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Critical thinking skills are essential for all nurses. They are a necessity for the provision of safe, high-quality clinical care. Nurses today are caring for patients who have complex, culturally diverse health care needs, making the importance of critical thinking in nursing even more paramount.
The growing body of research, patient acuity, and complexity of care demand higher-order thinking skills. A lack of experience can limit a nurse’s ability to reason, think and judge, which can pose a hazard to patients.
Therefore, expert nursing performance is dependent upon continual learning and evaluation of performance. For over 50 years, nursing education has emphasized critical thinking as an essential nursing skill. Professional and regulatory bodies in nursing education have required that critical thinking be component of all nursing curricula.
What is Critical Thinking in Nursing?
The National League for Nursing Accreditation Commission (NLNAC) has defined critical thinking as “the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based.
This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research.” Critical thinking in nursing involves applying knowledge and experience to identify patient problems and directing clinical judgments by selecting from alternatives, weighing evidence, using intuition, and by pattern recognition. It includes questioning, data collection, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, creativity, and verification.
A nurse who thinks critically utilizes core cognitive thinking skills and justification based on evidence to carry out actions that result in positive patient outcomes.
Core Cognitive Critical Thinking Skills
Skillful nurses can think critically because they possess the following characteristics: motivation, perseverance, fair-mindedness, innovation, creativity, flexibility, intuition, and deliberate and careful attention to thinking. The expert critical thinker uses the following core cognitive critical thinking skills:
Interpretation involves clarifying the meaning of patient data. Interpretation may include determining the significance of laboratory values, vital signs, and physical assessment data as well as understanding the meaning of a patient's behavior or statements.
Analysis is determining the patient's problems based on assessment data. At times, the actual problem cannot be validated initially, but several hypotheses can be identified.
Evaluation is identifying expected nursing care outcomes and assessing whether or not they are met. If not met, the nurse ascertains the reason, allowing for the revision of actions and goals.
Inference is about making deductions about information. For example, the nurse uses careful monitoring to determine when a patient's health status improves or declines. Inferences are created through the concepts and assumptions the nurse brings to the table.
Explanation is the ability to justify actions. The nurse implements interventions based on research or other sources of evidence. Explanation includes the application of nursing theories and models, an appropriate ethical framework, and research-based knowledge from nursing and the sciences.
Self-regulation is the process of assessing one's practice and adjusting or improving it if necessary. Nurses must be able to plan, execute, monitor, and evaluate their learning and develop an awareness of their abilities. This creates self-directed lifelong learners.
Critical Thinking Pitfalls
Critical thinking can fall by the wayside when patient care is dictated by prejudice, preferences, self-interests, or fear. When the critical thinking process is not understood and applied correctly, nurses’ clinical judgment may be inaccurate and associated with inappropriate interventions that can lead to poor patient outcomes.
Nurses with poor critical thinking skills frequently fail to detect impending patient deterioration. This results in ‘failure to rescue,’ defined as mortality of patients who experience a hospital-acquired complication, which can occur for a multitude of reasons.
Nurses may have difficulty differentiating between a clinical problem that requires immediate attention and one that is less acute. Errors can also occur when a large amount of complex data must be processed in a time sensitive manner.
How to Improve Critical Thinking Skills in Nursing
Learning to provide safe and quality health care requires experience, technical expertise, critical thinking skills, and clinical judgment. The high-performance expectation of nurses is dependent upon continual learning, professional accountability, independent and interdependent decision making, and creative problem-solving abilities.
Nurses can gain the necessary expertise by engaging in self-reflective and collegial dialogue about professional practice, volunteering on committees and task forces, and attending continuing education opportunities, conventions, and conferences. It requires commitment and motivation to develop the core cognitive skills central to critical thinking.
Anyone can develop these skills by practicing, nurturing, and reinforcing them over time. To start, nurses can focus on the ‘five rights’ of clinical reasoning (also known as critical thinking):
Right cues are the available patient information (i.e., handoff reports, patient history, previous nursing/medical assessments), current clinical assessment data, and the recall of nursing knowledge.
Right patient refers to the process of identifying and prioritizing a patient at risk of critical illness or a severe adverse event.
Right time means nurses identify clinically at-risk patients promptly and carry out nursing interventions at the right time and in the right sequence.
Right action occurs when the nurse decides which part of the plan takes priority, who should carry out the nursing actions, which procedures and policies are involved, and who should be notified.
Right reason indicates that the reasoning is ethical, legal, and professional. ‘‘Right” may refer to the right conclusion being reached, or it may refer to the process, or preferably both.
The importance of critical thinking in nursing cannot be overstated. Patients are diverse; their clinical presentations are unique. Nurses must be capable of making rational clinical decisions and solving problems in order to provide safe, high-quality care.
Critical thinking is vital for nurses to meet the challenges of caring for increasingly complex patients. Advancing your education by earning an online nursing program offered by Carson-Newman University, is the first step on the road to developing the core cognitive skills employers are seeking.
To learn more, please see our earlier blog posts on The Value of Nursing Associations.
Benner, P., Hughes, R. G., and Sutphen, M. (2008). Clinical reasoning, decision making, and action: Thinking critically and clinically. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality.
Chabeli, M. M. (2007). Facilitating critical thinking within the nursing process framework: A literature review. Health SA Gesondheid: Journal of Interdisciplinary Health Sciences, 12(4), 69-89.
Ignatavicius, D. D. (2001). 6 critical thinking skills for at-the-bedside success: Key ways to practice, nurture, and reinforce staff members' cognitive skills. Nursing Management, 32(1), 37-39
Levett-Jones T., Hoffman, K., Dempsey, J., Jeong, S. Y., Noble, D., Norton, C. A., Roche, J., and Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today, 30, 515-510.