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:
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.
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.
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.
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.
To become a professional nurse requires that you learn to think like a nurse. What makes the thinking of a nurse different from a doctor, a dentist or an engineer? It is how we view the client and the type of problems we deal with in practice when we engage in client care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.
Critical thinking is the disciplined, intellectual process of applying skilful reasoning as a guide to belief or action (Paul, Ennis & Norris). In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip). Critical thinking when developed in the practitioner includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgments and safe decision-making.
Intellectual Standards for Reasoning
Practitioners in nursing who are critical thinkers value and adhere to intellectual standards. Critical thinkers strive to be clear, accurate, precise, logical complete, significant and fair when they listen, speak, read and write. Critical thinkers think deeply and broadly. Their thinking is adequate for their intended purpose (Paul, Scriven, Norris & Ennis). All thinking can be examined in light of these standards and as we reflect on the quality of our thinking we begin to recognize when we are being unclear, imprecise, vague or inaccurate. As nurses, we want to eliminate irrelevant, inconsistent and illogical thoughts as we reason about client care. Nurses use language to clearly communicate in-depth information that is significant to nursing care. Nurses are not focused on the trivial or irrelevant.
Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas.
Elements of Reasoned Thinking
Reasoning in nursing involves eight elements of thought. Critical thinking involves trying to figure out something; a problem, an issue, the views of another person, a theory or an idea. To figure things out we need to enter into the thinking of the other person and then to comprehend as best we can the structure of their thinking. This also applies to our own thinking as well. When I read an author I'm trying to figure out what the author is saying; what problem or issue the author is addressing, what point of view or frame of reference he is coming from, what the goal or purpose is of this piece of writing, what evidence, data or facts are being used and what theories, concepts, principles or ideas are involved. I want to understand the interpretations and claims the author is making and the assumptions that underlie his thinking. I need to be able to follow the author's lines of formulated thought and the inferences which lead to a particular conclusion. I need to understand the implications and consequences of the author's thinking. As I come to understand the author in-depth I will also begin to recognize the strength and weakness of his reasoning. I will be able to offer my perspective on the subject at hand with a clear understanding of how the author would respond to my ideas on the subject.
The Elements of Thought
All thinking, if it is purposeful, includes the following elements of thought (Paul, 1990).
- The problem, question, concern or issue being discussed or thought about by the thinker. What the thinker is attempting to figure out.
- The purpose or goal of the thinking. Why we are attempting to figure something out and to what end. What do we hope to accomplish.
- The frame of reference, points of view or even world view that we hold about the issue or problem.
- The assumptions that we hold to be true about the issue upon which we base our claims or beliefs.
- The central concepts, ideas, principles and theories that we use in reasoning about the problem.
- The evidence, data or information provided to support the claims we make about the issue or problem.
- The interpretations, inferences, reasoning, and lines of formulated thought that lead to our conclusions.
- The implications and consequences that follow from the positions we hold on the issue or problem.
When nurses reason they use these elements of thought to figure out difficult questions and recognize that their thinking could be flawed or limited by lack of in-depth understanding of the problem at issue therefore, they critically monitor their thinking to ensure that their thinking meets the standards for intellectual thought.
In summary, as a critical thinker, I am able to figure out by reading or listening critically what nurse scholars believe about nursing and on what basis nurses act as they practice nursing. To do this I must clearly comprehend the thinking of another person by figuring out the logic of their thinking. I must comprehend clearly the thinking of myself by figuring out my own thoughts on the subject at hand. Finally, I must use intellectual standards to evaluate my thinking and the thinking of others on a given problem such that I can come to a defensible, well reasoned view of the problem and therefore, know what to believe or do in a given circumstance. To do this I must be committed to developing my mind as a self-directed, independent critical thinker. I must value above all else the intellectual traits and habits of thought that critical thinkers possess.
Intellectual Traits and Habits of Thought
To develop as a critical thinker one must be motivated to develop the attitudes and dispositions of a fair-minded thinker. That is, one must be willing to suspend judgments until one truly understands another point of view and can articulate the position that another person holds on an issue. Nurses come to reasoned judgments so that they can act competently in practice. They continually monitor their thinking; questioning and reflecting on the quality of thinking occurring in how they reason about nursing practice. Sloppy, superficial thinking leads to poor practice.
Critical inquiry is an important quality for safe practice. Nurses must pose questions about practice and be willing to attempt to seek answers about practice. Nurses must be willing to attempt to seek answers to the difficult questions inherent in practice, as well as the obvious. Question posing presupposes intellectual humility and a willingness to admit to one's areas of ignorance as well as, intellectual curiosity and perseverance and willingness to seek answers. Critical thinkers in nursing are truth seekers and demonstrate open-mindedness and tolerance for others' views with constant sensitivity to the possibility of their own bias.
Nurse's who are critical thinkers value intellectually challenging situations and are self-confident in their well reasoned thoughts. To reason effectively, nurses have developed skills and abilities essential for sound reasoning.
Critical Thinking Skills and Abilities
Critical thinkers in nursing are skilful in applying intellectual skills for sound reasoning. These skills have been defined as information gathering, focusing, remembering, organizing, analyzing, generating, integrating and evaluating (Registered Nurse's Association of British Columbia, 1990). The focus of classroom and clinical activities is to develop the nurse's understanding of scholarly, academic work through the effective use of intellectual abilities and skills. As you encounter increasingly more complex practice situations you will be required to think through and reason about nursing in greater depth and draw on deeper, more sophisticated comprehension of what it means to be a nurse in clinical practice. Nursing is never a superficial, meaningless activity. All acts in nursing are deeply significant and require of the nurse a mind fully engaged in the practice of nursing. This is the challenge of nursing; critical, reflective practice based on the sound reasoning of intelligent minds committed to safe, effective client care.
To accomplish this goal, students will be required to reason about nursing by reading, writing, listening and speaking critically. By doing so you will be thinking critically about nursing and ensuring that you gain in-depth knowledge about nursing as a practice profession.
Critical Thinking...a Holistic Approach
Critical Listening: A mode of monitoring how we are listening so as to maximize our accurate understanding of what another person is saying. By understanding the logic of human communication - that everything spoken expresses point of view, uses some ideas and not others, has implications, etc., critical thinkers can listen so as to enter empathetically and analytically into the perspective of others.
Critical Thinking: 1) Disciplined, self-directed thinking which implies the perfection of thinking appropriate to a particular mode or domain of thinking. 2) Thinking that displays master of intellectual skills and abilities. 3) The art of thinking about your thinking while you are thinking in order to make your thinking better: more clear, more accurate, or more defensible.
Critical Writing: To express oneself in languages required that one arrange ideas in some relationships to each other. When accuracy and truth are at issue, then we must understand what our thesis is, how we can support it, how we can elaborate it to make it intelligible to others, what objections can be raised to it from other points of view, what the limitations are to our point of view, and so forth. Disciplined writing requires disciplined thinking; disciplined thinking is achieved through disciplined writing.
Critical Reading: Critical reading is an active, intellectually engaged process in which the reader participates in an inner dialogue with the writer. Most people read uncritically and so miss some part of what is expressed while distorting other parts. A critical reader realizes the way in which reading, by its very nature, means entering into a point of view other than our own, the point of view of the writer. A critical reader actively looks for assumptions, key concepts and ideas, reasons and justifications, supporting examples, parallel experiences, implications and consequences, and any other structural features of the written text to interpret and assess it accurately and fairly. ( Paul, 1990, pp 554 & 545 )
Critical Speaking: Critical speaking is an active process of expressing verbally a point of view, ideas and thoughts such that others attain an in-depth understanding of the speaker's personal perspective on an issue. Monitoring how we express ourselves verbally will ensure that we maximize accurate understanding of what we mean through active dialogue and openness to feedback on our views. (Heaslip, 1993).
Paul, R.W. (1990). Critical Thinking: What Every Person Needs to Survive in a Rapidly Changing World. Rohnert Park, California: Center for Critical Thinking and Moral Critique
Norris, S. P. & Ennis, R.H. (1989). Evaluating critical thinking. Pacific Grove, CA: Midwest Publications, Critical Thinking Press