Critical Thinking and Decision Making In Nursing Practice

What is Critical Thinking and Decision Making In Nursing Practice. By applying critical thinking to anticipate and understand your patients’ needs, you can positively influence the quality of care and outcomes.

The Critical Thinking and Decision Making In Nursing Practice

Critical thinking and decision-making are essential skills in nursing practice and enable nurses to provide safe, effective, and patient-centered care. These skills include analyzing patient situations, identifying problems, evaluating options, and making informed decisions to guide interventions and achieve positive patient outcomes.

Critical thinking and decision-making are fundamental to nursing practice. By developing these essential skills, nurses can provide high-quality, safe, and patient-centered care, thus contributing to positive patient outcomes. An example of critical thinking in nursing is interpreting these changes without bias. Making unbiased decisions based on evidence rather than opinions.

Critical Thinking and Decision Making

In response to advances in health care since the 1960s, the responsibilities of professional nurses have evolved to accommodate the complexity of health care, advanced technology, changing demographics of the patient population, and the acuity of patients. Nurses must be able to process an ever-increasing amount of information to make complex decisions and solve complicated problems in the delivery of patient care (Facione, Facione, & Sanchez, 1994).

Nurses must master effective critical thinking, clinical judgment, clinical reasoning, communication, and assessment skills (American Association of Colleges of Nursing [AACN], 2008). Nurse leaders and managers must not only practice critical thinking and effective decision making but also be role models to their staff. They must develop the intellectual capacities and skills necessary to become disciplined, self-directed, critical thinkers (Heaslip, 2008, para. 1).

In addition, they must be experts in decision making and problem solving at various levels of the organization. This topic breaks down the processes of critical thinking and decision making, relates them to the nursing process, and describes effective tools nurse leaders and managers can use when engaged in these processes. Knowledge, skills, and attitudes related to the following core competencies are included in this topic: patient-centered care, teamwork and collaboration, and informatics.

Critical Thinking

Critical thinking is a complicated process that involves skillfully directing the thinking process and imposing intellectual standards on the elements of thought. A more formal definition is as follows: “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” (Scriven & Paul, n.d., para.1).

Nursing organizations and accrediting agencies identify critical thinking as an important skill for professional nursing practice (AACN, 2008; American Nurses Association [ANA], 2015a; National Council of State Boards of Nursing [NCSBN], 2013). Critical thinking in nursing “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” (Heaslip, 2008, para.2).

Various definitions of critical thinking found in the nursing literature. Critical thinking is an important component of professional nursing because it is an essential skill for processing patient data and is inherent in making sound clinical judgments and safe patient care decisions. Nursing actions require critical thinking to integrate increasingly complex knowledge, skills, technologies, and patient care activities into evidence-based nursing practice (NCSBN, 2013, p.3).

Critical thinking plays an integral role in clinical practice as well as in nursing leadership and management. It is a critical process that systematically frames the nurse leader and manager’s thoughts, decisions, and actions (Porter-O’Grady et al., 2005).

Elements of and Cognitive Skills for Critical Thinking

Critical thinking involves eight elements of thought (Heaslip, 2008, para. 5):

The problem, question, concern, or issue being thought about by the thinker (i.e., what the thinker is attempting to figure out)
The purpose or goal of the thinking (i.e., what does the thinker hope to accomplish?)
The frame of reference, point of view, or worldview the thinker holds about the issue or problem
The assumptions the thinker holds true about the issue or problem
The central concepts, ideas, principles, and theories the thinker uses in reasoning about the issue or problem
The evidence, data, or information provided to support the claims the thinker makes about the issue or problem
The interpretations, inferences, reasoning, and lines of formulated thought that lead to the thinker’s conclusions
The implications and consequences that follow from the positions the thinker holds on the issue or problem Critical thinking is a skill that requires practice and that must be nurtured and reinforced over time (Ignatavicius, 2001).

It is more than seeking a solution to an issue or problem—it involves examining and analyzing situations, considering all points of view, and identifying options. To think critically and make sound decisions, nurse leaders and managers must engage in the processes of reflection, judgment, evaluation, and criticism (Zori & Morrison, 2009). There are six essential cognitive skills necessary to becoming an expert critical thinker (Porter-O’Grady et al., 2005):

Interpretation involves clarifying data and circumstances to determine meaning and significance. For nurse leaders and managers, interpretation reflects their ability to comprehend the significance of a wide variety of circumstances, establish priorities, categorize data, and clarify the related impact on people and systems.
Analysis is determining a problem or issue based on assessment data. Nurse leaders and managers engage in analysis to identify relationships among structures, processes, outcomes, and other frameworks of thought with the goals of examining various arguments, issues, and themes and determining elements and origins of the argument.
Inference is about drawing conclusions. Nurse leaders and managers draw conclusions about situations after careful analysis and begin to form a foundation on which an action will be based.
Evaluation is determining whether expected outcomes have or have not been met. If outcomes have not been met, evaluation also involves examining why. Nurse leaders and managers engage in evaluation to assess the reliability and credibility of the descriptions, perceptions, experiences, situations, and relationships of these elements to determine their value in the overall process. The nurse leader and manager gains confidence in the evaluation of the outcome, which will direct decisions and actions.
Explanation is the ability to justify actions with evidence. Nurse leaders and managers establish a viable explanation about the conclusions drawn during the evaluation process. The role of the nurse leader and manager is to provide systematic and organized reasoning behind the conclusion so that it can be translated into a level of understanding for others.
Self-regulation is the process of examining one’s practice for strengths and weak nesses in critical thinking and promoting continuous improvement. Nurse leaders and managers engage in self-regulation to become more informed and refine their skills in problem identification, analysis, and inference and to develop expert critical thinking skills.

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