The Value of Critical Thinking in Nursing

Critical Thinking for Nurses

Clinical skills in nursing are obviously important, but critical thinking is at the core of being a good nurse.

Critical thinking skills are very important in the nursing field because they are what you use to prioritize
and make key decisions that can save lives. Nurses give critical care 24/7, so the critical thinking skills of
nurses can really mean the difference between someone living or dying. These types of skills are
important not just for clinical care, but for making important policy decisions.

For you to become a successful nurse, you will need to learn how a nurse thinks on the job. In nursing
school, you will learn how to do an IV, dress a wound and to save lives, but there is more to being a
nurse than just having good clinical skills. Standard protocols in nursing will work 99% of the time, but
what about that 100th time when they don’t work? That’s when your critical thinking skills can either
save or cost a life.

What is different about the thinking of a nurse from a sound engineer or dentist? Mainly it is how the
nurse views the patient and the sorts of problems nurses have to deal with in their work. Thinking like a
nurse requires you to think about the entire world and content of nursing, including ideas, theories, and
concepts in nursing. It also is important that we better develop our intellects and our skills so that we
become highly proficient critical thinkers in nursing.

In nursing, critical thinkers need to be:

1. Precise
2. Complete
3. Logical
4. Accurate
5. Clear
6. Fair

All of these attributes must be true, whether the nurse is talking, speaking or acting. You also need to do
these things when you are reading, writing and talking. Always keep these critical thinking attributes in
mind in nursing!

Nurses have to get rid of inconsistent, irrelevant and illogical thinking as they think about patient care.
Nurses need to use language that will clearly communicate a lot of information that is key to good
nursing care. It is important to note that nurses are never focused in irrelevant or trivial information.
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.
 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.
 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.
 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
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

Critical thinking can fail when logic is improperly used. One common fallacy is when one uses a circular
argument. A nurse could write a nursing diagnosis that reads Coping is ineffective, as can be seen by the
inability to cope.’ This just makes the problem into a circle and does not solve it.

Another 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.

Logic errors also can happen when a thinking makes generalizations and does not think about the
evidence.

Bias

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

Biases can complicate patient care. If you think that someone who is alcoholic is a manipulator, you
might ignore their complaint that they are anxious or in pain, and miss the signs of delirium tremens.

Closed Minded

Being closed-minded in nursing is dangerous because it ignores other points of view. Also ignored is
essential input from other experts, as well as patients and families. This means that fewer clinical
options are explored and fewer innovative ideas are used.

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.

So, no matter if you are a public health nurse or a nurse practitioner, you should always keep in mind
the importance of critical thinking in the nursing field.