Critical Thinking for Nurses
Some experts describe a person's ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking, whereas others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, 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 health care 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."
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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 are responsible for the care of multiple patients during their shifts. Strong critical thinking skills are crucial when juggling a variety of tasks so patient safety and care are not compromised.
Dr. Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talked about examples of critical thinking in a healthcare environment, saying:
"Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe."
The pandemic of 2020-2021 created hospital care situations where critical thinking was essential and expected of the nurses on the general floor and in intensive care units. Dr. Crystal Slaughter is an advanced practice nurse in the ICU and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.
"Nurses are at the patient's bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider," she explains.
Top 5 Ways Nurses Can Improve Critical Thinking Skills
We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.
1. Case-Based Approach
Slaughter is a fan of the case-based approach to learning critical thinking skills. In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. "What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?"
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.
2. Practice Self-Reflection
Rhoads is an advocate for self-reflection. "Nurses should reflect upon what went well or did not go well in their workday, and identify areas of improvement or situations in which they should have reached out for help." Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.
This gives you the opportunity to discover mistakes you may have made and establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded. It's important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.
During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer but often will help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?
3. Develop a Questioning Mind
McGowan has learned that "critical thinking is a self-driven process. It isn't something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive."
In other words, to acquire critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking.
However, learning to ask insightful questions is a skill you must develop. Faced with staff shortages, declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than complete the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.
It is easier to practice questioning in a nonstressful, quiet environment until it becomes a habit. Then, in the chaos of the moment when your patient's care depends on your ability to ask the right question, you are ready to rise to the occasion.
4. Practice Self-Awareness in the Moment
Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you're struggling to finish every task needed for your patients. Passing medication, changing dressings, and hanging IVs all while trying to assess your patient's mental and emotional status can affect your focus.
Staying present helps you to be proactive in your thinking and anticipate what might happen. For example, bringing extra lubricant for a catheterization or extra gloves for a dressing change.
By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information on which to base your interventions and decisions.
5. Use a Process
As you are developing critical thinking skills, it can be helpful to use a process. For example:
- Ask Questions
- Gather Information
- Implement a Strategy
- Evaluate the Results
- Consider Another Point of View
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 on the top of his list of common pitfalls to critical thinking in nursing.
"We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care," he states. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.
New nurses may be overwhelmed by the transition from academics to clinical practice, which can lead to a task-oriented mindset; this conflicts with critical thinking skills. "Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient's blood pressure because medication administration is a task that must be completed," Slaughter states. "A nurse employing critical thinking skills would address the low blood pressure, review the patient's blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld."
Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgement when you're faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that ultimately would benefit the patient. Nurses with strong critical thinking skills exhibit the following:
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.
Meet Our Contributors
Crystal Slaughter, DNP, APRN, ACNS-BC, CNE, is a core faculty member in Walden University's RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Dr. Slaughter's clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.
Dr. Jenna Liphart Rhoads 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. She currently resides in Wisconsin with her husband and two children.
Nicholas McGowan, BSN, RN, CCRN 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.
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