thinking on the job every day, as told by nurses themselves.

Example #1: Patient Assessments

“Doing a thorough assessment on your patient can help you detect that something is wrong, even if you’re not quite sure what it is,” said Shantay Carter , registered nurse and co-founder of Women of Integrity . “When you notice the change, you have to use your critical thinking skills to decide what’s the next step. Critical thinking allows you to provide the best and safest care possible.”

Example #2: First Line of Defense

Often, nurses are the first line of defense for patients.

“One example would be a patient that had an accelerated heart rate,” said nurse educator and adult critical care nurse Dr. Jenna Liphart Rhoads . “As a nurse, it was my job to investigate the cause of the heart rate and implement nursing actions to help decrease the heart rate prior to calling the primary care provider.”

Nurses with poor critical thinking skills may fail to detect a patient in stress or deteriorating condition. This can result in what’s called a “ failure to rescue ,” or FTR, which can lead to adverse conditions following a complication that leads to mortality.

Example #3: Patient Interactions

Nurses are the ones taking initial reports or discussing care with patients.

“We maintain relationships with patients between office visits,” said registered nurse, care coordinator, and ambulatory case manager Amelia Roberts . “So, when there is a concern, we are the first name that comes to mind (and get the call).”

“Several times, a parent called after the child had a high temperature, and the call came in after hours,” Roberts said. “Doing a nursing assessment over the phone is a special skill, yet based on the information gathered related to the child’s behavior (and) fluid intake, there were several recommendations I could make.”

Deciding whether it was OK to wait until the morning, page the primary care doctor, or go to the emergency room to be evaluated takes critical thinking.

Example #4: Using Detective Skills

Nurses have to use acute listening skills to discern what patients are really telling them (or not telling them) and whether they are getting the whole story.

“I once had a 5-year-old patient who came in for asthma exacerbation on repeated occasions into my clinic,” said Pompilio. “The mother swore she was giving her child all her medications, but the asthma just kept getting worse.”

Pompilio asked the parent to keep a medication diary.

“It turned out that after a day or so of medication and alleviation in some symptoms, the mother thought the child was getting better and stopped all medications,” she said.

Example #5: Prioritizing

“Critical thinking is present in almost all aspects of nursing, even those that are not in direct action with the patient,” said Rhoads. “During report, nurses decide which patient to see first based on the information gathered, and from there they must prioritize their actions when in a patient’s room. Nurses must be able to scrutinize which medications can be taken together, and which modality would be best to help a patient move from the bed to the chair.”

A critical thinking skill in prioritization is cognitive stacking. Cognitive stacking helps create smooth workflow management to set priorities and help nurses manage their time. It helps establish routines for care while leaving room within schedules for the unplanned events that will inevitably occur. Even experienced nurses can struggle with juggling today’s significant workload, prioritizing responsibilities, and delegating appropriately.

Example #6: Medication & Care Coordination

Another aspect that often falls to nurses is care coordination. A nurse may be the first to notice that a patient is having an issue with medications.

“Based on a report of illness in a patient who has autoimmune challenges, we might recommend that a dose of medicine that interferes with immune response be held until we communicate with their specialty provider,” said Roberts.

Nurses applying critical skills can also help ease treatment concerns for patients.

“We might recommend a patient who gets infusions come in earlier in the day to get routine labs drawn before the infusion to minimize needle sticks and trauma,” Robert said.

Example #7: Critical Decisions

During the middle of an operation, the anesthesia breathing machine Allen was using malfunctioned.

“I had to critically think about whether or not I could fix this machine or abandon that mode of delivering nursing anesthesia care safely,” she said. “I chose to disconnect my patient from the malfunctioning machine and retrieve tools and medications to resume medication administration so that the surgery could go on.”

Nurses are also called on to do rapid assessments of patient conditions and make split-second decisions in the operating room.

“When blood pressure drops, it is my responsibility to decide which medication and how much medication will fix the issue,” Allen said. “I must work alongside the surgeons and the operating room team to determine the best plan of care for that patient’s surgery.”

“On some days, it seems like you are in the movie ‘The Matrix,’” said Pompilio. “There’s lots of chaos happening around you. Your patient might be decompensating. You have to literally stop time and take yourself out of the situation and make a decision.”

Example #8: Fast & Flexible Decisions

Allen said she thinks electronics are great, but she can remember a time when technology failed her.

“The hospital monitor that gives us vitals stopped correlating with real-time values,” she said. “So I had to rely on basic nursing skills to make sure my patient was safe. (Pulse check, visual assessments, etc.)”

In such cases, there may not be enough time to think through every possible outcome. Critical thinking combined with experience gives nurses the ability to think quickly and make the right decisions.

Nurses who think critically are in a position to significantly increase the quality of patient care and avoid adverse outcomes.

“Critical thinking allows you to ensure patient safety,” said Carter. “It’s essential to being a good nurse.”

Nurses must be able to recognize a change in a patient’s condition, conduct independent interventions, anticipate patients and provider needs, and prioritize. Such actions require critical thinking ability and advanced problem-solving skills.

“Nurses are the eyes and ears for patients, and critical thinking allows us to be their advocates,” said Allen.

Image courtesy of iStock.com/ davidf

Last updated on Jul 24, 2024. Originally published on Aug 25, 2021.

Career Growth

The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice. Click here to read our full disclaimer

The product descriptions provided here are only brief summaries and may be changed without notice. The full coverage terms and details, including limitations and exclusions, are contained in the insurance policy. If you have questions about coverage available under our plans, please review the policy or contact us at 833-242-3794 or [email protected] . “20% savings” is based on industry pricing averages.

Berxi™ is a part of Berkshire Hathaway Specialty Insurance ( BHSI ). Insurance products are distributed through Berkshire Hathaway Global Insurance Services, California License # 0K09397. BHSI is part of Berkshire Hathaway’s National Indemnity group of insurance companies, consisting of National Indemnity and its affiliates, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor’s. The rating scales can be found at www.ambest.com and www.standardandpoors.com , respectively.

No warranty, guarantee, or representation, either expressed or implied, is made as to the correctness, accuracy, completeness, adequacy, or sufficiency of any representation or information. Any opinions expressed herein are subject to change without notice.

The information on this web site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment, and does not purport to establish a standard of care under any circumstances. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only based upon the information available at the time of presentation, and does not constitute medical, legal, regulatory, compliance, financial, professional, or any other advice.

BHSI makes no representation and assumes no responsibility or liability for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to consider and confirm any information obtained from or through this web site with other sources, and review all information regarding any medical condition or treatment with your physician or medical care provider. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING THAT YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE.

BHSI is not a medical organization, and does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information contained on or available through this web site. BHSI IS NOT RESPONSIBLE FOR, AND EXPRESSLY DISCLAIMS ALL LIABILITY FOR, ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER SERVICES OR PRODUCTS THAT YOU OBTAIN AFTER REVIEWING THIS WEB SITE.

Want Berxi articles delivered straight to your inbox? Sign up for our monthly newsletter below!

" * " indicates required fields

How we use your email address Berxi will not sell or rent your email address to third parties unless otherwise notified. Other than where necessary to administer your insurance policy or where required by law, Berxi will not disclose your email address to third parties. Your email address is required to identify you for access to the Berxi website. You may also receive newsletters, product updates, and communications about quotes and policies.

Paul Dughi is a contributing writer for Berxi, as well as a journalist and freelance writer. He has held executive management positions in the media industry for the past 25 years.

A pair of latex gloved hands holding bare hands that hold a red heart

Breaking Bad News to Patients: A Nurse’s Guide to SPIKES

Michael Walton Jul 24, 2024

sticky note showing delegation in nursing

Delegation in Nursing: Steps, Skills, & Solutions for Creating Balance at Work

Kristy Snyder Jul 24, 2024

Stressed female nurse in PPE leans on bed and rubs forehead

The 7 Most Common Nursing Mistakes (And What You Can Do If You Make One)

Paul Dughi Jul 24, 2024

Subscribe to journal Subscribe
Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Creative Ways to Enhance and Assess Critical Thinking in Nursing Students

Parker, Kimberly C.

About the Author Kimberly C. Parker, DNP, RN, is a clinical instructor, University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama. For more information, contact her at [email protected] .

The author has declared no conflict of interest.

Nursing students should be challenged to implement critical thinking decisions regarding conclusions they implement for patient care. This article reinforces common techniques and introduces new practices to teach critical thinking. Many ways are currently recognized utilizing an assortment of techniques. The concepts from an escape room are a great way to deliver opportunities for students to practice this skill and can be provided economically and easily. Being creative in managing these concepts will offer an exciting chance to introduce critical thinking for your students.

Full Text Access for Subscribers:

Individual subscribers.

Institutional Users

Not a subscriber.

You can read the full text of this article if you:

+ Favorites
View in Gallery

Readers Of this Article Also Read

Escape room: innovative teaching strategy to stimulate critical..., retention of nursing students: an integrative review, can you escape nursing school educational escape room in nursing education, learning clinical judgments with a lens of inclusivity, objectives and outcomes: the fundamental difference.

Why Critical Thinking Is Important in Nursing

Most nursing professionals have natural nurturing abilities, a desire to give others support, and an appreciation for science and anatomy. Successful nurses also possess a skill that is often overlooked: they can think critically.

A critical thinker will identify the problem, determine the best solution, and choose the most effective method. Critical thinkers evaluate the execution of a plan to see if it was effective and if it could have been done better.

The ability to think critically has multiple applications in your life, as you can see. But Why is critical thinking important in nursing? Learn why and how you can improve this skill by reading on.

Why Critical Thinking Is Important in Nursing?

Why Are Critical Thinking Skills in Nursing Important?

Critical thinking is an essential skill for nursing students to have. It’s not something that it can teach in a classroom, and it must be developed over time through experience and practice.

Critical thinking is the process of applying logic and reason to make decisions or solve problems. The ability to think critically will help you make better decisions on your own and collaborate with others when solving problems – both are essential skills for nurses.

Nursing has always been a profession that relies on critical thinking. Nurses are constantly faced with new situations and problems, which they need to think critically about to solve.

Critical thinking is essential for nurses because it helps them make decisions based on the available information and their past experiences and knowledge of the field. It also allows nurses to plan before making any changes to be most effective as possible.

It is an essential skill for nurses to have to provide the best care possible. Critical thinkers can comprehend a problem and think about how they can solve it, rather than reactively or automatically.

Critical thinking is a crucial skill for doctors, nurses, and other health care providers.

How can you develop your critical thinking skills?

As you know, learning doesn’t end when you graduate from nursing school. You must continue to grow as a professional and develop your critical thinking skills.

Critical thinkers are better problem solvers than others in the same situation because they examine all the facts before coming up with solutions. They can also take many different perspectives into account when solving problems.

It’s easy for people to come to conclusions too quickly, but those who think critically will avoid this trap by first looking at every possible angle.

When faced with difficult decisions, these nurses won’t just rely on their gut feelings or what seems right according to society’s norms; instead, they’ll analyze all available information carefully until they develop the best solution.

Critical thinking is also crucial because it helps nurses avoid making mistakes in their work by providing them with a way to examine each situation and identify any potential risks or problems that may arise from subsequent actions before they take place.

It’s not enough for you to have empathy if your compassion isn’t backed up by critical thought and understanding of how certain decisions might affect others in various circumstances, so keep learning ways to become more thoughtful about the world around you.

The skills involved in being a good nurse are many and varied, but one thing all nurses need, regardless of what specialty they choose, is critical solid thinking abilities.

Reasons Critical Thinking In Nursing Is Important

Nurses’ experiences often include making life-altering decisions, establishing authority in stressful situations, and helping patients and their loved ones cope with some of the most stressful and emotional times of their lives. Critical thinking is an essential aspect of nursing.

Following are the reasons:

Nurses’ critical thinking has a significant impact on patient care
Recognizing changes in patient status is essential
It’s essential to an honest and open exchange of ideas
It enables you to ensure patient safety
Nurses can find quick fixes with it
Improvements can be made through critical thinking
It Contributes to Rational Decision Making

Further critical thinking is essential to nursing because nurses can establish authority in a stressful situation, such as issuing orders or administering care when needed.

This can be difficult because it may require balancing medical expertise with empathy and compassion towards patients’ feelings, leading them to question your judgment at some point in time.

Another reason this skill set is crucial involves making decisions that will have life-changing effects on a patient’s health and well-being.

These are often irreversible choices that only you know how much weight they carry within the context of each situation, so you need to make sure all factors are carefully considered before deciding what action must be taken next without hesitation.

Skills that Critical Thinkers Need

When it comes to critical thinking, some skills are more important than others. Using a framework known as the Nursing Process, some of these skills are applied to patient care. The most important skills are:

Interpretation: Understanding and explaining a specific event or piece of information.

Analysis: Studying data based on subjective and objective information to determine the best course of action.

Evaluation: Here, you assess the information you received. Is the information accurate, reliable, and credible? The ability to determine if outcomes have been fully achieved requires this skill as well.

The nurse can then use clinical reasoning to determine what the problem is based on those three skills.

The decisions need to be based on sound reasoning:

Provide a clear, concise explanation of your conclusions. Nurses should provide a rationale for their answers.

Self-regulation – You need to be aware of your thought processes. As a result, you must reflect on the process that led to your conclusion. In this process, you should self-correct as necessary. Keep an eye out for bias and incorrect assumptions.

Critical Thinking Pitfalls

It can fall by the wayside when it’s not seen as necessary or when there are more pressing issues.

Critical thinking is important in nursing because it can fall by the wayside when it’s not seen as an essential or more pressing issue.
It can be difficult to think critically about complex, ambiguous situations with a shortage of information and time in healthcare settings.
If we don’t use critical thinking skills, problems might go undetected or unresolved, leading to further complications down the road.

Sometimes nurses can’t differentiate between a less acute clinical problem and one that needs immediate attention. When a large amount of complex data must be processed in a time-critical manner, errors can also occur.

Conclusion:

Nurses cannot overstate the importance of critical thinking. The clinical presentations of patients are diverse. To provide safe, high-quality care, nurses must make rational clinical decisions and solve problems. Nurses need critical thinking skills to handle increasingly complex cases.

Why Is Research Important in Nursing?
Why Is the Nursing Process Important?
Why Compassion is Important in Nursing

Download Nurse Bingo Today!

Liven up any shift with a fun game of bingo. See who can fill a row first! Fill a whole card and lose grip with reality.

Your privacy is protected. We will never spam you.

About The Author

Brittney wilson, bsn, rn, related posts, shocking truth – nurses depend too much on charting.

Volunteer Nurse Options: Where To Volunteer As A Nurse

nurse fleece jacket nurse holding fleece jackets

7 Awesome Nurse Fleece Jackets to Keep You Warm and Stylish

From White to Blue: Nursing Uniforms Evolve

Start typing and press enter to search

Practice Test
Fundamentals of Nursing
Anatomy and Physiology
Medical and Surgical Nursing
Perioperative Nursing
Psychiatric Mental Health Nursing
Maternal & Child Nursing
Community Health Nursing
Pathophysiology
Nursing Research
Study Guide and Strategies
Nursing Videos
Work for Us!
Privacy Policy

Journals and Essays

Thinking Like a Nurse: The Critical Thinking Skills in the Nursing Practice

Thinking how to nurse is thinking like a nurse. Florence Nightingale (1860) wrote on her notes that women who have charge of the other’s health—to which the application of her integrated experiences must teach herself to think how to nurse, a self-learning acquired from “hints”.

Perhaps, Nightingale referred “hints” as the use of critical thinking skills in patient’s care. The ability to think critically was the foundation of nursing practice started from historic times and is becoming one of the key performance indicators for both students and nursing professionals nowadays.

Educational system continues to evolve and progresses heeding to the needs of the society, and parallel to the changing educational structure and methodology. However, Haber (2020) reported that only 75% of employers claim that the students they hire who underwent 12 or more years of formal education lack of critical thinking and problem-solving abilities despite the progress in the educational system.

What is Critical Thinking?

Critical thinking skills, a fundamental skill that plays a pivotal role in our daily survival. In general terms, the skill will not stop in memorization, the process goes beyond connecting the dots from one to concept to another, problem-solving techniques, think creatively, and apply the learned knowledge in new ways (Walden University, 2020). Kaminske (2019), defines critical thinking skills as a domain-specific skill on the ability to solve problems and make effective decisions that require expertise to be applied in a range of situations and scenarios.

In the nursing practice, Critical thinking skill works in assimilation with critical reasoning as a practice-based discipline of decision-making to the health care professionals. Critical thinking is the process of the intentional higher level of thinking to identify patient’s health care needs and appraise evidence-based practice to make choices in the delivery of care.

On the other hand, clinical reasoning as integrated to clinical thinking in application to clinical situation works as a cognitive process to utilized thinking strategies to gather and critically analyze the data concerning the health care needs of the patient, organized the information according to its prioritization, and formulate efficient nursing care plans to improve patient’s outcomes (Berman, et al., 2016).

“Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action”, a precise definition presented by Michael Scriven and Richard Paul at the Eighth Annual International Conference on Critical Thinking and Education Reform during the summer of 1987 (Lakhanigam, 2017).

Lakhanigam added the definition published by the Journal of Nursing Education in 2010 that describes critical thinking as the process involving interpretation and analysis of the problem, reasoning to find a solution, applying, and finally evaluation of the outcomes”. Regis College (2020), emphasized the use of deductive reasoning in observation, analyzing information, formulate conclusions, and performing appropriate actions in a self-directed process .

Theories on the Physiology of Thinking

From the ancient theory of “tabula rasa”, as describes in Wikipedia (2020) that humans are born without built-in mental content, and all knowledge is collected by the brain from experiences and perceptions. In this computer age, a neurologist discovered neurological pathways on how to re-program or reformat our brains like computers by analyzing how the brain appears to process, recognize, remember and transfer information at the level of neural circuits, synapses and neurotransmitters. Willis (2012) discussed the brain’s neuroplastic response to stimulation called neuroplasticity. The information is processed in the reflective and cognitive functions of prefrontal cortex wherein learning incorporated into networks of longterm conceptual memory.

Neuroplasticity is greatly affected by stress, boredom and frustration as seen in the neuroimaging scans of students showed that active metabolic states block the processing in the prefrontal cortex. In response to stress, the amygdala as the switching station became hyperactive resulting to switches of input and output away from the prefrontal cortex down to the control of the lower reactive brain, this response is called fight/flight/freeze (act out/zone out). In this situation, the lower brain’s reactive behaviours are in control. This will result in the loss of information access to the prefrontal cortex and new learning is not retained.

Elseways, Knowles (1984) four principles of andragogy of adult learning included (a.) experiences from mistakes that provide the basis for the learning activities; and (b.) the importance of problems and crisis, as adult learning is problem-centred rather than content-oriented; as well as (c.) involvement in the planning and evaluation of learning; and lastly, (d.) that adults are most interested in a subject that is relevant to their job and personal life.

Learning and thinking as applied in a higher-level context, Ausubel’s assimilation theory may recount the theories on critical thinking. In this theory, Ausubel claimed that learning occurs as a result of the interaction between the acquired learning and the cognitive structure in application to practice (Seel, 2012). Moreover, critical analysis and differentiation of interrelationships between concepts called concept mapping refines the knowledge into a more organized, precise, specific, and integrated learning.

In different circumstances, nursing as a professional working in a toxic environment of the sick, pained, hopeless, weak, and dying patients; bullying, queen bee syndrome, and seniority egoism of colleagues; and backbreaking workloads—have reported cases of work-related boredom and stress. The application of the three theories may improve mentoring-learning strategies in meaningful nursing education and training.

Theories on learning acquisition from the collection of information, physiologic processing on cognitive-reflective functions of the brain, concept mapping, and internal/external utilization of knowledge in application to critical thinking are the frameworks of a skilled critical thinker.

Characteristics of a Skilled Critical-Thinker

Health care system can go a long way, achieving a considerable success having employees that possess the ability to think critically thus decreasing errors in clinical judgments. For this purpose, every nurse is required to obtain the characteristics of an excellent skilled critical thinker.

The study of Scheffer and Rubenfeld revealed the common qualities among internationally diverse expert nurses from nine different countries supporting the idea of critical thinking in nursing that encompasses logic and reasoning (Berman, et. Al., 2016), and that includes:

11 Affective Components of a Skilled Critical-Thinker Nurse:

Perseverance
Open-mindedness
Flexibility
Inquisitiveness
Intellectual integrity
Perspective

7 Cognitive Skills of a Skilled Critical-Thinker Nurse:

Information seeking
Discriminating
Transforming knowledge
Applying standards
Logical reasoning

Critical Thinking Beyond Exigency and Expediency

Undeniably, nurses with critical thinking ability diversified with effective problem-solving and efficient decision-making skills are the most in-demand and highly valued in the field of the health care industry and academe.

As a nurse striding in the most complicated, stressful and multi-tasking job, you are responsible for making life-changing decisions under the pressure of time and emotions. These reasons as to why critical thinking skills in nursing practice plays a vital role in the care of the patient. Luna (2020), cited seven importance of critical thinking skills in the practice of nursing, such as:

Nurses’ Critical Thinking Heavily Impacts Patient Care
It’s Vital to Recognizing Shifts in Patient Status
It’s Integral to an Honest and Open Exchange of Ideas
It Allows You to Ensure Patient Safety
It Helps Nurses Find Quick Fixes and Troubleshooting
Critical Thinking can Lead to Innovative Improvements
It Plays a Role in Rational Decision Making

Critical thinking skill is needed in problems identification and implementation of interventions resulting in improved patients outcomes, as well as development in nursing practice by providing new insights on the learned knowledge. Feedback and reflections provide interconnections between nursing research , critical thinking and the nursing practice (Berman, et. Al., 2016).

Critical Thinking Skills: The Mastery, Update and Upgrade

Critical thinking skill is an ability beyond thinking rationally and clearly. It is a process of thinking independently and working at your own feet in formulating own opinions or new theory by utilizing critical analysis on the interrelationship of two or more ideas and delineating conclusions without external control (Wabisabi Learning, 2020).

Modified Wabisabi Learning’s 12 Solid Strategies for Teaching Critical Thinking Skills, and its Application to Nursing Education, Training and Practice:

1. Practice on Eloquence in Question and Answer (Solution Fluency)

Mastery requires ample amount of practice to become highly skilled in critical thinking. Accustom to deliberate open discussions encouraging brainstorming on issues affecting the practice and daily living by using explicit open-ended questions and comprehensive instructions for problem-solving may provide opportunities to apply knowledge into practice as well as encouraging the transfer of ideas between domains (Haber, 2020). Brainstorming is an excellent learning tool to exercise critical thinking (Walden University, 2020) particularly if applied in a situational crisis or a hospital scenario.

2. Create a Foundation

From the theory of back to basic, mastery of low-level skills is a requirement in preparatory to the application of critical thinking skills (Kaminske, 2019).

Learning experiences from theoretical and experiential knowledge are good foundations to start critical thinking. Moreover, practicing thinking skills obtained from theoretical and experiential undertakings improve intellectual ability (Berman, et. al., 2016). Practical understanding and specialization on a particular focus may excel you more in thinking critically. The competence and skills acquired from clinical experience are the most essential learning in developing clinical judgment.

3. Consult the Classics

Nursing theorists and their work are the best examples of consulting the classics. In critical thinking, nurses identify claims based on facts, conclusions, judgment/opinions and evidence-based practice. Exploring nursing theorists and their works are like exploring great minds, acquiring lessons on character motivation, refuting theories or formulating a new theory from existing theory. Case studies and in-depth objective critiques of nursing theories may not only promote critical thinking but act as a leverage to bridge the gap between theory and practice.

4. Create an Environment for Open Communication

During clinical rounds, nurses and/or students with a clinical instructor are engaged into thinking process by providing the opportunity to communicate assessment data, collaborate ideas, formulate nursing care plan, and discuss the various context of the situation from different perspectives (Di Vito-Thomas, 2005).

5. Use Information Fluency

Information fluency is mastering the proper use of information and to the ability to intuitively analyze and interpret it in unearthing knowledge and appropriate facts useful in solving a problem (Wabisabi Learning, 2020).

Knowledge of medical conditions, procedures and its connections to patient’s care are important in building critical thinking. Learning from available resources like medical journals, surfing the internet, and meaningful dialogue with colleagues can increase your medical know-how (Jillings, 2020).

6. Utilize Peer Groups

Peer groups, particularly well experienced and highly skilled colleagues are an excellent source of information, questions, and problem-solving techniques as it expands thinking and viewpoints. It also develops interpersonal skills like teamwork and resolving conflicts (Berman, et. Al., 2016).

7. Try One Sentence of Reflections at a time

Reflections will teach the learner to apply their knowledge, logic and reasoning by explaining themselves in a low-pressure setting. It provides an opportunity to explore situations with a different approach and better solutions for future use (Jillings, 2020).

The mastery of metacognition helps the learner to use reflection in defining clinical experiences and explore ways on how to improve it. Recollecting facts and events in patient’s care may integrate the learner into different concepts by connecting different ideas from one another (Di Vito-Thomas, 2005).

8. Problem-solving with Reasoning

Understanding rationale, the sets of reasons or logical basis for a course of action assist the learners to gain a broad knowledge of the topic and promotes a higher level of understanding. Problem-solving guided by rationale is a technique to the use of deductive and inductive reasoning in the thinking process (Di Vito-Thomas, 2005).

9. Roleplaying and Return Demonstration

Role-playing is a self-directed activity that encourages analytic and creative thinking. It helps the learner to internalize empathy while compromising in portraying a role or another persona creating a wider chance for memory retention.

Practice and repetition of observed procedures during return demonstration creates an avenue for re-thinking ways on how to do a task properly with ease in your own phase as you implement it by yourself.

10. Thinking and Speaking With Sketch (Concept Mapping)

Incorporating a concept with multiple perspectives and connecting complex ideas in a structured way to search for potential solutions. These processes create an abstract concept that encourages logical arguments used in critical thinking (Kaminske, 2019).

Interactive activities such as case study with a panel discussion, observing clinical dynamics during in-depth arguments, making a multidisciplinary joint care plan for patient promotes an environment for critical thinking thus facilitating the development of clinical judgment (Di Vito-Thomas, 2005).

11. Do Some Prioritizing and Decision-making

Make critical thinking as a culture and not just an activity by encouraging decision-making. Prioritizing through analyzing information, applying knowledge, and evaluating a prospected solution are the cornerstones of decision-making. This will allows the learner to apply learned theories to a different scenario by weighing the advantages and disadvantages of different solutions and option in deciding best practices.

12. Correct Misconceptions and Personal Bias

Personal beliefs greatly influence one’s ability to think critically as people always seek out ideas that conform to their own beliefs (Kaminske (2019). Several factors that act as the pitfalls in critical thinking are misconceptions, personal bias, and assumptions—which can bring a learner into a wrong direction. A discussion with colleagues who have mastery in evidence-based practice and conducting more in-depth investigations can give ideas and extends point of view (Jillings, 2020).

Conclusion and Suggestions:

Analytical skills through keen observation, understanding important data, and identifying a pattern of recognition; problem-solving capacity by connecting relationship of phenomena, data interpretation guided by significance and rationale; and use of reflection and evaluation abilities in formulating conclusion are the important factors in clinical judgment and decision-making.

Critical thinking is a learned skill resulted from a rolled-up innate curiosity in the application of strong theoretical and experiential foundations in solving clinical problems that direct to the best care decision, which produce positive patient outcomes and improve patient care services.

In this era of technological advancement where machine replaces almost of everything, critical thinking still plays an important role in the nursing practice. Nurses who can manipulate complex clinical situations with efficient skills on critical/analytical thinking, problem-solving and decision-making are often in the front line to compete for the position with greater autonomy and higher chances for opportunities.

Nightingale, F. (1860). Notes on Nursing: What it Is, and what it is Not. London: Harrisons & Sons.
Haber, J. (2020). It’s Time to Get Serious About Teaching Critical Thinking. Inside Higher Ed. Retrieved on 24 October 2020 from https://www.insidehighered.com/views/2020/03/02/teaching-students-think-critically-opinion
Walden University. (2020). 7 Ways to Teach Critical Thinking in Elementary Education. Retrieved on 24 October 2020 from https://www.waldenu.edu/online-bachelors-programs/bs-in-elementary-education/resource/seven-ways-to-teach-critical-thinking-in-elementary-education
Kaminske, A.N. (2019). Can We Teach Critical Thinking?. The Learning Scientists. Retrieved on 24 October 2020 from https://www.learningscientists.org/blog/2019/2/28/can-we-teach-critical-thinking#:~:text=beliefs%20(3).-,Can%20we%20teach%20critical%20thinking%3F,happens%20to%20enjoy%20science%20fiction
Berman, A., Snyder, S.J. & Frandsen, G. (2016). Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 10 th New Jersey: Pearson Education, Inc.
Lakhanigam, S. (2017). Critical Thinking: A Vital Trait for Nurses. Minority Nurse. Retrieved on 24 October 2020 from https://minoritynurse.com/critical-thinking-vital-trait-nurses/
Regis College (2020). How to Leverage Critical Thinking in Nursing Practice. Retrieved on 24 October 2020 from https://online.regiscollege.edu/blog/how-to-leverage-critical-thinking-in-nursing-practice/
(2020). Tabula Rasa. Retrieved on 24 October 2020 from https://en.wikipedia.org/wiki/Tabula_rasa
Willis, J. (2012). A Neurologist Makes the Case for Teaching Teachers About the Brain. George Lucas Educational Foundation. Retrieved on 24 October 2020 from https://www.edutopia.org/blog/neuroscience-higher-ed-judy-willis
Knowles, M. (1984). The Adult Learner: A Neglected Species, 3 rd Houston, TX: Gulf Publishing.
Seel, N.M. (2012). Assimilation Theory of Learning. In: Seel N.M. (eds) Encyclopedia of the Sciences of Learning. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1428-6_358
Luna, A. (2020). 7 Reasons Critical Thinking In Nursing Is Important. AMN Healthcare Company. Retrieved on 24 October 2002 from https://www.onwardhealthcare.com/nursing-resources/seven-reasons-critical-thinking-in-nursing-is-important/
Wabisabi Learning. (2020). 12 Solid Strategies for Teaching Critical Thinking Skills. Retrieved on 24 October 2020 from https://wabisabilearning.com/blogs/critical-thinking/teaching-critical-thinking-skills
Di Vito-Thomas, P. (2005). Nursing Student Stories on Learning How to Think Like a Nurse. Nurse Educator, 30(3), pp. 133-136.
Jillings, B. (2020). Critical Thinking in Nursing: Why It’s Important and How to Improve. AMN Healthcare Company. Retrieved on 24 October 2020 from https://www.americanmobile.com/mobile/NZArticle/?articleId=3346

Search form

Advanced search
Search responses
Search blogs
News & Views
Margaret McCartney:...

Nurses are critical thinkers

Rapid response to:

Margaret McCartney: Nurses must be allowed to exercise professional judgment

Related content
Article metrics
Rapid responses

Rapid Response:

The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.

The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.

As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier

The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report

Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.

NMC (2010) New Standards for Pre-Registration Nursing. London: Nursing and Midwifery Council.

Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465

Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)

Competing interests: No competing interests

Critical Thinking and the Nursing Process

In today’s health care arena, the nurse is faced with increasingly complex issues and situations resulting from advanced technology, greater acuity of patients in hospital and community settings, an aging population, and complex disease processes, as well as ethical and cultural factors. Traditionally, nurses have used a problem-solving approach in planning and providing nursing care. Today the decision-making part of problem solving has become increasingly complex and requires critical thinking.

Definition of Critical thinking

Critical thinking is a multidimensional skill, a cognitive or mental process or set of procedures. It involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. Critical thinking leads to the formulation of conclusions and the most appropriate, often creative, decisions, options, or alternatives. Critical thinking includes metacognition, the examination of one’s own reasoning or thought processes while thinking, to help strengthen and refine thinking skills. Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize information within the context in which it is presented. Nursing practice in today’s society mandates the use of high-level critical thinking skills within the nursing process. Critical thinking enhances clinical decision making, helping to identify patient needs and to determine the best nursing actions that will assist the patient in meeting those needs. Critical thinking and critical thinkers have distinctive characteristics. As indicated in the above definition, critical thinking is a conscious, outcome-oriented activity; it is purposeful and intentional. The critical thinker is an inquisitive, fair-minded truth seeker with an open-mindedness to the alternative solutions that might surface.

Critical thinking Process: Rationality and Insight

Critical thinking is systematic and organized. The skills involved in critical thinking are developed over time through effort, practice, and experience. Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Critical thinking requires background knowledge and knowledge of key concepts as well as standards of good thinking. The critical thinker uses reality-based deliberation to validate the accuracy of data and the reliability of sources, being mindful of and questioning inconsistencies. Interpretation is used to determine the significance of data that are gathered, and analysis is used to identify patient problems indicated by the data. The nurse uses inference to draw conclusions. Explanation is the justification of actions or interventions used to address patient problems and to help a patient move toward desired outcomes. Evaluation is the process of determining whether outcomes have been or are being met, and self-regulation is the process of examining the care provided and adjusting the interventions as needed. Critical thinking is also reflective, involving metacognition, active evaluation, and refinement of the thinking process. The critical thinker considers the possibility of personal bias when interpreting data and determining appropriate actions. The critical thinker must be insightful and have a sense of fairness and integrity, the courage to question personal ethics, and the perseverance to strive continuously to minimize the effects of egocentricity, ethnocentricity, and other biases on the decision making process.

Components of Critical thinking

Certain cognitive or mental activities can be identified as key components of critical thinking. When thinking critically, a person will do the following:

Ask questions to determine the reason why certain developments have occurred and to see whether more information is needed to understand the situation accurately.
Gather as much relevant information as possible to consider as many factors as possible.
Validate the information presented to make sure that it is accurate (not just supposition or opinion), that it makes sense, and that it is based on fact and evidence.
Analyze the information to determine what it means and to see whether it forms clusters or patterns that point to certain conclusions.
Draw on past clinical experience and knowledge to explain what is happening and to anticipate what might happen next, acknowledging personal bias and cultural influences.
Maintain a flexible attitude that allows the facts to guide thinking and takes into account all possibilities.
Consider available options and examine each in terms of its advantages and disadvantages.
Formulate decisions that reflect creativity and independent decision making.

Critical thinking requires going beyond basic problem solving into a realm of inquisitive exploration, looking for all relevant factors that affect the issue, and being an “out-of-the-box” thinker. It includes questioning all findings until a comprehensive picture emerges that explains the phenomenon, possible solutions, and creative methods for proceeding. Critical thinking in nursing practice results in a comprehensive patient plan of care with maximized potential for success.

Critical thinking In Nursing Practice

Using critical thinking to develop a plan of nursing care requires considering the human factors that might influence the plan. The nurse interacts with the patient, family, and other health care providers in the process of providing appropriate, individualized nursing care. The culture, attitude, and thought processes of the nurse, the patient, and others will affect the critical thinking process from the data-gathering stage through the decision-making stage; therefore, aspects of the nurse-patient interaction must be considered. Nurses must use critical thinking skills in all practice settings—acute care, ambulatory care, extended care, and in the home and community. Regardless of the setting, each patient situation is viewed as unique and dynamic. The unique factors that the patient and nurse bring to the health care situation are considered, studied, analyzed, and interpreted. Interpretation of the information presented then allows the nurse to focus on those factors that are most relevant and mostsignificant to the clinical situation. Decisions about what to do and how to do it are then developed into a plan of action.

Fonteyn (1998) identified 12 predominant thinking strategies used by nurses, regardless of their area of clinical practice:

Recognizing a pattern

Setting priorities
Searching for information
Generating hypotheses
Making predictions
Forming relationships
Stating a proposition (“if–then”)
Asserting a practice rule
Making choices (alternative actions)
Judging the value
Drawing conclusions
Providing explanations

Fonteyn further identified other, less prominent thinking strategies the nurse might use:

Posing a question
Making assumptions (supposing)
Making generalizations

These thought processes are consistent with the characteristics of critical thinking and cognitive activities discussed earlier. Fonteyn asserted that exploring how these thinking strategies are used in various clinical situations, and practicing using the strategies, might assist the nurse–learner in examining and refining his or her own thinking skills.

Throughout the critical thinking process, a continuous flow of questions evolves in the thinker’s mind. Although the questions will vary according to the particular clinical situation, certain general inquiries can serve as a basis for reaching conclusions and determining a course of action. When faced with a patient situation, it is often helpful to seek answers to some or all of the following questions in an attempt to determine those actions that are most appropriate:

What relevant assessment information do I need, and how do I interpret this information? What does this information tell me?
To what problems does this information point? Have I identified the most important ones? Does the information point to any other problems that I should consider?
Have I gathered all the information I need (signs/symptoms, laboratory values, medication history, emotional factors, mental status)? Is anything missing?
Is there anything that needs to be reported immediately? Do I need to seek additional assistance?
Does this patient have any special risk factors? Which ones are most significant? What must I do to minimize these risks?
What possible complications must I anticipate?
What are the most important problems in this situation? Do the patient and the patient’s family recognize the same problems?
What are the desired outcomes for this patient? Which have the highest priority? Does the patient see eye to eye with me on these points?
What is going to be my first action in this situation? How can I construct a plan of care to achieve the goals?
Are there any age-related factors involved, and will they require some special approach? Will I need to make some change in the plan of care to take these factors into account?
How do the family dynamics affect this situation, and will this have an affect on my actions or the plan of care?
Are there cultural factors that I must address and consider?
Am I dealing with an ethical problem here? If so, how am I going to resolve it?
Has any nursing research been conducted on this subject?

Nursing care of the dying.

opens in a new window

Nurse Career

5 Ways To Improve Critical Thinking in Nursing

Being an outstanding nurse requires an abundance of acquired skills used to communicate with healthcare teams, patients, and their families. Critical thinking tops this list and is essential for problem-solving and decision-making. To be successful, administrative and clinical nursing leaders must have rock solid critical thinking skills. The same goes when advancing in the nursing world.

Critical thinking allows you to question belief systems, test previously held assumptions, and recognize uncertainty as verification. Experts describe it as a person’s ability to identify problems and biases and infer and draw conclusions. As a nurse, it’s important to determine the relevance of all the information you’ve gathered. A good way to approach critical thinking is to apply it to the fundamental steps of the nursing process while assessing, diagnosing, planning, implementing, and evaluating.

Since nurses are often at patients’ bedsides, they usually are the first to notice issues. Nursing requires you to make clinical decisions through the view of several lenses like evidence-based practice, fairness, and ethics. It’s thinking beyond completing assigned tasks to deliver the best care. Critical thinking helps you anticipate and understand changes in a patient’s conditions.

Here are five ways you can improve your critical thinking as a nurse.

Awareness is the First Step

Today’s healthcare is intricate and dynamic; as a result, nurses need to make complex decisions to deliver safe and beneficial care. Successful critical thinkers demonstrate the ability to recognize their own biases and learn to spot them when they arise.

Being aware is the first step—only then can one determine if a personal bias is instrumental in making the wrong conclusion.

This is especially important for new nurses to recognize as they are so often overwhelmed by the transition from textbook learning to clinical practice. Fear and ego also inhibit the development of critical thinking competence. They can stop you from questioning things that might benefit the patient in the long run. Ways to combat this would be to treat each patient interaction as part of a whole and to problem-solve with colleagues.

Take a Care-based Approach

Each patient brings their own set of symptoms and medical history, so no two patients are identical. Ask questions like what information is missing that can fill in a gap or how quickly you need to act. This is where working with a mentor can be extremely helpful. Their guidance through case studies helps you stay in a learning mode environment, gathering data and reaching conclusions together to help keep an eye out for when personal biases might appear.

Welcome New Habits

When challenging situations present themselves, seek out the truth by investigating.

Consciously work to suspend your judgment and try to be open-minded toward other views. This increases your ability to work as a team, focusing on the goals and interests of the patients, ultimately enhancing the organization as a whole. Clinicians who view their relationships with patients more as partnerships are more likely to see patients as being on the same “team” and collaborate towards a shared goal.

Another tactic is to take a moment at the end of each workday to think about what did and didn’t go well, not just for you, but for others on your team. Can you learn from their mistakes? Did you make a decision too soon? Should you have waited a little longer before acting? If you lived your day in reverse, what would you have done differently? What could have gone better? These are questions that are easy to lose sight of during a hectic day. Taking time to assess is not only good for growth but stress management, too.

Confront Personal Bias

Analyzing and reflecting on your thinking process can lead to seeing personal biases.

Extensive research shows us that unconscious biases lead to different treatment of patients by race, gender, age, weight, income, language, and insurance status. Skills that can lower biases involve perspective-taking, which can inhibit unconscious stereotypes and prejudices. When healthcare team members are empathetic, it positively affects patient satisfaction. Nurses must learn to separate their own biases from each patient to avoid making false assumptions that might impede the quality of care.

Create a Foolproof Process

As you are actively working to develop critical thinking skills, creating a list can be helpful. Then you can check off each step. Below is an example of points to consider:

Are you asking enough questions? (Is there anything you don’t fully understand?)
How much information have you gathered?
Can you implement a strategy to remedy the situation?
When you evaluate the results, do they seem clear?
Have you considered another point of view?

Female nurse taking blood pressure of older female patient

How to Change Careers to Nursing

Medical-surgical nurse in an operating room looking at chart

5 Things You Need to Know About Medical-Surgical Nurses

Doctors and nursing smiling and talking with coffee

The Essential Role of Mentoring in Nursing Professional Development

We use cookies on our website to support technical features that enhance your user experience, and to help us improve our website. By continuing to use this website, you accept our privacy policy .

Student Login
Call Us: 888-549-6755
888-559-6763
Search site Search our site Search Now Close
Request Info

Skip to Content (Press Enter)

Why Critical Thinking Skills in Nursing Matter (And What You Can Do to Develop Them)

By Hannah Meinke on 07/05/2021

The nursing profession tends to attract those who have natural nurturing abilities, a desire to help others, and a knack for science or anatomy. But there is another important skill that successful nurses share, and it's often overlooked: the ability to think critically.

Identifying a problem, determining the best solution and choosing the most effective method to solve the program are all parts of the critical thinking process. After executing the plan, critical thinkers reflect on the situation to figure out if it was effective and if it could have been done better. As you can see, critical thinking is a transferable skill that can be leveraged in several facets of your life.

But why is it so important for nurses to use? We spoke with several experts to learn why critical thinking skills in nursing are so crucial to the field, the patients and the success of a nurse. Keep reading to learn why and to see how you can improve this skill.

Why are critical thinking skills in nursing important?

You learn all sorts of practical skills in nursing school, like flawlessly dressing a wound, taking vitals like a pro or starting an IV without flinching. But without the ability to think clearly and make rational decisions, those skills alone won’t get you very far—you need to think critically as well.

“Nurses are faced with decision-making situations in patient care, and each decision they make impacts patient outcomes. Nursing critical thinking skills drive the decision-making process and impact the quality of care provided,” says Georgia Vest, DNP, RN and senior dean of nursing at the Rasmussen University School of Nursing.

For example, nurses often have to make triage decisions in the emergency room. With an overflow of patients and limited staff, they must evaluate which patients should be treated first. While they rely on their training to measure vital signs and level of consciousness, they must use critical thinking to analyze the consequences of delaying treatment in each case.

No matter which department they work in, nurses use critical thinking in their everyday routines. When you’re faced with decisions that could ultimately mean life or death, the ability to analyze a situation and come to a solution separates the good nurses from the great ones.

How are critical thinking skills acquired in nursing school?

Nursing school offers a multitude of material to master and upholds high expectations for your performance. But in order to learn in a way that will actually equip you to become an excellent nurse, you have to go beyond just memorizing terms. You need to apply an analytical mindset to understanding course material.

One way for students to begin implementing critical thinking is by applying the nursing process to their line of thought, according to Vest. The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation.

“One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.”

Nursing students often find that there are multiple correct solutions to a problem. The key to nursing is to select the “the most correct” solution—one that will be the most efficient and best fit for that particular situation. Using the nursing process, students can narrow down their options to select the best one.

When answering questions in class or on exams, challenge yourself to go beyond simply selecting an answer. Start to think about why that answer is correct and what the possible consequences might be. Simply memorizing the material won’t translate well into a real-life nursing setting.

How can you develop your critical thinking skills as a nurse?

As you know, learning doesn’t stop with graduation from nursing school. Good nurses continue to soak up knowledge and continually improve throughout their careers. Likewise, they can continue to build their critical thinking skills in the workplace with each shift.

“To improve your critical thinking, pick the brains of the experienced nurses around you to help you get the mindset,” suggests Eileen Sollars, RN ADN, AAS. Understanding how a seasoned nurse came to a conclusion will provide you with insights you may not have considered and help you develop your own approach.

The chain of command can also help nurses develop critical thinking skills in the workplace.

“Another aid in the development of critical thinking I cannot stress enough is the utilization of the chain of command,” Vest says. “In the chain of command, the nurse always reports up to the nurse manager and down to the patient care aide. Peers and fellow healthcare professionals are not in the chain of command. Clear understanding and proper utilization of the chain of command is essential in the workplace.”

How are critical thinking skills applied in nursing?

“Nurses use critical thinking in every single shift,” Sollars says. “Critical thinking in nursing is a paramount skill necessary in the care of your patients. Nowadays there is more emphasis on machines and technical aspects of nursing, but critical thinking plays an important role. You need it to understand and anticipate changes in your patient's condition.”

As a nurse, you will inevitably encounter a situation in which there are multiple solutions or treatments, and you'll be tasked with determining the solution that will provide the best possible outcome for your patient. You must be able to quickly and confidently assess situations and make the best care decision in each unique scenario. It is in situations like these that your critical thinking skills will direct your decision-making.

Do critical thinking skills matter more for nursing leadership and management positions?

While critical thinking skills are essential at every level of nursing, leadership and management positions require a new level of this ability.

When it comes to managing other nurses, working with hospital administration, and dealing with budgets, schedules or policies, critical thinking can make the difference between a smooth-running or struggling department. At the leadership level, nurses need to see the big picture and understand how each part works together.

A nurse manager , for example, might have to deal with being short-staffed. This could require coaching nurses on how to prioritize their workload, organize their tasks and rely on strategies to keep from burning out. A lead nurse with strong critical thinking skills knows how to fully understand the problem and all its implications.

How will patient care be affected by having fewer staff?
What kind of strain will be on the nurses?

Their solutions will take into account all their resources and possible roadblocks.

What work can be delegated to nursing aids?
Are there any nurses willing to come in on their day off?
Are nurses from other departments available to provide coverage?

They’ll weigh the pros and cons of each solution and choose those with the greatest potential.

Will calling in an off-duty nurse contribute to burnout?
Was this situation a one-off occurrence or something that could require an additional hire in the long term?

Finally, they will look back on the issue and evaluate what worked and what didn’t. With critical thinking skills like this, a lead nurse can affect their entire staff, patient population and department for the better.

Beyond thinking

You’re now well aware of the importance of critical thinking skills in nursing. Even if you already use critical thinking skills every day, you can still work toward strengthening that skill. The more you practice it, the better you will become and the more naturally it will come to you.

If you’re interested in critical thinking because you’d like to move up in your current nursing job, consider how a Bachelor of Science in Nursing (BSN) could help you develop the necessary leadership skills.

EDITOR’S NOTE: This article was originally published in July 2012. It has since been updated to include information relevant to 2021.

Share on Facebook
Share on Twitter
Share on Pinterest
Share on LinkedIn

Request More Information

Talk with an admissions advisor today.

Fill out the form to receive information about:

Program Details and Applying for Classes
Financial Aid (for those who qualify)
Customized Support Services
Detailed Program Plans

There are some errors in the form. Please correct the errors and submit again.

Please enter your first name.

Please enter your last name.

There is an error in email. Make sure your answer has:

An "@" symbol
A suffix such as ".com", ".edu", etc.

There is an error in phone number. Make sure your answer has:

10 digits with no dashes or spaces
No country code (e.g. "1" for USA)

There is an error in ZIP code. Make sure your answer has only 5 digits.

Please choose a School of study.

Please choose a program.

Please choose a degree.

The program you have selected is not available in your ZIP code. Please select another program or contact an Admissions Advisor (877.530.9600) for help.

The program you have selected requires a nursing license. Please select another program or contact an Admissions Advisor (877.530.9600) for help.

Rasmussen University is not enrolling students in your state at this time.

By selecting "Submit," I authorize Rasmussen University to contact me by email, phone or text message at the number provided. There is no obligation to enroll. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

About the author

Hannah Meinke

Posted in General Nursing

nursing education

Nursing: Critical Thinking for Nurses

PICO(T) Questions
Basic Search Strategies
Advanced Strategies
Article Tools
How to Read a Research Article
Specific Journal Search
Other Nursing Resources

Critical Thinking for Nurses

Nursing Diagnosis
EBP-Crash Course
Free Nursing Journals
Nursing Theories

Article Citation: Morris, G. (2021).The Value of Critical Thinking in Nursing. Nurse Journal. https://nursejournal.org/articles/the-value-of-critical-thinking-in-nursing/

Some experts describe a person's ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking, whereas others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

How Do Nurses Use Critical Thinking?

Nurses are responsible for the care of multiple patients during their shifts. Strong critical thinking skills are crucial when juggling a variety of tasks so patient safety and care are not compromised.

Dr. Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talked about examples of critical thinking in a healthcare environment, saying:

"Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe."

The pandemic of 2020-2021 created hospital care situations where critical thinking was essential and expected of the nurses on the general floor and in intensive care units. Dr. Crystal Slaughter is an advanced practice nurse in the ICU and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

"Nurses are at the patient's bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider," she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

1. Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills. In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. "What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?"

2. Practice Self-Reflection

Rhoads is an advocate for self-reflection. "Nurses should reflect upon what went well or did not go well in their workday, and identify areas of improvement or situations in which they should have reached out for help." Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded. It's important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer but often will help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

3. Develop a Questioning Mind

McGowan has learned that "critical thinking is a self-driven process. It isn't something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive."

In other words, to acquire critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind . Meaningful questions lead to useful answers and are at the core of critical thinking.

However, learning to ask insightful questions is a skill you must develop. Faced with staff shortages, declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than complete the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a nonstressful, quiet environment until it becomes a habit. Then, in the chaos of the moment when your patient's care depends on your ability to ask the right question, you are ready to rise to the occasion.

4. Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you're struggling to finish every task needed for your patients. Passing medication, changing dressings, and hanging IVs all while trying to assess your patient's mental and emotional status can affect your focus.

Staying present helps you to be proactive in your thinking and anticipate what might happen. For example, bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information on which to base your interventions and decisions.

5. Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

Ask Questions
Gather Information
Implement a Strategy
Evaluate the Results
Consider Another Point of View

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what's happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases on the top of his list of common pitfalls to critical thinking in nursing.

"We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care," he states. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, which can lead to a task-oriented mindset; this conflicts with critical thinking skills. "Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient's blood pressure because medication administration is a task that must be completed," Slaughter states. "A nurse employing critical thinking skills would address the low blood pressure, review the patient's blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld."

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgement when you're faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that ultimately would benefit the patient. Nurses with strong critical thinking skills exhibit the following:

Learn from their mistakes and the mistakes of other nurses
Look forward to integrating changes that improve patient care
Treat each patient interaction as a part of a whole
Evaluate new events based on past knowledge and adjust decision-making as needed
Solve problems with their colleagues
Are self-confident
Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE, is a core faculty member in Walden University's RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Dr. Slaughter's clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Dr. Jenna Liphart Rhoads Ph.D., RN

Dr. Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care , interventional radiology procedures, and conscious sedation in adult and pediatric populations.

<< Previous: Other Nursing Resources
Next: Nursing Diagnosis >>
Last Updated: Jul 10, 2024 9:10 AM
URL: https://wallawallacc.libguides.com/nursing

The One Thing Every Nurse Educator Must Do to Develop Critical Thinking

Keith Rischer – Ph.D., RN, CCRN, CEN

As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…

The Ultimate Solution to Develop Clinical Judgment Skills

KeithRN’s Think Like a Nurse Membership

Access exclusive active learning resources for faculty and students, including KeithRN Case Studies, making it your go-to resource.

Sign up to receive a free KeithRN NextGen Case Study!

Develop clinical judgment skills with this innovative new case study on asthma to prepare your students for nextgen nclex and practice.

" * " indicates required fields

Keith Rischer

Why nursing education fails to prepare most students for practice, recommended for you.

APPLY ONLINE

Find Work Fast

1300 301 493

Call 1300 301 493, critical thinking in nursing: 8 tips on how it is important.

Critical thinking in nursing is a vital skill that is often overlooked. This is a shame because nursing can literally involve life and death decisions – all of which would benefit from critical thinking. Read this blog to find out about the importance of critical thinking in nursing.

What is Critical Thinking?

Critical thinking is a very simple term for a very complex mindset. Broadly speaking, it is examining your own thought processes and identifying any narrow-mindedness, bias, assumptions or oversights. By being aware of these influences over how you think, you can evaluate them and ensure that you are making a decision based on logic, reason and evidence.

While no one can completely remove influencing factors, by being self-aware and practising critical thinking you can make decisions that you feel comfortable about.

There are two forms of critical thinking , with differing levels of difficulty.

1. General Critical Thinking

General critical thinking is a skill set that you can apply to any situation. It is mostly determined by your self-awareness, and some people have higher natural affinities for it than others. The reason it is so difficult is because there are basic skills that need to be known before you can be effective at critical thinking.

For example, it is difficult to identify a biased opinion if you have no general knowledge about the subject in the first place.

2. Domain-Specific Critical Thinking

Domain-specific critical thinking is easier to learn and practise. Just by becoming a nurse, you will have amassed a huge knowledge base about nursing.

Armed with this knowledge, you’ll find it much easier to spot flaws in your reasoning while you are working. Domain-specific is also easier to practise because you are constantly facing opportunities to refine your thinking as you go about your workday.

Now you know the difference between the two forms of critical thinking, find out more about critical thinking in nursing.

8 Steps on How to Use Critical Thinking in Nursing

The Australian College of Nursing has created an 8-step process for nurses to follow if they want to apply critical thinking in nursing.

The steps on critical thinking in nursing are as follows :

Look : look at, and assess, the patient
Collect : gather any available information about the patient
Process : analyse the information and make your interpretations
Decide/Identify : diagnose the patient based on the evidence
Plan : decide what outcome you believe is achievable
Act : Make a treatment plan and act on it
Evaluate : review the patient’s progress and condition
Reflect : identify opportunity areas and how you will learn from them

This process may seem overly time-consuming, but the more you do it the faster it will be. Eventually, most of these steps on critical thinking in nursing will happen subconsciously.

8 Tips on the Application of Critical Thinking in Nursing.

Critical thinking makes you better at a variety of skills, like decision making and problem solving. It also helps you avoid common unhelpful mental processes that stop you from reaching your full potential.

1. Objectivity

While nursing is a job that requires emotional intelligence and compassion, it is important that treatment decisions are made objectively. By using critical thinking to focus on the facts before you, rather than on assumptions or biases, you can make sure your decisions are correct.

2. Decision Making Clarity

By stripping away influences like bias and personal opinion, decisions are easier to make with critical thinking. This is because they are evidence and logic based, rather than emotional. By removing the emotional response, you will feel less doubt and avoid second-guessing yourself, which will let you make decisions faster.

3. Teamwork and Feedback Acceptance

Teamwork is crucial to providing proper patient care. By using critical thinking to reflect on criticism and feedback, you can separate useful information from your emotional response.

By not letting hurt feelings and a sense of inadequacy or disappointment spoil the message, not only can you improve yourself based on your teams’ feedback, you can learn how to provide valuable feedback to others in return. While an individual critical thinker is great, a team of critical thinkers is unbeatable.

4. Integrity

The great thing about critical thinking in nursing is that you can use it to hold yourself accountable. Critical thinkers are constantly examining their own beliefs and ethics. Because of that, If you are instructed to do something you believe is incorrect or wrong, you will have the confidence to question it.

You’ll find it much easier to stand up for your convictions when they are clear to you.

5. Curiosity and Problem Solving

Once you begin to tear down assumptions in favour of evidence, you’ll naturally start to become more curious. After all, the more evidence you have, the more accurate your decisions can be.

For most people, it is compelling to maintain the status quo. Once you realise that you are simply following the crowd, you will begin to think outside the box to see if different methods could be more efficient or lead to improved patient outcomes.

6. Perseverance

As your critical thinking abilities develop, you’ll become aware of when you are opting for the path of least resistance. This could be a shortcut in a patient’s treatment or avoiding confronting a colleague over poor performance.

Nurses who use critical thinking are perseverant because they don’t cut corners – they keep going until they find the right solution.

7. Avoid Becoming Trapped in Tradition

A common phenomenon in hospitals is the appeal of tradition. Doing something “because that’s the way it has always been done” can be commonplace because of the mix of ages and experience levels that can be present in a ward. Critical thinking is ideal for avoiding doing something just because it is traditional.

With critical thinking, you can determine whether a tradition is valuable or not by considering it from an impartial, evidence-based point of view.

While that may seem like a lot of different skills to learn, remember that critical thinking is an ongoing, lifelong attempt at self-improvement.

8. Employers Love Critical Thinking in Nursing

Another great benefit of critical thinking in nursing is how great it looks on your resume. Employers love critical thinkers because they know that they are consistent, trustworthy, principled and committed to personal development. Most of all, it shows you are capable of working autonomously.

Learn more about the value of autonomy in nursing.

Nurse agencies in particular place a high value on critical thinking. Agency nurses are able to manage their own schedules and may work across multiple healthcare fields. When they see critical thinking on a resume, they know that the applicant can work independently and that they will bring their own set of standards to any workplace.

If you are considering joining a nursing agency, Nurses Now is the perfect choice. They pride themselves on their values and high standards, so you can rest assured that you are among professionals who embody all the positive traits of critical thinking in nursing.

To learn more about Nurses Now, see our website.

To apply, get in touch today.

Clinical Reasoning In Nursing (Explained W/ Example)

Clinical Reasoning In Nursing-examples-critical-thinking

Last updated on August 19th, 2023

In this article, we will cover:

What is Clinical Reasoning?

Definition of clinical reasoning in nursing.

What is the concept of clinical reasoning?

Why is Clinical Reasoning Important in Nursing?

What are the types of clinical reasoning, what are the three elements of clinical reasoning, what are the steps of clinical reasoning, what is the importance of clinical reasoning and judgement in nursing, what is the difference between critical thinking and clinical reasoning, clinical reasoning in nursing example.

Clinical reasoning refers to the cognitive process that healthcare professionals, such as doctors, nurses, and other clinicians, use to analyze and make decisions about a patient’s condition and appropriate treatment.

It’s a complex and dynamic process that involves gathering and interpreting information from various sources, including patient history, physical examinations, laboratory tests, imaging studies, and the clinician’s own experience and knowledge.

Medicine, physical therapy, and occupational therapy were the first to introduce clinical reasoning to the healthcare disciplines. Since then, the nursing profession has used these strategies to improve patient care.

What is Clinical Reasoning in Nursing?

Clinical reasoning in nursing is dynamic and adaptive, as nurses continuously gather new information and adjust care plans based on patient responses.

It’s a crucial skill that guides nurses in providing safe, effective, and patient-centered care. Clinical reasoning involves the integration of clinical knowledge, critical thinking , and experience to address the complex and dynamic nature of patient situations.

It involves balancing medical knowledge with critical thinking , empathy, and ethical considerations to provide comprehensive and compassionate patient care.

Clinical reasoning in nursing refers to the cognitive process that nurses use to collect and assess patient information, analyze data, make informed judgments, and develop appropriate care plans.

What is the Concept of Clinical Reasoning?

Clinical reasoning is the cognitive process used by healthcare professionals to make informed decisions regarding patient care.

It encompasses tasks such as collecting information, analyzing data, identifying patterns, generating hypotheses, and making judgments for diagnosis and treatment.

Clinical reasoning blends science and intuition in medical practice. It combines evidence-based knowledge with experience-derived judgment to attain accurate diagnoses and treatments while addressing uncertainties.

As an essential component of clinical practice, clinical reasoning guides healthcare providers in delivering safe and effective patient care.

Clinical reasoning is important in nursing for several reasons. Some reasons are listed below.

Patient-Centered Care:

Clinical reasoning helps nurses tailor care plans to individual patients, considering their unique needs, preferences, and circumstances, leading to more personalized and effective care.

Safe and Effective Care:

It ensures that nurses make well-informed decisions based on thorough assessments, reducing the risk of errors and promoting patient safety.

Optimal Outcomes:

Through clinical reasoning, nurses can identify early signs of complications, make timely interventions, and contribute to better patient outcomes.

Nurtured Critical Thinking:

Clinical reasoning cultivates nurses’ critical thinking abilities, empowering them to dissect complex situations, appraise evidence, and make rational choices.

Efficient Resource Utilization:

It helps nurses prioritize care tasks, allocate resources effectively, and manage time efficiently, enhancing workflow and patient care delivery.

Evidence-Based Practice:

Nursing practice is constantly evolving with new research and evidence. Clinical reasoning involves integrating the latest evidence-based knowledge into decision-making, ensuring that care plans are aligned with the best available practices.

Complex Cases:

Nurses often encounter intricate patient cases; clinical reasoning equips them to navigate complexity, address multiple issues, and make comprehensive care plans.

Interdisciplinary Collaboration:

Effective clinical reasoning supports collaboration with other healthcare professionals, promoting well-rounded patient care.

Adaptation to Change:

In rapidly changing healthcare environments, clinical reasoning enables nurses to adapt to new information, technologies, and practices.

Critical Decision-Making:

Nurses face complex situations where quick and accurate decisions are critical. Clinical reasoning equips them with the ability to analyze data, identify patterns, and generate hypotheses. This enables nurses to make informed decisions about interventions, medications, and treatments, leading to effective care.

Early Detection and Prevention:

Through clinical reasoning, nurses can detect subtle changes in a patient’s condition that might signal complications or deterioration. This allows for early interventions, preventing potential health crises and improving patient prognosis.

Error Reduction:

Clinical reasoning encourages systematic thinking, reducing the likelihood of errors in administering medications, performing procedures, and assessing patients. This promotes patient safety and prevents adverse events.

Holistic Care:

Patient’s health is influenced by various factors beyond just medical conditions. Clinical reasoning enables nurses to consider the social, emotional, and psychological aspects of patients, promoting holistic care and overall well-being.

Ethical Dilemmas:

Nursing often involves ethical challenges. Clinical reasoning guides nurses in making ethically sound decisions by considering patients’ autonomy, values, and cultural beliefs.

Communication and Collaboration:

Clinical reasoning enhances nurses’ ability to communicate effectively with patients, families, and other healthcare professionals. It fosters collaboration by enabling nurses to articulate their assessments, interventions, and rationales clearly.

Professional Growth:

Developing strong clinical reasoning skills enhances nurses’ professional growth. It increases their confidence, competence, and ability to take on more complex patient cases and leadership roles.

In summary , clinical reasoning is an important component of nursing practice, allowing nurses to provide safe, effective, and patient-centered care.

It enables nurses to make informed decisions, improve patient outcomes, and navigate the dynamic and complex healthcare setting.

Clinical reasoning involves three key elements that healthcare professionals integrate to make informed decisions about patient care:

1. Patient Information:

This element encompasses all the relevant data about the patient’s medical history, current condition, symptoms, physical examination findings, diagnostic test results, and social and contextual factors.

Gathering comprehensive and accurate patient information is essential for forming an accurate understanding of the patient’s health status and needs.

2. Clinical Knowledge and Expertise:

Healthcare professionals draw upon their extensive medical knowledge, clinical experience, and expertise to interpret patient information.

This knowledge includes an understanding of anatomy, physiology, pathophysiology, pharmacology, and medical guidelines.

Clinical expertise is built over years of practice, exposure to a variety of cases, and ongoing learning.

3. Critical Thinking and Decision-Making Skills:

Critical thinking involves the analytical and logical thought processes that healthcare professionals use to evaluate patient information in the context of their clinical knowledge.

It includes the ability to identify patterns, assess potential diagnoses, consider alternative explanations, and weigh the pros and cons of different treatment options.

Effective decision-making is the outcome of critical thinking , as healthcare professionals choose the most appropriate course of action based on the available information.

These three elements are interdependent and work together to form the foundation of clinical reasoning.

Healthcare professionals integrate patient information with their clinical knowledge and expertise while applying critical thinking skills to reach accurate diagnoses, develop effective treatment plans, and provide high-quality patient care.

The balance between these elements varies based on the complexity of the clinical situation and the healthcare provider’s level of experience and expertise.

8 Stages of the Clinical Reasoning Cycle

Clinical reasoning involves several key steps:

1. Data Collection: Gathering relevant information about the patient’s medical history, symptoms, physical examination findings, and any diagnostic tests that have been conducted.

2. Pattern Recognition: Recognizing patterns and relationships in the collected data to identify potential diagnoses or issues. This involves comparing the patient’s presentation to previous cases and medical knowledge.

3. Hypothesis Generation: Formulating hypotheses or possible explanations for the patient’s condition based on the patterns and information observed. This step often involves generating a list of potential diagnoses that fit the available evidence.

4. Differential Diagnosis: Narrowing down the list of potential diagnoses by considering the likelihood of each condition and ruling out less likely options. This is where critical thinking and medical knowledge come into play.

5. Testing and Validation: Ordering further diagnostic tests or investigations to confirm or rule out specific diagnoses. This could include blood tests, imaging studies, biopsies, or other procedures.

6. Synthesis: Integrating the results of diagnostic tests and additional information to refine the diagnosis and treatment plan. This may involve adjusting the initial hypotheses based on new data.

7. Treatment Planning: Developing a comprehensive treatment plan that addresses the diagnosed condition, the patient’s unique circumstances, preferences, and any potential risks or benefits of various treatment options.

8. Monitoring and Adaptation: Continuously monitoring the patient’s progress and adjusting the treatment plan as needed based on how the patient responds and any new information that emerges.

Clinical reasoning requires a deep understanding of medical science, anatomy, physiology, and pathology, as well as the ability to apply this knowledge to real-world clinical scenarios.

It also involves critical thinking skills , logical reasoning, and the ability to handle uncertainty, as medical situations can be complex and patients may present with atypical symptoms.

Overall, clinical reasoning is a crucial skill for healthcare professionals, as it forms the foundation for making accurate diagnoses and providing effective patient care.

Clinical reasoning and judgment are of paramount importance in nursing for several reasons:

Accurate Diagnosis and Treatment: Effective clinical reasoning enables nurses to accurately assess patients’ conditions, identify potential problems, and make informed decisions about appropriate interventions and treatments. Accurate diagnosis and treatment are crucial for improving patient outcomes and preventing complications.
Patient Safety: Sound clinical judgment helps nurses recognize potential risks and make timely interventions to ensure patient safety. By identifying early signs of deterioration or complications, nurses can take appropriate actions to prevent adverse events.
Individualized Care: Clinical reasoning allows nurses to tailor care plans to each patient’s unique needs, preferences, and circumstances. This patient-centered approach improves patient satisfaction and contributes to better treatment outcomes.
Early Detection of Changes: Nurses often spend the most time with patients, which puts them in a prime position to notice subtle changes in a patient’s condition. Strong clinical reasoning skills enable nurses to detect these changes early and respond appropriately.
Effective Communication: Nurses with strong clinical reasoning skills can communicate more effectively with patients, families, and interdisciplinary healthcare teams. They can convey complex medical information, treatment plans, and concerns in a clear and organized manner.
Ethical Decision-Making: Clinical reasoning includes ethical considerations in decision-making. Nurses must weigh the ethical implications of their actions and decisions, especially when faced with complex situations that involve moral dilemmas.
Resource Utilization: Effective clinical reasoning helps nurses allocate resources efficiently. By accurately assessing patient needs and prioritizing care, nurses can optimize the use of time, personnel, and equipment.
Adaptation to Change: Healthcare is dynamic, and patients’ conditions can change rapidly. Nurses with strong clinical reasoning skills can adapt quickly to changing situations, making necessary adjustments to care plans and interventions.
Continuity of Care: Nurses often play a critical role in ensuring continuity of care as patients transition between different healthcare settings. Effective clinical reasoning facilitates clear communication of patient information and ensures a smooth transition of care.
Professional Growth: Developing clinical reasoning and judgment skills enhances a nurse’s professional growth. These skills are transferrable and applicable across various healthcare settings, allowing nurses to provide high-quality care regardless of the environment.
Confidence and Job Satisfaction: Nurses who feel confident in their clinical reasoning abilities experience greater job satisfaction. Confidence comes from knowing that decisions are based on a solid foundation of knowledge, experience, and critical thinking.
Advocacy: Nurses with strong clinical reasoning skills can effectively advocate for their patients, ensuring that their needs are met, their voices are heard, and their rights are respected within the healthcare system.
Quality Improvement: Clinical reasoning plays a role in quality improvement efforts by identifying areas for improvement in patient care processes and outcomes.

In summary, clinical reasoning and judgment are essential for nurses to provide safe, effective, and patient-centered care.

These skills underpin the entire nursing process, enabling nurses to make informed decisions, communicate effectively, and positively impact patient outcomes and experiences.

Critical Thinking :

Critical thinking is a cognitive process that involves analyzing, evaluating, and synthesizing information, ideas, and arguments to make reasoned judgments and decisions.

It is a broader skill applicable to various aspects of life and professions, encouraging logical, evidence-based thinking and minimizing biases.

Critical thinking aims to enhance problem-solving, decision-making, and analytical abilities in a wide range of contexts beyond healthcare.

Clinical Reasoning:

Clinical reasoning, on the other hand, is a specialized form of critical thinking that is primarily focused on healthcare and clinical situations.

It specifically pertains to the cognitive process healthcare professionals, especially nurses and doctors, use to collect, assess, analyze, and apply information to make informed clinical judgments and decisions.

Clinical reasoning is crucial for providing safe and effective patient care, as it integrates medical knowledge, patient assessments, ethical considerations, and treatment planning.

Critical Thinking vs. Clinical Reasoning


	The ability to analyze, evaluate, and synthesize information, ideas, and arguments to make reasoned judgments and decisions.	The cognitive process of collecting, assessing, analyzing, and applying information to make informed clinical judgments and decisions.
	Broadly applicable to various aspects of life and professions.	Primarily focused on healthcare and clinical situations.
	Applied to diverse contexts and disciplines.	Applied specifically to patient care scenarios, diagnostics, and treatment planning in healthcare.
	Applies beyond the clinical setting.	Primarily relevant within the healthcare context.
	Enhances general problem-solving, decision-making, and analytical skills.	Supports safe and effective patient care by integrating medical knowledge, assessments, and ethical considerations.
	Can be developed and honed through practice, reflection, and exposure to various ideas.	Developed through clinical experience, education, and applying knowledge to actual patient cases.
	Evaluating the credibility of news sources, identifying fallacies in arguments, and analyzing the pros and cons of an issue.	Diagnosing a patient’s condition based on symptom presentation, medical history, and diagnostic tests.
	Encourages logical, evidence-based thinking, minimizing bias, and informed decision-making.	Leads to appropriate and well-informed interventions, improved patient outcomes, and enhanced patient safety.

Clinical reasoning can be categorized into different types or approaches. Each of which represents a particular way of thinking and making decisions in clinical practice.

Some of the commonly recognized types of clinical reasoning include:

Deductive Reasoning: This type of reasoning starts with a general principle or theory and applies it to a specific case. Healthcare professionals use deductive reasoning to make predictions or decisions based on established medical knowledge. For example, if a patient presents with a set of symptoms consistent with a well-known disease, the clinician may deduce that the patient likely has that disease.
Inductive Reasoning: In contrast to deductive reasoning, inductive reasoning involves making generalizations or conclusions based on specific observations or cases. Clinicians use inductive reasoning to form hypotheses or theories from individual patient experiences. For instance, a nurse may notice a pattern of symptoms in several patients and develop a hypothesis about a potential new condition.
Abductive Reasoning: Abductive reasoning combines elements of both deductive and inductive reasoning. It involves making educated guesses or hypotheses to explain observations or data that don’t fit neatly into established patterns. Clinicians use abductive reasoning when they encounter cases that don’t seem to fit existing diagnoses or models, and they generate plausible explanations to guide further investigation.
Analytical Reasoning: This type of reasoning involves systematically breaking down a complex situation or problem into smaller parts to understand its components and relationships. Healthcare professionals use analytical reasoning to dissect complex patient cases, focusing on details and relationships to arrive at a diagnosis or treatment plan.
Intuitive Reasoning: Intuitive reasoning relies on a healthcare professional’s experience, intuition, and gut feeling. It involves drawing on one’s own clinical experience and recognizing patterns that may not be immediately apparent. Intuitive reasoning is often employed in situations where rapid decision-making is necessary.
Procedural Reasoning: Procedural reasoning focuses on the steps or processes needed to manage a clinical situation. It involves thinking about the sequence of actions required to address a patient’s needs. For example, a nurse may use procedural reasoning when administering medications, performing wound care, or carrying out other routine clinical procedures.
Narrative Reasoning: Narrative reasoning involves considering the patient’s story, values, and context as essential components of clinical decision-making. It emphasizes understanding the patient’s perspective and tailoring care plans to the individual’s unique circumstances.
Hypothetico-Deductive Reasoning: This approach involves generating and testing hypotheses systematically to arrive at a diagnosis. Healthcare professionals consider various possible diagnoses, then order specific tests to confirm or rule out each hypothesis.
Pattern Recognition Reasoning: This type of reasoning relies on recognizing familiar patterns based on clinical experience and knowledge. Healthcare providers quickly identify common clinical presentations and apply established treatment protocols.

Emily Davis, a 68-year-old woman, is admitted to the medical unit with a diagnosis of Acute Exacerbation of COPD. She has a history of chronic obstructive pulmonary disease (COPD) and has been experiencing increased shortness of breath, cough, and decreased oxygen saturation levels.

How does your understanding of nursing fundamentals influence your clinical reasoning?

Nursing Action:

• Reflect on the nursing care provided to patients with COPD and respiratory distress.

• Review the pharmacologic treatments that will improve the patient’s COPD.

• Reflect the non-pharmacologic measures that will help to improve the patient’s respiratory distress.

• Determine the most appropriate assessments and interventions for managing respiratory distress in patients with COPD.

Implementation of Interventions:

• Assess Emily’s respiratory rate, depth, and effort, as well as oxygen saturation levels.

• Administer prescribed bronchodilators, and nebulization to improve airway patency.

• Elevate the head of the bed to promote better lung expansion.

• Encourage deep breathing exercises and effective coughing techniques.

• Consult with the physician to determine pharmacologic therapy

• Monitor Emily’s response to interventions and adjust care as needed. How does your understanding of pathophysiology guide your clinical reasoning?

• Knowledge of COPD’s pathophysiology helps anticipate complications and tailor interventions.

In this scenario, the nurse’s grasp of nursing fundamentals enables them to provide appropriate care for a patient with COPD.

By considering the patient’s history and symptoms, the nurse takes action to manage respiratory distress.

Implementing interventions such as bronchodilators and elevation of the head of the bed aligns with nursing knowledge.

Additionally, understanding the pathophysiology of COPD aids in predicting potential complications and choosing interventions to support the patient’s respiratory function.

What is Critical Thinking in Nursing? (Explained W/ Examples)
How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples
What Are Socratic Questions?
What is the “5 Whys” Technique?
15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

Clinical reasoning in nursing involves the skillful integration of medical knowledge, critical thinking , and patient assessment to make informed decisions about patient care.

It enables nurses to provide safe, effective, and patient-centered interventions while considering individual needs and complex healthcare situations.

Comments are closed.

Medical & Legal Disclaimer

All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. However, we aim to publish precise and current information. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Read the privacy policy and terms and conditions.

Terms & Conditions

Visit Nurse.com on Facebook
Visit Nurse.com on YouTube
Visit Nurse.com on Instagram
Visit Nurse.com on LinkedIn

IMAGES

Why Critical Thinking Skills in Nursing Matter (And What You
Chapter 2 Critical thinking and Nursing Process Diagram
What Is Critical Thinking in Nursing?
Critical thinking in nursing
7 Reasons Critical Thinking in Nursing is Important
The Nursing Process and Critical Thinking (Step by Step)

COMMENTS

What is Critical Thinking in Nursing? (With Examples, Importance, & How
The following are examples of attributes of excellent critical thinking skills in nursing. 1. The ability to interpret information: In nursing, the interpretation of patient data is an essential part of critical thinking. Nurses must determine the significance of vital signs, lab values, and data associated with physical assessment.
Critical Thinking in Nursing: Developing Effective Skills
Here are five ways to nurture your critical-thinking skills: Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice. That knowledge helps you make informed decisions in stressful moments. Practice reflection.
The Value of Critical Thinking in Nursing
Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood ...
Critical Thinking: The Development of an Essential Skill for Nursing
Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis ...
What is Critical Thinking in Nursing? (Explained W/ Examples)
In summary, critical thinking is an integral skill for nurses, allowing them to provide high-quality, patient-centered care by analyzing information, making informed decisions, and adapting their approaches as needed. It's a dynamic process that enhances clinical reasoning, problem-solving, and overall patient outcomes.
Critical thinking in nursing clinical practice, education and research
Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing ...
Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and
Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, and clinical judgment. The high-performance expectation of nurses is dependent upon the nurses' continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities.
Critical Thinking in Nursing: Key Skills for Nurses
Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Interpretation: Understanding the meaning of information or events. Analysis: Investigating a course of action based on objective and subjective data. Evaluation: Assessing the value of ...
How To Improve Critical Thinking Skills In Nursing? 24 Strategies With
2. Meeting with Colleagues: Collaborative Learning for Critical Thinking. Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills. Colleagues' insights can challenge assumptions and broaden ...
Creative Ways to Enhance and Assess Critical Thinking in... : Nursing
The concepts from an escape room are a great way to deliver opportunities for students to practice this skill and can be provided economically and easily. Being creative in managing these concepts will offer an exciting chance to introduce critical thinking for your students. Nursing Education Perspectives42 (6):E145-E146, November/December 2021.
Why Critical Thinking Is Important in Nursing
Nurses' critical thinking has a significant impact on patient care. Recognizing changes in patient status is essential. It's essential to an honest and open exchange of ideas. It enables you to ensure patient safety. Nurses can find quick fixes with it. Improvements can be made through critical thinking.
The Critical Thinking Skills In The Nursing Practice
Undeniably, nurses with critical thinking ability diversified with effective problem-solving and efficient decision-making skills are the most in-demand and highly valued in the field of the health care industry and academe. As a nurse striding in the most complicated, stressful and multi-tasking job, you are responsible for making life ...
Nurses are critical thinkers
Nurses are critical thinkers. The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice.
Critical Thinking and the Nursing Process
Critical thinking is a multidimensional skill, a cognitive or mental process or set of procedures. It involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. Critical thinking leads to the formulation ...
Critical Thinking Skills in Nursing: Definition and ...
Tips to improve your critical thinking skills in nursing. Here are several tips to enhance your critical thinking skills as a nurse: 1. Ask patients open-ended questions. It's important to give all patients the same standard of care. Asking patients to elaborate on their medical history or point of view may help you communicate more effectively ...
What Are 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 ...
5 Ways To Improve Critical Thinking in Nursing
A good way to approach critical thinking is to apply it to the fundamental steps of the nursing process while assessing, diagnosing, planning, implementing, and evaluating. Since nurses are often at patients' bedsides, they usually are the first to notice issues. Nursing requires you to make clinical decisions through the view of several ...
Why Critical Thinking Skills in Nursing Matter (And What You
The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation. "One of the fundamental principles for developing critical thinking is the nursing process," Vest says. "It needs to be a lived experience in the learning environment.". Nursing students often find that there are multiple correct ...
Critical Thinking for Nurses
Critical Thinking for Nurses. Some experts describe a person's ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking, whereas others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions ...
The One Thing Every Nurse Educator Must Do to Develop Critical Thinking
Filter everything you teach and use the principle of clinical reasoning to capture the ESSENCE of what is the one thing students must take away and never forget to think like a nurse. For example, I expected my students to know only one thing about pharmacology and the meds they passed in clinical. State the mechanism of action in your own words.
Critical Thinking in Nursing: 8 Tips on How it is Important?
1. Objectivity. While nursing is a job that requires emotional intelligence and compassion, it is important that treatment decisions are made objectively. By using critical thinking to focus on the facts before you, rather than on assumptions or biases, you can make sure your decisions are correct. 2.
Clinical Reasoning In Nursing (Explained W/ Example)
Clinical reasoning in nursing is dynamic and adaptive, as nurses continuously gather new information and adjust care plans based on patient responses. It's a crucial skill that guides nurses in providing safe, effective, and patient-centered care. Clinical reasoning involves the integration of clinical knowledge, critical thinking, and ...
How To Become a Critical Care Nurse
Step 4: Obtain experience in critical care After gaining general nursing experience, aspiring critical care nurses should seek opportunities to work in high-acuity settings. This can include: Working in an ICU: Many hospitals offer training programs or fellowships for nurses transitioning to the ICU, providing on-the-job training and mentorship.
How to Become a Critical Care Nurse in 4 Steps
What Does a Critical Care Nurse Do? Critical care RNs work alongside doctors and other members of the patient care team to assess, treat, and monitor patients' conditions while providing essential care. Critical care nurses are required to help implement complex treatment plans, such as intubation or placing multiple IV drips. Hence, they ...

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

What is Critical Thinking in Nursing?

5. Can I Be a Nurse If I Cannot Think Critically?

ANA Nursing Resources Hub

Critical Thinking in Nursing: Tips to Develop the Skill

What Is Critical Thinking in Nursing?

How Is Critical Thinking Important for Nurses?

Elements of Critical Thinking in Nursing

How to Develop and Apply Critical-Thinking Skills in Nursing

Related Resources

Item(s) added to cart

The Value of Critical Thinking in Nursing

How Do Nurses Use Critical Thinking?

Top 5 Ways Nurses Can Improve Critical Thinking Skills

Case-Based Approach

Practice Self-Reflection

Develop a Questioning Mind

Practice Self-Awareness in the Moment

Use a Process

Common Critical Thinking Pitfalls in Nursing

An Essential Skill for All Nurses

Frequently Asked Questions About Critical Thinking in Nursing

How does nursing school develop critical thinking skills?

Do only nurse managers use critical thinking?

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Jenna Liphart Rhoads, Ph.D., RN

Nicholas McGowan, BSN, RN, CCRN

Save citation to file

Add to My Bibliography

Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Similar articles

Grants and funding

LinkOut - more resources

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Affiliations

Critical Reflection, Critical Reasoning, and Judgment

Techne and Phronesis

Thinking Critically

Intuition and Perception

Evaluating Evidence

Sources of Evidence

Evidence-Based Practice

When Evidence Is Missing

The Three Apprenticeships of Professional Education

Clinical Grasp *

Making Qualitative Distinctions

Engaging in Detective Work, Modus Operandi Thinking, and Clinical Puzzle Solving

Recognizing Changing Clinical Relevance

Developing Clinical Knowledge in Specific Patient Populations

Clinical Forethought

Future think

Clinical forethought about specific diagnoses and injuries

Anticipation of crises, risks, and vulnerabilities for particular patients

Seeing the unexpected

In this Page

Other titles in this collection

Related information

Similar articles in PubMed

Recent Activity

Account Management

Why Critical Thinking in Nursing Is Important

Key Nursing Critical Thinking Skills

Example #1: Patient Assessments

Example #2: First Line of Defense

Example #3: Patient Interactions

Example #4: Using Detective Skills

Example #5: Prioritizing

Example #6: Medication & Care Coordination

Example #7: Critical Decisions

Example #8: Fast & Flexible Decisions

Related Articles

Breaking Bad News to Patients: A Nurse’s Guide to SPIKES

Delegation in Nursing: Steps, Skills, & Solutions for Creating Balance at Work

The 7 Most Common Nursing Mistakes (And What You Can Do If You Make One)

Secondary Logo

Creative Ways to Enhance and Assess Critical Thinking in Nursing Students

Full Text Access for Subscribers:

Institutional Users

Readers Of this Article Also Read

How Is Critical Thinking Important for Nurses? 