2. When was the patient’s last bowel movement?
3. Who is the patient’s emergency contact person?
4. Describe the patient’s current level of pain.
5. What information is in the patient’s medical record?
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.
Potter, P.A., Perry, A.G., Stockert, P. and Hall, A. (2013) Fundamentals of Nursing
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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.
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.
We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.
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.
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?
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.
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.
As you are developing critical thinking skills, it can be helpful to use a process. For example:
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.
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:
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.
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.
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.
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.
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.
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.
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.
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Ioanna v. papathanasiou.
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
Lambrini kourkouta.
4 Nursing Department, Alexander Technological Educational Institute of Thessaloniki, Greece
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.
Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis, synthesis and evaluation of information collected or derived from observation, experience, reflection, reasoning or the communication leading to conviction for action ( 1 ).
So, nurses must adopt positions that promote critical thinking and refine skills of critical reasoning in order a meaningful assessment of both the previous and the new information and decisions taken daily on hospitalization and use of limited resources, forces you to think and act in cases where there are neither clear answers nor specific procedures and where opposing forces transform decision making in a complex process ( 2 ).
Critical thinking applies to nurses as they have diverse multifaceted knowledge to handle the various situations encountered during their shifts still face constant changes in an environment with constant stress of changing conditions and make important decisions using critical thinking to collect and interpret information that are necessary for making a decision ( 3 ).
Critical thinking, combined with creativity, refine the result as nurses can find specific solutions to specific problems with creativity taking place where traditional interventions are not effective. Even with creativity, nurses generate new ideas quickly, get flexible and natural, create original solutions to problems, act independently and with confidence, even under pressure, and demonstrate originality ( 4 ).
The aim of the study is to present the basic skills of critical thinking, to highlight critical thinking as a essential skill for nursing education and a fundamental skill for decision making in nursing practice. Moreover to indicate the positive effect and relation that critical thinking has on professional outcomes.
Nurses in their efforts to implement critical thinking should develop some methods as well as cognitive skills required in analysis, problem solving and decision making ( 5 ). These skills include critical analysis, introductory and concluding justification, valid conclusion, distinguishing facts and opinions to assess the credibility of sources of information, clarification of concepts, and recognition conditions ( 6 , 7 ).
Critical analysis is applied to a set of questions that relate to the event or concept for the determination of important information and ideas and discarding the unnecessary ones. It is, thus, a set of criteria to rationalize an idea where one must know all the questions but to use the appropriate one in this case ( 8 ).
The Socratic Method, where the question and the answer are sought, is a technique in which one can investigate below the surface, recognize and examine the condition, look for the consequences, investigate the multiple data views and distinguish between what one knows and what he simply believes. This method should be implemented by nurses at the end of their shifts, when reviewing patient history and progress, planning the nursing plan or discussing the treatment of a patient with colleagues ( 9 ).
The Inference and Concluding justification are two other critical thinking skills, where the justification for inductive generalizations formed from a set of data and observations, which when considered together, specific pieces of information constitute a special interpretation ( 10 ). In contrast, the justification is deduced from the general to the specific. According to this, nurse starts from a conceptual framework–for example, the prioritization of needs by Maslow or a context–evident and gives descriptive interpretation of the patient’s condition with respect to this framework. So, the nurse who uses drawing needs categorizes information and defines the problem of the patient based on eradication, nutrition or need protection.
In critical thinking, the nurses still distinguish claims based on facts, conclusions, judgments and opinions. The assessment of the reliability of information is an important stage of critical thinking, where the nurse needs to confirm the accuracy of this information by checking other evidence and informants ( 10 ).
The concepts are ideas and opinions that represent objects in the real world and the importance of them. Each person has developed its own concepts, where they are nested by others, either based on personal experience or study or other activities. For a clear understanding of the situation of the patient, the nurse and the patient should be in agreement with the importance of concepts.
People also live under certain assumptions. Many believe that people generally have a generous nature, while others believe that it is a human tendency to act in its own interest. The nurse must believe that life should be considered as invaluable regardless of the condition of the patient, with the patient often believing that quality of life is more important than duration. Nurse and patient, realizing that they can make choices based on these assumptions, can work together for a common acceptable nursing plan ( 11 ).
The person applying critical thinking works to develop the following attitudes and characteristics independence of thought, fairness, insight into the personal and public level, humble intellect and postpone the crisis, spiritual courage, integrity, perseverance, self-confidence, research interest considerations not only behind the feelings and emotions but also behind the thoughts and curiosity ( 12 ).
Individuals who apply critical thinking as they mature acquire knowledge and experiences and examine their beliefs under new evidence. The nurses do not remain to what they were taught in school, but are “open-minded” in terms of different intervention methods technical skills.
Those who apply critical thinking are independent in different ways, based on evidence and not panic or personal and group biases. The nurse takes into account the views of both the younger and older family members.
Those who are using critical thinking and accept the possibility that their personal prejudices, social pressures and habits could affect their judgment greatly. So, they try to actively interpret their prejudices whenever they think and decide.
Humble intellect means to have someone aware of the limits of his own knowledge. So, those who apply critical thinking are willing to admit they do not know something and believe that what we all consider rectum cannot always be true, because new evidence may emerge.
The values and beliefs are not always obtained by rationality, meaning opinions that have been researched and proven that are supported by reasons and information. The courage should be true to their new ground in situations where social penalties for incompatibility are strict. In many cases the nurses who supported an attitude according to which if investigations are proved wrong, they are canceled.
Use of critical thinking to mentally intact individuals question their knowledge and beliefs quickly and thoroughly and cause the knowledge of others so that they are willing to admit and appreciate inconsistencies of both their own beliefs and the beliefs of the others.
The perseverance shown by nurses in exploring effective solutions for patient problems and nursing each determination helps to clarify concepts and to distinguish related issues despite the difficulties and failures. Using critical thinking they resist the temptation to find a quick and simple answer to avoid uncomfortable situations such as confusion and frustration.
According to critical thinking through well motivated reasoning leads to reliable conclusions. Using critical thinking nurses develop both the inductive and the deductive reasoning. The nurse gaining more experience of mental process and improvement, does not hesitate to disagree and be troubled thereby acting as a role model to colleagues, inspiring them to develop critical thinking.
Nurses need to recognize, examine and inspect or modify the emotions involved with critical thinking. So, if they feel anger, guilt and frustration for some event in their work, they should follow some steps: To restrict the operations for a while to avoid hasty conclusions and impulsive decisions, discuss negative feelings with a trusted, consume some of the energy produced by emotion, for example, doing calisthenics or walking, ponder over the situation and determine whether the emotional response is appropriate. After intense feelings abate, the nurse will be able to proceed objectively to necessary conclusions and to take the necessary decisions.
The internal debate, that has constantly in mind that the use of critical thinking is full of questions. So, a research nurse calculates traditions but does not hesitate to challenge them if you do not confirm their validity and reliability.
In their shifts nurses act effectively without using critical thinking as many decisions are mainly based on habit and have a minimum reflection. Thus, higher critical thinking skills are put into operation, when some new ideas or needs are displayed to take a decision beyond routine. The nursing process is a systematic, rational method of planning and providing specialized nursing ( 13 ). The steps of the nursing process are assessment, diagnosis, planning, implementation, evaluation. The health care is setting the priorities of the day to apply critical thinking ( 14 ). Each nurse seeks awareness of reasoning as he/she applies the criteria and considerations and as thinking evolves ( 15 ).
Problem solving helps to acquire knowledge as nurse obtains information explaining the nature of the problem and recommends possible solutions which evaluate and select the application of the best without rejecting them in a possible appeal of the original. Also, it approaches issues when solving problems that are often used is the empirical method, intuition, research process and the scientific method modified ( 16 ).
This method is mainly used in home care nursing interventions where they cannot function properly because of the tools and equipment that are incomplete ( 17 ).
Intuition is the perception and understanding of concepts without the conscious use of reasoning. As a problem solving approach, as it is considered by many, is a form of guessing and therefore is characterized as an inappropriate basis for nursing decisions. But others see it as important and legitimate aspect of the crisis gained through knowledge and experience. The clinical experience allows the practitioner to recognize items and standards and approach the right conclusions. Many nurses are sensing the evolution of the patient’s condition which helps them to act sooner although the limited information. Despite the fact that the intuitive method of solving problems is recognized as part of nursing practice, it is not recommended for beginners or students because the cognitive level and the clinical experience is incomplete and does not allow a valid decision ( 16 ).
The research method is a worded, rational and systematic approach to problem solving. Health professionals working in uncontrolled situations need to implement a modified approach of the scientific method of problem solving. With critical thinking being important in all processes of problem solving, the nurse considers all possible solutions and decides on the choice of the most appropriate solution for each case ( 18 ).
The decision is the selection of appropriate actions to fulfill the desired objective through critical thinking. Decisions should be taken when several exclusive options are available or when there is a choice of action or not. The nurse when facing multiple needs of patients, should set priorities and decide the order in which they help their patients. They should therefore: a) examine the advantages and disadvantages of each option, b) implement prioritization needs by Maslow, c) assess what actions can be delegated to others, and d) use any framework implementation priorities. Even nurses make decisions about their personal and professional lives. The successive stages of decision making are the Recognition of Objective or Purpose, Definition of criteria, Calculation Criteria, Exploration of Alternative Solutions, Consideration of Alternative Solutions, Design, Implementation, Evaluation result ( 16 ).
Acquiring critical thinking and opinion is a question of practice. Critical thinking is not a phenomenon and we should all try to achieve some level of critical thinking to solve problems and make decisions successfully ( 19 - 21 ).
It is vital that the alteration of growing research or application of the Socratic Method or other technique since nurses revise the evaluation criteria of thinking and apply their own reasoning. So when they have knowledge of their own reasoning-as they apply critical thinking-they can detect syllogistic errors ( 22 – 26 ).
In responsible positions nurses should be especially aware of the climate of thought that is implemented and actively create an environment that stimulates and encourages diversity of opinion and research ideas ( 27 ). The nurses will also be applied to investigate the views of people from different cultures, religions, social and economic levels, family structures and different ages. Managing nurses should encourage colleagues to scrutinize the data prior to draw conclusions and to avoid “group thinking” which tends to vary without thinking of the will of the group. 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.
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The importance of critical thinking in nursing.
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While not every decision is an immediate life-and-death situation, there are hundreds of decisions nurses must make every day that impact patient care in ways small and large.
“Being able to assess situations and make decisions can lead to life-or-death situations,” said nurse anesthetist Aisha Allen . “Critical thinking is a crucial and essential skill for nurses.”
The National League for Nursing Accreditation Commission (NLNAC) defines critical thinking in nursing this way: “the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief-based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research.”
An eight-year study by Johns Hopkins reports that 10% of deaths in the U.S. are due to medical error — the third-highest cause of death in the country.
“Diagnostic errors, medical mistakes, and the absence of safety nets could result in someone’s death,” wrote Dr. Martin Makary , professor of surgery at Johns Hopkins University School of Medicine.
Everyone makes mistakes — even doctors. Nurses applying critical thinking skills can help reduce errors.
“Question everything,” said pediatric nurse practitioner Ersilia Pompilio RN, MSN, PNP . “Especially doctor’s orders.” Nurses often spend more time with patients than doctors and may notice slight changes in conditions that may not be obvious. Resolving these observations with treatment plans can help lead to better care.
Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation.
These skills are used in conjunction with clinical reasoning. Based on training and experience, nurses use these skills and then have to make decisions affecting care.
It’s the ultimate test of a nurse’s ability to gather reliable data and solve complex problems. However, critical thinking goes beyond just solving problems. Critical thinking incorporates questioning and critiquing solutions to find the most effective one. For example, treating immediate symptoms may temporarily solve a problem, but determining the underlying cause of the symptoms is the key to effective long-term health.
Here are some real-life examples of how nurses apply critical thinking on the job every day, as told by nurses themselves.
“Doing a thorough assessment on your patient can help you detect that something is wrong, even if you're not quite sure what it is,” said Shantay Carter , registered nurse and co-founder of Women of Integrity . “When you notice the change, you have to use your critical thinking skills to decide what's the next step. Critical thinking allows you to provide the best and safest care possible.”
Often, nurses are the first line of defense for patients.
“One example would be a patient that had an accelerated heart rate,” said nurse educator and adult critical care nurse Dr. Jenna Liphart Rhoads . “As a nurse, it was my job to investigate the cause of the heart rate and implement nursing actions to help decrease the heart rate prior to calling the primary care provider.”
Nurses with poor critical thinking skills may fail to detect a patient in stress or deteriorating condition. This can result in what’s called a “ failure to rescue ,” or FTR, which can lead to adverse conditions following a complication that leads to mortality.
Nurses are the ones taking initial reports or discussing care with patients.
“We maintain relationships with patients between office visits,” said registered nurse, care coordinator, and ambulatory case manager Amelia Roberts . “So, when there is a concern, we are the first name that comes to mind (and get the call).”
“Several times, a parent called after the child had a high temperature, and the call came in after hours,” Roberts said. “Doing a nursing assessment over the phone is a special skill, yet based on the information gathered related to the child's behavior (and) fluid intake, there were several recommendations I could make.”
Deciding whether it was OK to wait until the morning, page the primary care doctor, or go to the emergency room to be evaluated takes critical thinking.
Nurses have to use acute listening skills to discern what patients are really telling them (or not telling them) and whether they are getting the whole story.
“I once had a 5-year-old patient who came in for asthma exacerbation on repeated occasions into my clinic,” said Pompilio. “The mother swore she was giving her child all her medications, but the asthma just kept getting worse.”
Pompilio asked the parent to keep a medication diary.
“It turned out that after a day or so of medication and alleviation in some symptoms, the mother thought the child was getting better and stopped all medications,” she said.
“Critical thinking is present in almost all aspects of nursing, even those that are not in direct action with the patient,” said Rhoads. “During report, nurses decide which patient to see first based on the information gathered, and from there they must prioritize their actions when in a patient’s room. Nurses must be able to scrutinize which medications can be taken together, and which modality would be best to help a patient move from the bed to the chair.”
A critical thinking skill in prioritization is cognitive stacking. Cognitive stacking helps create smooth workflow management to set priorities and help nurses manage their time. It helps establish routines for care while leaving room within schedules for the unplanned events that will inevitably occur. Even experienced nurses can struggle with juggling today’s significant workload, prioritizing responsibilities, and delegating appropriately.
Another aspect that often falls to nurses is care coordination. A nurse may be the first to notice that a patient is having an issue with medications.
“Based on a report of illness in a patient who has autoimmune challenges, we might recommend that a dose of medicine that interferes with immune response be held until we communicate with their specialty provider,” said Roberts.
Nurses applying critical skills can also help ease treatment concerns for patients.
“We might recommend a patient who gets infusions come in earlier in the day to get routine labs drawn before the infusion to minimize needle sticks and trauma,” Robert said.
During the middle of an operation, the anesthesia breathing machine Allen was using malfunctioned.
“I had to critically think about whether or not I could fix this machine or abandon that mode of delivering nursing anesthesia care safely,” she said. “I chose to disconnect my patient from the malfunctioning machine and retrieve tools and medications to resume medication administration so that the surgery could go on.”
Nurses are also called on to do rapid assessments of patient conditions and make split-second decisions in the operating room.
“When blood pressure drops, it is my responsibility to decide which medication and how much medication will fix the issue,” Allen said. “I must work alongside the surgeons and the operating room team to determine the best plan of care for that patient's surgery.”
“On some days, it seems like you are in the movie ‘The Matrix,’” said Pompilio. “There's lots of chaos happening around you. Your patient might be decompensating. You have to literally stop time and take yourself out of the situation and make a decision.”
Allen said she thinks electronics are great, but she can remember a time when technology failed her.
“The hospital monitor that gives us vitals stopped correlating with real-time values,” she said. “So I had to rely on basic nursing skills to make sure my patient was safe. (Pulse check, visual assessments, etc.)”
In such cases, there may not be enough time to think through every possible outcome. Critical thinking combined with experience gives nurses the ability to think quickly and make the right decisions.
Nurses who think critically are in a position to significantly increase the quality of patient care and avoid adverse outcomes.
“Critical thinking allows you to ensure patient safety,” said Carter. “It’s essential to being a good nurse.”
Nurses must be able to recognize a change in a patient’s condition, conduct independent interventions, anticipate patients and provider needs, and prioritize. Such actions require critical thinking ability and advanced problem-solving skills.
“Nurses are the eyes and ears for patients, and critical thinking allows us to be their advocates,” said Allen.
Image courtesy of iStock.com/ davidf
Last updated on Jan 05, 2024 .
Originally published on Aug 25, 2021 .
The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice. Click here to read our full disclaimer
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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.
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).
Unless the individuals of a nation thinkers, the masses can be drawn in any direction. Mustafa Kemal Atatürk
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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
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Nima Rezaei
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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
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Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.
Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.
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If you have gone to one day of nursing school you understand that “critical thinking” is a buzzword.
Nursing schools love to talk about critical thinking.
The job of a nurse is essentially to take millions of data points and be able to arrive at a correct decision based on that data.
This is no easy task and there are few jobs which require this on the scale of nursing or with human lives in the balance.
What is Critical Thinking?
Critical thinking is defined as: Clear, rational thinking involving critique. Its details vary amongst those who define it. According to Barry K. Beyer (1995), critical thinking means making clear, reasoned judgments. During the process of critical thinking, ideas should be reasoned, well thought out, and judged. The National Council for Excellence in Critical Thinking defines critical thinking as the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. Source .
So, while you are familiar with making decisions on a daily basis, most daily decisions do not require critical thinking (what color of shirt should I wear, what should I eat for dinner, etc).
It is a skill that can grow and develop with time and as you enter nursing school you are not expected to be an expert in the skill.
However, what you should understand is that critical thinking involves a level of decision making far beyond normal day to day decision making. With critical thinking you are analyzing, conceptualizing, and digging deep into the questions presented.
When it comes to nursing, often times you are presented with real life or death situations. You are presented with saving one patient or determining what the most important solution is to a highly complex problem.
Those nurses who develop advanced critical thinking skills find increased success in their careers.
Critical Thinking in Nursing
So let’s talk about critical thinking and how it applies to everything we are talking about here.
The NCSBN website states the following: Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.
Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.
Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!
There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.
So let’s dive in and provide you with a simple framework and method for developing critical thinking.
How to Critically Think in Nursing
While there are many frameworks and methods for developing critical thinking, here we will provide you with a basic 4 step method.
At the risk of sounding oversimplified, this simple method will allow you to cut through the clutter, think critically, and arrive at correct decisions in even the most complex of scenarios.
Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.
Before diving into the four individual steps let’s point out the use of the word “ALL” in each of the steps.
This is important because few individuals can make decisions with this inclusive word. It literally means ALL. To make a complete and holistic decision based upon critical thinking you have to have and weight ALL information. Otherwise you are just making a regular old decision.
You have to start by suspending all judgement. In other words, if you walk into a patients room and see them tachycardic an amature decision would be to run and grab the metoprolol to try to drop the heart rate.
An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .
Suspending judgement means that you don’t make a decision based upon the first sign. You also don’t walk into any situation of NCLEX question with a decision already made. You will treat all facts as equal until you can gather the needed information.
Not suspending judgment leaves you open to make biased decisions. This is detrimental in medicine and nursing. This will also result in poor success on nursing exams and the NCLEX.
As you read through nursing questions you must force yourself to refrain from jumping to conclusions until you have read the question in full. Do not allow yourself to assume what the question is asking or what the patient outcome is until you have read the question in full.
Obviously this sounds simple, but it is this step that, if missed, will through more nursing students and nurses off.
Now you must collect ALL information. This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.
Think of this as data mining. You are looking to have every piece of information you can find to put the puzzle pieces together.
When it comes to taking nursing tests you only have one place that you can collect the information . . . and that is from the test question itself. Do not go looking outside of the question of infer any details that are not provided within the question.
One thing we have noticed students doing almost more than anything else on test questions is reading into them. Don’t do this. Gather all the information you can . . . and when it comes to NCLEX questions, the only place you can gather information is from the question itself.
Now, balance all information. This means take all the data that you have and start weighing it to find out what is pertinent and what you can ignore. If the temp is 98.9 . . . it’s probably not the cause. If the BP is 74/56 are we looking at a volume issue?
In this step you are deciding what is important and what isn’t. While a pressure ulcer is important, if the patient is actively having a heart attack . . . it just doesn’t matter. At least, not until we take care of the MOST important issue.
NCLEX style questions will be FULL of extra information, things that you just really do not need to know to make a decision on the patient.
The NCSBN (who administers the NCLEX) in an effort to simulate real life nursing writes questions that include both important information and details that you just simply don’t need to know. It is your job to sift through the data and determine what you actually need to know.
Balancing means giving each data point a level of importance for your given patient. Some pieces of information will score much higher than others.
At this point you must all consider the implications of the possible options. Look at the available options and think to yourself, “if I choose this option, what happens next?”. As it relates to nursing, ask yourself these questions:
“Does this achieve a desired patient outcome?”
“If I do this and then go home, what happens to my patient?”
Forcing yourself to consider the implications allows you to look beyond the information presented and consider the RESULTS of your choices. Critical thinking thrives on looking beyond the presented data.
Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.
Your goal is to make the decision that best serves the patient and addresses their most immediate concerns.
Critical Thinking in Nursing and on the NCLEX®
Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .
Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!
A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?
42% of the students that have taken this question have selected this answer:
Administer IV fluid boluses to increase urinary output
The problem with that answer is that it fails to weigh the most important issue facing this patient.
Test takers see urine output as low . . . and want to correct that quickly with fluids.
However, this is a CHFer . . . you can’t (shouldn’t) bolu especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.
So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.
And I promise you this helps in “REAL” life too . . . not just in nursing. You will begin to be a tad more skeptical and deliberate with your decisions.
Here are a couple resources that will help you in the process of developing critical thinking.
The process for developing critical thinking is slow and arduous. However, don’t be hard on yourself. According to CriticalThiking.org the vast majority of colleges are not appropriately incorporating critical thinking into the college classroom. This means that while you might not being taught the skill as you should . . . most people aren’t. Using the strategies outlined above will put you light years ahead of most.
The nurse that is able to follow these four steps is a tremendous asset on a clinical floor.
When you start a FREE trial you gain access to the full outline as well as:
“Would suggest to all nursing students . . . Guaranteed to ease the stress!”
Test taking for the nclex®.
The Test-Taking course is the best place to start when you’re trying to figure out how to navigate NCLEX®-Style questions. Nursing school presents a unique challenge when it comes to test-taking. You’re no longer just looking for the right answer - you’re now looking for the most right answer or multiple right answers. In this course, we break down how to understand what these questions are even asking you, and our best tips for how to answer them. We also provide some strategies for goal-setting, studying, and note-taking that are sure to set you up for success on your exams and on the NCLEX®.
COMMENTS
Which statement regarding critical thinking in nursing is true? It is a systematic way of thinking. It shows trends and patterns in client status. It makes judgments based on conjecture. It supplies validation for reimbursement.
Study with Quizlet and memorize flashcards containing terms like Which statement regarding critical thinking in nursing is true?, A nurse administers medications to a client. Which step of the nursing process would the nurse perform next?, The implementation step in the nursing process involves and more.
Here are five ways to nurture your critical-thinking skills: Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice. That knowledge helps you make informed decisions in stressful moments. Practice reflection.
Study with Quizlet and memorize flashcards containing terms like Which statement regarding critical thinking in nursing is true? It is a systematic way of thinking. It shows trends and patterns in client status. It makes judgments based on conjecture. It supplies validation for reimbursement., A nurse is reading a journal article about providing individualized care. Which aspect would the ...
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.
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 ...
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 ...
Critical thinking in nursing is an essential component of professional accountability and quality nursing care. ... Scheffer BK, Rubenfeld MG. A consensus statement on critical thinking in nursing. J Nurs Educ. 2000; 39 (8):352-60. [PubMed ... a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in ...
Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis ...
Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Interpretation: Understanding the meaning of information or events. Analysis: Investigating a course of action based on objective and subjective data. Evaluation: Assessing the value of ...
Self Efficacy. Thinking*. Critical thinking skills are essential to function in today's complex health care environment and to ensure continuing competence for the future. This article provides a review of various definitions and research studies related to critical thinking. Educators and researchers need to clearly define ….
Which statements are correct about the critical thinking skill of self-regulation? Emphasizes reflection on reasons for one's actions. Enables recognition and correction of one's errors. Required for all steps of the nursing process. Necessitates monitoring of self-thinking.
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 ...
Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing ...
Critical thinking is defined as: Clear, rational thinking involving critique. Its details vary amongst those who define it. According to Barry K. Beyer (1995), critical thinking means making clear, reasoned judgments. During the process of critical thinking, ideas should be reasoned, well thought out, and judged.
Critical thinking is a broad term used in nursing that includes "reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.". [1] Certainly, there are many actions that nurses must complete during their shift, but nursing requires adaptation and flexibility to meet emerging patient needs.
Nursing Critical Thinking. Use of the nursing process in healthcare allows the nurse to address the needs of the patient. The nursing process is: Click the card to flip 👆. a universally applicable framework for nursing activities. The nursing process can be used with all patients, sick or well, of all ages and in all settings.
One statement regarding critical thinking in nursing that is true is that it involves the evaluation of evidence and logical reasoning to make informed decisions about patient care. Critical thinking is a vital skill for nurses as it enables them to analyze complex situations, identify potential problems, and develop appropriate interventions. 1.
The true statement regarding critical thinking in nursing is that it is a systematic way of thinking, which is a skill set that includes reflective reasoning, evidence-based decision-making, and problem-solving abilities. Explanation: The correct answer to the question, "Which statement regarding critical thinking in nursing is true?" is D.
The statement regarding critical thinking in nursing that is true is C) Critical thinking involves analyzing information, evaluating options, and making sound decisions. Critical thinking in nursing is essential to provide quality patient care and is not limited to emergency situations.
Study with Quizlet and memorize flashcards containing terms like Which of the following is a true statement about critical thinking in nursing? It is driven by personal needs. It is only useful to solve problems. It does not use intuition. It uses logic, A student completes an assessment of a patient and makes a decision about what he will do to care for the patient. Although the student is ...
The nursing priority is to: expect the client to be drowsy, and let the client rest. complete the postoperative assessment. administer pain medication. evaluate the abdominal dressing for drainage., Which statement regarding critical thinking in nursing is true? It shows trends and patterns in client status. It supplies validation for ...
Which statement regarding critical thinking in nursing is true? a) Nurses should rely solely on intuition b) Critical thinking is not essential in nursing c) It involves analyzing and evaluating information d) Nurses should always follow established protocols