What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

definition of critical thinking in nursing process

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.

What Is Critical Thinking In Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• 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?

definition of critical thinking in nursing process

  • Nurse Spotlight
  • Student Resources

The Value of Critical Thinking in Nursing

portrait of Gayle Morris, BSN, MSN

Gayle Morris

Contributing Writer

Learn about our editorial process .

Updated October 3, 2023

Male nurse checking on a patient

Are you ready to earn your online nursing degree?

Some experts describe a person's ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. 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 healthcare 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," he says.

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 care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

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 talks 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 COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (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.

Featured Online MSN Programs

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.

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.

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 to 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 can 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?

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."

To gain 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 and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish 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 non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient's care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

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 struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient's mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as 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 as a basis for your interventions and decisions.

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 at 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 says. 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, leading to a task-oriented mindset and a common new nurse mistake ; 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 says. "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 judgment when you are 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 would benefit the patient. Nurses with strong critical thinking skills exhibit:

  • Learn from their mistakes and the mistakes of other nurses
  • Look forward to integrating changes that improve patient care
  • Treat each patient interaction as a part of a whole
  • Evaluate new events based on past knowledge and adjust decision-making as needed
  • Solve problems with their colleagues
  • Are self-confident
  • Acknowledge biases and seek to ensure these do not impact patient care

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.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient's cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient's overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Portrait of Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter 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. Slaughter's clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Portrait of Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads, Ph.D., RN

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.

Portrait of Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan 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.

You might be interested in

HESI vs. TEAS Exam: The Differences Explained

HESI vs. TEAS Exam: The Differences Explained

portrait of Genevieve Carlton, Ph.D.

Genevieve Carlton

Published February 14, 2024 · 2 Min Read

Courtnee James

Contributing Editor

10 Nursing Schools That Don’t Require TEAS or HESI Exam

10 Nursing Schools That Don’t Require TEAS or HESI Exam

For Chiefs' RB Clyde Edwards-Helaire, Nursing Runs in the Family

For Chiefs' RB Clyde Edwards-Helaire, Nursing Runs in the Family

Published February 13, 2024 · 2 Min Read

NurseJournal.org is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

Whether you’re looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Find the right nursing program for you.

Book cover

Brain, Decision Making and Mental Health pp 179–189 Cite as

Critical Thinking in Nursing

  • Şefika Dilek Güven 3  
  • First Online: 02 January 2023

981 Accesses

Part of the Integrated Science book series (IS,volume 12)

Critical thinking is an integral part of nursing, especially in terms of professionalization and independent clinical decision-making. It is necessary to think critically to provide adequate, creative, and effective nursing care when making the right decisions for practices and care in the clinical setting and solving various ethical issues encountered. Nurses should develop their critical thinking skills so that they can analyze the problems of the current century, keep up with new developments and changes, cope with nursing problems they encounter, identify more complex patient care needs, provide more systematic care, give the most appropriate patient care in line with the education they have received, and make clinical decisions. The present chapter briefly examines critical thinking, how it relates to nursing, and which skills nurses need to develop as critical thinkers.

Graphical Abstract/Art Performance

definition of critical thinking in nursing process

Critical thinking in nursing.

This painting shows a nurse and how she is thinking critically. On the right side are the stages of critical thinking and on the left side, there are challenges that a nurse might face. The entire background is also painted in several colors to represent a kind of intellectual puzzle. It is made using colored pencils and markers.

(Adapted with permission from the Association of Science and Art (ASA), Universal Scientific Education and Research Network (USERN); Painting by Mahshad Naserpour).

  • Clinical decision-making
  • Critical thinking
  • Critical thinking skills
  • Decision-making
Unless the individuals of a nation thinkers, the masses can be drawn in any direction. Mustafa Kemal Atatürk

This is a preview of subscription content, log in via an institution .

Buying options

  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
  • Available as EPUB and PDF
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
  • Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Bilgiç Ş, Kurtuluş Tosun Z (2016) Birinci ve son sınıf hemşirelik öğrencilerinde eleştirel düşünme ve etkileyen faktörler. Sağlık Bilimleri ve Meslekleri Dergisi 3(1):39–47

Article   Google Scholar  

Kantek F, Yıldırım N (2019) The effects of nursing education on critical thinking of students: a meta-analysis. Florence Nightingale Hemşirelik Dergisi 27(1):17–25

Ennis R (1996) Critical thinking dispositions: their nature and assessability. Informal Logic 18(2):165–182

Riddell T (2007) Critical assumptions: thinking critically about critical thinking. J Nurs Educ 46(3):121–126

Cüceloğlu D (2001) İyi düşün doğru karar ver. Remzi Kitabevi, pp 242–284

Google Scholar  

Kurnaz A (2019) Eleştirel düşünme öğretimi etkinlikleri Planlama-Uygulama ve Değerlendirme. Eğitim yayın evi, p 27

Doğanay A, Ünal F (2006) Eleştirel düşünmenin öğretimi. In: İçerik Türlerine Dayalı Öğretim. Ankara Nobel Yayınevi, pp 209–261

Scheffer B-K, Rubenfeld M-G (2000) A consensus statement on critical thinking in nursing. J Nurs Educ 39(8):352–359

Article   CAS   Google Scholar  

Rubenfeld M-G, Scheffer B (2014) Critical thinking tactics for nurses. Jones & Bartlett Publishers, pp 5–6, 7, 19–20

Gobet F (2005) Chunking models of expertise: implications for education. Appl Cogn Psychol 19:183–204

Ay F-A (2008) Mesleki temel kavramlar. In: Temel hemşirelik: Kavramlar, ilkeler, uygulamalar. İstanbul Medikal Yayıncılık, pp 205–220

Birol L (2010) Hemşirelik bakımında sistematik yaklaşım. In: Hemşirelik süreci. Berke Ofset Matbaacılık, pp 35–45

Twibell R, Ryan M, Hermiz M (2005) Faculty perceptions of critical thinking in student clinical experiences. J Nurs Educ 44(2):71–79

The Importance of Critical Thinking in Nursing. 19 November 2018 by Carson-Newman University Online. https://onlinenursing.cn.edu/news/value-critical-thinking-nursing

Suzanne C, Smeltzer Brenda G, Bare Janice L, Cheever HK (2010) Definition of critical thinking, critical thinking process. Medical surgical nursing. Lippincott, Williams & Wilkins, pp 27–28

Profetto-McGrath J (2003) The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students. J Adv Nurs 43(6):569–577

Elaine S, Mary C (2002) Critical thinking in nursing education: literature review. Int J Nurs Pract 8(2):89–98

Brunt B-A (2005) Critical thinking in nursing: an integrated review. J Continuing Educ Nurs 36(2):60–67

Carter L-M, Rukholm E (2008) A study of critical thinking, teacher–student interaction, and discipline-specific writing in an online educational setting for registered nurses. J Continuing Educ Nurs 39(3):133–138

Daly W-M (2001) The development of an alternative method in the assessment of critical thinking as an outcome of nursing education. J Adv Nurs 36(1):120–130

Edwards S-L (2007) Critical thinking: a two-phase framework. Nurse Educ Pract 7(5):303–314

Rogal S-M, Young J (2008) Exploring critical thinking in critical care nursing education: a pilot study. J Continuing Educ Nurs 39(1):28–33

Worrell J-A, Profetto-McGrath J (2007) Critical thinking as an outcome of context-based learning among post RN students: a literature review. Nurse Educ Today 27(5):420–426

Morrall P, Goodman B (2013) Critical thinking, nurse education and universities: some thoughts on current issues and implications for nursing practice. Nurse Educ Today 33(9):935–937

Raymond-Seniuk C, Profetto-McGrath J (2011) Can one learn to think critically?—a philosophical exploration. Open Nurs J 5:45–51

Download references

Author information

Authors and affiliations.

Nevşehir Hacı Bektaş Veli University, Semra ve Vefa Küçük, Faculty of Health Sciences, Nursing Department, 2000 Evler Mah. Damat İbrahim Paşa Yerleşkesi, Nevşehir, Turkey

Şefika Dilek Güven

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Şefika Dilek Güven .

Editor information

Editors and affiliations.

Universal Scientific Education and Research Network (USERN), Stockholm, Sweden

Nima Rezaei

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Cite this chapter.

Güven, Ş.D. (2023). Critical Thinking in Nursing. In: Rezaei, N. (eds) Brain, Decision Making and Mental Health. Integrated Science, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-031-15959-6_10

Download citation

DOI : https://doi.org/10.1007/978-3-031-15959-6_10

Published : 02 January 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-15958-9

Online ISBN : 978-3-031-15959-6

eBook Packages : Behavioral Science and Psychology Behavioral Science and Psychology (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Publish with us

Policies and ethics

  • Find a journal
  • Track your research

Library homepage

  • school Campus Bookshelves
  • menu_book Bookshelves
  • perm_media Learning Objects
  • login Login
  • how_to_reg Request Instructor Account
  • hub Instructor Commons
  • Download Page (PDF)
  • Download Full Book (PDF)
  • Periodic Table
  • Physics Constants
  • Scientific Calculator
  • Reference & Cite
  • Tools expand_more
  • Readability

selected template will load here

This action is not available.

Medicine LibreTexts

1.3: Critical Thinking and Clinical Reasoning

  • Last updated
  • Save as PDF
  • Page ID 63335

  • Ernstmeyer & Christman (Eds.)
  • Chippewa Valley Technical College via OpenRN

Before learning how to use the nursing process, it is important to understand some basic concepts related to critical thinking and nursing practice. Let’s take a deeper look at how nurses think.

Critical Thinking and Clinical Reasoning

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [1] Using critical thinking means that nurses take extra steps to maintain patient safety and don’t just “follow orders.” It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research.

“Critical thinkers” possess certain attitudes that foster rational thinking. These attitudes are as follows:

  • Independence of thought: Thinking on your own
  • Fair-mindedness: Treating every viewpoint in an unbiased, unprejudiced way
  • Insight into egocentricity and sociocentricity: Thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
  • Intellectual humility: Recognizing your intellectual limitations and abilities
  • Nonjudgmental: Using professional ethical standards and not basing your judgments on your own personal or moral standards
  • Integrity: Being honest and demonstrating strong moral principles
  • Perseverance: Persisting in doing something despite it being difficult
  • Confidence: Believing in yourself to complete a task or activity
  • Interest in exploring thoughts and feelings: Wanting to explore different ways of knowing
  • Curiosity: Asking “why” and wanting to know more

Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. [3]

The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.

Assessment is the first step of the nursing process. The American Nurses Association (ANA) “Assessment” Standard of Practice is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.”    This includes collecting “pertinent data related to the health and quality of life in a systematic, ongoing manner, with compassion and respect for the wholeness, inherent dignity, worth, and unique attributes of every person, including but not limited to, demographics, environmental and occupational exposures, social determinants of health, health disparities, physical, functional, psychosocial, emotional, cognitive, spiritual/transpersonal, sexual, sociocultural, age-related, environmental, and lifestyle/economic assessments.” [1]

A registered nurse uses a systematic method to collect and analyze patient data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, a nurse’s assessment of a hospitalized patient in pain includes the patient’s response to pain, such as the inability to get out of bed, refusal to eat, withdrawal from family members, or anger directed at hospital staff. Nurses assess patients to gather clues, make generalizations, and diagnose human responses to health conditions and life processes. Patient data is considered either subjective or objective, and it can be collected from multiple sources.

The “Diagnosis” Standard of Practice is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” [13] A nursing diagnosis is the nurse’s clinical judgment about the client's response to actual or potential health conditions or needs. Nursing diagnoses are the bases for the nurse’s care plan and are different than medical diagnoses.

Outcomes Identification

The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses.

The “Planning” Standard of Practice is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” [16] Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care. [17]

Nursing Care Plans

Creating nursing care plans is a part of the “Planning” step of the nursing process. A nursing care plan is a type of documentation that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process. Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. 

Implementation

The “Implementation” Standard of Practice is defined as, “The nurse implements the identified plan.” Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s electronic medical record as they are completed.

The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed.

Benefits of Using the Nursing Process

Using the nursing process has many benefits for nurses, patients, and other members of the health care team. The benefits of using the nursing process include the following:

  • Promotes quality patient care
  • Decreases omissions and duplications
  • Provides a guide for all staff involved to provide consistent and responsive care
  • Encourages collaborative management of a patient’s health care problems
  • Improves patient safety
  • Improves patient satisfaction
  • Identifies a patient’s goals and strategies to attain them
  • Increases the likelihood of achieving positive patient outcomes
  • Saves time, energy, and frustration by creating a care plan or path to follow

By using these components of the nursing process as a critical thinking model, nurses plan interventions customized to the patient’s needs, plan outcomes and interventions, and determine whether those actions are effective in meeting the patient’s needs. In the remaining sections of this chapter, we will take an in-depth look at each of these components of the nursing process. Using the nursing process and implementing evidence-based practices are referred to as the “science of nursing.” Let’s review concepts related to the “art of nursing” while providing holistic care in a caring manner using the nursing process.

Holistic Nursing Care

The American Nurses Association (ANA) recently updated the definition of nursing as, “Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in the recognition of the connection of all humanity.”

The ANA further describes nursing is a learned profession built on a core body of knowledge that integrates both the art and science of nursing. The art of nursing is defined as, “Unconditionally accepting the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care.”

Nurses care for individuals holistically, including their emotional, spiritual, psychosocial, cultural, and physical needs. They consider problems, issues, and needs that the person experiences as a part of a family and a community as they use the nursing process. 

Caring and the Nursing Process

The American Nurses Association (ANA) states, “The act of caring is foundational to the practice of nursing.” Successful use of the nursing process requires the development of a care relationship with the patient. A care relationship is a mutual relationship that requires the development of trust between both parties. This trust is often referred to as the development of rapport and underlies the art of nursing. While establishing a caring relationship, the whole person is assessed, including the individual’s beliefs, values, and attitudes, while also acknowledging the vulnerability and dignity of the patient and family. Assessing and caring for the whole person takes into account the physical, mental, emotional, and spiritual aspects of being a human being.   Caring interventions can be demonstrated in simple gestures such as active listening, making eye contact, touching, and verbal reassurances while also respecting and being sensitive to the care recipient’s cultural beliefs and meanings associated with caring behaviors. 

  • Klenke-Borgmann, L., Cantrell, M. A., & Mariani, B. (2020). Nurse educator’s guide to clinical judgment: A review of conceptualization, measurement, and development. Nursing Education Perspectives, 41 (4), 215-221. ↵
  • Powers, L., Pagel, J., & Herron, E. (2020). Nurse preceptors and new graduate success. American Nurse Journal, 15 (7), 37-39. ↵
  • “ The Detective ” by paurian is licensed under CC BY 2.0 ↵
  • “ In the Quiet Zone… ” by C.O.D. Library is licensed under CC BY-NC-SA 2.0 ↵
  • NCSBN. (n.d.). NCSBN clinical judgment model . https://www.ncsbn.org/14798.htm ↵
  • American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  • “ The Nursing Process ” by Kim Ernstmeyer at Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  • “Patient Image in LTC.JPG” by ARISE project is licensed under CC BY 4.0 ↵
  • American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵
  • American Nurses Association. (n.d.). The nursing process . https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵
  • American Nurses Association. (2021). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association. ↵
  • American Nurses Association. (n.d.) The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process / ↵
  • American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process / ↵
  • Walivaara, B., Savenstedt, S., & Axelsson, K. (2013). Caring relationships in home-based nursing care - registered nurses’ experiences. The Open Journal of Nursing, 7 , 89-95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722540/pdf/TONURSJ-7-89.pdf ↵
  • “ hospice-1793998_1280.jpg ” by truthseeker08 is licensed under CC0 ↵
  • Watson Caring Science Institute. (n.d.). Watson Caring Science Institute. Jean Watson, PHD, RN, AHN-BC, FAAN, (LL-AAN) . https://www.watsoncaringscience.org/jean-bio/ ↵

Nurseship.com

What is Critical Thinking in Nursing? (Explained W/ Examples)

What-is-Critical-thinking-in-nursing-levels-important-why-how-process-fundamental

Last updated on August 23rd, 2023

Critical thinking is a foundational skill applicable across various domains, including education, problem-solving, decision-making, and professional fields such as science, business, healthcare, and more.

It plays a crucial role in promoting logical and rational thinking, fostering informed decision-making, and enabling individuals to navigate complex and rapidly changing environments.

In this article, we will look at what is critical thinking in nursing practice, its importance, and how it enables nurses to excel in their roles while also positively impacting patient outcomes.

how-to-apply-critical-thinking-in-nursing-concepts-for-critical-thinker

What is Critical Thinking?

Critical thinking is a cognitive process that involves analyzing, evaluating, and synthesizing information to make reasoned and informed decisions.

It’s a mental activity that goes beyond simple memorization or acceptance of information at face value.

Critical thinking involves careful, reflective, and logical thinking to understand complex problems, consider various perspectives, and arrive at well-reasoned conclusions or solutions.

Key aspects of critical thinking include:

  • Analysis: Critical thinking begins with the thorough examination of information, ideas, or situations. It involves breaking down complex concepts into smaller parts to better understand their components and relationships.
  • Evaluation: Critical thinkers assess the quality and reliability of information or arguments. They weigh evidence, identify strengths and weaknesses, and determine the credibility of sources.
  • Synthesis: Critical thinking involves combining different pieces of information or ideas to create a new understanding or perspective. This involves connecting the dots between various sources and integrating them into a coherent whole.
  • Inference: Critical thinkers draw logical and well-supported conclusions based on the information and evidence available. They use reasoning to make educated guesses about situations where complete information might be lacking.
  • Problem-Solving: Critical thinking is essential in solving complex problems. It allows individuals to identify and define problems, generate potential solutions, evaluate the pros and cons of each solution, and choose the most appropriate course of action.
  • Creativity: Critical thinking involves thinking outside the box and considering alternative viewpoints or approaches. It encourages the exploration of new ideas and solutions beyond conventional thinking.
  • Reflection: Critical thinkers engage in self-assessment and reflection on their thought processes. They consider their own biases, assumptions, and potential errors in reasoning, aiming to improve their thinking skills over time.
  • Open-Mindedness: Critical thinkers approach ideas and information with an open mind, willing to consider different viewpoints and perspectives even if they challenge their own beliefs.
  • Effective Communication: Critical thinkers can articulate their thoughts and reasoning clearly and persuasively to others. They can express complex ideas in a coherent and understandable manner.
  • Continuous Learning: Critical thinking encourages a commitment to ongoing learning and intellectual growth. It involves seeking out new knowledge, refining thinking skills, and staying receptive to new information.

Definition of Critical Thinking

Critical thinking is an intellectual process of analyzing, evaluating, and synthesizing information to make reasoned and informed decisions.

What is Critical Thinking in Nursing?

Critical thinking in nursing is a vital cognitive skill that involves analyzing, evaluating, and making reasoned decisions about patient care.

It’s an essential aspect of a nurse’s professional practice as it enables them to provide safe and effective care to patients.

Critical thinking involves a careful and deliberate thought process to gather and assess information, consider alternative solutions, and make informed decisions based on evidence and sound judgment.

This skill helps nurses to:

  • Assess Information: Critical thinking allows nurses to thoroughly assess patient information, including medical history, symptoms, and test results. By analyzing this data, nurses can identify patterns, discrepancies, and potential issues that may require further investigation.
  • Diagnose: Nurses use critical thinking to analyze patient data and collaboratively work with other healthcare professionals to formulate accurate nursing diagnoses. This is crucial for developing appropriate care plans that address the unique needs of each patient.
  • Plan and Implement Care: Once a nursing diagnosis is established, critical thinking helps nurses develop effective care plans. They consider various interventions and treatment options, considering the patient’s preferences, medical history, and evidence-based practices.
  • Evaluate Outcomes: After implementing interventions, critical thinking enables nurses to evaluate the outcomes of their actions. If the desired outcomes are not achieved, nurses can adapt their approach and make necessary changes to the care plan.
  • Prioritize Care: In busy healthcare environments, nurses often face situations where they must prioritize patient care. Critical thinking helps them determine which patients require immediate attention and which interventions are most essential.
  • Communicate Effectively: Critical thinking skills allow nurses to communicate clearly and confidently with patients, their families, and other members of the healthcare team. They can explain complex medical information and treatment plans in a way that is easily understood by all parties involved.
  • Identify Problems: Nurses use critical thinking to identify potential complications or problems in a patient’s condition. This early recognition can lead to timely interventions and prevent further deterioration.
  • Collaborate: Healthcare is a collaborative effort involving various professionals. Critical thinking enables nurses to actively participate in interdisciplinary discussions, share their insights, and contribute to holistic patient care.
  • Ethical Decision-Making: Critical thinking helps nurses navigate ethical dilemmas that can arise in patient care. They can analyze different perspectives, consider ethical principles, and make morally sound decisions.
  • Continual Learning: Critical thinking encourages nurses to seek out new knowledge, stay up-to-date with the latest research and medical advancements, and incorporate evidence-based practices into their care.

In summary, critical thinking is an integral skill for nurses, allowing them to provide high-quality, patient-centered care by analyzing information, making informed decisions, and adapting their approaches as needed.

It’s a dynamic process that enhances clinical reasoning , problem-solving, and overall patient outcomes.

What are the Levels of Critical Thinking in Nursing?

Levels-of-Critical-Thinking-in-Nursing-3-three-level

The development of critical thinking in nursing practice involves progressing through three levels: basic, complex, and commitment.

The Kataoka-Yahiro and Saylor model outlines this progression.

1. Basic Critical Thinking:

At this level, learners trust experts for solutions. Thinking is based on rules and principles. For instance, nursing students may strictly follow a procedure manual without personalization, as they lack experience. Answers are seen as right or wrong, and the opinions of experts are accepted.

2. Complex Critical Thinking:

Learners start to analyze choices independently and think creatively. They recognize conflicting solutions and weigh benefits and risks. Thinking becomes innovative, with a willingness to consider various approaches in complex situations.

3. Commitment:

At this level, individuals anticipate decision points without external help and take responsibility for their choices. They choose actions or beliefs based on available alternatives, considering consequences and accountability.

As nurses gain knowledge and experience, their critical thinking evolves from relying on experts to independent analysis and decision-making, ultimately leading to committed and accountable choices in patient care.

Why Critical Thinking is Important in Nursing?

Critical thinking is important in nursing for several crucial reasons:

Patient Safety:

Nursing decisions directly impact patient well-being. Critical thinking helps nurses identify potential risks, make informed choices, and prevent errors.

Clinical Judgment:

Nursing decisions often involve evaluating information from various sources, such as patient history, lab results, and medical literature.

Critical thinking assists nurses in critically appraising this information, distinguishing credible sources, and making rational judgments that align with evidence-based practices.

Enhances Decision-Making:

In nursing, critical thinking allows nurses to gather relevant patient information, assess it objectively, and weigh different options based on evidence and analysis.

This process empowers them to make informed decisions about patient care, treatment plans, and interventions, ultimately leading to better outcomes.

Promotes Problem-Solving:

Nurses encounter complex patient issues that require effective problem-solving.

Critical thinking equips them to break down problems into manageable parts, analyze root causes, and explore creative solutions that consider the unique needs of each patient.

Drives Creativity:

Nursing care is not always straightforward. Critical thinking encourages nurses to think creatively and explore innovative approaches to challenges, especially when standard protocols might not suffice for unique patient situations.

Fosters Effective Communication:

Communication is central to nursing. Critical thinking enables nurses to clearly express their thoughts, provide logical explanations for their decisions, and engage in meaningful dialogues with patients, families, and other healthcare professionals.

Aids Learning:

Nursing is a field of continuous learning. Critical thinking encourages nurses to engage in ongoing self-directed education, seeking out new knowledge, embracing new techniques, and staying current with the latest research and developments.

Improves Relationships:

Open-mindedness and empathy are essential in nursing relationships.

Critical thinking encourages nurses to consider diverse viewpoints, understand patients’ perspectives, and communicate compassionately, leading to stronger therapeutic relationships.

Empowers Independence:

Nursing often requires autonomous decision-making. Critical thinking empowers nurses to analyze situations independently, make judgments without undue influence, and take responsibility for their actions.

Facilitates Adaptability:

Healthcare environments are ever-changing. Critical thinking equips nurses with the ability to quickly assess new information, adjust care plans, and navigate unexpected situations while maintaining patient safety and well-being.

Strengthens Critical Analysis:

In the era of vast information, nurses must discern reliable data from misinformation.

Critical thinking helps them scrutinize sources, question assumptions, and make well-founded choices based on credible information.

How to Apply Critical Thinking in Nursing? (With Examples)

critical-thinking-skill-in-nursing-skills-how-to-apply-critical-thinking

Here are some examples of how nurses can apply critical thinking.

Assess Patient Data:

Critical Thinking Action: Carefully review patient history, symptoms, and test results.

Example: A nurse notices a change in a diabetic patient’s blood sugar levels. Instead of just administering insulin, the nurse considers recent dietary changes, activity levels, and possible medication interactions before adjusting the treatment plan.

Diagnose Patient Needs:

Critical Thinking Action: Analyze patient data to identify potential nursing diagnoses.

Example: After reviewing a patient’s lab results, vital signs, and observations, a nurse identifies “ Risk for Impaired Skin Integrity ” due to the patient’s limited mobility.

Plan and Implement Care:

Critical Thinking Action: Develop a care plan based on patient needs and evidence-based practices.

Example: For a patient at risk of falls, the nurse plans interventions such as hourly rounding, non-slip footwear, and bed alarms to ensure patient safety.

Evaluate Interventions:

Critical Thinking Action: Assess the effectiveness of interventions and modify the care plan as needed.

Example: After administering pain medication, the nurse evaluates its impact on the patient’s comfort level and considers adjusting the dosage or trying an alternative pain management approach.

Prioritize Care:

Critical Thinking Action: Determine the order of interventions based on patient acuity and needs.

Example: In a busy emergency department, the nurse triages patients by considering the severity of their conditions, ensuring that critical cases receive immediate attention.

Collaborate with the Healthcare Team:

Critical Thinking Action: Participate in interdisciplinary discussions and share insights.

Example: During rounds, a nurse provides input on a patient’s response to treatment, which prompts the team to adjust the care plan for better outcomes.

Ethical Decision-Making:

Critical Thinking Action: Analyze ethical dilemmas and make morally sound choices.

Example: When a terminally ill patient expresses a desire to stop treatment, the nurse engages in ethical discussions, respecting the patient’s autonomy and ensuring proper end-of-life care.

Patient Education:

Critical Thinking Action: Tailor patient education to individual needs and comprehension levels.

Example: A nurse uses visual aids and simplified language to explain medication administration to a patient with limited literacy skills.

Adapt to Changes:

Critical Thinking Action: Quickly adjust care plans when patient conditions change.

Example: During post-operative recovery, a nurse notices signs of infection and promptly informs the healthcare team to initiate appropriate treatment adjustments.

Critical Analysis of Information:

Critical Thinking Action: Evaluate information sources for reliability and relevance.

Example: When presented with conflicting research studies, a nurse critically examines the methodologies and sample sizes to determine which study is more credible.

Making Sense of Critical Thinking Skills

What is the purpose of critical thinking in nursing.

The purpose of critical thinking in nursing is to enable nurses to effectively analyze, interpret, and evaluate patient information, make informed clinical judgments, develop appropriate care plans, prioritize interventions, and adapt their approaches as needed, thereby ensuring safe, evidence-based, and patient-centered care.

Why critical thinking is important in nursing?

Critical thinking is important in nursing because it promotes safe decision-making, accurate clinical judgment, problem-solving, evidence-based practice, holistic patient care, ethical reasoning, collaboration, and adapting to dynamic healthcare environments.

Critical thinking skill also enhances patient safety, improves outcomes, and supports nurses’ professional growth.

How is critical thinking used in the nursing process?

Critical thinking is integral to the nursing process as it guides nurses through the systematic approach of assessing, diagnosing, planning, implementing, and evaluating patient care. It involves:

  • Assessment: Critical thinking enables nurses to gather and interpret patient data accurately, recognizing relevant patterns and cues.
  • Diagnosis: Nurses use critical thinking to analyze patient data, identify nursing diagnoses, and differentiate actual issues from potential complications.
  • Planning: Critical thinking helps nurses develop tailored care plans, selecting appropriate interventions based on patient needs and evidence.
  • Implementation: Nurses make informed decisions during interventions, considering patient responses and adjusting plans as needed.
  • Evaluation: Critical thinking supports the assessment of patient outcomes, determining the effectiveness of intervention, and adapting care accordingly.

Throughout the nursing process , critical thinking ensures comprehensive, patient-centered care and fosters continuous improvement in clinical judgment and decision-making.

What is an example of the critical thinking attitude of independent thinking in nursing practice?

An example of the critical thinking attitude of independent thinking in nursing practice could be:

A nurse is caring for a patient with a complex medical history who is experiencing a new set of symptoms. The nurse carefully reviews the patient’s history, recent test results, and medication list.

While discussing the case with the healthcare team, the nurse realizes that the current treatment plan might not be addressing all aspects of the patient’s condition.

Instead of simply following the established protocol, the nurse independently considers alternative approaches based on their assessment.

The nurse proposes a modification to the treatment plan, citing the rationale and evidence supporting the change.

This demonstrates independent thinking by critically evaluating the situation, challenging assumptions, and advocating for a more personalized and effective patient care approach.

How to use Costa’s level of questioning for critical thinking in nursing?

Costa’s levels of questioning can be applied in nursing to facilitate critical thinking and stimulate a deeper understanding of patient situations. The levels of questioning are as follows:

  • 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)
  • Nursing Concept Map (FREE Template)
  • Clinical Reasoning In Nursing (Explained W/ Example)
  • 8 Stages Of The Clinical Reasoning Cycle
  • How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples
  • What is the “5 Whys” Technique?
  • What Are Socratic Questions?

Critical thinking in nursing is the foundation that underpins safe, effective, and patient-centered care.

Critical thinking skills empower nurses to navigate the complexities of their profession while consistently providing high-quality care to diverse patient populations.

Reading Recommendation

Potter, P.A., Perry, A.G., Stockert, P. and Hall, A. (2013) Fundamentals of Nursing

Comments are closed.

Medical & Legal Disclaimer

All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. However, we aim to publish precise and current information. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Read the  privacy policy  and  terms and conditions.

definition of critical thinking in nursing process

Privacy Policy

Terms & Conditions

© 2024 nurseship.com. All rights reserved.

definition of critical thinking in nursing process

Logo for WI Technical Colleges Open Press

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

4.2 Basic Concepts

Open Resources for Nursing (Open RN)

Before learning how to use the nursing process, it is important to understand some basic concepts related to critical thinking and nursing practice. Let’s take a deeper look at how nurses think.

Critical Thinking and Clinical Reasoning

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [1]   Using critical thinking means that nurses take extra steps to maintain patient safety and don’t just “follow orders.” It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research.

“Critical thinkers” possess certain attitudes that foster rational thinking. These attitudes are as follows:

  • Independence of thought: Thinking on your own
  • Fair-mindedness: Treating every viewpoint in an unbiased, unprejudiced way
  • Insight into egocentricity and sociocentricity: Thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
  • Intellectual humility: Recognizing your intellectual limitations and abilities
  • Nonjudgmental: Using professional ethical standards and not basing your judgments on your own personal or moral standards
  • Integrity: Being honest and demonstrating strong moral principles
  • Perseverance: Persisting in doing something despite it being difficult
  • Confidence: Believing in yourself to complete a task or activity
  • Interest in exploring thoughts and feelings: Wanting to explore different ways of knowing
  • Curiosity: Asking “why” and wanting to know more

Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [2] To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. [3]

Inductive and Deductive Reasoning and Clinical Judgment

Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process.

Inductive reasoning involves noticing cues, making generalizations, and creating hypotheses. Cues are data that  fall outside of expected findings that give the nurse a hint or indication of a patient’s potential problem or condition. The nurse organizes these cues into patterns and creates a generalization. A generalization is a judgment formed from a set of facts, cues, and observations and is similar to gathering pieces of a jigsaw puzzle into patterns until the whole picture becomes more clear. Based on generalizations created from patterns of data, the nurse creates a hypothesis regarding a patient problem. A hypothesis is a proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring. If a “why” is identified, then a solution can begin to be explored.

No one can draw conclusions without first noticing cues. Paying close attention to a patient, the environment, and interactions with family members is critical for inductive reasoning. As you work to improve your inductive reasoning, begin by first noticing details about the things around you. A nurse is similar to the detective looking for cues in Figure 4.1. [4] Be mindful of your five primary senses: the things that you hear, feel, smell, taste, and see. Nurses need strong inductive reasoning patterns and be able to take action quickly, especially in emergency situations. They can see how certain objects or events form a pattern (i.e., generalization) that indicates a common problem (i.e., hypothesis).

Example: A nurse assesses a patient and finds the surgical incision site is red, warm, and tender to the touch. The nurse recognizes these cues form a pattern of signs of infection and creates a hypothesis that the incision has become infected. The provider is notified of the patient’s change in condition, and a new prescription is received for an antibiotic. This is an example of the use of inductive reasoning in nursing practice.

Photo showing person looking at camera through a magnifying glass

Deductive reasoning is another type of critical thinking that is referred to as “top-down thinking.” Deductive reasoning relies on using a general standard or rule to create a strategy. Nurses use standards set by their state’s Nurse Practice Act, federal regulations, the American Nursing Association, professional organizations, and their employer to make decisions about patient care and solve problems.

Example: Based on research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. (See Figure 4.2). [5]  The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking because the intervention is applied to all patients regardless if they have difficulty sleeping or not.

Photo showing sign that says Quiet Zone

Clinical judgment is the result of critical thinking and clinical reasoning using inductive and deductive reasoning. Clinical judgment is defined by the National Council of State Boards of Nursing (NCSBN) as, “The observed outcome of critical thinking and decision-making. It uses nursing knowledge to observe and assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions in order to deliver safe patient care.” [6] The NCSBN administers the national licensure exam (NCLEX) that measures nursing clinical judgment and decision-making ability of prospective entry-level nurses to assure safe and competent nursing care by licensed nurses.

Evidence-based practice (EBP) is defined by the American Nurses Association (ANA) as, “A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the health care consumer’s history and condition, as well as health care resources; and patient, family, group, community, and population preferences and values.” [7]

Nursing Process

The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. [8] The mnemonic ADOPIE is an easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: A ssessment, D iagnosis, O utcomes Identification, P lanning, I mplementation, and E valuation.

The nursing process is a continuous, cyclic process that is constantly adapting to the patient’s current health status. See Figure 4.3 [9] for an illustration of the nursing process.

Image showing workflow of nursing process, with labels

Review Scenario A in the following box for an example of a nurse using the nursing process while providing patient care.

Patient Scenario A : Using the Nursing Process [10]

Photo of simulated patient facing camera

A hospitalized patient has a prescription to receive Lasix 80mg IV every morning for a medical diagnosis of heart failure. During the morning assessment, the nurse notes that the patient has a blood pressure of 98/60, heart rate of 100, respirations of 18, and a temperature of 98.7F. The nurse reviews the medical record for the patient’s vital signs baseline and observes the blood pressure trend is around 110/70 and the heart rate in the 80s. The nurse recognizes these cues form a pattern related to fluid imbalance and hypothesizes that the patient may be dehydrated. The nurse gathers additional information and notes the patient’s weight has decreased 4 pounds since yesterday. The nurse talks with the patient and validates the hypothesis when the patient reports that their mouth feels like cotton and they feel light-headed. By using critical thinking and clinical judgment, the nurse diagnoses the patient with the nursing diagnosis Fluid Volume Deficit and establishes outcomes for reestablishing fluid balance. The nurse withholds the administration of IV Lasix and contacts the health care provider to discuss the patient’s current fluid status. After contacting the provider, the nurse initiates additional nursing interventions to promote oral intake and closely monitor hydration status. By the end of the shift, the nurse evaluates the patient status and determines that fluid balance has been restored.

In Scenario A, the nurse is using clinical judgment and not just “following orders” to administer the Lasix as scheduled. The nurse assesses the patient, recognizes cues, creates a generalization and hypothesis regarding the fluid status, plans and implements nursing interventions, and evaluates the outcome. Additionally, the nurse promotes patient safety by contacting the provider before administering a medication that could cause harm to the patient at this time.

The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.

The “Assessment” Standard of Practice is defined as, “The registered nurse collects pertinent data and information relative to the health care consumer’s health or the situation.” [11] A registered nurse uses a systematic method to collect and analyze patient data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, a nurse’s assessment of a hospitalized patient in pain includes the patient’s response to pain, such as the inability to get out of bed, refusal to eat, withdrawal from family members, or anger directed at hospital staff. [12]

The “Assessment” component of the nursing process is further described in the “ Assessment ” section of this chapter.

The “Diagnosis” Standard of Practice is defined as, “The registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.” [13] A nursing diagnosis is the nurse’s clinical judgment about the client's response to actual or potential health conditions or needs. Nursing diagnoses are the bases for the nurse’s care plan and are different than medical diagnoses. [14]

The “Diagnosis” component of the nursing process is further described in the “ Diagnosis ” section of this chapter.

Outcomes Identification

The “Outcomes Identification” Standard of Practice is defined as, “The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.” [15] The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the patient based on their assessment data and nursing diagnoses.

The “Outcomes Identification” component of the nursing process is further described in the “ Outcomes Identification ” section of this chapter.

The “Planning” Standard of Practice is defined as, “The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.” [16] Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each patient’s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the patient’s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care. [17]

The “Planning” component of the nursing process is further described in the “ Planning ” section of this chapter.

Nursing Care Plans

Creating nursing care plans is a part of the “Planning” step of the nursing process. A nursing care plan is a type of documentation that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process. Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. Some interventions can be delegated to Licensed Practical Nurses (LPNs) or trained Unlicensed Assistive Personnel (UAPs) with the RN’s supervision. Developing nursing care plans and implementing appropriate delegation are further discussed under the “ Planning ” and “ Implementing ” sections of this chapter.

Implementation

The “Implementation” Standard of Practice is defined as, “The nurse implements the identified plan.” [18] Nursing interventions are implemented or delegated with supervision according to the care plan to assure continuity of care across multiple nurses and health professionals caring for the patient. Interventions are also documented in the patient’s electronic medical record as they are completed. [19]

The “Implementation” Standard of Professional Practice also includes the subcategories  “Coordination of Care” and “Health Teaching and Health Promotion” to promote health and a safe environment. [20]

The “Implementation” component of the nursing process is further described in the “ Implementation ” section of this chapter.

The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [21] During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed. [22]

The “Evaluation” component of the nursing process is further described in the “ Evaluation ” section of this chapter.

Benefits of Using the Nursing Process

Using the nursing process has many benefits for nurses, patients, and other members of the health care team. The benefits of using the nursing process include the following:

  • Promotes quality patient care
  • Decreases omissions and duplications
  • Provides a guide for all staff involved to provide consistent and responsive care
  • Encourages collaborative management of a patient’s health care problems
  • Improves patient safety
  • Improves patient satisfaction
  • Identifies a patient’s goals and strategies to attain them
  • Increases the likelihood of achieving positive patient outcomes
  • Saves time, energy, and frustration by creating a care plan or path to follow

By using these components of the nursing process as a critical thinking model, nurses plan interventions customized to the patient’s needs, plan outcomes and interventions, and determine whether those actions are effective in meeting the patient’s needs. In the remaining sections of this chapter, we will take an in-depth look at each of these components of the nursing process. Using the nursing process and implementing evidence-based practices are referred to as the “science of nursing.” Let’s review concepts related to the “art of nursing” while providing holistic care in a caring manner using the nursing process.

Holistic Nursing Care

The American Nurses Association (ANA) recently updated the definition of nursing as, “Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in the recognition of the connection of all humanity.” [23]

The ANA further describes nursing is a learned profession built on a core body of knowledge that integrates both the art and science of nursing.  The art of nursing  is defined as, “Unconditionally accepting the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care.” [24]  

Nurses care for individuals holistically, including their emotional, spiritual, psychosocial, cultural, and physical needs. They consider problems, issues, and needs that the person experiences as a part of a family and a community as they use the nursing process. Review a scenario illustrating holistic nursing care provided to a patient and their family in the following box.

Holistic Nursing Care Scenario

A single mother brings her child to the emergency room for ear pain and a fever. The physician diagnoses the child with an ear infection and prescribes an antibiotic. The mother is advised to make a follow-up appointment with their primary provider in two weeks. While providing discharge teaching, the nurse discovers that the family is unable to afford the expensive antibiotic prescribed and cannot find a primary care provider in their community they can reach by a bus route. The nurse asks a social worker to speak with the mother about affordable health insurance options and available providers in her community and follows up with the prescribing physician to obtain a prescription for a less expensive generic antibiotic. In this manner, the nurse provides holistic care and advocates for improved health for the child and their family.

Caring and the Nursing Process

The American Nurses Association (ANA) states, “The act of caring is foundational to the practice of nursing.” [25] Successful use of the nursing process requires the development of a care relationship with the patient. A care relationship is a mutual relationship that requires the development of trust between both parties. This trust is often referred to as the development of rapport and underlies the art of nursing. While establishing a caring relationship, the whole person is assessed, including the individual’s beliefs, values, and attitudes, while also acknowledging the vulnerability and dignity of the patient and family. Assessing and caring for the whole person takes into account the physical, mental, emotional, and spiritual aspects of being a human being. [26]   Caring interventions can be demonstrated in simple gestures such as active listening, making eye contact, touching, and verbal reassurances while also respecting and being sensitive to the care recipient’s cultural beliefs and meanings associated with caring behaviors. [27] See Figure 4.4 [28] for an image of a nurse using touch as a therapeutic communication technique to communicate caring.

Dr. Jean Watson is a nurse theorist who has published many works on the art and science of caring in the nursing profession. Her theory of human caring sought to balance the cure orientation of medicine, giving nursing its unique disciplinary, scientific, and professional standing with itself and the public. Dr. Watson’s caring philosophy encourages nurses to be authentically present with their patients while creating a healing environment. [29]

Photo showing closeup of a younger hand holding an elderly one

Now that we have discussed basic concepts related to the nursing process, let’s look more deeply at each component of the nursing process in the following sections.

  • Klenke-Borgmann, L., Cantrell, M. A., & Mariani, B. (2020). Nurse educator’s guide to clinical judgment: A review of conceptualization, measurement, and development. Nursing Education Perspectives, 41 (4), 215-221. ↵
  • Powers, L., Pagel, J., & Herron, E. (2020). Nurse preceptors and new graduate success. American Nurse Journal, 15 (7), 37-39. ↵
  • “ The Detective ” by paurian is licensed under CC BY 2.0 ↵
  • “ In the Quiet Zone… ” by C.O.D. Library is licensed under CC BY-NC-SA 2.0 ↵
  • NCSBN. (n.d.). NCSBN clinical judgment model . https://www.ncsbn.org/14798.htm ↵
  • American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  • “ The Nursing Process ” by Kim Ernstmeyer at Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  • “Patient Image in LTC.JPG” by ARISE project is licensed under CC BY 4.0 ↵
  • American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵
  • American Nurses Association. (n.d.). The nursing process . https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵
  • American Nurses Association. (2021). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association. ↵
  • American Nurses Association. (n.d.) The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process / ↵
  • American Nurses Association. (n.d.). The nursing process. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process / ↵
  • Walivaara, B., Savenstedt, S., & Axelsson, K. (2013). Caring relationships in home-based nursing care - registered nurses’ experiences. The Open Journal of Nursing, 7 , 89-95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722540/pdf/TONURSJ-7-89.pdf ↵
  • “ hospice-1793998_1280.jpg ” by truthseeker08 is licensed under CC0 ↵
  • Watson Caring Science Institute. (n.d.). Watson Caring Science Institute. Jean Watson, PHD, RN, AHN-BC, FAAN, (LL-AAN) . https://www.watsoncaringscience.org/jean-bio/ ↵

Reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.

A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.

A type of reasoning that involves forming generalizations based on specific incidents.

Subjective or objective data that gives the nurse a hint or indication of a potential problem, process, or disorder.

A judgment formed from a set of facts, cues, and observations.

A proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring.

“Top-down thinking” or moving from the general to the specific. Deductive reasoning relies on a general statement or hypothesis—sometimes called a premise or standard—that is held to be true. The premise is used to reach a specific, logical conclusion.

The observed outcome of critical thinking and decision-making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care.

A lifelong problem-solving approach that integrates the best evidence from well-designed research studies, theories, clinical expertise, health care resources, and patient preferences and values.

An easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.

Individual, family, or group which includes significant others and populations.

Specific documentation of the planning and delivery of nursing care that is required by the Joint Commission.

Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.

A relationship described as one in which the whole person is assessed while balancing the vulnerability and dignity of the patient and family.

Developing a relationship of mutual trust and understanding.

Nursing Fundamentals Copyright © by Open Resources for Nursing (Open RN) is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Share This Book

Critical Thinking and the Nursing Process

In today’s health care arena, the nurse is faced with increasingly complex issues and situations resulting from advanced technology, greater acuity of patients in hospital and community settings, an aging population, and complex disease processes, as well as ethical and cultural factors.  Traditionally, nurses have used a problem-solving approach in planning and providing nursing care. Today the decision-making part of problem solving has become increasingly complex and requires critical thinking.

Definition of Critical thinking

Critical thinking is a multidimensional skill, a cognitive or mental process or set of procedures. It involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. Critical thinking leads to the formulation of conclusions and the most appropriate, often creative, decisions, options, or alternatives. Critical thinking includes metacognition, the examination of one’s own reasoning or thought processes while thinking, to help strengthen and refine thinking skills. Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize information within the context in which it is presented. Nursing practice in today’s society mandates the use of high-level critical thinking skills within the nursing process. Critical thinking enhances clinical decision making, helping to identify patient needs and to determine the best nursing actions that will assist the patient in meeting those needs. Critical thinking and critical thinkers have distinctive characteristics. As indicated in the above definition, critical thinking is a conscious, outcome-oriented activity; it is purposeful and intentional. The critical thinker is an inquisitive, fair-minded truth seeker with an open-mindedness to the alternative solutions that might surface.

Critical thinking Process: Rationality and Insight

Critical thinking is systematic and organized. The skills involved in critical thinking are developed over time through effort, practice, and experience. Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Critical thinking requires background knowledge and knowledge of key concepts as well as standards of good thinking. The critical thinker uses reality-based deliberation to validate the accuracy of data and the reliability of sources, being mindful of and questioning inconsistencies. Interpretation is used to determine the significance of data that are gathered, and analysis is used to identify patient problems indicated by the data. The nurse uses inference to draw conclusions. Explanation is the justification of actions or interventions used to address patient problems and to help a patient move toward desired outcomes. Evaluation is the process of determining whether outcomes have been or are being met, and self-regulation is the process of examining the care provided and adjusting the interventions as needed. Critical thinking is also reflective, involving metacognition, active evaluation, and refinement of the thinking process. The critical thinker considers the possibility of personal bias when interpreting data and determining appropriate actions. The critical thinker must be insightful and have a sense of fairness and integrity, the courage to question personal ethics, and the perseverance to strive continuously to minimize the effects of egocentricity, ethnocentricity, and other biases on the decision making process.

Components of Critical thinking

Certain cognitive or mental activities can be identified as key components of critical thinking. When thinking critically, a person will do the following:

  • Ask questions to determine the reason why certain developments have occurred and to see whether more information is needed to understand the situation accurately.
  • Gather as much relevant information as possible to consider as many factors as possible.
  • Validate the information presented to make sure that it is accurate (not just supposition or opinion), that it makes sense, and that it is based on fact and evidence.
  • Analyze the information to determine what it means and to see whether it forms clusters or patterns that point to certain conclusions.
  • Draw on past clinical experience and knowledge to explain what is happening and to anticipate what might happen next, acknowledging personal bias and cultural influences.
  • Maintain a flexible attitude that allows the facts to guide thinking and takes into account all possibilities.
  • Consider available options and examine each in terms of its advantages and disadvantages.
  • Formulate decisions that reflect creativity and independent decision making.

Critical thinking requires going beyond basic problem solving into a realm of inquisitive exploration, looking for all relevant factors that affect the issue, and being an “out-of-the-box” thinker. It includes questioning all findings until a comprehensive picture emerges that explains the phenomenon, possible solutions, and creative methods for proceeding. Critical thinking in nursing practice results in a comprehensive patient plan of care with maximized potential for success.

Critical thinking In Nursing Practice

Using critical thinking to develop a plan of nursing care requires considering the human factors that might influence the plan. The nurse interacts with the patient, family, and other health care providers in the process of providing appropriate, individualized nursing care. The culture, attitude, and thought processes of the nurse, the patient, and others will affect the critical thinking process from the data-gathering stage through the decision-making stage; therefore, aspects of the nurse-patient interaction must be considered. Nurses must use critical thinking skills in all practice settings—acute care, ambulatory care, extended care, and in the home and community. Regardless of the setting, each patient situation is viewed as unique and dynamic. The unique factors that the patient and nurse bring to the health care situation are considered, studied, analyzed, and interpreted. Interpretation of the information presented then allows the nurse to focus on those factors that are most relevant and mostsignificant to the clinical situation. Decisions about what to do and how to do it are then developed into a plan of action.

Fonteyn (1998) identified 12 predominant thinking strategies used by nurses, regardless of their area of clinical practice:

Recognizing a pattern

  • Setting priorities
  • Searching for information
  • Generating hypotheses
  • Making predictions
  • Forming relationships
  • Stating a proposition (“if–then”)
  • Asserting a practice rule
  • Making choices (alternative actions)
  • Judging the value
  • Drawing conclusions
  • Providing explanations

Fonteyn further identified other, less prominent thinking strategies the nurse might use:

  • Posing a question
  • Making assumptions (supposing)
  • Making generalizations

These thought processes are consistent with the characteristics of critical thinking and cognitive activities discussed earlier. Fonteyn asserted that exploring how these thinking strategies are used in various clinical situations, and practicing using the strategies, might assist the nurse–learner in examining and refining his or her own thinking skills.

Throughout the critical thinking process, a continuous flow of questions evolves in the thinker’s mind. Although the questions will vary according to the particular clinical situation, certain general inquiries can serve as a basis for reaching conclusions and determining a course of action. When faced with a patient situation, it is often helpful to seek answers to some or all of the following questions in an attempt to determine those actions that are most appropriate:

  • What relevant assessment information do I need, and how do I interpret this information? What does this information tell me?
  • To what problems does this information point? Have I identified the most important ones? Does the information point to any other problems that I should consider?
  • Have I gathered all the information I need (signs/symptoms, laboratory values, medication history, emotional factors, mental status)? Is anything missing?
  • Is there anything that needs to be reported immediately? Do I need to seek additional assistance?
  • Does this patient have any special risk factors? Which ones are most significant? What must I do to minimize these risks?
  • What possible complications must I anticipate?
  • What are the most important problems in this situation? Do the patient and the patient’s family recognize the same problems?
  • What are the desired outcomes for this patient? Which have the highest priority? Does the patient see eye to eye with me on these points?
  • What is going to be my first action in this situation? How can I construct a plan of care to achieve the goals?
  • Are there any age-related factors involved, and will they require some special approach? Will I need to make some change in the plan of care to take these factors into account?
  •  How do the family dynamics affect this situation, and will this have an affect on my actions or the plan of care?
  • Are there cultural factors that I must address and consider?
  • Am I dealing with an ethical problem here? If so, how am I going to resolve it?
  • Has any nursing research been conducted on this subject?

Related Posts

Giving iv push, administering intramuscular injections, urinary elimination.

  • - Google Chrome

Intended for healthcare professionals

  • Access provided by Google Indexer
  • My email alerts
  • BMA member login
  • Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Home

Search form

  • Advanced search
  • Search responses
  • Search blogs
  • News & Views
  • Margaret McCartney:...

Nurses are critical thinkers

Rapid response to:

Margaret McCartney: Nurses must be allowed to exercise professional judgment

  • Related content
  • Article metrics
  • Rapid responses

Rapid Response:

The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.

The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.

As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier

The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report

Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & 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(6), 515-520.

NMC (2010) New Standards for Pre-Registration Nursing. London: Nursing and Midwifery Council.

Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465

Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)

Competing interests: No competing interests

definition of critical thinking in nursing process

Critical thinking: the development of an essential skill for nursing students

Affiliations.

  • 1 Nursing Department, Technological Educational Institute of Thessaly, Greece.
  • 2 Nursing Department, Technological Educational Institute of Crete, Greece.
  • 3 State Mental Hospital of Attica "Daphne", Greece.
  • 4 Nursing Department, Alexander Technological Educational Institute of Thessaloniki, Greece.
  • PMID: 25395733
  • PMCID: PMC4216424
  • DOI: 10.5455/aim.2014.22.283-286

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

Keywords: clinical nurse education; clinical nursing practice; critical thinking; nursing education.

Fastest Nurse Insight Engine

  • MEDICAL ASSISSTANT
  • Abdominal Key
  • Anesthesia Key
  • Basicmedical Key
  • Otolaryngology & Ophthalmology
  • Musculoskeletal Key
  • Obstetric, Gynecology and Pediatric
  • Oncology & Hematology
  • Plastic Surgery & Dermatology
  • Clinical Dentistry
  • Radiology Key
  • Thoracic Key
  • Veterinary Medicine
  • Gold Membership

Critical Thinking, Clinical Judgment, and the Nursing Process

9 Critical Thinking, Clinical Judgment, and the Nursing Process Brenda Morris, EdD, RN, CNE OBJECTIVES At the completion of this chapter, the reader will be able to: •  Define critical thinking. •  Describe the components and characteristics of critical thinking. •  Understand the relationship of critical thinking to clinical judgment and the nursing process. •  Describe the steps of the nursing process and the relationships among those steps. •  Discuss nursing activities associated with each step of the nursing process. •  Evaluate the utility of the nursing process as a systematic framework for the delivery of nursing care. •  Apply critical thinking in nursing practice situations. The author acknowledges the important foundational work for this chapter developed by Dr. C. Fay Raines in the previous edition of this book. PROFILE IN PRACTICE Elizabeth R. Lenz PhD, RN, FAAN Dean and Professor, College of Nursing, The Ohio State University, Columbus, Ohio Critical thinking: it’s recognizable when someone does it well and certainly evident when it is not happening. During the past 20 years we have talked increasingly about critical thinking in nursing, but that wasn’t always the case. In the early 1960s, when I was entering the profession, serious efforts to change the “handmaiden” image of nursing were only just beginning. Clearly, if one’s role is defined as handmaiden, rather than as colleague or independent decision maker, critical thinking is not deemed particularly important or even desirable. Rather, blind, noncritical obedience is the order of the day. Fortunately, as nursing has become more truly professional and nurses have functioned with increasing autonomy in increasingly complex situations, critical thinking has become a most important and valued competency. What elements converge to produce a good critical thinker? It seems to me that there are several requisites, not the least of which is intelligence. However, even though intelligence is a necessary condition, critical thinking is not guaranteed to occur without training and a nourishing environment as well. We assume that critical thinking is something that can be learned; hence we address it at all levels of nursing curricula. Based on my experience, I believe that two essential types of learning provide the basis for critical thinking. The first is substantive. It is impossible to think truly critically about something you do not understand or about which you possess only partial information. Mastery of the theory and research findings that relate to the problem or issue to be addressed is critical, but this is not something that nurses always take time to achieve. Unfortunately, we have been less successful than other professions (namely, medicine) in socializing our practitioners to value learning as a career-long pursuit; yet pursuit of the most state-of-the-science information is an essential ingredient of critical thinking. The second type of learning involves the process of critical thinking itself. The skills of raising questions, using logic, and comprehensively considering alternative perspectives, explanations, and courses of action can often best be learned experientially within a structure that encourages and, in fact, mandates that kind of thoughtful consideration. The model that comes to mind is the daily medical rounds in which physicians-in-training are challenged to present cases and to lay out their diagnostic reasoning clearly for others to critique. Equally valid as an environment for cultivating critical thinking is that found in many of the social sciences and humanities, where freewheeling debate and open challenge of ideas are encouraged. At first frightened by that kind of candor during my doctoral studies in sociology, I later came to value greatly the critical input of my peers. More of that kind of willingness to challenge one another’s assumptions and ideas within an atmosphere of mutual respect would benefit our profession. For me, the groundwork for critical thinking was laid early in my education. Fortunately, the faculty responsible for the BSN program I attended were forward-thinking and highly committed to the emerging definition of nursing as a true profession, with the requisite obligation to base action on scientific knowledge and clear and logical thinking. Without labeling the goal as such, we were consistently encouraged, groomed, and enabled to be critical thinkers. We were continually challenged by being asked to provide rationales for our decisions, to make explicit all of the alternative approaches and explanations we had considered and rejected, and to explain why. Not inconsequentially, the school was in a small liberal arts institution, where we were exposed on a daily basis to a wide range of points of view and disciplinary perspectives and assumptions. If anything, the nursing students were the “oddballs” whose pragmatism and goal-directedness seemed strange to the arts, sciences, and music majors. I wrestled more than once with how in the world assignments such as dissecting the symbolism in Moby Dick might be relevant to my career in nursing, but I now appreciate the mind-expanding contribution that such activities made to my ability to think critically. The base hopefully having been laid during one’s professional education, critical thinking depends not only on training but also on an environment or context that enables, encourages, and rewards it. Regretfully, today’s employment picture in nursing is typically one with precious little time for contemplation. Downsizing, high proportions of nonprofessional personnel, high levels of acuity, and high productivity requirements may discourage critical thinking. That means every effort must be made to counter the tendency to let critical thinking slide and, instead, to encourage, nurture, and reward it, even if that means bucking the tide and incurring some additional short-term costs. The “community of scholars” type of environment to which top educational institutions aspire should, by definition, be conducive to critical thinking. Nevertheless, even in those settings, time and energy to engage in deliberation, to exchange ideas, and to critique those ideas openly are scarce, and the kind of culture that encourages such scholarly dialogue is relatively rare. When it is in place, it is wonderful. One of my most exciting opportunities to engage in intense and prolonged critical thinking occurred when a group of four colleagues and I were “freed up” from many of our routine responsibilities to plan a doctoral program “from scratch.” In weekly full-day sessions we argued, debated, challenged, cajoled, compromised, and created. We drew on what we knew substantively about nursing, science, philosophy, and the disciplines of our respective doctoral degrees (none of which were in nursing). It was hard work, but invigorating. The ground rules were that no idea was to be belittled or rejected out of hand; all perspectives were heard and considered. We were given time to think with minimal interruption and maximal flexibility; accordingly, the end product was excellent and the process truly energizing. Such time away from the routine is rarely available in today’s environment, but the model is certainly not without merit. Essential are a culture and leadership that permit and encourage critique without recrimination. In clinical settings, time to engage in deliberative critical thinking is even more difficult to attain. Rather, critical thinking seems to be expected to occur routinely without much cultivation. Benner’s model of progression from novice to expert suggests that excellent clinical experience fosters critical thinking that eventually becomes almost automatic and intuitive. However, I assert that the level of critical thinking displayed by clinical experts needs to be developed deliberately and strategically. The clinical environment in which I have seen critical thinking encouraged most effectively was one in which the expectations were explicit, critical thinking was measured routinely in the practice context, relevant learning and growth opportunities were provided, and critical thinking was taken into account in performance evaluation. In other words, the nursing leadership in that academic medical center truly valued critical thinking and was willing to assign it priority. Nursing has reached the point in its evolution in which a consistent and continuous pattern of critical thinking by its practitioners is a mandate—a sine qua non . The assurance that critical thinking will be truly woven into the fabric of our profession will depend on our ability to recruit and retain intelligent, interested, and committed nurses; to provide challenging educational opportunities that develop the requisite competencies; and to provide and sustain the kinds of environments in which critical thinking is valued and demanded. Introduction The ability to process information from multiple sources and make decisions is a fundamental ability of professional nursing practice. Dramatic changes in the health care system and the practice of nursing have occurred during the past decade as a result of an aging population, cost containment efforts, technological advances, increased complexity of clients’ health care needs, decreased average hospital length of stay, and a shift from acute care to community-based care. All of these changes have emphasized the need for professional nurses to think critically in order to provide safe and effective client care to diverse populations. To function effectively in complex, rapidly changing health care environments, nurses must use higher-order thinking skills and apply content knowledge to clinical practice. The critical thinking process provides nurses with the ability to use purposeful thinking and reflective reasoning to examine ideas, assumptions, principles, conclusions, beliefs, and actions in the context of professional nursing practice ( Brunt, 2005 ). Professional nurses must think critically to process complex data from multiple sources and make intelligent decisions in planning, managing, delivering, and evaluating the health care of their clients. Nurses also use their critical thinking skills to reduce health care errors and improve client safety ( Fero, Witsberger, Wesmiller, Zullo, & Hoffman, 2008 ). To become a critical thinker, a nurse must understand the concept of critical thinking; possess or acquire the essential knowledge, skills, and attributes required to think critically; and deliberately apply critical thinking principles in making clinical judgments. This chapter covers both classical and current sources to examine critical thinking, clinical judgment, and the nursing process. Defining Critical Thinking Critical thinking, as a concept, has been examined and presented from a variety of perspectives. An early definition, proposed by Watson and Glaser (1964) , described critical thinking as the combination of abilities needed to define a problem, recognize stated and unstated assumptions, formulate and select hypotheses, draw conclusions, and judge the validity of inferences. A less prescriptive definition was offered by Ennis (1989) , who characterized critical thinking as “reasonable reflective thinking focused on deciding what to believe or do” (p. 4). Paul (1992) stated that critical thinking is a process of disciplined, self-directed rational thinking that “certifies what we know and makes clear wherein we are ignorant” (p. 47). Alfaro-LeFevre (2006) presented critical thinking for nursing as informed, purposeful, and outcome-focused thinking that requires the ability to identify problems, issues, and risks and make judgments based on evidence. Bandman and Bandman (1995) describe critical thinking for nursing as “the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs, and actions” (p. 7) and include the following functions: •  Discriminating among use and misuse of language •  Analyzing the meaning of terms •  Formulating nursing problems •  Analyzing arguments and issues into premises and conclusions •  Examining nursing assumptions •  Reporting data and clues accurately •  Making and checking inferences based on data •  Formulating and clarifying beliefs •  Verifying, corroborating, and justifying claims, beliefs, conclusions, decisions, and actions •  Giving relevant reasons for beliefs and conclusions •  Formulating and clarifying value judgments •  Seeking reasons, criteria, and principles that justify value judgments •  Evaluating the soundness of conclusions Conclusions are drawn as a result of this reasoning process. In nursing practice, the desired outcome of this reasoning is effective action. Conflicting viewpoints exist regarding whether critical thinking is subject specific or generalizable ( U.S. Department of Education, 1995 ). Most authors agree that the critical thinking processes are not discipline specific but, rather, are generalizable ( Ennis, 1987 ; Facione, 1990 ; Paul, 1992 ; Watson & Glaser, 1964 ). The same critical thinking skills of interpretation, analysis, inference, and evaluation are applied in different subjects. However, the difference lies in how the critical thinking processes are applied to specific disciplines. For example, professional nurses apply critical thinking skills to client care situations in order to make sound clinical judgments, whereas engineers apply critical thinking skills to business or industrial situations in order to make sound decisions. Meyers (1991) and McPeck (1990) believe that mastery of basic terms, concepts, and methodologies must occur before critical thinking skills can be developed. Ennis (1987) agrees that some familiarity with subject matter is necessary for the development of critical thinking; however, some principles of critical thinking bridge many disciplines and can transfer to new situations. An attempt to define critical thinking by consensus was begun in the late 1980s, and the results became known as the Delphi Report. The Delphi research project used an expert panel of theoreticians representing several disciplines from the United States and Canada to develop a conceptualization of critical thinking from a broad perspective ( Facione, 1990 ). The resulting work described critical thinking in terms of cognitive skills and affective dispositions. The outcome was a definition of critical thinking as the process of purposeful, self-regulatory judgments: an interactive, reflective reasoning process ( Facione & Facione, 1996 ). A critical thinker gives reasoned consideration to evidence, context, theories, methods, and criteria to form a purposeful judgment. At the same time, the critical thinker monitors, corrects, and improves the judgment. The Delphi project produced the following consensus definition from its panel of experts: We understand critical thinking (CT) to be purposeful, self-regulatory, judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. … CT is essential as a tool of inquiry. As such, CT is a liberating force in education and a powerful resource in one’s personal and civic life. ( American Philosophical Association, 1990 ) The Delphi participants identified core critical thinking skills as interpretation, analysis, inference, evaluation, and explanation. These critical thinking cognitive skills and subskills are listed in Box 9-1 . BOX 9-1     Critical Thinking Cognitive Skills and Subskills Interpretation Inference Categorization Querying evidence Decoding sentences Conjecturing alternatives Clarifying meaning Drawing conclusions Analysis Explanation Examining ideas Stating results Identifying arguments Justifying procedures Analyzing arguments Presenting arguments Evaluation Self-regulation Assessing claims Self-examination Assessing arguments Self-correction Critical Thinking in Nursing Scheffer and Rubenfeld (2000) replicated the Delphi study with a panel of 55 nurse educators to obtain a consensus definition of critical thinking for nursing. That study resulted in the identification of 17 dimensions of critical thinking and agreement on the definition of critical thinking for nursing as: … an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. (p. 7) Although many areas overlap with the American Philosophical Association’s (1990) Delphi Report definition of critical thinking, some important differences also exist. According to Allen, Rubenfeld, and Scheffer (2004) , the dimensions of creativity, intuition, and transforming knowledge that are so crucial to effective clinical practice were not included in the Delphi Report definition. These dimensions emerged in the consensus definition of critical thinking for nursing. SUMMARY OF DEFINITIONS OF CRITICAL THINKING Although a universally accepted definition of critical thinking has not emerged, agreement exists that it is a complex process. The variety of definitions helps provide insight into the myriad dimensions of critical thinking. Commonalities in definitions include an emphasis on knowledge, cognitive skills, beliefs, actions, problem identification, and consideration of alternative views and possibilities ( Daly, 1998 ). The definitions presented earlier are summarized for comparison in Table 9-1 , and characteristics of critical thinking are listed in Box 9-2 . BOX 9-2     Characteristics of Critical Thinking Involves conceptualization Is rational and reasonable Is reflective Is partially attitudinal Is autonomous Includes creativity Is fair Focuses on what to believe and do From Wilkinson, J. M. (2001). Nursing process: A critical thinking approach (2nd ed.). Upper Saddle River, NJ: Prentice-Hall. TABLE 9-1 Definitions of Critical Thinking Author(s) Definition Watson and Glaser (1964) Combination of abilities needed to define problems, recognize assumptions, formulate and select hypotheses, draw conclusions, and judge validity of inferences Ennis (1989) Reasonable reflective thinking focused on deciding what to believe or do Paul (1992) Process of self-disciplined, self-directed, rational thinking that verifies what we know and clarifies what we do not know The Delphi Report ( American Philosophical Association, 1990 ); Facione, Facione, and Sanchez (1994) Purposeful, self-regulatory judgments resulting in interpretation, analysis, inference, evaluation, and explanation Bandman and Bandman (1995) Rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs, and actions Alfaro-LeFevre (2006) Informed, purposeful, and outcome-focused thinking that uses evidence to make clinical judgments The activities involved in the process of critical thinking include appraisal, problem solving, creativity, and decision making. The interrelationships among these concepts are illustrated in Figure 9-1 . These activities are embedded in the critical thinking process in both nursing education and nursing practice. FIGURE 9-1 Critical thinking model. (Modified from Strader, M. K., & Decker, P. J. [1995]. Role transition to patient care management. Upper Saddle River, NJ: Prentice-Hall.) CRITICAL THINKING AND THE NURSING PROCESS In nursing, critical thinking has often been portrayed as a rational, linear process that is synonymous with clinical judgment, problem solving, and the nursing process ( Ford & Profetto-McGrath, 1994 ; Huckabay, 2009 ; Jones & Brown, 1993 ; Kintgen-Andrews, 1991 ; Wilkinson, 1996 ). However, some critics believe that the problem-solving emphasis of the nursing process constrains critical thinking because it does not incorporate the creativity and open-mindedness components of critical thinking ( Conger & Mezza, 1996 ; Duchscher, 1999 ; Jones & Brown, 1993 ; Miller & Malcolm, 1990 ). Although critical thinking skills are important components of the nursing process and problem solving, these are not synonymous terms. The nursing process serves as a tool for applying critical thinking to nursing practice. The nurse uses critical thinking throughout the nursing process, by sorting and categorizing data; identifying patterns in the data; drawing inferences; developing hypotheses that are stated in the form of outcomes; testing these hypotheses as care is delivered; and making criterion-based judgments of effectiveness. Therefore critical thinking can distinguish between fact and fiction, providing a rational basis for clinical judgments and the delivery of nursing care. Although an argument can be made that the nursing process constrains critical thinking because of its structured format, general agreement exists that critical thinking skills and subskills are evident throughout the nursing process ( Alfaro-LeFevre, 2006 ). Although the components of the nursing process are described as separate and distinct steps, they become an integrated way of thinking as nurses gain more clinical experience. An overview of critical thinking throughout the nursing process is presented in Table 9-2 . A thorough understanding of the nursing process reveals that critical thinking is indeed an integral part of its most effective use. TABLE 9-2 Overview of Critical Thinking Throughout the Nursing Process Nursing Process Critical Thinking Assessment Observing Distinguishing relevant from irrelevant data Distinguishing important from unimportant data Validating data Organizing data Categorizing data Analysis/diagnosis Finding patterns and relationships Making inferences Stating the problem Suspending judgment Planning Generalizing Transferring knowledge from one situation to another Developing evaluative criteria Hypothesizing Implementation Applying knowledge Testing hypotheses Evaluation Deciding whether hypotheses are correct Making criterion-based evaluations and judgments Modified from Wilkinson, J. M. (2001). Nursing process: A critical thinking approach (2nd ed.). Upper Saddle River, NJ: Prentice-Hall. The Nursing Process The nursing process is a systematic, problem-solving approach used extensively in the United States and Canada for the delivery of nursing care. The nursing process was first described in the literature in 1955 by Lydia Hall. Her approach was built around three interrelated spheres of nursing activity: care, core, and cure. The focus in the care sphere is the body, including assessment and evaluation of the client’s ability to perform basic functions and activities of daily living. The focal point in the core sphere was on the therapeutic use of self in providing nursing care, whereas nursing activities related to the cure sphere centered on the administration of treatments and therapies, as well as supporting the patient and family during the treatment process. Subsequently, many others have described a “nursing process,” but the model that has withstood the test of time is that developed by Yura and Walsh (1988) . They proposed a four-step nursing process model that consisted of assessing, planning, implementing, and evaluating. The current model closely resembles the Yura and Walsh model, but with the addition of a diagnostic component. The five-step nursing process consists of the following elements: •  Assessment —gathering and validating client health data, strengths, risks, and concerns •  Analysis/diagnosis —processing client data and identifying appropriate nursing diagnoses •  Planning —designing strategies to solve identified problems and build on client strengths •  Implementation —delivering and documenting the planned care •  Evaluation —determining the effectiveness of the care delivered The American Nurses Association (ANA), in its publication Nursing: Scope and Standards of Practice (2004), parallels the steps of the nursing process and supports its use. Outcome identification, which follows the nursing diagnosis phase and precedes the planning phase, is identified as a separate step in the ANA model. The nursing process is sometimes depicted as a systematic, linear model proceeding from assessment through diagnosis, planning, implementation, and evaluation. It is more appropriately conceptualized as a continuous and interactive model ( Figure 9-2 ), thereby providing a flexible and dynamic approach to client care. This model can accommodate changes in the client’s health status or failure to achieve expected outcomes through a feedback mechanism. The interactive nature of the model with its feedback mechanism permits the nurse to reenter the nursing process at the appropriate stage to collect additional data, restructure nursing diagnoses, design a new plan, or change implementation strategies. This model is consistent with the concept of critical thinking as a continuous reflective process. Further examination of the elements of the nursing process reveals the multiple activities embedded in each step. FIGURE 9-2 The interactive nursing process model. (Modified from Christensen, P. J., & Kenney J. W. [1995]. Nursing process: Application of conceptual models [4th ed.], St. Louis: Mosby.) ASSESSMENT In the assessment phase, the nurse deliberately and systematically collects data to determine the client’s health, functional status, strengths, and risk factors ( Carpenito, 2008 ). Data collection centers on the use of multiple sources and types of data, a variety of data collection techniques, and the use of reliable and valid measurement instruments. All these elements are critical to building a comprehensive database. Sources of Data The primary source of data is the client, whether the client is defined as the individual, the family, or the community. Secondary sources of data include written records, other health care providers, and significant others (e.g., family members, friends). To strengthen the overall assessment and validate client data, it is important to use primary and secondary data sources. Data Collection Techniques Assessment techniques include measurement, observation, and interview. Measurement is used to determine the dimensions of a given indicator (e.g., blood pressure) or to ascertain characteristics such as quantity, size, or frequency. Measurement may require the use of specialized equipment (e.g., stethoscope, thermometer) or specialized assessment tools (e.g., pain scale, depression scale) to assess functional, behavioral, social, or cognitive domains. Data collection by observation requires the use of the senses, including visual observation and tactile (palpation) and auditory techniques (auscultation). Observation provides a variety and depth of data that may be difficult to obtain by other methods. A structured or unstructured interview may be used to obtain information such as a health history and demographic data. A structured interview is commonly used in emergency situations when the nurse needs to gather specific information. An unstructured interview is commonly used in situations in which the nurse wishes to elicit information from the client’s perspective or gain insight to the client’s understanding of a problem. The unstructured interview allows the nurse to use active listening skills while building rapport with the client through the use of an open-ended interview format. These communication techniques are discussed in chapter 8 Types of Data To complete a comprehensive assessment, objective and subjective data are obtained. Objective data are factual data, usually obtained through observation or measurement. An example of objective data occurs when the nurse uses an otoscope to assess the client’s tympanic membrane and observes that it is reddened and inflamed. Subjective data are based on the client’s perception of the health problem. An example of subjective data occurs when the client states that he is having pain in his right ear. It is important to collect both objective and subjective data to complete a comprehensive assessment. Care should be taken to record data factually and to avoid personal or biased interpretations. Data Collection Instruments The use of selected data collection measures and instruments can assist the nurse in compiling a comprehensive database and organizing data into meaningful patterns. Assessment usually begins by taking a nursing history and conducting a physical examination. Many clinical areas have developed nursing history and physical forms specific to the type of agency and the clients served. Regardless of the format, the nursing database should include the following categories of information ( Edelman & Mandle, 1994 ): •  Demographic data •  Current and past medical problems •  Family medical history •  Surgical and (if appropriate) obstetrical history •  Childhood illnesses •  Allergies •  Current medications •  Psychological status •  Social history •  Environmental background •  Physical assessment

Share this:

  • Click to share on Twitter (Opens in new window)
  • Click to share on Facebook (Opens in new window)

Related posts:

  • Genetics and Genomics in Professional Nursing
  • Intimate Partner Violence as a Health Care Problem
  • Ethical Dimensions of Nursing and Health Care
  • Theories and Frameworks for Professional Nursing Practice

definition of critical thinking in nursing process

Stay updated, free articles. Join our Telegram channel

Comments are closed for this page.

definition of critical thinking in nursing process

Full access? Get Clinical Tree

definition of critical thinking in nursing process

The Importance of Critical Thinking in Nursing

Nurse using critical thinking at work

An American Association of Nurse Practitioners (AANP) survey found that a majority of nurse practitioners saw three or more patients per hour. Nurse practitioners see patients of all ages with a broad spectrum of potential ailments. Critical thinking skills in nursing improve patient outcomes by enabling evidence-based decision-making. 

Nurse practitioners gather considerable amounts of patient data through evaluations, tests and conversations. Each patient’s information can be interpreted and analyzed to determine the best courses of action for their health. A growing emphasis on critical thinking in nursing stems from the increasing importance of nurse practitioners in primary care.

Earn Your MSN-FNP Part-Time For Less than $30k

Growing need for critical thinking in nursing.

There is a significant shortage of primary care services throughout the United States. GoodRx identified 80% of counties as “health care deserts” or locations without easy access to necessary services. This data includes the following categories relevant to family nurse practitioners:

  • 9% of counties lack enough primary care providers to serve the local population
  • Residents in 20% of counties are at least 30 minutes away from hospitals
  • Residents in 45% of counties are at least 20 minutes away from community health centers

“Health care deserts” are worsening because of a shortage of primary care physicians. The Association of American Medical Colleges ( AAMC ) estimates up to 48,000 more primary care providers are needed to meet patient care needs by 2034. This shortfall translates to a lack of preventive care and increased reliance on emergency care facilities.

The U.S. Bureau of Labor Statistics ( BLS ) projects a 52% growth in nurse practitioner roles by 2030. This growth is fueled not only by “health care deserts” but an aging population and public health threats like COVID-19. Critical thinking by nurse practitioners can overcome these challenges even with limited resources and stressful situations.

The Critical Thinking Process

The first step in incorporating critical thinking into patient care is understanding the critical thinking process. The National League for Nursing Accreditation Commission ( NLNAC ) defines 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.”

Critical thinking in nursing does not move in a straight line because each patient is unique. There isn’t a one-size-fits-all diagnosis for patients because there isn’t a single type of patient. Nurse practitioners can apply the following steps in the Clinical Reasoning Cycle as they evaluate patient care decisions.

Consider the Situation

First impressions of new patients can distract from effective evaluations. Personal experiences and assumptions may lead to hasty conclusions about patient needs. The first step to critical thinking in nursing involves a dispassionate consideration of the facts.

Nurse practitioners often have the basic facts about their patients’ conditions before stepping into exam rooms. A simple repetition of the patient’s age and reported illness counters assumptions that can negatively impact patient care.

Collect Information

Critical thinking requires the synthesis of existing and new information for effective analysis. Nurse practitioners can pull useful details from patient charts and histories when they are available. An evaluation of visual appearance, speech, blood pressure and other metrics builds on this previous work.

Skilled practitioners automatically apply their knowledge of physiology, pharmacology and other areas during the collection process. They also keep best practices, cultural competence and ethics in mind while working with patients. This recall makes it easier to process information during diagnosis.

Process Information

There is a multi-step process for turning raw information into useful insights for patient care. Nurse practitioners effectively process patient data by:

  • Analyzing information within the context of normal and abnormal ranges
  • Separating relevant and irrelevant data while finding information gaps
  • Focus on relationships between symptoms and cues
  • Deduce potential causes of health problems
  • Compare similar situations between current and past patients
  • Predict potential outcomes and complications from treatment

Nurse practitioners are ready to diagnose patient conditions following this process. Depending on symptoms, they’ll have considered and eliminated multiple diagnoses based on careful consideration of the facts. This step also takes into consideration risks for other health issues without treatment.

Set Goals and Act

A patient’s course of treatment should follow the SMART model for goal-setting. The best treatment plans are Specific, Measurable, Achievable, Realistic and Timely to support the measurement of their efficacy. This model creates a repeatable process that is effective across patient demographics and conditions.

Critical thinking in nursing produces clear goals that are essential to patient adherence to treatment. Treatment plans may include prescribed medications, therapies and visits with specialists. Nurse practitioners collaborate with their patients and colleagues on supportive frameworks for effective treatment.

Evaluate and Reflect

Follow-up appointments provide opportunities for evaluation of treatment plans. Nurse practitioners compare past and present metrics when determining improvements in patient conditions. A useful method for evaluating success is whether the following rights of clinical reasoning were applied:

  • Right cues 
  • Right patient
  • Right action
  • Right reason

Frequent reflection on this process is essential for improvement as a nurse practitioner. Self-directed explorations of what should have been done and what could have happened in each case sharpen critical thinking skills. An understanding of what was learned in each case creates points of comparison for future patients.

Improving Your Critical Thinking

Critical thinking in nursing improves through thoughtful deliberation and frequent use. Nurse practitioners should speak with their colleagues and mentors about their applications of critical thinking. Frequent collaboration on patient care also places the focus on evidence-based care rather than personal assumptions.

Updated knowledge of nursing resources and tools makes it easier to implement critical thinking in nursing. Medical journals and continuing education courses reinforce what nurse practitioners have learned throughout their careers. Carson-Newman University provides a strong foundation for improved critical thinking through its Online MSN-FNP.

Preparing for Clinical Decisions at Carson-Newman

Carson-Newman’s innovative program prepares BSN & MSN-educated nurses for future roles as family nurse practitioners (FNPs). The in-person requirements for this 100% online degree are clinical placements and a three-day campus residency. Students can complete the Online MSN-FNP in as little as 32 months.

Every course in the program is taught by an experienced nurse educator who also practices in their community. Carson-Newman reinforces the importance of critical thinking in nursing with courses on topics including:

  • Advanced Health Assessment
  • Advanced Pathophysiology
  • Advanced Primary Care Nursing for Adults

FNP students receive full support from Carson-Newman to identify clinical placements in their communities. They also receive one-on-one guidance from Student Success Advisors throughout their time at the University. This commitment to nursing education helped Carson-Newman reach the top third of graduate nursing programs in U.S. News & World Report's rankings.

Contact an enrollment advisor today to learn how Carson-Newman can prepare you for a role as an FNP.

Request Your Free Program Brochure

About carson-newman’s online fnp programs.

Founded in 1851, Carson-Newman is a nationally ranked Christian liberal arts university. An online, yet personal, learning environment connects you with fellow students, faculty, and staff. Faith and learning are combined to create evidence-based online graduate nursing programs designed to transform you into a more autonomous caregiver.

Through its online program and student-centric curriculum, Carson-Newman provides a life-changing education where students come first. Designed for working nurses, Carson-Newman’s affordable FNP programs feature 100% online coursework with no mandatory log-in times, clinical placement service, and exceptional individualized support that prepare graduates to pass the FNP licensure exam.

If you’re ready for the next step in your nursing career, consider the online Master of Science in Nursing – Family Nurse Practitioner offered by Carson-Newman University and accredited by the CCNE.

For those who already hold an MSN degree, consider pursuing a Post-Master’s FNP Certificate to enjoy all the leadership opportunities, job satisfaction and autonomy of a family primary care provider. For more information, visit onlinenursing.cn.edu.

Request Information

Download Brochure

Carson-Newman University Online

Carson-Newman University • 1646 Russell Ave. Jefferson City, TN • © Copyright 2024 Carson-Newman University. All rights reserved. • Sitemap • Privacy Policy | California Privacy Notice

Critical thinking definition

definition of critical thinking in nursing process

Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement.

Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process, which is why it's often used in education and academics.

Some even may view it as a backbone of modern thought.

However, it's a skill, and skills must be trained and encouraged to be used at its full potential.

People turn up to various approaches in improving their critical thinking, like:

  • Developing technical and problem-solving skills
  • Engaging in more active listening
  • Actively questioning their assumptions and beliefs
  • Seeking out more diversity of thought
  • Opening up their curiosity in an intellectual way etc.

Is critical thinking useful in writing?

Critical thinking can help in planning your paper and making it more concise, but it's not obvious at first. We carefully pinpointed some the questions you should ask yourself when boosting critical thinking in writing:

  • What information should be included?
  • Which information resources should the author look to?
  • What degree of technical knowledge should the report assume its audience has?
  • What is the most effective way to show information?
  • How should the report be organized?
  • How should it be designed?
  • What tone and level of language difficulty should the document have?

Usage of critical thinking comes down not only to the outline of your paper, it also begs the question: How can we use critical thinking solving problems in our writing's topic?

Let's say, you have a Powerpoint on how critical thinking can reduce poverty in the United States. You'll primarily have to define critical thinking for the viewers, as well as use a lot of critical thinking questions and synonyms to get them to be familiar with your methods and start the thinking process behind it.

Are there any services that can help me use more critical thinking?

We understand that it's difficult to learn how to use critical thinking more effectively in just one article, but our service is here to help.

We are a team specializing in writing essays and other assignments for college students and all other types of customers who need a helping hand in its making. We cover a great range of topics, offer perfect quality work, always deliver on time and aim to leave our customers completely satisfied with what they ordered.

The ordering process is fully online, and it goes as follows:

  • Select the topic and the deadline of your essay.
  • Provide us with any details, requirements, statements that should be emphasized or particular parts of the essay writing process you struggle with.
  • Leave the email address, where your completed order will be sent to.
  • Select your prefered payment type, sit back and relax!

With lots of experience on the market, professionally degreed essay writers , online 24/7 customer support and incredibly low prices, you won't find a service offering a better deal than ours.

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • v.8(4); 2021 Jul

Factors associated with the critical thinking ability of professional nurses: A cross‐sectional study

Tuan van nguyen.

1 Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho Vietnam

2 School of Nursing, College of Medicine, Chang Gung University, Taoyuan Taiwan

Hsueh‐Erh Liu

3 Department of Rheumatology, Chang Gung Memorial Hospital, Linkou Taiwan

4 Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan

Associated Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

To measure the level of critical thinking among Vietnamese professional nurses and to identify the related factors.

A cross‐sectional design was used.

The total sample included 420 professional nurses. Data were collected from July to September 2019 in three public hospitals located in Southwestern Vietnam. The level of critical thinking was measured using the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire. The data were analysed using the independent Student's t tests, ANOVA, Pearson's correlation and regression analysis.

Most of the participants had a low (48.3%) or moderate (45.5%) level of critical thinking. Age, gender, ethnicity, education level, health condition, duration of working as a nurse, duration of working in the current hospital, having heard the term “critical thinking” and work position had an impact on the critical thinking ability. Work position and gender explained 11% of the total variance in critical thinking ability.

1. INTRODUCTION

Critical thinking is defined as the cognitive process of reasoning that involves trying to minimize errors and to maximize positive outcomes while attempting to make a decision during patient care (Zuriguel‐Pérez et al.,  2015 ). The importance of critical thinking in nursing practice has been identified in the literature (Chang et al.,  2011 ; Ludin,  2018 ; Mahmoud & Mohamed,  2017 ; Yurdanur,  2016 ; Zuriguel‐Pérez et al.,  2015 ). The current nursing environment has become more complex and demanding, especially regarding the acuity and safety of patients and the rapid turnover rate of hospitalization. If professional nurses want to provide high‐quality care, critical thinking is required (Berkow et al.,  2011 ; Brunt,  2005 ; Fero et al.,  2009 ; Zuriguel‐Pérez et al.,  2015 ). Nurses are often the first‐line professionals to observe and provide direct care for patients. Therefore, critical thinking is a necessary skill for them to be able to analyse clinical situations in order to make fast and correct decisions (Lee et al.,  2017 ). More importantly, critical thinking can also improve patient outcomes by preventing habitual thinking that may lead to incorrect medication or procedures (Fesler‐Birch,  2005 ). The critical thinking ability of nurses can have an impact on the patient's safety, and it is a priority in educational programs for healthcare providers (Berkow et al.,  2011 ; Buerhaus et al.,  2006 ). We can identify those with poor critical thinking and provide in‐service education. Although critical thinking has been shown that is influenced by the experience and knowledge acquired during clinical practice (Zuriguel‐Pérez et al.,  2015 ), other personal information needs to be considered to clarifying. Therefore, it is essential to measure the levels of critical thinking and to identify the work‐related and personal‐related factors that influence the critical thinking of nurses.

2. BACKGROUND

The literature has identified that there is a relationship between leadership and positive patient outcomes, such as fewer medication errors and nosocomial infections, lower patient mortality and higher patient satisfaction (Van Dyk et al.,  2016 ; Wong,  2015 ). Alongside leadership, critical thinking is an important factor that supports the management. They can apply critical thinking skills in decision‐making and problem‐solving, and they can develop strategies that help staff nurses to improve their critical thinking ability (Van Dyk et al.,  2016 ; Wong,  2015 ; Zuriguel‐Pérez et al., 2018 ). Thus, the ability to think critically is necessary for nurses because it will help them to effectively make decisions and to solve problems in practice.

Although the importance of critical thinking in nursing practice has been identified, a limited number of studies have been conducted in this population. Particularly, few hospitals have evaluated the critical thinking skills of nurses before employment or during the clinical competency evaluation (Lang et al.,  2013 ). By reviewing 90 articles to assess the current state of the scientific knowledge regarding critical thinking in nursing, Zuriguel‐Pérez et al., ( 2015 ) found that only 16 studies used working nurses as participants. Furthermore, Zuriguel‐Pérez et al., ( 2018 ) reported that few studies have explored the critical thinking ability of nurse managers (NMs). Moreover, several studies have identified that working nurses have a low (Lang et al.,  2013 ; Yurdanur,  2016 ) or moderate level of critical thinking (Chang et al.,  2011 ; Lang et al.,  2013 ; Zuriguel‐Pérez et al., 2018 ). To the researchers’ knowledge, no studies have investigated this issue in Vietnam.

In order to improve the quality and safety of patient care, various types of professional nurses have been established, such as Registered Nurses (RNs), NMs and administrative assistants (AAs). RNs provide direct care to the patients, NMs are responsible for forwarding management and delivering expert clinical care for patients, and AAs are an integral part of maintaining the quality of patient care. The AAs perform administrative tasks (e.g. filing, taking meeting minutes and distributing them and undertaking regular reports) that help NMs to spend more time assisting staff nurses and taking care of patients (Locke et al.,  2011 ). Therefore, RNs, NMs and AAs need to cooperate to help patients to regain their health.

In Vietnam, professional nurses work in three different positions, which are NMs, general nurses (GNs) and AAs (Ministry of Health,  1997 ). Specifically, NMs are recognized as head nurses in Western countries, and their responsibilities are in charge of organizing and implementing comprehensive patient care and conduct a variety of administrative work (e.g. planning and assigning work to nurses, planning the acquisition of tools and consumables, checking care sheets, recording daily labour). GNs are similar to RNs in Western countries, and they provide direct and comprehensive care to patients. AAs perform administrative tasks (e.g. keeping records about the hospitalized and discharged patients, preserving medical records, managing daily medications). They also participate in patients care if necessary (Ministry of Health,  1997 , 2011 ). Although the roles of these three types of professional nurses are different, their final goal is the same to provide holistic care for patients. With the cooperation and effort of these three types of professional nurses, patients can recover. Therefore, more surveys are needed that examine these participants’ level of critical thinking and the associated work‐related factors.

Previous studies have also found that several personal‐related factors are associated with the nurses' critical thinking ability, which are age, gender, ethnicity, education qualification, working experience and shift work (Chang et al.,  2011 ; Feng et al.,  2010 ; Howenstein et al.,  1996 ; Lang et al.,  2013 ; Ludin,  2018 ; Mahmoud & Mohamed,  2017 ; Ryan & Tatum,  2012 ; Wangensteen et al.,  2010 ; Yildirim et al.,  2012 ; Yurdanur,  2016 ; Zuriguel‐Pérez et al., 2018 ). However, the relationships between the critical thinking ability and these variables are inconsistent. For example, age and critical thinking have been found to be positively correlated (Chang et al.,  2011 ; Ludin,  2018 ; Zuriguel‐Pérez et al., 2018 ), negatively correlated (Howenstein et al.,  1996 ) and not related (Lang et al.,  2013 ; Mahmoud & Mohamed,  2017 ; Yurdanur,  2016 ). Gender and critical thinking have been reported with a statistically significant relationship (Liu et al.,  2019 ; Ludin,  2018 ) and no relationship (Mahmoud & Mohamed,  2017 ; Wangensteen et al.,  2010 ). Level of education and critical thinking have been found in a positive association (Chang et al.,  2011 ; Ludin,  2018 ) and not association (Lang et al.,  2013 ; Mahmoud & Mohamed,  2017 ). Year of experiences and critical thinking have been shown to be positively correlated (Chang et al.,  2011 ; Ludin,  2018 ), negatively correlated (Howenstein et al.,  1996 ) and not related (Lang et al.,  2013 ; Mahmoud & Mohamed,  2017 ). Those inconsistent findings indicated the relationships between the personal‐characteristics and the critical thinking ability of professional nurses need further exploration. Therefore, this study aimed to examine the level of critical thinking of professional nurses and to explore the work‐related and personal‐related factors. This is the first study to investigate this issue in Vietnam. The results of the current study will make a significant contribution to the literature because it will provide thorough descriptions of the critical thinking of professional nurses and its associated factors. Furthermore, the findings may be used as a baseline for nurse managers and nurse educators to propose further strategies to improve this ability in professional nurses.

3.1. Research design

A cross‐sectional design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were applied in this report (Von Elm et al.,  2014 ).

3.2. Setting and sampling

Data collection was carried out from July to September 2019 in three representative and major public hospitals located in the Southwestern region of Vietnam. These hospitals have the same organizational structure, role of treating, operation of professional nursing and provide similar quality of health care to people around that area. The total numbers of professional in these three hospitals nurses were around 1,200. Besides, our study has two steps. The first step was to translate the English version of the Nursing Critical Thinking in Clinical Practice Questionnaire (N‐CT‐4 Practice) into the Vietnamese version. In that step, we used data as a pilot study to estimate the sample size in the second step, which was reported here. Sample size calculation was done by the formula: n  = 1.96 2  × p × (1‐p)/0.05 2 , where p  = .46 came from the poor level of critical thinking among nurses in the first step and 0.05 indicated the acceptable margin of error (5.0%); 382 participants were required by this formula. An additional 10% of participants were done to adjust for potential failures such as withdrawals or missing data (Suresh & Chandrashekara,  2012 ). Therefore, in total, 420 participants were required for this study. Convenience sampling was conducted to recruit the sample. The inclusion criteria were the nurses' employed full‐time employment in the study hospitals. Participants who participated in step 1 or being absent during the data collection such as sick leave or delivering a baby were excluded. Participants were grouped in each hospital and received an envelope with all questionnaires. Then, researchers explained the research's purpose, benefits and risks to the potential participants and the procedure for ensuring confidentiality, and the voluntary nature of the participation. The informed consent form was signed immediately after they agreed to participate in this study. Then, the participants were required to complete the questionnaires in 20 to 30 min and to return them to the data collector.

3.3. Data assessment

3.3.1. sample characteristics.

This instrument collected data about the personal information and occupational variables. The personal information included age, gender, marital status, ethnicity, religion, education level and self‐rated health conditions. The occupational variables were the duration of working as a nurse, the duration of working in the current hospital, the duration of working in the specific position, having heard the term “critical thinking” or not, previous exposure to critical thinking training or education or not, and type of work position.

3.3.2. Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire ((N‐CT‐4 Practice (V‐v))

The N‐CT‐4 Practice (V‐v) was used to measure the critical thinking ability of the professional nurses. The original instrument (N‐CT‐4 Practice) was established and classified based on the four dimensions of the 4‐circle critical thinking model of Alfaro‐LeFevre (Zuriguel‐Pérez et al., 2017 ). These four dimensions were personal; intellectual and cognitive; interpersonal and self‐management; and technical dimensions. The personal dimension has 39 items to assess the individual pattern of intellectual behaviours; the intellectual and cognitive dimension has 44 items to assesses the knowledge of activity comprehension connected to the nursing process and decision‐making. For the interpersonal and self‐management dimension, it has 20 items to analyse interpersonal abilities that allow for therapeutic communication with patients and health teams and to gain information that is associated with the patient in the clinical environment. The final one, the technical dimension, has 6 items to is concerned with knowledge and expertise in the procedures that are part of the discipline of nursing. This scale has 109 items that are rated using a four‐point Likert response format (1 = never or almost never, 2 = occasionally, 3 = often, and 4 = always or almost always), for example: “I recognize my own emotions.” (item 1); “I have the scientific knowledge required to carry out my professional practice.” (item 40); “I adapt information to the needs and capacities of the patient.” (item 84); “I possess skills in the use of information and communication technologies needed to produce optimal professional results.” (item 105). The total score is obtained from the sum of the 109 items. The scores range from 109–436, and they are categorized into a low level (score <329), moderate level (score between 329–395) and high level (score >395). The overall Cronbach's alpha was 0.96, and the intraclass correlation coefficient (ICC) was 0.77 (Zuriguel‐Pérez et al., 2017).

The N‐CT‐4 Practice (V‐v) was translated, and its psychometric properties were tested with 545 Vietnamese nurses. The results showed that the N‐CT‐4 Practice (V‐v) has acceptable reliability (Cronbach's alpha) and validity (content and construct validity). Particularly, the overall Cronbach's alpha was 0.98, with that of the four dimensions ranging from 0.86–0.97. The ICC was 0.81 over two weeks. The item content validity index was 1.0. Moreover, the goodness‐of‐fit indexes in a confirmatory factor analysis showed acceptable values, which were χ 2 / df  = 2.87, root mean square error of approximation (RMSEA) = 0.059, standardized root mean square residual (SRMR) = 0.063, comparative fit index (CFI) = 0.73 and Tucker Lewis index (TLI) = 0.72 (T. V. Nguyen & Liu,  2021 ). Therefore, the N‐CT‐4 Practice (V‐v) can be used to measure the critical thinking ability of Vietnamese professional nurses.

3.4. Ethical considerations

This study conformed with the ethical principles of the Declaration of Helsinki (Helsinki Declaration,  2013 ), and it was granted research ethics committee approval by the ethical review board of the first author's institution.

3.5. Data analysis

The data were analysed using SPSS for Windows version 23.0 (IBM Corp.), and both descriptive and inferential statistics were calculated. The level of significance for all analyses was set at < 0.05. First, descriptive statistics were employed to summarize the collected data. The continuous variables were described using the mean and standard deviation ( SD ), and the frequency and percentage (%) were used for the categorical variables. Next, independent Student's t tests, analysis of variance (with Scheffe's post hoc comparison) and Pearson's correlation analysis were conducted to explore the association between the critical thinking ability and the personal and occupational factors. Then, a multiple regression analysis using the stepwise method was performed to identify the predictors of critical thinking ability (Pallant,  2010 ).

4.1. Characteristics of the participants

A total of 420 participants completed the questionnaires; the characteristics of overall participants and subjects in each group are listed in Table  1 . Three groups of subjects were included, which were NMs (24.8%), GNs (49.8%) and AAs (25.4%), respectively. Regarding the personal variables, almost all participants were Vietnamese (96.7%), no religion (73.1%) and had good health condition (60%). Meanwhile, the comparison among each group showed that age ( F  = 9.89, p  < .001), gender (χ 2  = 6.48, p  < .05), marital status (χ 2  = 6.77, p  < .05) and education level (χ 2  = 147.38, p  < .001) had reached the statistical significance. Further analysis showed that the age of NMs was significantly older than subjects in both the GN and AA group, AA group had a higher ratio of that in the GN group, and the AA group had a higher ratio of married one than the GN group. For educational levels, subjects in the NM group had a higher ratio of bachelor and master degree, whereas the other two groups had a high ratio of diploma and associate degree.

Characteristics of the participants ( n  = 420)

Abbreviations: AA, Administrator assistant; CT , Critical thinking; GN, General nurse; NM, Nurses manager ; SD , standard deviation.

Chi‐square and one‐way ANOVA test; significant at * p  < .05; ** p  < .01; *** p  < .001.

Regarding work‐related factors, the characters of all participants and subjects in each group are also listed in Table  1 . The comparison of professional experience, such as duration of working as a nurse, duration of working in the current hospital, duration of working in this specific position and heard the terminology of "critical thinking" showed a significant statistical difference among the three groups ( p  < .001). They showed that NMs had a longer duration of working as a nurse (mean = 12.30, SD  = 7.12) and duration of working in the current hospital (mean = 11.6, SD  = 7.02) than the other two groups; GNs had the longest duration of working in the specific position (mean = 7.41, SD  = 6.21). More subjects in the NM group heard the terminology of "critical thinking" than subjects in the other two groups. However, none of the subjects had been exposed to critical thinking training or education. Furthermore, there was a positive correlation among age, the duration of working as a nurse, the duration of working in the current hospital and duration of working in a specific position ( r  = .78–.975, p  < .01).

4.2. Level of the critical thinking of the professional nurses

The mean of the total scores of the N‐CT‐4 Practice (V‐v) for all participants was 333.86 ± 40.22 (with the average score/item = 3.06 ± 0.37), the median score was 331 (interquartile range [IQR] = 311–359), and it ranged from 204–436, which indicates that they generally had a moderate level of critical thinking. Meanwhile, most of the participants reported a low (48.3%) or moderate (45.5%) level of critical thinking. Only 6.2% of the participants had a high level of critical thinking. Regarding the four dimensions of the N‐CT‐4 Practice (V‐v), the average sum score was 119.52 ± 14.19 (with the average score/item = 3.06 ± 0.36) in the personal dimension, 136.38 ± 17.62 (with the average score/item = 3.10 ± 0.40) in the intellectual and cognitive dimension, 68.71 ± 12.65 (with the average score/item = 3.44 ± 0.63) in the interpersonal and self‐management dimension and 18.09 ± 3.01 (with the average score/item = 3.01 ± 0.50) in the technical dimension.

4.3. Work‐related and personal‐related factors associated with critical thinking ability

There were statistically significant associations between the critical thinking ability and some work‐related factors, such as work position ( F  = 23.30, p  < .001), duration of working as a nurse ( r  = 0.15, p  < .01), duration of working in the current hospital ( r  = 0.13, p  < .05) and having heard the term "critical thinking" ( t  = −2.48, p  < .05; Table  2 ). The findings indicated that NMs had higher scores than GNs and AAs. Moreover, nurses who had worked for a longer duration as a nurse or worked longer in the current hospital had a higher critical thinking ability. Meanwhile, those who had not heard the term "critical thinking" had lower scores than participants who had heard this term.

Association between the participants’ characteristics and the critical thinking ability ( n  = 420)

The bolded values indicate the level of statistical significance (with p < .05; p < .01; or p < .001) between the independent and dependent variables.

Abbreviations: SD , standard deviation.

There were statistically significant associations between the critical thinking ability and some personal‐related factors, such as age ( r  = 0.12, p  < .05), gender ( t  = 2.32, p  < .05), ethnicity ( t  = 1.97, p  < .05), education level ( F  = 7.45, p  < .01) and health condition ( F  = 3.14, p  < .05; Table  2 ). The findings indicated that the older nurses reported a higher critical thinking ability, and male nurses had a higher score than female ones. Vietnamese participants had higher scores than participants with other ethnicities. Participants with a bachelor's/graduate degree level of education had higher scores than participants with a diploma and associate degree level of education. Those with very good health had a higher score than participants who rated their health as fair/bad/very bad.

All of the statistically significant variables identified in the univariate analysis were selected as independent variables to determine the predictors of critical thinking ability. For the regression analysis, the categorical variables were first coded as dummy variables. The factors of having never heard of “critical thinking,” being an NM being male, being Vietnamese, having a diploma degree and being in very good health were selected as the standard factors. The results of the stepwise multiple regression method showed that there were only two predictors, namely the variables of work position and gender. Working as an AA or GN or being female can predict the critical thinking ability, and they accounted for 11% of the total variance ( F  = 17.12, p  < .001). This indicates that the AAs and GNs had a lower level of critical thinking than the NMs. Besides, when compared with male nurses, the female nurses exhibited a lower level of critical thinking (Table  3 ).

Predictors of the critical thinking ability ( n  = 420)

5. DISCUSSION

This study showed that the critical thinking ability of most professional nurses was at a low or moderate level. This finding is consistent with previous studies (Chang et al.,  2011 ; Lang et al.,  2013 ; Zuriguel‐Pérez et al., 2018 ). Using the same tool, Zuriguel‐Pérez et al. ( 2018 ) found that the median score of the N‐CT‐4 Practice was 363 (IQR = 340–386) for clinical nurses in Spain. Our study found a slightly lower median score (331; IQR = 311–359) but it was still in a moderate level (range of score: 329–395). Although critical thinking is a relatively new issue in Vietnamese professional nurses, it is not a brand new concept. Certain elements have been included in the nursing curriculum and clinical practice (e.g. the nursing process, problem‐based learning, evidence‐based practice). Therefore, up to 66.7% of participants had never heard the term "critical thinking," but 45.5% still reported a moderate level when measured using the N‐CT‐4 Practice (V‐v).

In Vietnam, clinical professional nurses are categorized into NMs, GNs and AAs with different job descriptions. Critical thinking ability has been identified as an important component for the high quality of care around the world, except in Vietnam. In order to identify this ability, we collected data from 3 hospitals in one region and grouped these data for analysis. Based on the comparison among NMs, GNs and AAs, it was found that NMs had a higher level of critical thinking than GNs and AAs. This can be explained by the fact that NMs have a higher age, work experience and high educational qualification than the other two groups. This result partially supports the finding that NMs report a slightly higher level of critical thinking than RNs (Zuriguel‐Pérez et al., 2018 ). Critical thinking is a necessary skill for effective and efficient management. Evidently, at present, NMs with a high level of critical thinking create positive practice environments that can help the staff nurses to deliver high quality and safe patient care (Zori et al.,  2010 ). Therefore, all healthcare personnel needs to learn and apply critical thinking in order to conduct their work effectively and efficiently.

For clinical nurses, continuous in‐service education is very important to update their knowledge and skill of care. Literature found various factors associated with curriculum design and learning of critical thinking ability. Therefore, grouping subjects in the present study together in order to identify the related factors could help the development of further in‐service education of critical thinking ability effectively and efficiently. In this study, a statistically significant positive correlation was found between the critical thinking ability and age, the duration of working as a nurse and the duration of working in the current hospital. These findings are consistent with previous studies. For example, older nurses have a higher level of critical thinking than younger ones (Chang et al.,  2011 ; Chen et al.,  2019 ; Feng et al.,  2010 ; Ludin,  2018 ; Wangensteen et al.,  2010 ; Yurdanur,  2016 ; Zuriguel‐Pérez et al., 2018 ), and nurses with more experience report a better critical thinking ability than those with less experience (Chang et al.,  2011 ; Chen et al.,  2019 ; Feng et al.,  2010 ; Ludin,  2018 ). Older and experienced nurses are more mature in their way of thinking (Chen et al.,  2019 ; Ludin,  2018 ). Because there were statistically significant positive correlations among age, the duration of working as a nurse and the duration of working in the current hospital. This indicates that older nurses have a longer duration of working as a nurse or working in the current hospital so they have better critical thinking. However, the correlation between these factors and critical thinking in the current study is small; further explorations are suggested.

This study showed that there is a significant association between critical thinking ability and gender and ethnicity, which is also supported by the literature. Ludin ( 2018 ) found that female nurses reported a lower critical thinking ability than male nurses. Traditionally, females have generally had fewer opportunities to receive education and more difficulty asserting their rights during decision‐making than males in Vietnam (L. T. Nguyen et al.,  2017 ). Even today, the phenomenon of gender inequality still exists in certain areas in Vietnam. This traditional burden and the limited opportunities to practice in a clinical care setting might lower the levels of the female participants’ critical thinking. Ethnicity has a similar impact, as found in the present study. For example, it has been reported that Caucasian and Hispanic/Latino participants have a significantly higher critical thinking ability than African American participants (Lang et al.,  2013 ) and that Malaysian and Indian participants report different levels of critical thinking; nevertheless, only 0.9% of the participants were Indian (Ludin,  2018 ). However, in the present study, as almost all of the participants were Vietnamese (96.7%), the skewed distribution of the ethnicity might limit the generalizability of the results. In future studies, an equal distribution of ethnicity is strongly recommended.

This study also confirmed that those who had a bachelor's/graduate degree had a higher level of critical thinking than those who had a diploma or associate degree, even though the former had never heard the term "critical thinking." A vast amount of studies has found that education has a positive impact on the level of critical thinking (Chang et al.,  2011 ; Gloudemans et al.,  2013 ; Ludin,  2018 ; Yildirim et al.,  2012 ; Zuriguel‐Pérez et al., 2018 ). Meanwhile, this study found that participants who had heard the term "critical thinking" displayed a higher level of critical thinking than those who had not heard this term. Education might be the major reason for this variation. In the present study, only 40.7% of participants had a bachelor's/graduate degree. In order to promote their levels of critical thinking, it is necessary to arrange for them, to encourage them, to attend advanced education or to provide further content in the in‐service education.

In this study, participants with very good health had a higher level of critical thinking than participants who self‐rated their health as fair/bad/very bad. Health status does have an impact on work productivity, job performance, quality of care and extra learning (Letvak et al.,  2011 ). Thus, poor health limits their learning and critical thinking ability. This ability is an important predictor of real‐life outcomes (e.g. interpersonal, work, financial, health and education) (Butler et al.,  2017 ). Therefore, the causal effects between health and critical thinking ability need further exploration.

In the current study, only the female gender and the type of work position as an AA or GN were identified as predictors, and they explained only 11% of the total variance of critical thinking ability in the regression model. The uneven distribution of gender and work position might be the reason for the low variance. Even though the male was significantly less than the female, NM was fewer than GN and AA. More factors need to be included in further studies.

The limitations of this study include that it used a convenience sample from only three public hospitals located in the Southwestern part of Vietnam. This sample does not represent all professional nurses in Vietnam. The N‐CT‐4 Practice is the instrument with good psychometric properties specific for clinical practice and translated into English (Zuriguel‐Pérez et al., 2017), Persian (FallahNezhad & Ziaeirad,  2018 ) and Turkish (Urhan & Seren, 2019 ). Different points of the Likert response format were selected by tools to measure critical thinking ability. For example, the N‐CT‐4 Practice selected a four‐point Likert response and it was rated in frequency, such as 1 = never or almost never and 4 = always or almost always. However, a seven‐point Likert scale for the Critical Thinking Disposition Assessment (CTDA) was selected and rated in levels of agreement, such as 1 for very strongly disagree and 7 for very strongly agree (Cui et al.,  2021 ). Which response format can be more reprinting the characters of critical thinking ability? Further investigation is strongly suggested. Besides, the N‐CT‐4 Practice (V‐v) questionnaire has too many items that may lead to the boredom of the participants to answer and thus affect the accuracy of the results. Moreover, the collapsing of three distinctly separate groups of nurses into one group for most of the analyses lead to not showing differences in critical thinking and influencing factors among the three groups. These factors all limit the generalization of the present results. Based on these limitations, it is suggested that the use of nationwide systematic sampling and an international comparison are strongly suggested in further studies. Regarding the critical thinking questionnaire, it would be better to use the revised versions with fewer questions. Therefore, developmental and psychometric properties are suggested to shorten this questionnaire.

6. CONCLUSIONS

The results demonstrate that most of the professional nurses had a low or moderate critical thinking ability. Certain personal and occupational variables were significantly associated with the level of critical thinking. Being male or working as an NM were statistically significant predictors of critical thinking ability, and they explained only 11% of the total variance.

The findings of this study indicate that it is necessary to develop strategies to improve the critical thinking ability of professional nurses. The critical thinking ability has been confirmed to be an essential factor for high‐quality health care that focuses on the quality of patient care and patient safety. Besides, providing more opportunities to pursue advanced degrees or enhancing the provision of in‐service education in hospitals that involves classroom teaching or web‐based learning is strongly recommended for this specific group of nurses. Consequently, the quality of patient care could be improved.

CONFLICT OF INTEREST

The authors declare that they have no competing interests.

ACKNOWLEDGEMENTS

The authors would like to thank the expert panel, translators, research assistants, the hospitals and all of the clinical nurses who participated in this study. We are indebted to the study participants and would like to dedicate the research findings to improving the critical thinking ability of Vietnamese professional nurses in the future. No specific grant was received from funding agencies in the public, commercial, or not‐for‐profit sectors.

Van Nguyen T, Liu H‐E. Factors associated with the critical thinking ability of professional nurses: A cross‐sectional study . Nurs Open . 2021; 8 :1970–1980. 10.1002/nop2.875 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

  • Berkow, S. , Virkstis, K. , Stewart, J. , Aronson, S. , & Donohue, M. (2011). Assessing individual frontline nurse critical thinking . Journal of Nursing Administration , 41 ( 4 ), 168–171. 10.1097/NNA.0b013e3182118528 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Brunt, B. A. (2005). Critical thinking in nursing: An integrated review . The Journal of Continuing Education in Nursing , 36 ( 2 ), 60–67. 10.3928/0022-0124-20050301-05 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Buerhaus, P. I. , Donelan, K. , Ulrich, B. T. , Norman, L. , & Dittus, R. (2006). State of the registered nurse workforce in the United States . Nursing Economics , 24 ( 1 ), 6. [ PubMed ] [ Google Scholar ]
  • Butler, H. A. , Pentoney, C. , & Bong, M. P. (2017). Predicting real‐world outcomes: Critical thinking ability is a better predictor of life decisions than intelligence . Thinking Skills and Creativity , 25 , 38–46. 10.1016/j.tsc.2017.06.005 [ CrossRef ] [ Google Scholar ]
  • Chang, M. J. , Chang, Y. J. , Kuo, S. H. , Yang, Y. H. , & Chou, F. H. (2011). Relationships between critical thinking ability and nursing competence in clinical nurses . Journal of Clinical Nursing , 20 ( 21–22 ), 3224–3232. 10.1111/j.1365-2702.2010.03593.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Chen, F.‐F. , Chen, S.‐Y. , & Pai, H.‐C. (2019). Self‐reflection and critical thinking: The influence of professional qualifications on registered nurses . Contemporary Nurse , 55 ( 1 ), 59–70. 10.1080/10376178.2019.1590154 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Cui, L. , Zhu, Y. , Qu, J. , Tie, L. , Wang, Z. , & Qu, B. (2021). Psychometric properties of the critical thinking disposition assessment test amongst medical students in China: A cross‐sectional study . BMC Medical Education , 21 ( 1 ), 1–8. 10.1186/s12909-020-02437-2 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Helsinki Declaration (2013). Ethical principels for medical research involving human subject . Helsinki Declaration. [ Google Scholar ]
  • FallahNezhad, Z. , & Ziaeirad, M. (2018). The relationship between the quality of working life and critical thinking of nurses in Milad Hospital of Isfahan, Iran . Preventive Care in Nursing and Midwifery Journal , 8 ( 3 ), 62–68. 10.29252/pcnm.8.3.62 [ CrossRef ] [ Google Scholar ]
  • Feng, R. C. , Chen, M. J. , Chen, M. C. , & Pai, Y. C. (2010). Critical thinking competence and disposition of clinical nurses in a medical center . Journal of Nursing Research , 18 ( 2 ), 77–87. 10.1097/JNR.0b013e3181dda6f6 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Fero, L. J. , Witsberger, C. M. , Wesmiller, S. W. , Zullo, T. G. , & Hoffman, L. A. (2009). Critical thinking ability of new graduate and experienced nurses . Journal of Advanced Nursing , 65 ( 1 ), 139–148. 10.1111/j.1365-2648.2008.04834.x [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Fesler‐Birch, D. M. (2005). Critical thinking and patient outcomes: A review . Nursing Outlook , 53 ( 2 ), 59–65. 10.1016/j.outlook.2004.11.005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Gloudemans, H. A. , Schalk, R. M. , & Reynaert, W. (2013). The relationship between critical thinking skills and self‐efficacy beliefs in mental health nurses . Nurse Education Today , 33 ( 3 ), 275–280. 10.1016/j.nedt.2012.05.006 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Howenstein, M. A. , Bilodeau, K. , Brogna, M. J. , & Good, G. (1996). Factors associated with critical thinking among nurses . The Journal of Continuing Education in Nursing , 27 ( 3 ), 100–103. 10.3928/0022-0124-19960501-04 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Lang, G. M. , Beach, N. L. , Patrician, P. A. , & Martin, C. (2013). A cross‐sectional study examining factors related to critical thinking in nursing . Journal for Nurses in Professional Development , 29 ( 1 ), 8–15. 10.1097/NND.0b013e31827d08c8 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Lee, D. S. , Abdullah, K. L. , Subramanian, P. , Bachmann, R. T. , & Ong, S. L. (2017). An integrated review of the correlation between critical thinking ability and clinical decision‐making in nursing . Journal of Clinical Nursing , 26 ( 23–24 ), 4065–4079. 10.1111/jocn.13901 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Letvak, S. , Ruhm, C. , & Lane, S. (2011). The impact of nurses' health on productivity and quality of care . JONA. The Journal of Nursing Administration , 41 ( 4 ), 162–167. 10.1097/NNA.0b013e3182118516 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Liu, N.‐Y. , Hsu, W.‐Y. , Hung, C.‐A. , Wu, P.‐L. , & Pai, H.‐C. (2019). The effect of gender role orientation on student nurses’ caring behaviour and critical thinking . International Journal of Nursing Studies , 89 , 18–23. 10.1016/j.ijnurstu.2018.09.005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Locke, R. , Leach, C. , Kitsell, F. , & Griffith, J. (2011). The impact on the workload of the ward manager with the introduction of administrative assistants . Journal of Nursing Management , 19 ( 2 ), 177–185. 10.1111/j.1365-2834.2011.01229.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Ludin, S. M. (2018). Does good critical thinking equal effective decision‐making among critical care nurses? A cross‐sectional survey . Intensive & Critical Care Nursing , 44 , 1–10. 10.1016/j.iccn.2017.06.002 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Mahmoud, A. S. , & Mohamed, H. A. (2017). Critical thinking disposition among nurses working in puplic hospitals at port‐said governorate . International Journal of Nursing Sciences , 4 ( 2 ), 128–134. 10.1016/j.ijnss.2017.02.006 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Ministry of Health (1997). Decision No. 1895/1997/QĐ‐BYT of the ministry of health on the promulgation of Hospital Regulations . Retrieved from http://vbpl.yte.gov.vn/van‐ban‐phap‐luat/quyet‐dinh‐18951997qd‐byt‐.1.2286.html
  • Ministry of Health (2011). Circular No. 07/2011/TT‐BYT dated 26/01/2011 of the Ministry of Health on guiding on patient care in hospitals . Retrieved from https://kcb.vn/wp‐content/uploads/2015/07/TT‐07.2011.TT‐BYT‐ngay‐26.01.2011.pdf .
  • Nguyen, L. T. , Annoussamy, L. C. , & LeBaron, V. T. (2017). Challenges Encountered by Vietnamese Nurses When Caring for Patients With Cancer . Paper presented at the Oncology nursing forum. [ PubMed ]
  • Nguyen, T. V. , & Liu, H. E. (2021). The Vietnamese version of the nursing critical thinking in clinical practice questionnaire: Translation and psychometric evaluation . Nursing Open , 1–8. 10.1002/nop2.834 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Pallant, J. (2010). SPSS survival manual: A step by step guide to data analysis using SPSS . Maidenhead. Open University Press/McGraw‐Hill. [ Google Scholar ]
  • Ryan, C. , & Tatum, K. (2012). Objective measurement of critical‐thinking ability in registered nurse applicants . Journal of Nursing Administration , 42 ( 2 ), 89–94. 10.1097/NNA.0b013e318243360b [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Suresh, K. , & Chandrashekara, S. (2012). Sample size estimation and power analysis for clinical research studies . Journal of Human Reproductive Sciences , 5 ( 1 ), 7. 10.4103/0974-1208.97779 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ] Retracted
  • Urhan, E. , & Seren, A. K. H. (2019). Validity and reliability of Turkish version of the nursing critical thinking in clinical practice questionnaire . University of Health Sciences Journal of Nursing , 1 ( 3 ), 147–156. [ Google Scholar ]
  • Van Dyk, J. , Siedlecki, S. L. , & Fitzpatrick, J. J. (2016). Frontline nurse managers' confidence and self‐efficacy . Journal of Nursing Management , 24 ( 4 ), 533–539. 10.1111/jonm.12355 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Von Elm, E. , Altman, D. G. , Egger, M. , Pocock, S. J. , Gøtzsche, P. C. , Vandenbroucke, J. P. , & Initiative, S. (2014). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies . International Journal of Surgery , 12 ( 12 ), 1495–1499. 10.1016/j.ijsu.2014.07.013 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Wangensteen, S. , Johansson, I. S. , Bjorkstrom, M. E. , & Nordstrom, G. (2010). Critical thinking dispositions among newly graduated nurses . Journal of Advanced Nursing , 66 ( 10 ), 2170–2181. 10.1111/j.1365-2648.2010.05282.x [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: State of the science . Journal of Nursing Management , 23 ( 3 ), 275–278. 10.1111/jonm.12307 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Yildirim, B. , Özkahraman, Ş. , & Ersoy, S. (2012). Investigation of critical thinking disposition in nurses working in public hospitals . International Journal of Business, Humanities and Technology , 2 , 61–67. [ Google Scholar ]
  • Yurdanur, D. (2016). Critical Thinking Competence and Dispositions among Critical Care Nurses: A Descriptive Study . International Journal , 9 ( 2 ), 489. [ Google Scholar ]
  • Zori, S. , Nosek, L. J. , & Musil, C. M. (2010). Critical thinking of nurse managers related to staff RNs’ perceptions of the practice environment . Journal of Nursing Scholarship , 42 ( 3 ), 305–313. 10.1111/j.1547-5069.2010.01354.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Zuriguel‐Pérez, E. , Falcó‐Pegueroles, A. , Roldán‐Merino, J. , Agustino‐Rodriguez, S. , Gómez‐Martín, M. C. , & Lluch‐Canut, M. T. (2017). Development and psychometric properties of the nursing critical thinking in clinical practice questionnaire . Worldviews on Evidence‐Based Nursing , 14 ( 4 ), 257–264. 10.1111/wvn.12220 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Zuriguel‐Pérez, E. , Lluch Canut, M. T. , Falcó Pegueroles, A. , Puig Llobet, M. , Moreno Arroyo, C. , & Roldán Merino, J. (2015). Critical thinking in nursing: Scoping review of the literature . International Journal of Nursing Practice , 21 ( 6 ), 820–830. 10.1111/ijn.12347 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Zuriguel‐Pérez, E. , Lluch‐Canut, M. T. , Agustino‐Rodríguez, S. , Gómez‐Martín, M. D. C. , Roldán‐Merino, J. , & Falcó‐Pegueroles, A. (2018). Critical thinking: A comparative analysis between nurse managers and registered nurses . Journal of Nursing Management , 26 ( 8 ), 1083–1090. 10.1111/jonm.12640 [ PubMed ] [ CrossRef ] [ Google Scholar ]

IMAGES

  1. PPT

    definition of critical thinking in nursing process

  2. PPT

    definition of critical thinking in nursing process

  3. The Nursing Process And Critical Thinking (Step by Step)

    definition of critical thinking in nursing process

  4. PPT

    definition of critical thinking in nursing process

  5. 5 Steps to Improve Critical Thinking in Nursing

    definition of critical thinking in nursing process

  6. Critical thinking & Nursing Process drjma

    definition of critical thinking in nursing process

VIDEO

  1. Webinar

  2. Critical Thinking Definition (By pair)

  3. unit 1 critical thinking in nursing fon2

  4. Definition of thinking #nursingclasses #thinking #nursingpassion #psychologydefinition

COMMENTS

  1. Chapter 4 Nursing Process

    Critical Thinking and Clinical Reasoning. Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes "reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow." [1] Using critical thinking means that nurses take extra steps to maintain patient safety ...

  2. What is Critical Thinking in Nursing? (With Examples, Importance, & How

    The following are examples of attributes of excellent critical thinking skills in nursing. 1. The ability to interpret information: 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.

  3. The Value of Critical Thinking in Nursing

    Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised. 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.

  4. Critical Thinking in Nursing

    Critical Thinking in Nursing. Critical thinking in nursing profession has been defined as "the process of reflective and reasonable thinking about nursing problems without a single solution and is focused on deciding what to believe and do" (Yildrim and Ozkahraman, 2011, p.257). From: Nurse Education Today, 2018.

  5. Critical Thinking in Nursing

    Therefore, critical thinking in nursing is the process of making clinical decisions through thinking by using knowledge, experience, evidence, and intuition to define patient problems and choose among alternatives. It involves inquiry, collection, analysis, synthesis, and interpretation of data, reasoning inductively and deductively, using ...

  6. 1.3: Critical Thinking and Clinical Reasoning

    Critical Thinking and Clinical Reasoning. Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. Critical thinking is a broad term used in nursing that includes "reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow." [1] Using critical thinking means that nurses take extra steps to maintain patient safety ...

  7. What is Critical Thinking in Nursing? (Explained W/ Examples)

    Critical thinking is a cognitive process that involves analyzing, evaluating, and synthesizing information to make reasoned and informed decisions. It's a mental activity that goes beyond simple memorization or acceptance of information at face value. Critical thinking involves careful, reflective, and logical thinking to understand complex ...

  8. 4.2 Basic Concepts

    The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. ... The American Nurses Association (ANA) recently updated the definition of nursing as, "Nursing integrates the art and ...

  9. Critical Thinking and the Nursing Process

    Definition of Critical thinking. Critical thinking is a multidimensional skill, a cognitive or mental process or set of procedures. It involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas.

  10. Nurses are critical thinkers

    Nurses are critical thinkers. The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice.

  11. Critical thinking: the development of an essential skill for nursing

    DOI: 10.5455/aim.2014.22.283-286. Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical th ….

  12. Critical Thinking Skills in Nursing: Definition and ...

    Critical thinking is the process of gathering information, fully assessing it and then developing an opinion in response. Nurses use critical thinking to make informed decisions about a patient's medical care such as choosing which tests to run and communicating their opinions to doctors. Nurses often are the first to examine a patient in a ...

  13. Critical Thinking, Clinical Judgment, and the Nursing Process

    Defining Critical Thinking. Critical thinking, as a concept, has been examined and presented from a variety of perspectives. An early definition, proposed by Watson and Glaser (1964), described critical thinking as the combination of abilities needed to define a problem, recognize stated and unstated assumptions, formulate and select hypotheses, draw conclusions, and judge the validity of ...

  14. The Importance of Critical Thinking in Nursing

    The National League for Nursing Accreditation Commission ( NLNAC) defines 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.". Critical thinking in nursing does not move in a straight line ...

  15. PDF Critical Thinking in Nursing Process and Education

    Key Words: Critical Thinking, Nursing Process, Critical Thinking in Nursing Process CRITICAL THINKING There is no universally accepted definition of critical thinking; however the Delphi report published by the American Philosophical Association gave us a description of critical thinking in terms of cognitive skills and affective dispositions ...

  16. Using Critical Thinking in Essays and other Assignments

    Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement. Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process ...

  17. Factors associated with the critical thinking ability of professional

    1. INTRODUCTION. Critical thinking is defined as the cognitive process of reasoning that involves trying to minimize errors and to maximize positive outcomes while attempting to make a decision during patient care (Zuriguel‐Pérez et al., 2015).The importance of critical thinking in nursing practice has been identified in the literature (Chang et al., 2011; Ludin, 2018; Mahmoud & Mohamed ...