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Critical Thinking in Nursing: Tips to Develop the Skill

4 min read • February, 09 2024

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

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

What Is Critical Thinking in Nursing?

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

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

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

How Is Critical Thinking Important for Nurses? 

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

Elements of Critical Thinking in Nursing

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

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

How to Develop and Apply Critical-Thinking Skills in Nursing

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

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

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

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

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8.7: Critical Thinking, Clinical Judgment and the Nursing Profession

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Figure 8.12 Image by Moondance from Pixabay

Critical thinking involves the skillful analysis of information to make informed judgments. To engage in critical thinking, it's crucial to recognize and address personal biases and assumptions when encountering information, and to consistently apply standards for evaluating sources.

Critical Thinking in Nursing

Critical thinking is indispensable in nursing as it empowers caregivers to make decisions that optimize patient care. During education, educators and clinical instructors introduced critical-thinking examples in nursing, emphasizing tools for assessment, diagnosis, planning, implementation, and evaluation.

The cultivation of these skills continues into practice. Critical thinking is pivotal in delivering quality patient care and evolves throughout a nursing career, eventually becoming instinctive. Critical thinking in nursing involves identifying problems, determining optimal solutions, and executing effective resolutions through clinical decision-making. Reflection follows action to assess outcomes and consider alternative approaches where necessary.

Nurses play a crucial role as primary patient advocates, often the first to detect changes in status. Critical thinking enables unbiased interpretation of these changes based on evidence rather than conjecture. Anticipating patient needs through critical-thinking skills significantly influences care quality and outcomes.

Key elements of critical thinking in nursing include:

• Clinical judgment: Prioritizing patient needs, interpreting data, and anticipating complications.
• Patient safety: Recognizing deviations and taking preventive actions.
• Communication and collaboration: Fostering interdisciplinary teamwork.
• Problem-solving skills: Analyzing issues and implementing effective solutions.

Developing critical-thinking skills involves continuous learning, reflection on practice, openness to diverse perspectives, and structured problem-solving approaches like SWOT analysis. These skills mature with experience, enabling nurses to navigate complex healthcare scenarios effectively.

In conclusion, critical thinking is indispensable for safe, patient-centered care in nursing. Its ongoing development equips nurses to navigate challenges and uphold standards of excellence in an evolving healthcare landscape.

Clinical Judgement

Clinical judgment is the application of critical thinking to the clinical setting, which includes assessing, analyzing, and synthesizing complex patient data to develop and implement effective patient care plans. It involves interpreting patient information, drawing conclusions, and making decisions about patient care. Clinical judgment centers on interpreting and synthesizing patient data to make informed decisions about nursing interventions. It aims to make accurate and timely clinical decisions that positively impact patient outcomes. Nurses use clinical judgment to prioritize patient needs, anticipate complications, and adapt care plans based on patient responses. It integrates critical thinking skills into real-time clinical situations.

Clinical Decision Making

Clinical decision making refers to the process of choosing the best course of action among various alternatives to achieve a desired patient outcome. It involves selecting appropriate interventions based on a synthesis of clinical judgment, evidence-based practice, patient preferences, and available resources. Clinical decision making is focused on choosing the best action to meet specific patient needs and goals. It aims to provide safe, effective, and patient-centered care. Nurses engage in clinical decision making to determine treatment plans, prioritize care activities, and manage patient responses. It relies on critical thinking and clinical judgment to weigh options and select the most appropriate intervention.

In nursing practice, critical thinking, clinical judgment, and clinical decision-making are interrelated and essential:

• Critical thinking underpins both clinical judgment and decision-making by guiding the analysis and evaluation of information.
• Clinical judgment utilizes critical thinking to interpret patient data and make informed decisions about care priorities and interventions.
• Clinical decision-making integrates critical thinking and clinical judgment to choose effective interventions and strategies for achieving positive patient outcomes.

While critical thinking focuses on the process of reasoning and evaluating information, clinical judgment applies this thinking to clinical situations to interpret and prioritize patient needs. Clinical decision-making then uses critical thinking and clinical judgment to select the best course of action for optimal patient care. Together, these elements form the foundation of professional nursing practice, ensuring safe, effective, and patient-centered care delivery.

Differentiating Between Critical Thinking and Clinical Judgment in Caring for a Patient with Pneumonia

Instructions:

Review the patient scenario provided below. For each action taken by the nurse, determine whether it demonstrates critical thinking or clinical judgment. Write "CT" for critical thinking and "CJ" for clinical judgment next to each action. Explain why you classified each action as either critical thinking or clinical judgment.

Patient Scenario:

Mrs. Johnson, a 68-year-old woman, is admitted to the hospital with pneumonia. She presents with a fever of 101.8°F, productive cough, shortness of breath, and chest pain. Her medical history includes hypertension and type 2 diabetes.

1.Reviewing Mrs. Johnson’s Medical History and Lab Results: - Action: The nurse reviews Mrs. Johnson’s past medical history and her recent lab results to understand her overall health status. - Classification: ___ - Rationale: ___

2. Administering Prescribed Antibiotics: - Action: The nurse administers the prescribed antibiotics as ordered by the physician. - Classification: ___ - Rationale: ___

3. Monitoring Vital Signs: - Action: The nurse frequently monitors Mrs. Johnson’s vital signs, including temperature, blood pressure, respiratory rate, and oxygen saturation. - Classification: ___ - Rationale: ___

4. Evaluating the Effectiveness of Interventions: - Action: After administering antibiotics, the nurse assesses Mrs. Johnson’s response, including a reduction in fever and improvement in breathing. - Classification: ___ - Rationale: ___

5. Prioritizing Care: - Action: The nurse prioritizes interventions, ensuring that Mrs. Johnson receives oxygen therapy before other less urgent tasks. - Classification: ___ - Rationale: ___

6. Educating the Patient and Family: - Action: The nurse educates Mrs. Johnson and her family about pneumonia, its treatment, and how to manage symptoms at home. - Classification: ___ - Rationale: ___

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Critical Thinking in Nursing

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Critical Thinking and Nursing Practice

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Critical Thinking in Nursing Practice

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Critical Thinking in Nursing Practice. CRITICAL THINKING. Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others (Pg. 216) Recognize that an issue exists Analyzing information about the issue Evaluating information

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CRITICAL THINKING Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others (Pg. 216) Recognize that an issue exists Analyzing information about the issue Evaluating information Making conclusions

Critical Thinking Requires… • Cognitive skills • Ask questions • Remain well-informed • Be honest in facing personal biases • Be willing to reconsider and think clearly about issues

Attributes of a Critical Thinker • Asks pertinent questions • Is able to admit a lack of understanding or information • Is interested in finding new solutions • Listens carefully to others and is able to give feedback • Examines problems closely

Critical Thinking Can Lead To… • Sound clinical decisions • Using the Nursing Process to guide patient care • Evidence-Based Practice (EBP)

Nursing Process • Definition • The act of reviewing the patient’s situation in order to obtain information of past history, present status, and to identify patient current and potential problems and needs

Developing Critical Thinking Skills • Reflection = the process of purposefully thinking back or recalling a situation to discover its purpose or meaning • Concept mapping – see other power point

Nursing Assessment

Nursing Process (ADPIE) • Assessment • Nursing Diagnosis • Planning • Implementation/Intervention • Evaluation

Assessment • The deliberate and systematic collection of data to determine a client’s current and past health status and functional status and to determine the client’s present and past coping patterns. • Collection and verification of data • Primary source = patient • Secondary source = family, medical record • Analysis of data

Data Collection • Subjective • Patient states • Objective • Observations or Measurements • Vitals • Inspection of a wound

Methods of Data Collection • Interview • Helps clients relate their own interpretation and understanding of their condition • Three phases • Orientation • Begin a relationship • Understand client’s primary needs • Working • Gather information about the client’s health status • Termination

Methods of Data Collection Cont’d. • Nursing Health History • Biographical information • Reason for seeking health care • Client expectations • Present illness or health concerns • Health history • Family history • Environmental history (work, home, exposure) • Psychosocial history (support system, coping skills) • Spiritual health • Review of systems • Documentation of findings

Putting It All Together • Physical exam • Observe client behavior • Diagnostic and laboratory data • Interpreting assessment data and making nursing judgments • Validate data, ensure it isn’t an inference • Holistic perspective for better clinical decision making • Leads to nursing diagnosis

Nursing Diagnosis

Nursing Diagnosis • Classifies health problems within the domain of nursing • DOMAIN • A TERRITORY GOVERNED BY A SINGLE RULER • A REALM OR RANGE OF PERSONAL KNOWLEDGE AND RESPONSIBILITY

Nursing Diagnosis Cont’d. A nursing diagnosis is a clinical judgment about individuals, families, or communities and their responses to actual and/or potential health problems or life processes (Pg. 248) (NANDA International, 2007)

Problem List Fractured hip – In traction Confusion Hypertension (HTN) Insulin Dependent Diabetes (IDDM) History of falls Atrial Fibrillation (A-fib) Pain

Establishing Priorities Helps nurses to anticipate and sequence nursing interventions Classification of priorities: High = if untreated may result in harm Intermediate = non-life threatening needs Low = not always directly related to specific illness or prognosis; affects the client’s future well-being

Potentials for Nursing Diagnosis Safety Confusion History of falls Skin integrity Immobility Pain Fractured hip

Building A Nursing Diagnosis 1. PROBLEM 2. ETIOLOGY 3. SYMPTOMS

PES PROBLEM P –At risk for impaired skin integrity RELATED TO (R/T) E –Immobilization AS EVIDENCED BY (AEB) S –Bedrest and traction

Planning Nursing Care

Goals and Outcomes States in terms of PATIENT goals and outcomes Not NURSING goals May be short, intermediate or long term (>one week) Written using “S-M-A-R-T” acronym

S-M-A-R-T Specific: What needs to be accomplished? Measurable: How will we know when the goal has been met? Attainable: Possible to meet goal with available resources. Realistic: Patient must have the capacity to meet the goal. Time-specific: When will the goal be achieved?

Guidelines for Writing Goals

Establishing Goals and Expected Outcomes Goal A broad statement that describes the desired change in a client’s condition or behavior Expected Outcome Measurable criteria to evaluate goal achievement; a specific measurable change in a client’s status that you expect to occur in response to nursing care

Goals • Client-Centered • A specific and measurable behavior or response; “PATIENT WILL” • Short-term • An objective behavior or response expected within hours to a week • Long-term • An objective behavior or response expected within days, weeks, or months

Goal Statement PATIENT’S SKIN WILL REMAIN INTACT THROUGHOUT HOSPITALIZATION.

Goal • Client Centered • Skin will remain intact • Observable? • Yes • Time Limited • During hospitalization • Realistic? • Yes

NIC/NOC • Nursing Outcomes Classification • Published by the Iowa Intervention Project • Linked to NANDA International nursing diagnoses • Nursing Interventions Classification • Three levels • Domains: use broad terms to organize the more specific classes and interventions • Classes: 30 which offer useful clinical categories to refer to when selecting interventions • Interventions: 542 treatments based upon clinical judgment and knowledge that a nurse performs to enhance outcomes

Implementing Nursing Care

Nursing Interventions • Any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance client outcomes • Direct = tx performed through interactions with client • Indirect = tx performed away from the client but on behalf of the client

Types of Interventions • Nurse Initiated • Independent • Physician Initiated • Dependent • Collaborative • Interdependent

Planning Nursing Care • DECIDE ON AN INTERVENTION TO PREVENT SKIN BREAKDOWN

Interventions • Nursing Orders • Reposition every two hours • Skin care to all boney prominences with repositioning • RN skin assessment every shift • MD Orders • Specific dressings/ointments to wounds • Collaborative Orders • Wound care consult

Evaluation • You conduct evaluative measures to determine if you met expected outcomes, not if nursing interventions were completed • Did you meet the expected goal/outcome? • Evaluation is ongoing, as is the nursing process

The Nursing Process in Ongoing Care Each care plan must evolve as the patient progresses Based on evaluation (assessment), the nursing diagnoses, priorities, and interventions will change

Time Factor in Setting Priorities The planning of nursing care occurs in three phases: Initial Ongoing Discharge Planning

Communication

Communication and Nursing Practice • Communication is a lifelong learning process • Functioning as a client advocate, nurses need to be assertive • The intimate moment of connection that makes all the difference in the quality of care and meaning for the client and the nurse • Effective communication helps maintain effective relationships and helps meet legal, ethical, and clinical standards of care

Communication and Interpersonal Relationships • Requires a sense of mutuality and a belief that the nurse-client relationship is a partnership and both are equal participants • Every nuance of posture, every small expression and gesture, every word chosen, and every attitude held all have the potential to hurt or heal

Levels of Communication • Intrapersonal = Occurs within an individual • Interpersonal = One-to-one interaction • Transpersonal = Occurs within a person’s spiritual domain; prayer, meditation, guided reflection, religious rituals • Small-Group = Occurs when a small number of persons meet together • Public = Interaction with an audience

Basic Elements of the Communication Process • Referent = refers to, object of conversation • Sender and Receiver = encodes and decodes • Messages = content of the communication • Channels = means of conveying and receiving messages through senses • Feedback = the message the receiver returns • Interpersonal Variables = factors that influence communication; perception • Environment = the setting for the interaction; needs to meet participant needs

Nonverbal Communication • Personal appearance • Posture and gait • Facial expressions • Eye contact • Gestures • Sounds • Territoriality and Personal space

Professional Nursing Relationships • Nurse-Client Helping Relationships • Nurse-Family Relationships • Nurse-Health Care Team Relationships • Nurse-Community Relationships

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