How To Improve Critical Thinking Skills For Nursing

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

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

Critical Thinking for Nurses

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

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

In nursing, critical thinkers need to be:

  • Precise

  • Complete

  • Logical

  • Accurate

  • Clear

  • Fair

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

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

Key Critical Thinking Skills

Some skills are more important than others when it comes to critical thinking. Some of these skills are applied in patient care, via the framework known as the Nursing Process. The skills that are most important are:

  • Interpreting – Understanding and explaining the meaning of information, or a particular event.

  • Analyzing – Investigating a course of action, that is based upon data that is objective and subjective.

  • Evaluating – This is how you assess the value of the information that you got. Is the information relevant, reliable and credible? This skill is also needed to determine if outcomes have been fully reached.

Based upon those three skills, the nurse can then use clinical reasoning to determine what the problem is. These decisions have to be based upon sound reasoning:

  • Explaining – Clearly and concisely explaining your conclusions. The nurse needs to be able to give a sound rationale for her answers.

  • Self regulating – You have to monitor your own thinking processes. This means that you must reflect on the process that lead to the conclusion. You should self correct in this process as needed. Be on alert for bias and improper assumptions.

Critical Thinking Pitfalls

Errors that occur in critical thinking in nursing can cause incorrect conclusions. This is particularly dangerous in nursing, because an incorrect conclusion can lead to incorrect clinical actions.

Illogical Processes

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

Another common illogical thought process is known as ‘appeal to tradition.’ This is what people are doing when they say ‘it’s always been done like this.’ Creative, new approaches are not tried because of tradition.

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

Bias

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

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

Closed Minded

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

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

Not so long ago, nurses were task-workers who simply carried out doctors’ orders and followed a fixed set of rules. Today, they are skilled and capable professionals whose expertise is essential to patient care and public health initiatives. It’s been a long road. And it’s clear that developing critical thinking skills has helped to bring about this transformation within the profession during the last half century.

So what exactly is critical thinking? There are a multitude of definitions – some of them very complex – so the Foundation for Critical Thinking (2010) has assembled some of them on its website. This one is our favorite:

Critical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes.

 

It’s not hard to apply this definition to nursing, is it? Nurses do all those things every day! It can be made even more specific to nursing by saying that critical thinking is a systematic approach to the nursing process that employs all the steps above to bring about excellent clinical outcomes while enhancing patient safety and patient satisfaction.

Critical thinking is definitely a skill that develops over time and as you gain more experience. But that doesn’t mean it’s absent in young or less experienced nurses. In fact, critical thinking skills are what make young nurses effective while they are gaining on-the-job experience. A less experienced nurse with keen critical thinking skills will be able to strategize and manage all sorts of new situations, while dealing effectively with everyone involved – the patient, family members, physicians, and other care team members.

When do you need critical thinking?

If you consider critical thinking to be multi-dimensional thinking, it becomes clearer when it’s most effectively employed. Multi-dimensional thinking means approaching a situation from more than one point of view. In contrast, one-dimensional thinking tackles the task at hand from a single frame of reference. It definitely has its place in nursing – one-dimensional thinking is used when nurses chart vital signs or administer a medication.

Critical thinking skills are needed when performing a nursing assessment or intervention, or acting as a patient advocate. As a patient’s status changes, you have to recognize, interpret, and integrate new information in order to plan a course of action. For example, what would the course of action be if an elderly patient became confused from his medications, was unable to understand instructions, and put himself at risk for falls? There may be no single “right” answer – you have to weigh all of the variables, prioritize goals, and temper next steps with empathy and compassion.

Critical thinking also involves viewing the patient as a whole person – and this means considering his own culture and goals, not just the goals of the healthcare organization. How would you handle a teenage girl who comes into your clinic asking for information about STDs? What about a seriously hypertensive patient who admits he can afford his medication, but doesn’t believe it is important that he take it every day without fail?

Critical thinking forms the foundation of certain nursing specialties, like case management and infection control. These areas require strategizing, collaborative relationships, and a multi-dimensional approach to tackling a problem (like preventing unnecessary hospital readmissions or discovering the source of an infection outbreak, for example). And of course, nurse managers use critical thinking skills every day as they keep their units running smoothly.

So what’s the next step?

To develop your critical thinking skills, you can:

  • Suspend judgment; demonstrate open-mindedness and a tolerance for other cultures and other views.
  • Seek out the truth by actively investigating a problem or situation.
  • Ask questions and never be afraid to admit to a lack of knowledge.
  • Reflect on your own thinking process and the ways you reach a conclusion.
  • Indulge your own intellectual curiosity; be a lifelong learner.
  • View your patients with empathy and from a whole-person perspective.
  • Look for a mentor with more experience than you have; join professional organizations.
  • Advance your nursing education.

The best way to develop your critical thinking skills and empower yourself with knowledge is through an online RN to BSN or RN to BSN/MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in nursing education, nursing informatics, and executive leadership.

Written by Bruce Petrie, Ph.D., VP, Research and Institutional Effectiveness
Revised July 2017
Tagged as nursing skills

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