an example of critical thinking in nursing

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?

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The importance of critical thinking in nursing.

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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.”

Why Critical Thinking in Nursing Is Important

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.

8 Examples of Critical Thinking in Nursing

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.

Improving the Quality of Patient Care

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 Jan 05, 2024 .

Originally published on Aug 25, 2021 .

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

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Critical Thinking in Nursing Practice

Chapter 15 Critical Thinking in Nursing Practice Objectives •  Describe characteristics of a critical thinker. •  Discuss the nurse’s responsibility in making clinical decisions. •  Discuss how reflection improves clinical decision making. •  Describe the components of a critical thinking model for clinical decision making. •  Discuss critical thinking skills used in nursing practice. •  Explain the relationship between clinical experience and critical thinking. •  Discuss the critical thinking attitudes used in clinical decision making. •  Explain how professional standards influence a nurse’s clinical decisions. •  Discuss the relationship of the nursing process to critical thinking. Key Terms Clinical decision making, p. 196 Concept map, p. 202 Critical thinking, p. 193 Decision making, p. 195 Diagnostic reasoning, p. 196 Evidence-based knowledge, p. 193 Inference, p. 196 Nursing process, p. 197 Problem solving, p. 195 Reflection, p. 202 Scientific method, p. 195 http://evolve.elsevier.com/Potter/fundamentals/ •  Review Questions •  Case Study with Questions •  Audio Glossary •  Interactive Learning Activities •  Key Term Flashcards •  Content Updates Every day you think critically without realizing it. If it’s hot outside, you take off a sweater. If your DVD doesn’t start, you reposition the disc. If you decide to walk the dogs, you change to a pair of walking shoes. These examples involve critical thinking as you face each day and prepare for all possibilities. As a nurse, you will face many clinical situations involving patients, family members, health care staff, and peers. In each situation it is important to try to see the big picture and think smart. To think smart you have to develop critical thinking skills to face each new experience and problem involving a patient’s care with open-mindedness, creativity, confidence, and continual inquiry. When a patient develops a new set of symptoms, asks you to offer comfort, or requires a procedure, it is important to think critically and make sensible judgments so the patient receives the best nursing care possible. Critical thinking is not a simple step-by-step, linear process that you learn overnight. It is a process acquired only through experience, commitment, and an active curiosity toward learning. Clinical Decisions in Nursing Practice Nurses are responsible for making accurate and appropriate clinical decisions. Clinical decision making separates professional nurses from technical personnel. For example, a professional nurse observes for changes in patients, recognizes potential problems, identifies new problems as they arise, and takes immediate action when a patient’s clinical condition worsens. Technical personnel simply follow direction in completing aspects of care that the professional nurse has identified as necessary. A professional nurse relies on knowledge and experience when deciding if a patient is having complications that call for notification of a health care provider or decides if a teaching plan for a patient is ineffective and needs revision. Benner (1984) describes clinical decision making as judgment that includes critical and reflective thinking and action and application of scientific and practical logic. Most patients have health care problems for which there are no clear textbook solutions. Each patient’s problems are unique, a product of the patient’s physical health, lifestyle, culture, relationship with family and friends, living environment, and experiences. Thus as a nurse you do not always have a clear picture of a patient’s needs and the appropriate actions to take when first meeting a patient. Instead you must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient. Because no two patients’ health problems are the same, you always apply critical thinking differently. Observe patients closely, gather information about them, examine ideas and inferences about patient problems, recognize the problems, consider scientific principles relating to the problems, and develop an approach to nursing care. With experience you learn to creatively seek new knowledge, act quickly when events change, and make quality decisions for patients’ well-being. You will find nursing to be rewarding and fulfilling through the clinical decisions you make. Critical Thinking Defined Mr. Jacobs is a 58-year-old patient who had a radical prostatectomy for prostate cancer yesterday. His nurse, Tonya, finds the patient lying supine in bed with arms extended along his sides but tensed. When Tonya checks the patient’s surgical wound and drainage device, she notes that the patient winces when she gently places her hands to palpate around the surgical incision. She asks Mr. Jacobs when he last turned onto his side, and he responds, “Not since last night some time.” Tonya asks Mr. Jacobs if he is having incisional pain, and he nods yes, saying, “It hurts too much to move.” Tonya considers the information she has observed and learned from the patient to determine that he is in pain and has reduced mobility because of it. She decides that she needs to take action to relieve Mr. Jacobs’ pain so she can turn him more frequently and begin to get him out of bed for his recovery. In the case example the nurse observes the clinical situation, asks questions, considers what she knows about postoperative pain and risk for immobility, and takes action. The nurse applies critical thinking, a continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant ( Heffner and Rudy, 2008 ). Critical thinking involves recognizing that an issue (e.g., patient problem) exists, analyzing information about the issue (e.g., clinical data about a patient), evaluating information (reviewing assumptions and evidence) and making conclusions ( Settersten and Lauver, 2004 ). A critical thinker considers what is important in each clinical situation, imagines and explores alternatives, considers ethical principles, and makes informed decisions about the care of patients. Critical thinking is a way of thinking about a situation that always asks “Why?”, “What am I missing?”, “What do I really know about this patient’s situation?”, and “What are my options?” ( Heffner and Rudy, 2008 ; Paul and Heaslip, 1995 ). Tonya knew that pain was likely going to be a problem because the patient had extensive surgery. Her review of her observations and the patient’s report of pain confirmed her knowledge that pain was a problem. Her options include giving Mr. Jacobs an analgesic and waiting until it takes effect so she is able to reposition and make him more comfortable. Once he has less acute pain, Tonya offers to teach Mr. Jacobs some relaxation exercises. You begin to learn critical thinking early in your practice. For example, as you learn about administering baths and other hygiene measures, take time to read your textbook and the nursing literature about the concept of comfort. What are the criteria for comfort? How do patients from other cultures perceive comfort? What are the many factors that promote comfort? The use of evidence-based knowledge, or knowledge based on research or clinical expertise, makes you an informed critical thinker. Thinking critically and learning about the concept of comfort prepares you to better anticipate your patients’ needs, identify comfort problems more quickly, and offer appropriate care. Critical thinking requires cognitive skills and the habit of asking questions, remaining well informed, being honest in facing personal biases, and always being willing to reconsider and think clearly about issues ( Facione, 1990 ). When core critical thinking skills are applied to nursing, they show the complex nature of clinical decision making ( Table 15-1 ). Being able to apply all of these skills takes practice. You also need to have a sound knowledge base and thoughtfully consider what you learn when caring for patients. TABLE 15-1 Critical Thinking Skills SKILL NURSING PRACTICE APPLICATIONS Interpretation Be orderly in data collection. Look for patterns to categorize data (e.g., nursing diagnoses [see Chapter 17 ]). Clarify any data you are uncertain about. Analysis Be open-minded as you look at information about a patient. Do not make careless assumptions. Do the data reveal what you believe is true, or are there other options? Inference Look at the meaning and significance of findings. Are there relationships between findings? Do the data about the patient help you see that a problem exists? Evaluation Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior. Explanation Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients. Self-regulation Reflect on your experiences. Identify the ways you can improve your own performance. What will make you believe that you have been successful? Modified from Facione P: Critical thinking: a statement of expert consensus for purposes of educational assessment and instruction. The Delphi report: research findings and recommendations prepared for the American Philosophical Association, ERIC Doc No. ED 315, Washington, DC, 1990, ERIC. Nurses who apply critical thinking in their work are able to see the big picture from all possible perspectives. They focus clearly on options for solving problems and making decisions rather than quickly and carelessly forming quick solutions ( Kataoka-Yahiro and Saylor, 1994 ). Nurses who work in crisis situations such as the emergency department often act quickly when patient problems develop. However, even these nurses exercise discipline in decision making to avoid premature and inappropriate decisions. Learning to think critically helps you care for patients as their advocate, or supporter, and make better-informed choices about their care. Facione and Facione (1996) identified concepts for thinking critically ( Table 15-2 ). Critical thinking is more than just problem solving. It is a continuous attempt to improve how to apply yourself when faced with problems in patient care. TABLE 15-2 Concepts for a Critical Thinker CONCEPT CRITICAL THINKING BEHAVIOR Truth seeking Seek the true meaning of a situation. Be courageous, honest, and objective about asking questions. Open-mindedness Be tolerant of different views; be sensitive to the possibility of your own prejudices; respect the right of others to have different opinions. Analyticity Analyze potentially problematic situations; anticipate possible results or consequences; value reason; use evidence-based knowledge. Systematicity Be organized, focused; work hard in any inquiry. Self-confidence Trust in your own reasoning processes. Inquisitiveness Be eager to acquire knowledge and learn explanations even when applications of the knowledge are not immediately clear. Value learning for learning’s sake. Maturity Multiple solutions are acceptable. Reflect on your own judgments; have cognitive maturity. Modified from Facione N, Facione P: Externalizing the critical thinking in knowledge development and clinical judgment, Nurs Outlook 44(3):129, 1996. Thinking and Learning Learning is a lifelong process. Your intellectual and emotional growth involves learning new knowledge and refining your ability to think, problem solve, and make judgments. To learn, you have to be flexible and always open to new information. The science of nursing is growing rapidly, and there will always be new information for you to apply in practice. As you have more clinical experiences and apply the knowledge you learn, you will become better at forming assumptions, presenting ideas, and making valid conclusions. When you care for a patient, always think ahead and ask these questions: What is the patient’s status now? How might it change and why? Which physiological and emotional responses do I anticipate? What do I know to improve the patient’s condition? In which way will specific therapies affect the patient? What should be my first action? Do not let your thinking become routine or standardized. Instead, learn to look beyond the obvious in any clinical situation, explore the patient’s unique responses to health alterations, and recognize which actions are needed to benefit the patient. With experience you are able to recognize patterns of behavior, see commonalities in signs and symptoms, and anticipate reactions to therapies. Thinking about these experiences allows you to better anticipate each new patient’s needs and recognize problems when they develop. Levels of Critical Thinking in Nursing Your ability to think critically grows as you gain new knowledge in nursing practice. Kataoka-Yahiro and Saylor (1994) developed a critical thinking model ( Fig. 15-1 ) that includes three levels: basic, complex, and commitment. An expert nurse thinks critically almost automatically. As a beginning student you make a more conscious effort to apply critical thinking because initially you are more task oriented and trying to learn how to organize nursing care activities. At first you apply the critical thinking model at the basic level. As you advance in practice, you adopt complex critical thinking and commitment. FIG. 15-1 Critical thinking model for nursing judgment. (Redrawn from Kataoka-Yahiro M, Saylor C: A critical thinking model for nursing judgment, J Nurs Educ 33(8):351, 1994. Modified from Glaser E: An experiment in the development of critical thinking, New York, 1941, Bureau of Publications, Teachers College, Columbia University; Miller M, Malcolm N: Critical thinking in the nursing curriculum, Nurs Health Care 11:67, 1990; Paul RW: The art of redesigning instruction. In Willsen J, Blinker AJA, editors: Critical thinking: how to prepare students for a rapidly changing world, Santa Rosa, Calif, 1993, Foundation for Critical Thinking; and Perry W: Forms of intellectual and ethical development in the college years: a scheme , New York, 1979, Holt, Rinehart, & Winston.) Basic Critical Thinking At the basic level of critical thinking a learner trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles. For example, as a nursing student you use a hospital procedure manual to confirm how to insert a Foley catheter. You likely follow the procedure step by step without adjusting it to meet a patient’s unique needs (e.g., positioning to minimize the patient’s pain or mobility restrictions). You do not have enough experience to anticipate how to individualize the procedure. At this level answers to complex problems are either right or wrong (e.g., when no urine drains from the catheter, the catheter tip must not be in the bladder), and one right answer usually exists for each problem. Basic critical thinking is an early step in developing reasoning ( Kataoka-Yahiro and Saylor, 1994 ). A basic critical thinker learns to accept the diverse opinions and values of experts (e.g., instructors and staff nurse role models). However, inexperience, weak competencies, and inflexible attitudes can restrict a person’s ability to move to the next level of critical thinking. Complex Critical Thinking Complex critical thinkers begin to separate themselves from experts. They analyze and examine choices more independently. The person’s thinking abilities and initiative to look beyond expert opinion begin to change. A nurse learns that alternative and perhaps conflicting solutions exist. Consider the case of Mr. Rosen, a 36-year-old man who had hip surgery. The patient is having pain but is refusing his ordered analgesic. His health care provider is concerned that the patient will not progress as planned, delaying rehabilitation. While discussing the importance of rehabilitation with Mr. Rosen, the nurse, Edwin, realizes the patient’s reason for not taking pain medication. Edwin learns that the patient practices meditation at home. As a complex critical thinker, Edwin recognizes that Mr. Rosen has options for pain relief. Edwin decides to discuss meditation and other nonpharmacological interventions with the patient as pain control options and how, when combined with analgesics, these interventions can potentially enhance pain relief. In complex critical thinking each solution has benefits and risks that you weigh before making a final decision. There are options. Thinking becomes more creative and innovative. The complex critical thinker is willing to consider different options from routine procedures when complex situations develop. You learn a variety of different approaches for the same therapy. Commitment The third level of critical thinking is commitment ( Kataoka-Yahiro and Saylor, 1994 ). At this level a person anticipates when to make choices without assistance from others and accepts accountability for decisions made. As a nurse you do more than just consider the complex alternatives that a problem poses. At the commitment level you choose an action or belief based on the available alternatives and support it. Sometimes an action is to not act or to delay an action until a later time. You choose to delay as a result of your experience and knowledge. Because you take accountability for the decision, you consider the results of the decision and determine whether it was appropriate. Critical Thinking Competencies Kataoka-Yahiro and Saylor (1994) describe critical thinking competencies as the cognitive processes a nurse uses to make judgments about the clinical care of patients. These include general critical thinking, specific critical thinking in clinical situations, and specific critical thinking in nursing. General critical thinking processes are not unique to nursing. They include the scientific method, problem solving, and decision making. Specific critical thinking competencies in clinical health care situations include diagnostic reasoning, clinical inference, and clinical decision making. The specific critical thinking competency in nursing involves use of the nursing process. Each of the competencies is discussed in the following paragraphs. General Critical Thinking Scientific Method The scientific method is a way to solve problems using reasoning. It is a systematic, ordered approach to gathering data and solving problems used by nurses, physicians, and a variety of other health care professionals. This approach looks for the truth or verifies that a set of facts agrees with reality. Nurse researchers use the scientific method when testing research questions in nursing practice situations (see Chapter 5 ). The scientific method has five steps: 1  Identifying the problem 2  Collecting data 3  Formulating a question or hypothesis 4  Testing the question or hypothesis 5  Evaluating results of the test or study Consider the following example of the scientific method in nursing practice. A nurse caring for patients who receive large doses of chemotherapy for ovarian cancer sees a pattern of patients developing severe inflammation in the mouth (mucositis) (identifies problem). The nurse reads research articles (collects data) about mucositis and learns that there is evidence to show that having patients keep ice in their mouths (cryotherapy) during the chemotherapy infusion reduces severity of mucositis after treatment. He or she asks (forms question), “Do patients with ovarian cancer who receive chemotherapy have less severe mucositis when given cryotherapy versus standard mouth rinse in the oral cavity?” The nurse then collaborates with colleagues to develop a nursing protocol for using ice with certain chemotherapy infusions. The nurses on the oncology unit collect information that allows them to compare the incidence and severity of mucositis for a group of patients who use cryotherapy versus those who use standard-practice mouth rinse (tests the question). They analyze the results of their project and find that the use of cryotherapy reduced the frequency and severity of mucositis in their patients (evaluating the results). They decide to continue the protocol for all patients with ovarian cancer. Problem Solving You face problems every day such as a computer program that doesn’t function properly or a close friend who has lost a favorite pet. When a problem arises, you obtain information and use it, plus what you already know, to find a solution. Patients routinely present problems in practice. For example, a home care nurse learns that a patient has difficulty taking her medications regularly. The patient is unable to describe what medications she has taken for the last 3 days. The medication bottles are labeled and filled. The nurse has to solve the problem of why the patient is not adhering to or following her medication schedule. The nurse knows that the patient was discharged from the hospital and had five medications ordered. The patient tells the nurse that she also takes two over-the-counter medications regularly. When the nurse asks her to show the medications that she takes in the morning, the nurse notices that she has difficulty reading the medication labels. The patient is able to describe the medications that she is to take but is uncertain about the times of administration. The nurse recommends having the patient’s pharmacy relabel the medications in larger lettering. In addition, the nurse shows the patient examples of pill organizers that will help her sort her medications by time of day for a period of 7 days. Effective problem solving also involves evaluating the solution over time to make sure that it is effective. It becomes necessary to try different options if a problem recurs. From the previous example, during a follow-up visit the nurse finds that the patient has organized her medications correctly and is able to read the labels without difficulty. The nurse obtained information that correctly clarified the cause of the patient’s problem and tested a solution that proved successful. Having solved a problem in one situation adds to a nurse’s experience in practice, and this allows the nurse to apply that knowledge in future patient situations. Decision Making When you face a problem or situation and need to choose a course of action from several options, you are making a decision. Decision making is a product of critical thinking that focuses on problem resolution. Following a set of criteria helps to make a thorough and thoughtful decision. The criteria may be personal; based on an organizational policy; or, frequently in the case of nursing, a professional standard. For example, decision making occurs when a person decides on the choice of a health care provider. To make a decision, an individual has to recognize and define the problem or situation (need for a certain type of health care provider to provide medical care) and assess all options (consider recommended health care providers or choose one whose office is close to home). The person has to weigh each option against a set of personal criteria (experience, friendliness, and reputation), test possible options (talk directly with the different health care providers), consider the consequences of the decision (examine pros and cons of selecting one health care provider over another), and make a final decision. Although the set of criteria follows a sequence of steps, decision making involves moving back and forth when considering all criteria. It leads to informed conclusions that are supported by evidence and reason. Examples of decision making in the clinical area include determining which patient care priority requires the first response, choosing a type of dressing for a patient with a surgical wound, or selecting the best teaching approach for a family caregiver who will assist a patient who is returning home after a stroke. Specific Critical Thinking Diagnostic Reasoning and Inference Once you receive information about a patient in a clinical situation, diagnostic reasoning begins. It is the analytical process for determining a patient’s health problems ( Harjai and Tiwari, 2009 ). Accurate recognition of a patient’s problems is necessary before you decide on solutions and implement action. It requires you to assign meaning to the behaviors and physical signs and symptoms presented by a patient. Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a patient situation (e.g., a patient who is feeling light-headed with blurred vision and who has a history of diabetes is possibly experiencing a problem with blood glucose levels), observes patterns and themes (e.g., symptoms that include weakness, hunger, and visual disturbances suggest hypoglycemia), and makes decisions quickly (e.g., offers a food source containing glucose). The information a nurse collects and analyzes leads to a diagnosis of a patient’s condition. Nurses do not make medical diagnoses, but they do assess and monitor patients closely and compare the patients’ signs and symptoms with those that are common to a medical diagnosis. This type of diagnostic reasoning helps health care providers pinpoint the nature of a problem more quickly and select proper therapies. Part of diagnostic reasoning is clinical inference, the process of drawing conclusions from related pieces of evidence and previous experience with the evidence. An inference involves forming patterns of information from data before making a diagnosis. Seeing that a patient has lost appetite and experienced weight loss over the last month, the nurse infers that there is a nutritional problem. An example of diagnostic reasoning is forming a nursing diagnosis such as imbalanced nutrition: less than body requirements (see Chapter 17 ). In diagnostic reasoning use patient data that you gather or collect to logically recognize the problem. For example, after turning a patient you see an area of redness on the right hip. You palpate the area and note that it is warm to the touch and the patient complains of tenderness. You press over the area with your finger; after you release pressure, the area does not blanch or turn white. After thinking about what you know about normal skin integrity and the effects of pressure, you form the diagnostic conclusion that the patient has a pressure ulcer. As a student, confirm your judgments with experienced nurses. At times you possibly will be wrong, but consulting with nurse experts gives you feedback to build on future clinical situations. Often you cannot make a precise diagnosis during your first meeting with a patient. Sometimes you sense that a problem exists but do not have enough data to make a specific diagnosis. Some patients’ physical conditions limit their ability to tell you about symptoms. Some choose to not share sensitive and important information during your initial assessment. Some patients’ behaviors and physical responses become observable only under conditions not present during your initial assessment. When uncertain of a diagnosis, continue data collection. You have to critically analyze changing clinical situations until you are able to determine the patient’s unique situation. Diagnostic reasoning is a continuous behavior in nursing practice. Any diagnostic conclusions that you make will help the health care provider identify the nature of a problem more quickly and select appropriate medical therapies. Clinical Decision Making As in the case of general decision making, clinical decision making is a problem-solving activity that focuses on defining a problem and selecting an appropriate action. In clinical decision making a nurse identifies a patient’s problem and selects a nursing intervention. When you approach a clinical problem such as a patient who is less mobile and develops an area of redness over the hip, you make a decision that identifies the problem (impaired skin integrity in the form of a pressure ulcer) and choose the best nursing interventions (skin care and a turning schedule). Nurses make clinical decisions all the time to improve a patient’s health or maintain wellness. This means reducing the severity of the problem or resolving the problem completely. Clinical decision making requires careful reasoning (i.e., choosing the options for the best patient outcomes on the basis of the patient’s condition and the priority of the problem). Improve your clinical decision making by knowing your patients. Nurse researchers found that expert nurses develop a level of knowing that leads to pattern recognition of patient symptoms and responses ( White, 2003 ). For example, an expert nurse who has worked on a general surgery unit for many years is more likely able to detect signs of internal hemorrhage (e.g., fall in blood pressure, rapid pulse, change in consciousness) than a new nurse. Over time a combination of experience, time spent in a specific clinical area, and the quality of relationships formed with patients allow expert nurses to know clinical situations and quickly anticipate and select the right course of action. Spending more time during initial patient assessments to observe patient behavior and measure physical findings is a way to improve knowledge of your patients. In addition, consistently assessing and monitoring patients as problems occur help you to see how clinical changes develop over time. The selection of nursing therapies is built on both clinical knowledge and specific patient data, including: •  The identified status and situation you assessed about the patient, including data collected by actively listening to the patient regarding his or her health care needs. •  Knowledge about the clinical variables (e.g., age, seriousness of the problem, pathology of the problem, patient’s preexisting disease conditions) involved in the situation, and how the variables are linked together. •  A judgment about the likely course of events and outcome of the diagnosed problem, considering any health risks the patient has; includes knowledge about usual patterns of any diagnosed problem or prognosis. •  Any additional relevant data about requirements in the patient’s daily living, functional capacity, and social resources. •  Knowledge about the nursing therapy options available and the way in which specific interventions will predictably affect the patient’s situation.

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• Critical Thinking

Q&A: What is critical thinking and when would you use critical thinking in the clinical setting?

(Write 2-3 paragraphs)

In literature ‘critical thinking’ is often used, and perhaps confused, with problem-solving and clinical decision-making skills and clinical reasoning. In practice, problem-solving tends to focus on the identification and resolution of a problem, whilst critical thinking goes beyond this to incorporate asking skilled questions and critiquing solutions.

Critical thinking has been defined in many ways, but is essentially the process of deliberate, systematic and logical thinking, while considering bias or assumptions that may affect your thinking or assessment of a situation. In healthcare, the clinical setting whether acute care sector or aged care critical thinking has generally been defined as reasoned, reflective thinking which can evaluate the given evidence and its significance to the patient’s situation. Critical thinking occasionally involves suspension of one’s immediate judgment to adequately evaluate and appraise a situation, including questioning whether the current practice is evidence-based. Skills such as interpretation, analysis, evaluation, inference, explanation, and self-regulation are required to interpret thinking and the situation. A lack of critical thinking may manifest as a failure to anticipate the consequences of one’s actions.

Critical thinking is that mode of thinking – about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them.

The Paul-Elder framework has three components:

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

Critical thinking can be defined as, “the art of analysing and evaluating thinking with a view to improving it”. The eight Parts or Elements of Thinking involved in critical thinking:

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

Q&A: To become a nurse requires that you learn to think like a nurse. What makes the thinking of a nurse different from a doctor, a dentist or an engineer?

It is how we view the health care consumer or aged care consumer, and the type of problems nurses deal with in clinical practice when we engage in health care patient centred care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts, ethics and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.

As a nurse you are required to think about the entire patient/s and what you have learnt as a nurse including; ideas, theories, and concepts in nursing. It is important that we develop our skills so that we become highly proficient critical thinkers in nursing.

In nursing, critical thinkers need to be:

Nurses need to use language that will clearly communicate a lot of information that is key to good nursing care, for handover and escalation of care for improving patient safety and reducing adverse outcomes, some organisations use the iSoBAR (identify–situation–observations–background–agreed plan–read back) format. Firstly, the “i”, for “identify yourself and the patient”, placed the patient’s identity, rather than the diagnosis, in primary position and provided a method of introduction. (This is particularly important when teams are widely spread geographically.) The prompt, “S” (“situation”) “o” for “observations”, was included to provide an adequate baseline of factual information on which to devise a plan of care. and “B” (“background”), “A” “agreed plan” and “R” “read back” to reinforce the transfer of information and accountability.

In clinical practice experienced nurses engage in multiple clinical reasoning episodes for each patient in their care. An experienced nurse may enter a patient’s room and immediately observe significant data, draw conclusions about the patient and initiate appropriate care. Because of their knowledge, skill and experience the expert nurse may appear to perform these processes in a way that seems automatic or instinctive. However, clinical reasoning is a learnt skill.

Key critical thinking skills – the clinical reasoning cycle / critical thinking process

To support nursing students in the clinical setting, breakdown the critical thinking process into phases;

• Decide/identify

This is a dynamic process and nurses often combine one or more of the phases, move back and forth between them before reaching a decision, reaching outcomes and then evaluating outcomes.

For nursing students to learn to manage complex clinical scenarios effectively, it is essential to understand the process and steps of clinical reasoning. Nursing students need to learn rules that determine how cues shape clinical decisions and the connections between cues and outcomes.

Start with the Patient – what is the issue? Holistic approach – describe or list the facts, people.

Collect information – Handover report, medical and nursing, allied health notes. Results, patient history and medications.

• New information – patient assessment

Process Information – Interpret- data, signs and symptoms, normal and abnormal.

• Analyse – relevant from non-relevant information, narrow down the information
• Evaluate – deductions or form opinions and outcomes

Identify Problems – Analyse the facts and interferences to make a definitive diagnosis of the patients’ problem.

Establish Goals – Describe what you want to happen, desired outcomes and timeframe.

Take action – Select a course of action between alternatives available.

Evaluate Outcomes – The effectiveness of the actions and outcomes. Has the situation changed or improved?

Reflect on process and new learning – What have you learnt and what would you do differently next time.

Scenario: Apply the clinical reasoning cycle, see below, to a scenario that occurred with a patient in your clinical practice setting. This could be the doctor’s orders, the patient’s vital signs or a change in the patient’s condition.

(Write 3-5 paragraphs)

Important skills for critical thinking

Some skills are more important than others when it comes to critical thinking. The skills that are most important are:

• Interpreting – Understanding and explaining the meaning of information, or a particular event.
• Analysing – Investigating a course of action, that is based upon data that is objective and subjective.
• Evaluating – This is how you assess the value of the information that you have. Is the information relevant, reliable and credible?

This skill is also needed to determine if outcomes have been fully reached.

Based upon those three skills, you can use clinical reasoning to determine what the problem is.

These decisions have to be based upon sound reasoning:

• Explaining – Clearly and concisely explaining your conclusions. The nurse needs to be able to give a sound rationale for their answers.
• Self-regulating – You have to monitor your own thought processes. This means that you must reflect on the process that lead to the conclusion. Be on alert for bias and improper assumptions.

Critical thinking pitfalls

Errors that occur in critical thinking in nursing can cause incorrect conclusions. This is particularly dangerous in nursing because an incorrect conclusion can lead to incorrect clinical actions.

Illogical Processes

A common illogical thought process is known as “appeal to tradition”. This is what people are doing when they say it’s always been done like this. Creative, new approaches are not tried because of tradition.

All people have biases. Critical thinkers are able to look at their biases and not let them compromise their thinking processes.

Biases can complicate decision making, communication and ultimately effect patient care.

Closed Minded

Being closed-minded in nursing is dangerous because it ignores other team members points of view. Essential input from other experts, as well as patients and their families are also ignored which ultimately impacts on patient care. This means that fewer clinical options are explored, and fewer innovative ideas are used for critical thinking to guide decision making.

So, no matter if you are an intensive care nurse, community health nurse or a nurse practitioner, you should always keep in mind the importance of critical thinking in the nursing clinical setting.

It is essential for nurses to develop this skill: not only to have knowledge but to be able to apply knowledge in anticipation of patients’ needs using evidence-based care guidelines.

American Management Association (2012). ‘AMA 2012 Critical Skills Survey: Executive Summary’. (2012). American Management Association. http://playbook.amanet.org/wp-content/uploads/2013/03/2012-Critical-Skills-Survey-pdf.pdf   Accessed 5 May 2020.

Korn, M. (2014). ‘Bosses Seek ‘Critical Thinking,’ but What Is That?,’ The Wall Street Journal . https://www.wsj.com/articles/bosses-seek-critical-thinking-but-what-is-that-1413923730?tesla=y&mg=reno64-wsj&url=http://online.wsj.com/article/SB12483389912594473586204580228373641221834.html#livefyre-comment Accessed 5 May 2020.

School of Nursing and Midwifery Faculty of Health, University of Newcastle. (2009). Clinical reasoning. Instructors resources. https://www.newcastle.edu.au/__data/assets/pdf_file/0010/86536/Clinical-Reasoning-Instructor-Resources.pdf  Accessed 11 May 2020

The Value of Critical Thinking in Nursing + Examples. Nurse Journal social community for nurses worldwide. 2020.  https://nursejournal.org/community/the-value-of-critical-thinking-in-nursing/ Accessed 8 May 2020.

Paul And Elder (2009) Have Defined Critical Thinking As: The Art of Analysing And Evaluating …

https://www.chegg.com/homework-help/questions-and-answers/paul-elder-2009-defined-critical-thinking-art-analyzing-evaluating-thinking-view-improving-q23582096 Accessed 8 May 2020 .

Cody, W.K. (2002). Critical thinking and nursing science: judgment, or vision? Nursing Science Quarterly, 15(3), 184-189.

Facione, P. (2011). Critical thinking: What it is and why it counts. Insight Assessment , ISBN 13: 978-1-891557-07-1.

McGrath, J. (2005). Critical thinking and evidence- based practice. Journal of Professional Nursing, 21(6), 364-371.

Porteous, J., Stewart-Wynne, G., Connolly, M. and Crommelin, P. (2009). iSoBAR — a concept and handover checklist: the National Clinical Handover Initiative. Med J Aust 2009; 190 (11): S152.

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How to Apply Critical Thinking in Nursing

Harnessing the power of critical thinking can be the key to becoming a successful and competent nurse. 

Developing and refining your critical thinking skills is crucial as you embark on your nursing journey. By doing so, you’ll enhance your ability to provide high-quality care, advance your professional growth, and contribute to the ever-evolving nursing field.

What is critical thinking in nursing?

Critical thinking is an essential cognitive process that enables nurses to analyze, evaluate, and synthesize information to make informed decisions. In the context of nursing, it involves observing, interpreting, and responding to patient needs effectively. 

Critical thinking allows nurses to go beyond memorized facts and apply logical reasoning to address patient problems holistically.

As a nurse, you’ll encounter multifaceted healthcare scenarios, each presenting its unique challenges. Critical thinking enables you to approach these situations systematically, evaluate the available data, identify relevant factors, and understand the patient’s condition comprehensively.

By employing critical thinking skills, you can differentiate between urgent and non-urgent issues, prioritize care, anticipate potential complications, and adapt your interventions accordingly. This analytical approach helps minimize errors, promote patient safety, and achieve positive patient outcomes.

Why is critical thinking important in nursing?

Critical thinking serves as the backbone of nursing practice. You’ll encounter various uncertainties, changing conditions, and ethical dilemmas as a nurse. Developing critical thinking abilities empowers you to navigate these challenges confidently and provide optimal patient care.

In nursing, critical thinking is crucial for the following reasons:

• Enhanced Clinical Judgment: Critical thinking enables assessing complex situations, analyzing available information, and drawing logical conclusions. It enhances your clinical judgment, allowing you to make informed decisions based on the best available evidence and expert consensus.
• Effective Problem Solving: Nursing involves encountering problems and finding effective solutions. Critical thinking equips you with the tools to identify underlying issues, explore alternative options, and implement interventions that address the root cause of the problem.
• Patient Advocacy: Critical thinking empowers you to advocate for your patients’ needs. By actively engaging in critical inquiry, you can challenge assumptions, question policies, and promote patient-centered care.
• Adapting to Changing Environments: Healthcare is constantly evolving, with new research findings, technologies, and treatments emerging regularly. Developing critical thinking skills helps you adapt to these changes, ensuring you stay updated and deliver evidence-based care.

Examples of Critical Thinking in Nursing

Let’s dive into some real-life examples that highlight how critical thinking plays a crucial role in nursing practice:

• Prioritization: Imagine working in an emergency department where multiple patients arrive simultaneously with varying degrees of severity. Utilizing critical thinking, you can assess each patient’s condition, prioritize care based on the urgency of their needs, and allocate resources effectively.
• Medication Administration: When administering medication, critical thinking prompts you to cross-check the prescribed dose, assess potential drug interactions or allergies, and evaluate the patient’s response to the medication. This proactive approach ensures patient safety and minimizes medication errors.
• Ethical Dilemmas: Critical thinking helps you navigate complex ethical dilemmas by analyzing the values at stake, considering legal and ethical principles, and collaborating with the healthcare team to make decisions that align with the patient’s best interests.

Supplement Your Nursing Studies and Boost Your Grades

At SimpleNursing , we understand the significance of critical thinking in nursing education. Our comprehensive digital study tools are designed to enhance your critical thinking abilities, providing you with interactive case studies, practice questions, and simulated patient scenarios. 

Boost your confidence and excel in your nursing studies with SimpleNursing’s innovative study resources.

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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. Learn more about earning your BSN in our article “ How an RN to BSN Program Will Differ from Your ADN Experience .”

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

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About the author

Hannah Meinke

Posted in General Nursing

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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.

© 2020 John Wiley & Sons Ltd.

• Attitude of Health Personnel*
• Education, Nursing / methods
• Nursing Process
• Nursing Research / methods

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

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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. 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 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 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 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.

Two Examples of How I Used Critical Thinking to Care for my Patient (Real Life Nursing Stories) | NURSING.com

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Critical Thinking on the Nursing Floor

Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.

The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!

Critical Thinking in Nursing: Example 1

I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs for the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90s on oxygen.

I stopped. And thought. What the heck is going on?

I looked at his history. Congestive heart failure.

I looked at his intake and output. He was positive 1.5 liters.

I thought about how he’s got extra fluid in general, and because of his CHF, he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..

His lungs were clear earlier. I heard crackles throughout both lungs.

OK, so he’s got extra fluid that he can’t get out of his body. What do I know that will get rid of extra fluid and make him pee? Maybe some Lasix?

I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said “Give him 20 mg IV Lasix one time, and I’ll put the order in.” CLICK.

I gave the Lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.

Badda Bing Bada Boom!

Critical Thinking in Nursing: Example 2

My patient just had her right leg amputated above her knee. She was on a Dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. She told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with the goal of weaning off PCA.

“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?

I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.

I thought about nerve pain. I thought about other patients that report similar pain. Diabetics with neuropathy would talk about similar pain… “What did they do for it? ” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.

“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.

I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain after I described my patient’s type of pain and thought process.

“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner. ”

She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort were significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.

And that we did!

She was able to work with therapy more because her pain was tolerable and was finally able to get rest.

What the HELL is Critical Thinking . . . and Why Should I Care?

What your nursing professor won’t tell you about critical thinking .

by Ashely Adkins RN BSN

When I started nursing school, I remember thinking,   “how in the world am I going to remember all of this information, let alone be able to apply it and critically think?”   You are not alone if you feel like your critical thinking skills need a little bit of polishing.

Let’s step back for a moment, and take a walk down memory lane. It was my first semester of nursing school and I was sitting in my Fundamentals of Nursing course. We were learning about vital signs, assessments, labs, etc. Feeling overwhelmed with all of this new information (when are you   not   overwhelmed in nursing school?), I let my mind wonder to a low place…

Am I really cut out for this? Can I really do this? How can I possibly retain all of this information?  Do they really expect me to remember everything AND critically think at the same time?

One of my first-semester nursing professors said something to me that has stuck with me throughout my nursing years. It went a little something like this:

“Critical thinking does not develop overnight . It takes time. You don’t learn to talk overnight or walk overnight. You don’t   learn to critically think overnight .”

My professor was absolutely right.

As my journey throughout nursing school, and eventually on to being a “real nurse” continued, my critical thinking skills began to BLOSSOM. With every class, lecture, clinical shift, lab, and simulation, my critical thinking skills grew.

You may ask…how?

Well, let me tell you…

• Questioning

These are the key ingredients to growing your critical thinking skills.

Time.   Critical thinking takes time. As I mentioned before, you do not learn how to critically think overnight. It is important to set   realistic   expectations for yourself both in nursing school and in other aspects of your life.

Exposure.   It is next to impossible to critically think if you have never been exposed to something. How would you ever learn to talk if no one ever talked to you? The same thing applies to nursing and critical thinking.

Over time, your exposure to new materials and situations will cause you to think and ask yourself, “why?”

This leads me to my next point.   Questioning.   Do not be afraid to ask yourself…

“Why is this happening?”

“Why do I take a blood pressure and heart rate before I give a beta-blocker?”

“Why is it important to listen to a patient’s lung sounds before and after they receive a blood transfusion?”

It is important to constantly question yourself. Let your mind process your questions, and discover answers.

Confidence.   We always hear the phrase, “confidence is key!” And as cheesy as that phrase may be, it really holds true. So many times, we often times sell ourselves short.

YOU KNOW MORE THAN YOU THINK YOU KNOW.

In case you did not catch it the first time…

Be confident in your knowledge, because trust me, it is there. It may be hiding in one single neuron in the back of your brain, but it is there.

It is impossible to know everything. Even experienced nurses do not know everything.

And if they tell you that they do…they are wrong!

The   key   to critical thinking is   not about knowing everything ; It is about   how you respond when you do not know something .

How do you reason through a problem you do not know the answer to? Do you give up? Or do you persevere until you discover the answer?

If you are a nursing student preparing for the NCLEX, you know that the NCLEX   loves   critical thinking questions. NRSNG has some great tips and advice on   critical thinking when it comes to taking the NCLEX .

There are so many pieces to the puzzle when it comes to nursing, and it is normal to feel overwhelmed. The beauty of nursing is when all of those puzzle pieces come together to form a beautiful picture.

That is critical thinking.

Critical thinking is something you’ll do every day as a nurse and honestly, you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution, and trying it out. Critical thinking in nursing is just that but in a clinical setting.

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• v.7(2); 2020 Mar

Critical thinking skills of nursing students: Observations of classroom instructional activities

Christian makafui boso.

1 Department of Nursing and Midwifery, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town South Africa

2 School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast Ghana

Anita S. van der Merwe

Janet gross.

3 Peace Corps Liberia, Mother Patern College of Health Sciences, Stella Maris Polytechnic, Monrovia Liberia

Critical thinking (CT) is vital for nursing practice. Nursing schools should provide learning experiences that enable nursing students to acquire CT skills. Yet, these authors are not aware of any study that has directly observed instructional activities related to CT skills acquisition in the classroom environment. The aim of this study was to explore instructional activities in the classroom environment in relation to acquisition of CT skills of students.

Qualitative non‐participant observation.

Using a purposive sampling, 10 classroom teaching sessions were observed and mediating factors of CT skills acquisition of students noted. Data were analysed thematically. Data were collected from October–December 2017. 

Three key themes of instructional activities relating to acquisition of CT skills of students emerged, namely educators’ behaviour, students’ characteristics and university‐wide factors/administrative support. Class sizes ranged from 34–162 students with an average of 95.

1. INTRODUCTION

The ever‐changing and complex healthcare environment requires that nurses acquire critical thinking (CT) skills to meet the complex challenges of the environment (Von Colln‐Appling & Giuliano, 2017 ). Nurses should be able to select and use data for effective clinical judgements to promote good health outcomes (Nelson, 2017 ; Von Colln‐Appling & Giuliano, 2017 ). Consequently, nursing schools must offer learning experiences that assist students to think critically about complex issues instead of just merely becoming receptacles for information (Toofany, 2008 ; Von Colln‐Appling & Giuliano, 2017 ). It is the duty of nurse educators to help students to acquire CT skills (Nelson, 2017 ; Von Colln‐Appling & Giuliano, 2017 ).

Attempts have been made to conceptualize CT to guide the facilitation of CT skills of students. Worth noting are Dwyer, Hogan, and Stewart ( 2014 ) and Duron, Limbach, and Waugh’s ( 2006 ) frameworks, which could be relevant in the classroom setting. Focusing on learning outcomes, Dwyer et al. ( 2014 ) posited that long‐term memory and comprehension are foundational processes for CT application. The framework incorporates both reflective judgement and self‐regulatory functions of metacognition as a requirement for CT. Self‐regulation refers to an individual's ability, willingness and the perceived need to think critically when solving specific problems. Therefore, factors that influence the interrelationship between short‐term and long‐term memory (the bedrock of CT), comprehension, reflective judgement and self‐regulation functions of metacognition will influence CT skills of the students. On the other, Duron et al.’s model focused on practical instructional activities needed to guide students in acquiring CT skills. The five‐step framework requires that educators: (a) determine learning objectives; (b) teach through questioning; (c) practice before assessing; (d) review, refine and improve; and (e) provide feedback and assessment of learning.

Nursing literature is replete with studies demonstrating that adopting appropriate teaching methods/strategies, such as active learning, improves the CT scores of students. Examples of such approaches include problem‐based learning (Jones, 2008 ; Jun, Lee, Park, Chang, & Kim, 2013 ), concept mapping (Wheeler & Collins, 2003 ) and simulation (Sullivan‐Mann, Perron, & Fellner, 2009 ). Furthermore, based on a systematic review, Chan ( 2013 ) suggested three strategies to facilitate CT skills of nursing students, which include appropriate questioning strategy, reflective writing on learning experiences and discussion of case study.

The classroom environment provides a vital opportunity for educators to create the necessary milieu to encourage students to develop their CT skills. It is therefore required that negative factors to the development of CT are minimized or removed and those factors that enhance the development of CT skills are accentuated. However, these factors that influence CT have received less attention in nursing education (Raymond, Profetto‐McGrath, Myrick, & Strean, 2018 ). Furthermore, no direct observations have been made to identify specific factors influencing CT in the classroom setting.

Studies such as those of Mangena and Chabeli ( 2005 ) and Shell ( 2001 ) assessed factors that inhibit CT acquisition of nursing students. Mangena and Chabeli's study focused on educators and students’ perspectives. They found that educators’ lack of knowledge of CT teaching methods and evaluation, negative attitudes of educators, student selection and educational background, socialization, culture and language inhibited the development of CT skills of students. Shell also found negative student factors, demand to cover content and time constraints both on class time and on educators’ development that hindered CT skills development of students.

Raymond and Profetto‐McGrath ( 2005 ) also identified internal and external factors of educators that had an impact on their CT. These factors included physical and mental well‐being, the view of leadership on CT and collegial relationships that existed in the educators’ environment. Similarly, Raymond et al. ( 2018 ) identified personal (elements/conditions originating from the educator), interpersonal (elements originating from the student–educator relationship) and broader environmental factors (conditions evident in the larger physical setting or political milieu) that influenced educators’ CT and influenced their abilities to role model CT skills.

The above authors focused on factors influencing CT from different perspectives. Shell ( 2001 ) and Mangena and Chabeli ( 2005 ) focused on barriers to student development of CT. Also, Shell examined educators’ perspectives. Mangena and Chabeli examined both educators’ and students’ views. Raymond and Profetto‐McGrath ( 2005 ) and Raymond et al. ( 2018 ) specifically focused on nurse educators' CT skills. None of the above studies directly observed classroom teaching though similar factors were identified.

2. BACKGROUND

The “greatest healthcare resource is the healthcare personnel, of which nurses are a primary component” (Talley, 2006 , p. 50). However, limited resources in nursing schools especially in developing countries where this study was undertaken (Talley, 2006 ) impede the experiences required for the students to develop CT skills. For example, studies have identified lack of qualified educators (Bell, Rominski, Bam, Donkor, & Lori, 2013 ; Salifu, Gross, Salifu, & Ninnoni, 2018 ) as well as infrastructural and logistical constraints (Talley, 2006 ), large class sizes and absenteeism (Wilmot, Kumfo, Danso‐Mensah, & Antwi‐Danso, 2013 ) as some of the challenges affecting nursing education. These challenges have led to the dominance of inappropriate teaching approaches (Boso & Gross, 2015 ; Wilmot et al., 2013 ).

Similarly, studies regarding CT have reported the negative influence of sociocultural norms such as the seniority tradition (Chan, 2013 ; Jenkins, 2011 ; Kawashima, 2003 ; Mangena & Chabeli, 2005 ). In such cultures, students are not encouraged to speak out openly (Chan, 2013 ). For example, an individual is not expected to disagree nor question an authority figure in public. In the context of this study, the seniority tradition could have been manifested in the classroom where the faculty is regarded as an authority whose ideas may be seen as sacrosanct by students. These authors argue that it is necessary to identify the factors through direct observation that might hinder or enhance the facilitation of CT of students in the classroom setting. Notwithstanding, the authors of this paper had not found any publication in the nursing literature where direct observation for CT teaching methods/strategies had been carried out in the classroom setting. Therefore, this study explored factors that might influence students’ ability to memorize and comprehend content towards CT skills acquisition. Also, educators’ instructional activities that either enhanced or inhibited students’ CT facilitation in the classroom context were explored.

3. THE AIM OF THE STUDY

The aim of this study was to explore instructional activities towards the development of CT skills of students in a classroom environment. This study was part of a larger research project aimed at developing a CT‐based curriculum framework of students.

4. RESEARCH DESIGN

Qualitative non‐participant observation design was used. This design was to allow for the observation of first‐hand (Patton, 2015 ) and unusual aspects (Creswell & Creswell, 2018 ) real‐time classroom practices whilst being present. Also, qualitative observation has been noted as a primary means of understanding the experiences of users (Reddacliff, 2017 ).

5.1. Setting

The study was conducted in classroom settings of an undergraduate nursing programme in a public university in Ghana. As a school in a developing country, there are constraints such as logistical inadequacies and lack of adequate qualified faculty, which could inhibit meaningful learning experience towards CT skills development of students existed. The classes are scheduled based on the demands of the various departments of the university. The university runs several programmes, and each programme is allocated with venues as demanded.

5.2. Sampling

Through a purposive method ten (10) teaching sessions from class levels 200 to 400 were observed from October to December 2017. Educators who had lectures within the period were approached face‐to‐face. Ten out of 16 educators agreed to participate. They provided informed consent. The 10 sessions provided rich data to be able to deduce current practices of instruction as occurring in the classroom environment. The main selection criterion was a full teaching session (1–3 hr) of B.Sc. nursing undergraduate programme taught by an educator in the selected nursing school.

5.3. Data collection and instrumentation

Data were collected between October and December 2017. The observations were from five level 200, three level 300 and two level 400 classes; six medical–surgical, one maternal health, one biomedical and two nursing fundamental/theoretical courses were taught. Two individuals—first author and an assistant, consistent with Winter and Munn‐Giddings’ ( 2001 ) recommendation for observation, observed the teaching sessions. A six‐item semi‐structured observation guide/protocol using Billing and Halstead's ( 2005 ) six steps of designing learning experiences for developing CT skills was employed for data collection. Billing and Halstead's six steps of designing experiences for developing CT skills were consistent with identifying factors that enhance or inhibit memory, comprehension, reflective judgement and instruction identical to Dwyer et al. ( 2014 ) and Duron et al.’s ( 2006 ) frameworks. The protocol was pre‐tested in a classroom at an analogous nursing school. Though the sixth step of Billing and Halstead's ( 2005 ) six steps of designing learning experiences for developing CT skills proposes both summative and formative assessments, in the context of this observation, only formative assessment methods used by the educators could be observed.

Billing and Halstead's six steps of designing experiences for developing CT skills are as follows. Step 1 involved determining the learning outcome for the specific class. These learning objectives should be explicitly clear to students and fit for purpose. Step 2 involved creating an anticipatory set. The educator's strategies that generate students’ interest in content, encourage their participation and create collegial environment for students were observed. Step 3 consisted of selecting teaching and learning strategies. Observation focused on identifying active learning methods of teaching against passive teaching methods. Also, whether the educator or students dominated the class was explored. Whether the nurse educator combined different teaching methods/strategies were explored. Step 4 considered implementation issues. Class size, involvement of students, classroom arrangement, use of teaching aids and materials and instructional media were observed. Step 5 involved the observation of how the learning experience was closed. This included how the educator summarized the lesson and related lessons to next class period. Step 6 involved how students’ learning experiences were evaluated. The educator's strategies for the assessment and evaluation of student learning experience during class period were observed.

The observers positioned themselves at the back of the classrooms throughout each period of teaching. Participants did not appear distracted or uncomfortable during the periods of observation. Thoughts and feeling of the observers relative to observed situations were captured as field notes. In order not to distract and cause discomfort to participants, the observers took minimal notes and expanded them immediately after the observations. Transcripts from the observations were compared and agreed on by the two observers. Differences were resolved through discussion. Also, the educators whose teaching sessions were observed were asked to provide feedback and revision made based on educators' comment(s). This was to minimize observers’ bias.

5.4. Data analysis

Bryman's ( 2010 ) four stages of qualitative analysis as described by Gibbs ( 2010 ) were used to analyse the data. The first author and an assistant described each observation. Later, the first author read the transcript at least four times to enable a meaningful content analysis. Data were coded, and themes and sub‐themes were derived. Subsequently, the second and third authors who are the supervisors of this research project cross‐checked the themes and sub‐themes with the observational transcripts for validation.

5.5. Ethical consideration

This study was approved as one part of a doctoral project by the Health Research Ethics Committee of Stellenbosch University (Ref. no S17/05/106) and the university where the study was done. Permission was also sought from the dean of the selected school. The first author visited the students at their various classrooms to explain the nature and purpose of the study to them. Likewise, the nurse educators were provided with information on the purpose and nature of the study. They were provided individually with informed consent forms for signing before data were collected. They were assured of their rights to opt out at any stage of the study. Confidentiality and anonymity were also assured. Individual participants were not identified with the data (during data collection, analysis and reporting).

Three overall themes were deduced from the classroom observation data, namely educators’ behaviour, students’ behaviour and university‐wide factors/administrative support. These themes related to the Dwyer et al. ( 2014 ) and Duron et al.’s ( 2006 ) frameworks of CT development. To reiterate, these factors could either enhance or inhibit memory (foundation of CT development), comprehension, reflective judgement and self‐regulatory functions of metacognition as a requirement for CT.

6.1. Theme I: Educators’ classroom behaviour

Educators’ behaviour includes actions and inactions of the educators that might either enhance or inhibit students’ positive learning experiences towards the acquisition of CT skills. Four sub‐themes under this theme were identified namely beginning and ending on time; creating a conducive and participatory environment; and teaching methods and styles and managing the class.

6.1.1. Subtheme A: Beginning and ending on time

Only one (observation 6) started on time. The lecturer was in the class before scheduled time waiting for students. However, nine of the classes started late. The lateness ranged from 10 min (observations 2 and 7) to 44 min (observation 3). In one case (observation 5), the lecturer was on time but students were not available because they were moving immediately from another lecture. In other words, the ending time from the other lecture overlapped with the starting time of the new lecture. In another case (observation 8), the lecturer was engaged in an analogous official duty and therefore reported late.

6.1.2. Subtheme B: Creating a conducive and participatory environment

Some attitudes demonstrated by the educators appeared to have encouraged collegiality. For example, one lecturer's statement, "no answer is wrong, it could only be a right answer to a different question" (observation 2) caused students to participate in the teaching/learning process, which is consistent with CT teaching strategies. Also, some lecturers demonstrated a good sense of humour that was appreciated by students. For example, in observation 3, the lecturer asked a question and after the question, jokingly said, "my question to those in spectacles", which generated laughter from the students. The same lecturer appeared receptive to students’ views—allowed students to disagree with his views and even thanked students for asking questions. These strategies also demonstrated modelling of open‐mindedness (an attribute of CT) on part of the educators.

Active participation in the teaching and learning process is required to facilitate CT skills of students. However, some actions taken by some lecturers appeared to have resulted in students not fully participating in the learning process. For example, students appeared tense or nervous after the lecturer made the statements that "they [students] must respect and not make offensive statements; some of you are still adolescents. You must respect, I have always told you" (observation 8). This statement was in reaction to a comment from a student that the lecturer found to be offensive.

6.1.3. Subtheme C: Teaching methods and styles

The most frequent teaching method used was student presentation. In one case (observation 6), students were given case studies from which they were requested to draw a plan of care. However, students themselves used lectures whilst presenting. General discussions followed students' presentations led by the lecturer. The presentation encouraged students to share their views freely. However, during student presentations, several students appeared disinterested and were passive in the process. Some presenters just read from the power point slides verbatim. In cases where lecturers taught, they often used the lecture method interspersed with periods of questions and answers (observations 2, 3, 4 and 8).

In one lecture (observation 3), the lecturer related lessons to real life situations (stories from the clinical settings) that appeared to have sustained the interest of the students. The lecturer also frequently moved up and down the aisles during the class session. These actions appeared to have caused students to be more attentive (which enhances memory) throughout the session.

6.1.4. Subtheme D: Managing the class

Management of the class appeared to be challenging to some lecturers. For example, in observation 10, the lecturer did not act even when students were engaged in distractive behaviours. Most students generally appeared interested in the lesson. However, several students appeared indifferent with what was happening, and some conversed throughout the session (observation 10).

6.2. Theme II Students' characteristics

Students’ characteristics refer to actions and inactions of the students during observations that might either enhance or inhibit students’ positive learning experiences towards the acquisition of CT skills. Two sub‐themes under this theme were identified, namely distractive student behaviour and punctuality.

6.2.1. Subtheme A: Distractive student behaviour

Attention/perception processing is needed to enhance short‐term memory, which leads to long‐term memory (Dwyer et al., 2014 ). In all classes observed, several students were engaged in distractive behaviours that might hinder memory, namely fidgeting with phones, beeping/ringing phones, petty chatting and whispering—especially those sitting at the back roll of the class. However, what appeared to be the source of most distractive behaviour—the mobile phone—was useful in helping students in some of the presentations. Students sitting in front appeared more attentive. Movement of lecturers up and down the aisles appeared to limit distractive behaviours.

6.2.2. Subtheme B: Punctuality

Students arrived to lectures late. For example, during observation 2, approximately 70 students were late, with some more than 1 hr late. Also, another class session began with 62 students and ended with 117 (about 55 students late). In another instance, at a pre‐scheduled time, only 29 students were present. One student came after about 1 hr 21 min (observation 5), whilst some students left before the classes concluded.

6.3. Theme III: University‐wide factors/administrative support

University‐wide factors/administrative support relate to administrative factors in the university or school that might either enhance or inhibit students’ positive learning experiences towards the acquisition of CT skills. Three sub‐themes under this theme were identified: class size; scheduling of classes; and classroom layout and equipment.

6.3.1. Subtheme A: Class size

Class sizes observed for the 10 sessions ranged from 34–162 with an average of 95 students. Most classes (7) were above 90 students.

6.3.2. Subtheme B: Scheduling of classes

Some students who were to have a lecture immediately after the session were packed at the entrance to the lecture hall whilst engaging in conversation apparently causing distraction (observation 4). Also, some lectures started immediately after a lecture had ended with no time to move from one lecture hall to another.

6.3.3. Subtheme C: Classroom layout and equipment

Classrooms’ arrangements/layouts are rectangular with desks and chair bolted down. Most ceiling mounted projectors in classrooms were dysfunctional forcing lecturers to use movable projectors which were placed too close to screens. This made power point font sizes small. Some screens were torn and dirty making projected content unclear (observation 3). Also, some public address systems were dysfunctional, and therefore, some students could not hear the lecturers. For example, during a lecture (observation 4) on three different occasions, students drew the attention of the lecturer to the fact that they could not hear him. At a point, rain stopped the lecture because students could not hear the lecturer.

7. DISCUSSION

Based on the observation of classroom environment in relation to instructional activities, several factors need to be considered to provide students with the desired learning experiences to the development of their CT skills. Educators’ positive behaviour which served as factors towards the enhancement of CT skills of students identified in this study is worth noting. These factors including educators’ good sense of humour and open‐mindedness appeared to inspire students to engage in the teaching–learning process were encouraging. The learning and learning process were also made entertaining. This finding is consistent with Ulloth's ( 2002 ) study which found humour to be useful in holding students’ attention, relieving anxiety, establishing rapport and making learning fun. Froneman, Du Plessis, and Koen's ( 2016 ) study on student–educator relationship identified similar characteristics needed for meaningful learning experiences of students. Similarly, other studies (Mangena & Chabeli, 2005 ; Raymond & Profetto‐McGrath, 2005 ; Raymond et al., 2018 ) buttress the need for nurse educators to create a conducive environment for students to develop CT skills.

Another finding worth highlighting in this study was negative educators’ factors such as being unfriendly in correcting students, using inappropriate teaching methods and poor class management skills. Similar factors were identified among educators in South Africa (Mangena & Chabeli, 2005 ) and Canada (Raymond & Profetto‐McGrath, 2005 ; Raymond et al., 2018 ). Mangena and Chabeli ( 2005 ) found that educators’ lack of knowledge, inappropriate teaching and assessment methods and educators’ negative attitude as barriers to the facilitation of CT skills of students.

A further noteworthy finding is the inappropriate implementation of CT teaching methods by educators. Notably, the incongruous implementation of students’ presentation and discussion methods need to be highlighted. This finding is similar to Boso and Gross' ( 2015 ) study among nurse educators in Ghana and inappropriate teaching and assessment methods identified in Mangena and Chabeli’s ( 2005 ) study.

Students’ lateness to lectures (lack of punctuality) identified in this study is worth highlighting. This finding indicates loss of valuable time which may be needed to engage with the content which may hinder the development of students’ CT skills. Also, students’ lateness to lectures appears to correspond with educators’ own late start to lectures. This appears to agree with Jack, Hamshire and Chambers' ( 2017 ) findings which highlight the influence of educator's behaviour on students. This is similar to Cruess, Cruess, and Steinert ( 2008 ) and Billings and Halstead's ( 2005 ) assertions about role modelling.

Another important finding of this study was students’ distractive behaviour. Some students engaging in distractive behaviours are not unexpected, but the degree and extent of these distractive behaviours were unanticipated. Shell ( 2001 ) identified students’ behaviour as the highest barrier to the development of CT skills of students. Also, this finding may be indicative of nurse educators’ apparent lack of appropriate classroom management skills required for meaningful learning experience of students. For example, as seen in this study, educator's movements up and down the aisles aided in the minimization of distractive behaviours of students.

The use of mobile phone during class time as an example of distractive behaviours is worth highlighting. These students may have been engaged on social media platforms such as WhatsApp, Facebook and Twitter during class sessions underscoring the penetration of social media into every facet of the students’ lives. The risk of the use of technology or social media has been noted (Ferguson, 2013 ). Inappropriate use of social media by students found in this study may highlight the absence of social media guidelines for students and educators. Peck ( 2014 ) suggests a purposeful use of social media to improve learning. Schools of higher learning have used social media to improve connectedness, increase access to academic libraries, create virtual classrooms and create student learning experiences to achieve desired academic outcomes (Peck, 2014 ). Evidence supports increased knowledge and flexibility of learning when technology is introduced into the classroom such as blended‐learning (Strickland, Gray, & Hill, 2012 ) and flipped‐classroom (Missildine, Fountain, Summers, & Gosselin, 2013 ) approaches. A purposeful use of social media should reflect the availability of social media guidelines/policy, which will likely minimize the risk or abuse of social media use.

Large class sizes were observed in this study. Pressure to increase student intake appears to overwhelm the school's capacity in terms of space and the number of qualified nurse educators at post (Bell et al., 2013 ; Hornsby, Osman, & Matos‐Ala, 2013 ). This is similar to Raymond and Profetto‐McGrath, ( 2005 ) and Raymond et al.’s ( 2018 ) studies that highlight environmental factors that influence facilitation of CT in a school. The large class sizes appear to influence teaching methods/strategies (Hornsby et al., 2013 ) that could be adopted by educators as identified in Gibbs, Lucas, and Spouse's ( 1997 ) study.

Another finding of this study was scheduling of classes. Classes were sometimes beginning immediately after another for the same students. This was partly accounting for late arrival of students to the next class. The late arrival of students to class may reduce their contact hours and may influence the introduction of the appropriate learning methods/strategies. Given that found time as a factor in CT development of students, reduced contact hours could inhibit the facilitation of CT of the students.

Issues relating to classroom features were observed in this study. These findings primarily relate to logistical and design issues. Logistical issues included dysfunctional ceiling mounted projectors, torn/dirty screens and inadequate public address systems. These logistical constraints may impede meaningful learning experience and consequently hinder the development of CT skills acquisition of students. This finding is consistent with other reports on challenges in the Ghanaian nursing educational system (Bell et al., 2013 ; Talley, 2006 ; Wilmot et al.,  2013 ). The traditional rectangular classroom physical layouts with desks and chairs bolted down is inconsistent with CT skills tenets which require that physical features of classrooms involve small or large circle arrangements to allow for students to make eye contact with each other and the educator to facilitate open dialogue (Billings & Halstead, 2005 ).

8. LIMITATIONS

Given that this was a direct non‐participatory observational study, some observations might have been missed by the researchers (Creswell & Poth, 2018 ; Patton, 2015 ), especially when an attempt to minimize interruption of the teaching process, the observers of this observational study positioned themselves at the back of the classroom throughout each session. Also, there could have been observer bias. As noted by Creswell and Poth, there could have been impression management and potential deception on the part of the participants, especially the educators which might have influenced the data obtained. Several observations (10) were purposefully conducted to minimize this potential Hawthorne effect. In addition, some accounts might have been misinterpreted. However, this was minimized to some extent by reviewing the accounts with participants involved in the study.

9. RECOMMENDATION

Based on this study, further studies are recommended. The exploration of the experiences of nursing students and educators of instructional practices towards the development of CT skills in Ghana is highly recommended. Both quantitative and qualitative studies on how social media or technology in general could be used to facilitate meaningful learning are recommended.

This study also has implications for nurse educators and nursing school authorities who need to create a conducive environment for students for CT skills of students. Nurse educators should examine their own instructional methods/strategies with the view to adopting appropriate CT methods. In this regard, educators should aim at making learning fun and enjoyable. Educators should see themselves as role models to students regarding the demonstration of CT skills. School authorities should institute continuous faculty development programmes to help educators update their teaching skills regarding CT skills of students. School managers should provide the needed logistics needed for meaningful learning and commensurate to learning space, available faculty and other resources.

10. CONCLUSIONS

This study sought to observe instructional practices that influence the acquisition of CT skills of students in a classroom environment. The findings suggest that the educators’ teaching strategies have influence on learning atmosphere for CT skills facilitation of students. Also, several inhibiting and enhancing factors relating to students, university‐wide/administrative support were identified. It is therefore important that inhibiting factors are minimized or removed and enhancing factors are maintained or accentuated to help students engage in meaningful and purposeful learning experience with the view of developing their CT skills. Particularly, the role of the educators must be stressed to ensure that a conducive and participatory environment is created for student learning.

CONFLICT OF INTEREST

We do not have any conflict of interest to report.

AUTHOR CONTRIBUTIONS

CMB, ASVDM and JG: Conceptualization and designing of the study. CMB: Data collection, analysing and drafting of the manuscript. ASVDM and JG: Study supervision and made critical revisions on the paper. All the authors made substantial contributions to the manuscript.

ACKNOWLEDGEMENTS

We wish to acknowledge Victor Angbah for assisting in data collection. We also express our gratitude to the study participants.

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Critical thinking definition

Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement.

Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process, which is why it's often used in education and academics.

Some even may view it as a backbone of modern thought.

However, it's a skill, and skills must be trained and encouraged to be used at its full potential.

People turn up to various approaches in improving their critical thinking, like:

• Developing technical and problem-solving skills
• Engaging in more active listening
• Actively questioning their assumptions and beliefs
• Seeking out more diversity of thought
• Opening up their curiosity in an intellectual way etc.

Is critical thinking useful in writing?

Critical thinking can help in planning your paper and making it more concise, but it's not obvious at first. We carefully pinpointed some the questions you should ask yourself when boosting critical thinking in writing:

• What information should be included?
• Which information resources should the author look to?
• What degree of technical knowledge should the report assume its audience has?
• What is the most effective way to show information?
• How should the report be organized?
• How should it be designed?
• What tone and level of language difficulty should the document have?

Usage of critical thinking comes down not only to the outline of your paper, it also begs the question: How can we use critical thinking solving problems in our writing's topic?

Let's say, you have a Powerpoint on how critical thinking can reduce poverty in the United States. You'll primarily have to define critical thinking for the viewers, as well as use a lot of critical thinking questions and synonyms to get them to be familiar with your methods and start the thinking process behind it.

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Clinical Reasoning In Nursing (Explained W/ Example)

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

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.

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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.

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22 Nursing Interview Questions, Answers and Tips To Prepare

• March 22, 2024
• In Interviewing

Are you ready to take the next step in your nursing career? Whether you’re a new graduate or a seasoned professional, preparing for a nursing interview can be a daunting task. In this article, we’ll guide you through some of the most common nursing interview questions and provide expert tips on how to answer them effectively.

According to the U.S. Bureau of Labor Statistics , employment of registered nurses is projected to grow 6 percent from 2022 to 2032, which is faster than the average for all occupations.

Table of contents

General tips for nursing interviews

Common nursing interview questions and answers.

• Nursing interview questions for new grads

Behavioral nursing interview questions

Ethical nursing interview questions, personal nursing interview questions, critical thinking nursing interview questions.

When preparing for a nursing interview, there are several key tips to keep in mind. Here are some important considerations:

•   Research the organization : Before your interview, take the time to research the organization you are applying to. Familiarize yourself with their mission, values, and any recent news or developments. This will demonstrate your interest in the organization and help you tailor your answers to align with their goals.
• Dress professionally : It’s important to make a good first impression by dressing professionally for your nursing interview. Choose appropriate attire that reflects the level of professionalism expected in the healthcare industry.
• Review your resume and be prepared to discuss it : Be prepared to discuss your resume in detail during the interview. Review your past experiences, skills, and accomplishments , and be ready to provide specific examples that highlight your qualifications for the nursing position.
• Prepare your own questions to ask the interviewer : At the end of the interview, the interviewer will likely ask if you have any questions. It’s important to come prepared with thoughtful questions that demonstrate your interest in the role and organization. This is also an opportunity for you to gather more information about the position and the work environment.

Read more:  20+ Essential Nursing Skills for Your Resume [2024]

During a nursing interview, you can expect to be asked a variety of questions to assess your qualifications, experience, and fit for the role. Below are some common nursing interview questions:

What are your nursing qualifications and experience?

The interviewer wants to understand your background and experience in nursing. Be prepared to discuss your education, certifications, previous work experience, and any specialized training or skills you have acquired.

How do you handle difficult or challenging patients?

Describe your approach to handling such situations, emphasizing the importance of compassion, patience, and effective communication. Provide examples of how you have successfully managed difficult patient interactions in the past.

How do you prioritize patient care?

Explain your approach to prioritization, emphasizing the importance of assessing patient needs, collaborating with the healthcare team, and managing time effectively.

How do you handle medical emergencies?

Describe your experience and training in emergency situations, highlighting your ability to remain calm under pressure, follow protocols, and provide prompt and appropriate care.

How do you ensure patient safety?

Discuss your commitment to patient safety, including your adherence to protocols, attention to detail, and proactive approach to identifying and mitigating potential risks. Provide examples of how you have contributed to ensuring patient safety in your previous roles.

Nursing Interview questions for new grads

When preparing for a new grad nursing interview, anticipate questions about your passion for nursing, ability to learn quickly, and skills in communication and problem-solving. Here are common interview questions for new grads in nursing.

Tell me about yourself and why you chose nursing as your career.

What skills and training did you acquire in nursing school, how do you handle complex issues that involve good communication and problem-solving skills.

Behavioral nursing interview questions are designed to assess your skills, experiences, and behaviors in specific situations. Here are some common behavioral nursing interview questions and suggested answers:

Describe a time when you worked as part of a healthcare team to achieve a common goal.

Tell me about a situation where you had to handle conflict with a colleague or supervisor., describe a time when you had to adapt to a change in patient care or treatment plan., how do you communicate complex medical information to patients and their families, tell me about a time when you advocated for a patient’s needs or rights..

Read more:  41+ Behavioral Interview Questions and Answers

Describe a situation where you had to make a difficult ethical decision in patient care.

In a challenging ethical situation, it’s crucial to prioritize the well-being and rights of the patient. You can discuss a specific scenario where you had to navigate conflicting ethical considerations, ensuring patient autonomy, beneficence, and non-maleficence.Emphasize the importance of upholding ethical principles and maintaining open communication with the patient and their family to ensure informed decision-making and respectful care 

How do you maintain patient confidentiality?

Maintaining patient confidentiality is a fundamental aspect of healthcare practice. You can highlight the significance of safeguarding patients’ healthcare data and the ethical duty not to disclose patient information without authorization.Emphasize the need to ensure the security, privacy, and protection of patients’ healthcare data, especially in the age of fast-evolving information technology. Discuss the importance of obtaining patient consent before disclosing medical information to other healthcare providers actively involved in patient care 

How do you handle situations involving patient consent?

When addressing patient consent, emphasize the importance of informed consent to medical treatment as fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments to make well-considered decisions about their care. Discuss the significance of engaging patients in decisions involving their own care to the greatest extent possible, including when the patient has previously designated a surrogate to make decisions on their behalf. Highlight the ethical and legal aspects of obtaining consent and the exceptions to the requirement for informed consent in specific medical situations

Why did you choose nursing as a profession?

When addressing why you chose nursing as a profession, you can emphasize your passion for helping others and making a positive impact on people’s lives. You might also discuss any personal experiences or influential moments that inspired you to pursue a career in nursing. Highlight the rewarding nature of the job and the potential for stable work opportunities, demonstrating your genuine motivation for entering the field.

What are your long-term career goals in nursing?

In response to this question, you can discuss your long-term aspirations within the nursing profession. Consider mentioning specific professional development goals, such as acquiring skills in advancing technology, obtaining professional certifications, or taking on a management/leadership position. Emphasize the importance of continuous learning and self-development to stay current and relevant in the evolving field of nursing.

How do you handle stress and maintain work-life balance?

When addressing stress management and work-life balance, you can share strategies that demonstrate your ability to cope with the demands of the nursing profession. Discuss techniques such as practicing breathing exercises, meditation, regular exercise, and spending time in nature as effective stress-reducing activities. Additionally, emphasize the importance of self-care, maintaining personal time for friends and family, and effective time management to achieve a healthy work-life balance.

Critical thinking questions assess problem-solving skills and clinical expertise, aiming to gauge how you handle high-pressure scenarios. Provide real-life examples and express willingness to find answers if unsure.

Read more:  12 Hardest Interview Questions and Best Answers

These questions are designed to assess a nurse’s ability to think critically, make sound decisions, and effectively handle complex and high-pressure situations in a healthcare setting. When preparing for your interview, it’s essential to reflect on your experiences and be ready to provide specific examples that demonstrate your critical thinking skills and ability to navigate challenging clinical scenarios.

Remember , when answering nursing interview questions, use the STAR method (Situation, Task, Action, Result) to structure your responses. Provide specific examples and focus on the actions you took, the skills you utilized, and the positive outcomes achieved.

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