Written By: Darby Faubion BSN, RN 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. RECOMMENDED ONLINE MSN PROGRAMS Critical thinking in nursing is the process applied by nurses to solve problems related to patient care. It is an essential process necessary to provide efficient, safe, and skillful nursing care. Nurses who use critical thinking skills become influential in decision-making, resulting in enhanced effectiveness and more favorable patient outcomes. At its core, nursing involves critical thinking. The importance of developing critical thinking skills as a nurse cannot be overstated. Nurses are faced with decision-making situations daily, and those decisions impact patient outcomes, nurse-patient relationships, and interprofessional relationships. Critical thinking skills in nursing drive the nurse's decision-making ability. It impacts every aspect of patient care. Here are four reasons why nurses must develop critical thinking skills. Nurses who learn critical thinking can use those skills to understand normal or abnormal changes in patient conditions and determine what nursing intervention may be necessary to address those changes. It is not uncommon for nurses to encounter situations in patient care where there are multiple appropriate options for care or treatment. While more than one treatment option may be reasonable, the nurse's responsibility is to determine which treatment is most appropriate. Critical thinking in nursing promotes active thought and decision-making. When nurses demonstrate clinical thinking skills, they are able to promote improvement in patient care methods and improve professional development opportunities, which benefit patients and the healthcare team. Although nursing is considered a science, there are instances that require split-second decisions. Nurses who are critical thinkers are more likely to make rational, patient-centered decisions that benefit the client and healthcare team. Critical thinking in nursing is characterized by several attributes. The following are examples of attributes of excellent critical thinking skills in nursing. In nursing, the interpretation of patient data is an essential part of critical thinking. Nurses must determine the significance of vital signs, lab values, and data associated with physical assessment. Nurses must also interpret the meaning inferred by a patient's verbal or nonverbal communication and use their interpretation of communication and data to develop and implement effective care plans. Nurses who apply critical thinking use the knowledge and skills they have obtained to examine their beliefs when presented with new evidence. Independent thought means the nurse is open-minded and willing to consider different measures of care, practice, and technical skills and how each will impact patient and professional outcomes. Critical thinking nurses consider patient situations based on evidence, not others’ opinions. They remain objective and impartial, which creates an atmosphere conducive to effective communication, which benefits patients and the healthcare team. Intuition is the ability of someone to perceive and understand concepts without using conscious reasoning. Intuition is often referred to as sixth sense, instinct, suspicion, hunch, or a gut feeling. Although some people view intuition as guessing, and therefore inappropriate, others believe intuition as a legitimate and essential aspect of clinical judgment, acquired through knowledge and nursing experiences. While nurses should use conscious, intentional thought in decision-making, intuition is also an integral part of critical thinking in nursing. When nurses identify problems that represent an unsteady patient status or conflict at work, they use problem-solving. Although they go hand in hand, problem-solving and critical thinking are not the same things. Problem-solving occurs when nurses implement critical thinking measures to obtain information about a problem and suggest possible solutions. Despite our best efforts, there are days when patient statuses change unexpectedly, or we must work short-staffed, requiring us to be flexible. Nurses who practice critical thinking understand the importance of flexibility and how that characteristic can lead to better patient outcomes. Critical thinking in nursing requires a lifelong commitment to finding effective solutions to nursing and patient problems. Perseverance is a determination to clarify concepts and find effective ways to solve problems despite frustration or difficulties. Nurses who practice perseverance continue to address issues until a resolution is found. To be effective in nursing, critical thinking must represent integrity in practices. Integrity requires nurses to question their personal beliefs and knowledge as much as they would challenge those of others. It means being willing to admit inconsistencies within one's own beliefs and between their ideas and those of others. Nurses who successfully implement critical thinking are eager to listen to and learn from others to improve patient outcomes, even if it means changing their way of thinking or performing to better the patient and the team. Developing critical thinking in nursing takes time and determination. The following are some examples of critical thinking in nursing with scenarios of poor critical thinking and excellent critical thinking responses. Nurses are responsible for maintaining relationships between patients and staff. They take initial reports and discuss care options with patients, families, and other team members. Mrs. Hill’s four-year-old son has a high temperature and calls the after-hours nurse hotline for advice. The nurse taking the call must perform a nursing assessment by phone to determine which recommendations are appropriate. The nurse tells Mrs. Hill, “Since I can’t see your son right now, it’s really up to you whether you want to take him to the emergency room. Sometimes you just have to wait it out.” Applying excellent critical thinking in this scenario requires the nurse to ask questions to determine the next steps in patient care. For example, the nurse should ask Mrs. Hill the following questions: “How long has your son's temperature been elevated?" "What is his temperature now, and when is the last time he had medicine to help reduce the fever?" "Is your son able to drink fluids without becoming sick?" "Is your son drowsy or still active?” When the nurse gathers relevant information about the child, she can make a more informed decision about the next, most appropriate steps. Critical thinking in this scenario allows the nurse to decide whether it is okay to wait until the clinic opens the following day, page the primary doctor, or send the client to the emergency room for evaluation. Nurses with good critical thinking skills are instrumental in increasing the quality of patient care and improving patient outcomes. Nurses are the eyes and ears of the healthcare team, and critical thinking skills allow nurses to be effective patient advocates, promoting quality patient care. Mr. Reid is two days post-op following an emergency appendectomy. During the nursing assessment, the nurse notes increased agitation and noticeable tremors in his hands. He is afebrile but is experiencing a more rapid heart rate than four hours ago. Because the client had surgery two days ago, and is exhibiting agitation and increased heart rate, the nurse naturally suspects the client is becoming septic. She notifies the physician and requests an order for antibiotics to help resolve sepsis. Although Mr. Reid is exhibiting some symptoms associated with sepsis, the nurse considers other factors. She notes Mr. Reid's temperature is not elevated and has not been elevated since his admission to the post-surgical floor. The nurse realizes Mr. Reid's symptoms could indicate alcohol withdrawal. Due to the nature of his surgery being an emergency, a thorough medical history may not have been available at the time of initial admission. Before calling the physician, the nurse takes the time to gather a comprehensive medical history, including the use of alcohol or recreational drugs. Collaboration is a form of interpersonal critical thinking. Each person involved in collaboration must contribute to critical thinking to identify the needs and priorities related to the patient. Mrs. Bellows is a 40-year-old patient receiving treatment for H1N1 influenza. Since being admitted to your care, she has developed Guillain-Barre syndrome and is now on a ventilator. The attending physician has ordered Peramivir 600 mg administered intravenously over thirty minutes once daily for seven days. The nurse has never heard of Peramivir. After looking up the medication, the nurse discovers the drug is experimental and intended to treat complicated cases of Guillain-Barre. Because Peramivir is a relatively new drug and the nurse is unfamiliar with the medication, she chooses to follow the physician’s instructions, ordering the medication from the pharmacy and beginning the initial dose. Although the medication may be appropriate for the treatment of Mrs. Bellows, the nurse is unfamiliar with the drug and its potential side effects or adverse reaction. The nurse consults with the physician and the pharmacist to discuss possible reactions or side effects as a precaution. The nurse asks the physician and unit manager to be present during the administration of the initial dose. Although the nurse could administer the medication and report the patient’s response, collaborating with other team members puts the patient’s best interest and safety at the center of care. Precepting is an excellent way to foster critical thinking skills in nursing students, new nurse graduates, and nurses who are new to your department. Nurse Janna is the charge nurse responsible for precepting the newest nursing team member, Nurse Michael. Nurse Michael appears to be having trouble setting priorities for patient care which is evidenced by him concentrating on one patient at a time instead of considering the needs of all patients assigned to him. Nurse Janna attempts to organize work for Nurse Michael, but he does not carry the approach forward with his next assignment. Nurse Janna understands Nurse Michael may be overwhelmed. Instead of discussing options for prioritization and helping Nurse Michael develop an action plan, Nurse Janna asks him, “Which patients do you prefer to care for?” and offers to take on the role of primary nurse for some of his patient load. Nurse Janna realizes being a new nurse can feel overwhelming and wants to help Nurse Michael adjust to his role. Instead of organizing his work for him or taking over patient care, Nurse Janna takes time with Nurse Michael after shift report and asks him to identify priorities for patient care. By doing this, Nurse Janna allows Nurse Michael to refine and practice his own clinical thinking skills regarding prioritizing patient care. At the end of the shift, Nurse Janna discusses the day with Nurse Michael and determines what nursing actions worked well and which ones could have been done more effectively. (The following are 18 Simple Tips to help nurses improve their critical thinking skills.) Nurses who are open-minded take the knowledge and experiences of others into consideration. Open-mindedness in nursing demonstrates a willingness to learn from others and gain insight from the professional experiences of your peers and creates an environment in which you can develop essential nursing skills like critical thinking. Becoming self-aware means considering your values, ethics, morals, beliefs, and thought processes. People who practice self-awareness are familiar with the concept of analyzing, which is essential for critical thinking. Self-aware nurses know their strengths and weaknesses and use their knowledge of self as a guide to aid them in decision-making. Critical thinking in nursing requires being objective, which means being willing to suspend judgment. When you avoid judgment, you create an atmosphere conducive to effective communication, a necessary component of critical thinking and collaboration in nursing care. Everyone forms biases based on personal experiences. However, nurses must learn to separate personal biases from patient encounters to prevent making false assumptions that could negatively impact patient care. Consider your own thought processes and the ways you reach conclusions. If you identify a personal bias, take steps to eliminate it. In so doing, you allow yourself to be engaged in more multi-dimensional, objective ways of thinking, promoting improved critical thinking skills. Nursing is an ever-growing and evolving profession, requiring nurses to keep up. Part of critical thinking in nursing is having a willingness to ask questions and learn from others. Further, asking questions helps you make informed decisions and evaluate the effectiveness of patient care. Experienced nurses are excellent sources of knowledge and information. When you surround yourself with like-minded people that have more experience than you, you can take from their experiences and build your own strengths. For example, nurses who have worked in intensive care for years can offer insight on how to implement critical thinking to prioritize care. Other nurses understand the importance of growing, learning, and developing skills. Professional nursing organizations offer excellent opportunities to meet like-minded nurses who will encourage and challenge you. Many organizations offer members-only workshops and conferences focused on important topics such as critical thinking or decision-making. Self-reflection is a type of personal analysis used to observe and evaluate situations in your life and your responses to them. Self-reflection gives nurses the opportunity to discover and acknowledge mistakes and establish new patterns of behavior to improve decision-making later. Nurses who practice self-reflection may write in a journal or simply spend time alone thinking about their day and what, if anything, could have or should have been done differently. Reflecting on one's actions and behaviors is an excellent way to apply critical thinking in our personal lives, which can impact professional roles. No matter where you work, there will be a chain of command. Nurse managers are tasked with the responsibility of making sure patient care is provided in a timely, efficient manner. They have demonstrated the ability to exercise critical thinking and high-quality patient care. The decision to utilize the chain of command and seek direction, when needed, demonstrates a patient-centered level of critical thinking. Critical thinking skills in nursing require you to establish what information is most relevant to the problem or situation at hand. Informed decisions cannot be reached unless you have enough data pertaining to the situation. When you use critical thinking skills, you evaluate the amount of context of information or data and use it to make good decisions based on your nursing judgment. People in leadership roles must make important decisions that can affect patients and their teams. When you volunteer or ask for leadership opportunities, you are setting yourself up for real-world experiences that require critical thinking skills. If your employer has mentioned a new project or something they want to accomplish within the facility, ask to have a role in project leadership or to assist a team member in training to help improve your own critical thinking skills. Another great way to hone critical thinking skills as a nurse is to think about previous experiences you have had. Your decisions during those times influenced patient outcomes or relationships. Nurses often work in fast-paced environments where they must care for several patients. Each day, nurses must know what tasks, assessments, or patient concerns need to be addressed. Critical thinking measures help nurses determine which tasks are of higher priority so they can establish a plan of action for their day. Because the clinical environment may change quickly, nurses must remember to remain flexible even after an initial plan or priority checklist is made. Critical thinking nurses cultivate an attitude of confidence when making decisions about patient care. Keep in mind there is a difference between being confident and being conceited. Critical thinkers believed using well-reasoned reasoning will lead to reliable conclusions which improve patient outcomes. Nurses who are critical thinkers may value tradition in nursing practice, but they are also comfortable examining those traditions to ensure their validity and relevance in patient care today. Curious nurses ask questions including, “What would happen if we used a different approach to wound care?” “Would something else be more effective in improving patient outcomes?” or “How does this protocol align with the patient’s needs at this time?” Using critical thinking skills as a nurse requires a willingness to make impartial judgments by addressing the viewpoint of everyone involved in patient care. Being fair-minded means considering the thoughts and beliefs of the patient, family, and interdisciplinary team and demonstrating efforts to integrate change when improved patient outcomes are a possibility. It is impossible for one person to know everything about a patient, illness, or treatment. Nurses who practice intellectual humility are willing to admit what they do not know and accept instruction from more experienced nurses or staff. Intellectual humility is a characteristic of critical thinking in nursing that occurs when nurses accept knowing what everyone believes to be the right approach may not always be right or the best approach to patient care as new treatments and evidence emerge. Nurses who demonstrate critical thinking understand the importance of continuous learning. If you want to improve your critical thinking skills in nursing, take advantage of every opportunity to ask questions, learn new skills, and implement knowledge into daily practice. Critical thinking in nursing is essential to promote positive patient outcomes and build strong healthcare teams. Weak critical thinking skills can manifest in various ways, including inaction when action is needed, poor decision-making, and disinterest on the part of nurses. The consequences of poor critical thinking skills in nursing are far-reaching. The following are a few examples of how a lack of critical thinking skills can impact healthcare. Patients rely on nurses to make important decisions about their care. When nurses fail to use critical thinking skills or have not developed strong critical thinking skills, the risk that patients will lack adequate, high-quality care increases. Nurses are trained to use practice methods that include assessment, diagnosis, planning, implementation, and evaluation. When nurses fail to use critical thinking skills or have inadequate skills, it becomes difficult to anticipate and recognize changes in patient health or response to treatment, making it difficult (if not impossible) to apply necessary changes to care. When nurses have poor critical thinking skills, they may overlook changes in their patient's status, which could indicate the need to change the treatment plan. As failure to recognize these changes continues, patients can be subjected to unnecessary treatment. When the changes in a patient's status are recognized, nurses must create updated treatment plans. While it is not uncommon to need to update or change care plans, overlooking important information or symptoms due to poor critical thinking can prolong the amount of time patients require care, resulting in increased cost of healthcare services. Effective patient care requires each member of the team to exercise critical thinking and communication skills. Nurses who do not use critical thinking rarely question treatment plans or changes in their patient’s status. When there is an attitude that there is nothing to discuss, nurses stop communicating with one another and other members of the care team, resulting in poor team relationships and inappropriate patient outcomes. Critical thinking in nursing is an integral part of effective patient care. There are numerous books and resources focused on helping hone critical thinking skills. The following are examples of some resources to help improve critical thinking skills in nursing. • Tips to improve Knowledge and Critical Thinking Skills • Critical Thinking for New Nurses • What is Critical Thinking in Nursing? • Critical Thinking in the Nursing Process • 4 Steps to Master Critical Thinking • Critical Thinking and Writing in Nursing • Critical Thinking, Clinical Reasoning, and Clinical Judgment (A Practical Approach) • Think Like a Nurse (The Caputi Method for Learning Clinical Judgment) One of the most crucial skills nurses can develop is critical thinking. At its core, critical thinking helps promote positive patient outcomes and encourages effective communication between patients, families, and team members. Nurses who care enough to ask how to improve critical thinking in nursing are instrumental in providing safe, high-quality patient care. By implementing the 18 simple steps to improve critical thinking in nursing featured in this article, you can become a more efficient nurse and help positively impact patient outcomes and interprofessional relationships. A lack of critical thinking in nursing can have a significant impact on your nursing career. Each day, nurses are faced with situations that require critical thinking and decision-making skills. These skills make it possible to be effective caregivers and promote positive patient outcomes. Critical thinking is what many psychologists refer to as a “self-driven process.” Others cannot teach you to think critically. Instead, it is a practice that must be cultivated intentionally. Each person develops critical thinking skills differently. While there is no set amount of time it may take to improve critical thinking skills in nursing, you can implement measures to challenge yourself and strengthen your skills. Critical thinking skills in nursing are an essential part of effective patient care. Therefore, all nurses who wish to have a positive impact on patient care and the delivery of healthcare services should strive to develop excellent critical thinking skills. You can assess your critical thinking skills in nursing by assessing whether you meet certain critical thinking criteria. For example, if you demonstrate the following behaviors at work, you are more likely to exercise critical thinking skills. • 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?It is important to understand there is a difference between being a nurse and being a nurse with effective skills and practices. While you may graduate nursing school and pass the licensing exam with limited critical thinking skills, your chances of long-term success are not favorable. If you feel you lack effective critical thinking skills, do not give up. There are several ways you can work to improve your skills and develop strength in your nursing practice.
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What is an example of the critical thinking attitude of independent thinking in nursing practice?
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