critical thinking nursing
Article

How To Think Critically in Nursing


RN to BSN (Bachelor of Science in Nursing)

Nurses work on the front lines of patient care, monitoring for changes, updating care regimens and making diagnoses. Problem-solving is deeply ingrained into the work of any medical professional, especially a nurse. They’re often the first to handle stressful situations that arise with a patient and are responsible for guiding that patient’s family through every step of their treatment. Nurses have to be able to think on their feet, and developing strong critical thinking skills is a crucial component of making quick decisions.

Anyone can benefit from mental exercises that build critical thinking skills, but the benefits of critical thinking in nursing extend beyond nurses themselves and can have a significant impact on patient care and outcomes.

The Role of Critical Thinking in Nursing

First things first: What exactly is critical thinking? As it applies to nursing, critical thinking is an intentional process based on logic and evidence that leads to better patient outcomes. Minority Nurse magazine described it as follows, citing a study from 2010:

Critical thinking involves interpretation and analysis of the problem, reasoning to find a solution, applying, and finally evaluation of the outcomes.

The development of one’s mental skills relies on both past experience and the willingness to push the boundaries of accepted knowledge. Nurses are often required to make accurate assessments of patient conditions, and the ability to analyze information and synthesize knowledge within the scope of individual nursing practice contributes to effective care. Nursing has become a dynamic and rapidly evolving profession now characterized by research and its influence on critical thinking.

Nurses also should keep their minds open to new possibilities and ways of thinking. Broadening one’s way of thinking has led to significant changes in the medical field. For example, the “crash cart” for patient resuscitation and color-coded IV lines meant to prevent medication mix-ups are fixtures of the medical world now, but they never would’ve been if their inventors had not been thinking critically. They looked at the challenges they were facing and devised new ways to solve them rather than accepting the status quo.

There’s a quantifiable reason to stress the importance of critical thinking. One study found that nurses with more developed critical thinking skills made better decisions in the ER and are more likely to be able to handle the changing nature of their work. They were also better communicators, getting the necessary information to the rest of their team efficiently and allowing for better patient care.

Characteristics of Critical Thinking in Nursing

Strong critical thinking skills can mean the difference between life and death, and the ability to be a quick thinker under pressure isn’t something that happens naturally — it has to be worked at and it’s a skill that develops over time. But to truly understand and work on critical thinking skills, nurses first must identify what the core cognitive critical thinking skills are and how they can be put to use in the nursing industry. 

The ability to interpret and convey information is among the most important characteristics of critical thinking nursing. In other words, nurses do need to be able to understand and digest events and information, but they also need to have the skills to communicate that to patients and their families in a way they can understand. Of course, not all patients and families are the same so they need to be equipped with the skills to change their approach based on who they are talking to.

A study published in the Journal of Nursing Education in 2000 identified some additional “cognitive components” of the critical thinking process in nursing. The study, called A Consensus Statement on Critical Thinking in Nursing, identified analysis as a crucial part of critical thinking as well.

In this case, the analysis applies to more than reading and comprehending information and data. It includes making decisions and taking courses of action that are based on that experience and data — so it encompasses both objective and subjective criteria. This aspect of critical thinking in nursing ensures all decisions are made in an informed, thoughtful, deliberate manner.

Perhaps more than anything else, being logical is the most important aspect of critical thinking in nursing. Nurses who apply logic to the workplace are better able to identify, analyze and evaluate the information in front of them — not just in terms of how they communicate to patients and their families but also how they make treatment decisions and provide patient care.

How Nurses Use Critical Thinking

There are many situations in which nurses might find themselves needing to put their critical thinking skills to the test. Determining care priorities based on accurate assessment and observation within the context of available resources is key and being able to accurately assess patient needs and take action as their conditions rapidly change is key to successful outcomes.

Critical thinking is not only confined to acute care facilities. Although patients under in-home care may not be acutely ill, the fact that home care nurses visit their patients on their own means they need to independently make accurate assessments and judgments. Let's take a closer look at specific examples of how critical thinking is applied.

Applying Knowledge of Past Experience

One of the central tenants of critical thinking in nursing involves applying knowledge and past experience to current situations. For instance, consider the following problem: a patient who is self-administering morphine using a PCP pump who presents with respiratory depression and is difficult to arouse. This situation requires prompt and decisive action — time is of the essence.

Nurses who are adept at critical thinking will first look at the evidence. Respiratory depression is a common sign of morphine toxicity, so the next step is to take quick action. In this case, administering naloxone to reverse the effects of morphine toxicity and then closely monitoring the response. After addressing the situation, it's important for the nurse to assess the situation to better understand how it occurred (was it pump malfunction? User error? Incorrect dosage?) to prevent similar crises from arising in the future.

In this case, a nurse with strong critical thinking skills was able to bring a strong knowledge background to the situation (recognizing the signs of morphine toxicity), quickly gathered more information (the exact symptoms the patient was exhibiting) and had the experience to take quick action based on their knowledge and information gathering.

Pre-Operative Patient Assessment

Critical thinking in nursing also comes into play when patients are being assessed before undergoing procedures. A hypothetical: a nurse was instructed to give two units of blood to a patient who was scheduled to get a pacemaker. After administration, the nurse noticed the patient's blood oxygen level began to drop.

Drawing on their critical thinking skills, the nurse looks at the patient's history and discovers he has congestive heart failure, making it more difficult for him to pump out excess fluid, causing the drop in oxygen level. After confirming this hypothesis by listening to the patient's lungs to hear excess fluid, the nurse administered Lasix, which cleared the fluid and got the oxygen levels back up to normal.

This is illustrative of critical thinking in nursing because it highlights how nurses can use everything from patient history to their foundational knowledge to their assessment skills to achieve better patient outcomes.

In the Emergency Department

Critical thinking in the emergency department is essential; fast-paced environment and quick decisions can mean the difference between life and death and having the ability to accurately assess a patient's health, recognize symptoms and determine what actions are necessary.

Consider the following situation: a patient comes in who has been in a car crash and they are experiencing back pain. A nurse who is thinking critically would understand there could be several causes. For example, the crash could have injured the patient's kidneys, in which case checking the urine for blood can confirm or deny this hypothesis. Additionally, it could be a neurological issue — it's important to think about the spinal cord, and not just the spine itself.

Most importantly, nurses have to access their critical thinking skills in emergency situations to connect the dots. Sometimes there is more to an injury than face value, and it's critical to investigate all avenues.

How Critical Thinking Impacts Nursing

While it’s important to understand the characteristics of critical thinking in nursing, it’s even more essential to have a comprehensive understanding of how it exists in reality. To that end, Onward Healthcare outlined seven ways that critical thinking can impact the life of a nurse.

  1. Patient care. At the center of everything nurses do, critical thinking can have a significant impact on patient care and improving patient outcomes. More specifically, strong critical thinking skills result in better compliance with safety standards, correct interpretation of data and diagnostic skills. Each of these has an impact on the patients that nurses treat and all can be improved through a good foundation in critical thinking.
  2. Recognizing subtle changes in patient status. Observational skills are an often underappreciated aspect of critical thinking. But being closely attuned to the changes in patients’ well-being can have a big impact on their outcomes. Additionally, a nurse can leverage analytic skills and past experience to recognize whether a patient’s complaints are symptoms of deeper trouble.
  3. Promoting the open and efficient exchange of ideas. Critical thinking is an important aspect of being an effective communicator. When nurses make decisions about treatment plans or overall care, they must be able to map out their diagnoses and effectively explain why it’s the right course of action to the RN or doctor on duty.
  4. Ensuring patient safety. In addition to providing better patient care, critical thinking equips nurses with the tools to ensure patient safety. Nurses should be aware of factors like a patient’s religious affiliation and medication sensitivities when deciding how to treat them.
  5. Solving problems faster. Critical thinking skills help a nurse troubleshoot problems with a greater degree of skill when the tried-and-true methods of care don’t work.
  6. Fostering innovation and improvement. Critical thinking skills can help nurses think outside the box and find new and inventive ways to address common problems. The world of medicine is evolving day to day and week to week and knowing how to connect the dots others don’t see is vital to taking the next step forward.
  7. Improved decision-making. From the ER to the NICU to assisted living, snap decisions are a big part of being a nurse. The more practice they have thinking through difficult situations and the more experience and knowledge they must draw upon, the better decisions they will make.

How To Learn More

Critical thinking does not take place in a vacuum. Validating assessments, assumptions and plans with respected colleagues is one way to further develop skills. Maintaining a current knowledge base is also necessary. Developing an evidence-based practice through research is a contributing factor and being intentional about analyzing and synthesizing information when presented with a problem will also contribute to sharpening critical thinking skills.

Critical thinking shares similarities with the scientific process and nursing students can be introduced to this process through the Research and Evidence-Based Practice courses which are part of baccalaureate-level nursing and are further developed at the masters and doctoral level.

Critical thinking is an intentional process and is an integral part of the online RN to BSN program at Norwich University. Developing technology has created new opportunities to provide critical thinking challenges to students in a controlled environment where it is safe to make mistakes, to learn from these mistakes and to repeat these experiences to become successful.

Designed for nurses holding an unencumbered RN license issued in the U.S., the program will deepen nursing knowledge, leadership skills and evidence-based practice to better serve patients and the community.