Learning Objectives
By the end of this section, you will be able to:
- Define critical thinking
- Discuss the importance of critical thinking in nursing practice
- Explain the expansion of critical thinking to clinical judgment
Nurses use critical thinking skills every day, from one-on-one patient encounters in clinical settings, to the professional interactions they have with colleagues and the broader health care systems in which they work. Thinking critically means objectively considering and analyzing information and figuring out how to use it efficiently. According to the American Nurses Association (ANA), “critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills” (ANA, 2024, para 3). It’s a complex skill that incorporates education and training, experience, and available data. Critical thinking enables the nurse to make decisions that are well-informed, evidence-based, and patient-centered, which are decisions made with respect for the patient’s interests, needs, culture, values, and preferences.
Link to Learning
You can read more about critical thinking on the ANA website.
This section defines critical thinking and explains why it is a foundation of nursing practice. The section will also tie critical thinking to another skill necessary for effective nursing practice—clinical judgment.
Critical Thinking Defined
Critical thinking allows the nurse to use rational standards to analyze information, interpret values/assessments, and ask questions about the data they obtain about a patient as part of a comprehensive health assessment and physical exam. Critical thinking is a skill nurses constantly use, and a skill that evolves with experience. Every decision the nurse makes is rooted in critical thinking. A nurse must combine assessment skills using the evidence of the physical exam to understand the patient’s health concerns and help them achieve a positive outcome.
Critical Thinking in Nursing
The ability to think critically about information helps nurses make all kinds of decisions—from the day-to-day ones to the life-or-death ones. The nurse must consider all aspects of the data they have collected on a patient, whether it’s going through current medications to check for potential interactions or assessing a patient’s lifestyle risks. The nurse also needs to be aware of, and sensitive to, the different cues that patients give based on cultural diversity, gender, race, age, and ethnicity. There are also times when critical thinking can be more challenging, often because gathering data or being confident in those data may not be straightforward: for example, if a patient can’t communicate clearly or if a nurse is contending with their own bias about a patient’s situation. A nurse with critical thinking skills can make a split-second decision based on the health assessment that could save a patient’s life. Even if not lifesaving, critical thinking skills help the nurse ensure positive patient outcomes.
Critical thinking can be defined as habitually using a set of rational standards to guide decision-making (University of Tennessee Chattanooga, n.d.). Critical thinking skills allow nurses to gather a more complete picture when they are assessing and examining a patient. At times, what a patient is saying may not match what the nurse observes. The misalignment does not always mean the patient is lying. While critical thinking skills can help nurses identify when a patient is being untruthful or has limited health literacy, these skills are also crucial for helping the nurse identify barriers that can make it harder to get an accurate and cohesive picture of a patient’s health. Patients may not understand why they need to share certain information with their health care providers or the consequences of withholding that information. They may struggle to recognize or remember information that would be useful for them to share during a visit. Patient factors, such as cognition, communication, social stress, mental health, cultural background, personal beliefs, and health literacy level, also affect how they communicate with the health care team.
For example, consider a scenario where the nurse is talking to a patient with dementia. Due to their cognitive condition, the patient may give answers to the nurse’s assessment questions that don’t line up with what the nurse is observing or expecting. The patient is not lying intentionally, but they are unable to be a reliable historian/informant about their own health. A patient with dementia may state that they do not take any medications, but the nurse can see in the patient’s chart that they are prescribed several drugs to manage multiple chronic conditions, and the nurse may also know that the patient was administered a medication earlier that day. A patient with dementia may not recall any of their current health conditions and may not be able to describe their present state of health or concerns. The patient may say they feel “great,” but the nurse may question that statement if they note an elevated temperature and heart rate.
To ensure a holistic picture of the representation of the patient, the nurse uses critical thinking skills during the comprehensive health assessment and physical examination to explore a patient’s whole person needs. A comprehensive assessment and physical examination include not only details about physical state of health, but also the emotional, social, psychological, spiritual (Ambushe et al., 2023), cultural, sexual, energetic, and environmental aspects of a person’s life (ANA, 2019). These factors impact the health and well-being of the individual and are important in planning care for current health problems and preventative care (Figure 6.2).
Critical Thinking in Clinical Judgment
Integrating nursing knowledge and experience with the data collected and analyzed to make informed decisions about patient care is called clinical judgment. Clinical judgment will evolve with experience. Over time, nurses also develop a degree of intuition, or a “sixth sense” of knowing that largely comes from years of education and problem-solving in real-world patient situations. But even experienced nurses who have a sense of intuition must still call on their critical thinking skills; they would not simply rely on intuition alone.
One framework that explains how to transition from critical thinking to clinical judgment is the Clinical Judgment Measurement Model (CJMM). The process outlined in the model has several components (NCLEX, 2024):
- Recognizing cues: The nurse will acquire data from different sources, including the patient and medical records. They will identify specific facts or details within the data from assessments, patient conversations, and records to look for cues that will inform how they will approach caring for the patient.
- Analyzing cues: The nurse will take the patient’s needs into account and use the data to identify problems and create priorities. This includes organizing and analyzing the data to look for outliers or trends.
- Prioritizing hypotheses: The nurse uses the data and analysis to set priorities based on the possible causes of the patient’s condition and making sure that the most important problems are addressed first. They will work with an interdisciplinary team who is involved in the patient’s care to set goals.
- Generating solutions: The nurse will come up with possible interventions based on the patient’s needs, interests, and evidence-based practice (EBP) from current literature.
- Taking action: The nurse will objectively look at the interventions and assess how effective they are for the patient. They do research and seek insights from the interdisciplinary team to improve the patient’s care plan. Ultimately, the overall goals and steps taken are nurse driven.
- Evaluating outcomes: The nurse will look back on the clinical judgment process and identify areas of strength and weakness. They ask for feedback from colleagues to help them get an objective view of their skills, decision-making, and judgment.