Critical Thinking Skills In Nursing Care

The nursing profession tends to attract those who have natural nurturing abilities, a desire to help others and a knack for science or anatomy. But there is another important skill that successful nurses share and it’s often over-looked: the ability to think critically.

Identifying a problem, determining the best solution and choosing the most effective method are all parts of the critical thinking process. After executing the plan, critical thinkers reflect on the situation to figure out if it was effective and if it could have been done better. As you can see, critical thinking is a transferable skill that can be leveraged in several facets of your life.

But why is it so important for nurses to use? We spoke with several experts to learn why critical thinking skills in nursing are so crucial to the field, the patients and the success of a nurse. Keep reading to learn why and to see how you can improve this skill.

Why are critical thinking skills in nursing important?

You learn all sorts of practical skills in nursing school, like flawlessly dressing a wound, taking vitals like a pro or giving an IV without flinching. But without the ability to think clearly and make rational decisions, those skills alone won’t get you very far—you need to think critically as well.

“Nurses are faced with decision-making situations in patient care, and each decision they make impacts patient outcomes. Nursing critical thinking skills drive the decision-making process and impact the quality of care provided,” says Georgia Vest, DNP, RN and senior dean of nursing at Rasmussen College School of Nursing.

Critical thinking is embedded in a nurse’s everyday routine. They flex this mental muscle each day they enter the floor. When you’re faced with decisions that could ultimately mean life or death, the ability to analyze a situation and come to a solution separates the good nurses from the great ones.

How are critical-thinking skills acquired in nursing school?

Nursing school offers a multitude of material to master and high expectations for your performance. But in order to learn in a way that will actually equip you to become an excellent nurse, you have to go beyond just memorizing terms. You need to apply an analytical mindset to understanding course material.

One way for students to begin implementing critical thinking is by applying the nursing process to their line of thought, according to Vest. The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation.

“One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.”

Nursing students often find that there are multiple correct solutions to a problem. The key to nursing is to select the “the most correct” solution—one that will be the most efficient and best fit for that particular situation. You will often find yourself in situations where there are few “correct” forms of care, but one that is most appropriate. Using the nursing process, students can narrow down their options to select the best one.

When answering questions in class or on exams, challenge yourself to go beyond simply selecting an answer. Start to think about why that answer is correct and what the possible consequences might be. Simply memorizing the material won’t translate well into a real-life nursing setting.

How can you develop your critical thinking skills?

As you know, learning doesn’t stop with graduation from nursing school. Good nurses continue to soak up knowledge and continually improve throughout their careers. Likewise, they can continue to build their critical thinking skills in the workplace with each shift.

“To improve your critical thinking, pick the brains of the experienced nurses around you to help you get the mindset,” suggests Eileen Sollars, RN ADN, AAS. Understanding how a seasoned nurse came to a conclusion will provide you with insights you may not have considered and help you develop your own approach.

The chain of command can also help nurses develop critical thinking skills in the workplace.

“Another aid in the development of critical thinking I cannot stress enough is the utilization of the chain of command,” Vest says. “In the chain of command, the nurse always reports up to the nurse manager and down to the patient care aide. Peers and fellow healthcare professionals are not in the chain of command. Clear understanding and proper utilization of the chain of command is essential in the workplace.”

How are critical thinking skills applied in nursing?

“Nurses use critical thinking in every single shift,” Sollars says. “Critical thinking in nursing is a paramount skill necessary in the care of your patients. Nowadays there is more emphasis on machines and technical aspects of nursing, but critical thinking plays an important role. You need it to understand and anticipate changes in your patient's condition.”

As a nurse, you will inevitably encounter a situation in which there are multiple solutions or treatments and you’ll be tasked with determining the solution that will provide the best possible outcome for your patient. You must be able to quickly and confidently assess situations and make the best care decision in each unique scenario. It is in situations like these that your critical thinking skills will direct your decision making.

Beyond thinking

You’re now well aware of the importance of critical thinking skills in nursing. Even if you wouldn’t consider yourself a high-caliber critical thinker today, you can work toward strengthening that skill. The more you practice it, the better you will become and the more naturally it will come to you.

Critical thinking isn’t the only component that makes an effective nurse. Learn about how else you can position yourself to climb the ranks in your nursing career in our article, "Nursing Career Advancement: 7 Ways to Stand Out in Your Scrubs."

 

*This article was originally published in July 2012. It has since been updated to include information relevant to 2017.

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Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.

 

The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!

via GIPHY

 

RELATED ARTICLE:Ep211: Critical Thinking and Nursing Care Plans Go Together Like Chicken and Waffles

 

Critical Thinking in Nursing: Example 1

I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs to the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90’s on oxygen.

 

I stopped. And thought. What the heck is going on?

 

I looked at his history. Congestive heart failure.

 

I looked at his intake and output. He was positive 1.5 liters.

 

I thought about how he’s got extra fluid in general, and because of his CHF he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..

 

His lungs were clear earlier. I heard crackles throughout both lungs.

 

OK, so he’s got extra fluid that he can’t get out of his body.. What do I know that will get rid of extra fluid and make him pee? Maybe some lasix?

 

I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said.. “Give him 20 mg IV lasix one time.. I’ll put the order in.” CLICK.

 

I gave the lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.

 

Baddabing.. Badaboom.

 

RELATED ARTICLE:How to Use the Nursing Process to ACE Nursing School Exams

 

Critical Thinking in Nursing: Example 2

My patient just had her right leg amputated above her knee. She was on a dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. The told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with a goal of weaning off PCA.

 

“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?

 

I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.

 

I thought about nerve pain. I thought about other patients that report similar pain.. Diabetics with neuropathy would talk about similar pain… “What did they do for it?” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.

 

“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.

 

I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain, after I described my patient’s type of pain and thought process.

 

“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner.”

 

She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort was significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.

 

And that we did!

 

She was able to work with therapy more because her pain was tolerable and was finally able to get rest.

 

Conclusion

Critical thinking is something you’ll do every day as a nurse and honestly you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution and trying it out. Critical thinking in nursing is just that, but in a clinical setting.

 

We’ve written a MASSIVE post on careplans and critical thinking:

Read More on Critical ThinkingHow to develop critical thinking as a nurse.

 

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Date Published - Sep 30, 2016
Date Modified - Jun 12, 2017

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.

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