How To Teach Critical Thinking In Nursing

Not so long ago, nurses were task-workers who simply carried out doctors’ orders and followed a fixed set of rules. Today, they are skilled and capable professionals whose expertise is essential to patient care and public health initiatives. It’s been a long road. And it’s clear that developing critical thinking skills has helped to bring about this transformation within the profession during the last half century.

So what exactly is critical thinking? There are a multitude of definitions – some of them very complex – so the Foundation for Critical Thinking (2010) has assembled some of them on its website. This one is our favorite:

Critical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes.

 

It’s not hard to apply this definition to nursing, is it? Nurses do all those things every day! It can be made even more specific to nursing by saying that critical thinking is a systematic approach to the nursing process that employs all the steps above to bring about excellent clinical outcomes while enhancing patient safety and patient satisfaction.

Critical thinking is definitely a skill that develops over time and as you gain more experience. But that doesn’t mean it’s absent in young or less experienced nurses. In fact, critical thinking skills are what make young nurses effective while they are gaining on-the-job experience. A less experienced nurse with keen critical thinking skills will be able to strategize and manage all sorts of new situations, while dealing effectively with everyone involved – the patient, family members, physicians, and other care team members.

When do you need critical thinking?

If you consider critical thinking to be multi-dimensional thinking, it becomes clearer when it’s most effectively employed. Multi-dimensional thinking means approaching a situation from more than one point of view. In contrast, one-dimensional thinking tackles the task at hand from a single frame of reference. It definitely has its place in nursing – one-dimensional thinking is used when nurses chart vital signs or administer a medication.

Critical thinking skills are needed when performing a nursing assessment or intervention, or acting as a patient advocate. As a patient’s status changes, you have to recognize, interpret, and integrate new information in order to plan a course of action. For example, what would the course of action be if an elderly patient became confused from his medications, was unable to understand instructions, and put himself at risk for falls? There may be no single “right” answer – you have to weigh all of the variables, prioritize goals, and temper next steps with empathy and compassion.

Critical thinking also involves viewing the patient as a whole person – and this means considering his own culture and goals, not just the goals of the healthcare organization. How would you handle a teenage girl who comes into your clinic asking for information about STDs? What about a seriously hypertensive patient who admits he can afford his medication, but doesn’t believe it is important that he take it every day without fail?

Critical thinking forms the foundation of certain nursing specialties, like case management and infection control. These areas require strategizing, collaborative relationships, and a multi-dimensional approach to tackling a problem (like preventing unnecessary hospital readmissions or discovering the source of an infection outbreak, for example). And of course, nurse managers use critical thinking skills every day as they keep their units running smoothly.

So what’s the next step?

To develop your critical thinking skills, you can:

  • Suspend judgment; demonstrate open-mindedness and a tolerance for other cultures and other views.
  • Seek out the truth by actively investigating a problem or situation.
  • Ask questions and never be afraid to admit to a lack of knowledge.
  • Reflect on your own thinking process and the ways you reach a conclusion.
  • Indulge your own intellectual curiosity; be a lifelong learner.
  • View your patients with empathy and from a whole-person perspective.
  • Look for a mentor with more experience than you have; join professional organizations.
  • Advance your nursing education.

The best way to develop your critical thinking skills and empower yourself with knowledge is through an online RN to BSN or RN to BSN/MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in nursing education, nursing informatics, and executive leadership.

Written by Bruce Petrie, Ph.D., VP, Research and Institutional Effectiveness
Revised July 2017
Tagged as nursing skills

*Note: This post is the third in a series.

In the second post in this series on active learning strategies in nursing, I shared one nursing instructor’s way to set realistic expectations of her students beginning with the first time they step into the classroom. Now in this third post, let’s look at the ultimate question I hear everywhere I go: “How do I get my students to think critically?”

I attended an all-day conference by a nationally known speaker on this very topic. It was called, “How To Get Students to Think Critically.” I was pretty excited and looking forward to the day. It became pretty clear within the first hour of the day what the answer was. It was this: Involve your students. The speaker lectured to us for eight hours about how important it was to involve learners actively in the process. I found this amazing. We were not ourselves involved as learners once in that day. We were lectured to. We were lectured at, but we were never involved. I wanted to know how to involve my learners. That day ended without me gaining that knowledge.

I don’t blame the speaker. Her content was good. After all, she was doing what so many who teach nursing do - she was lecturing. To many people who teach, that’s all they have seen modeled. They are familiar with it. They can come in and do a “content dump” and feel they have done their job well. But who knows the content at the end of that lecture? The educator who give it knows it. The bad news is, he/she may be the only person retaining and understands that knowledge. Many educators have discovered that if they want to teach their students to think critically, they must create opportunities for their students to think critically. It’s like putting in a catheter. Can a student catheterize someone by hearing a lecture on it? No, one masters it by gathering the knowledge, watching a demo, getting the right supplies, and practicing on a manikin until feeling competent enough to get checked off by the teacher. The same is true for critical thinking.

So, how do you do that? I like to start off the thinking at the very beginning of class with something that looks fun or simple to start the brain thinking. Many of these activities can be found by putting these words into a search engine, “Brain puzzle of thinking puzzle.”  Here is one example I put on a PowerPoint slide and ask the students: “Based on the pattern established below, where do the 0, 7, and 9 go?”

Complete the series:

8, 5, 4, __, 1, __, 6, 10, 3, 2, __.

Where do 0, 7 and 9 go?

See if you can figure this problem out without reading further yourself. Have you solved it?

After two minutes I poll the group and ask why people made the selections. I then show them the completed list so they can check whether or not they were right. Also, check yourself:

Complete the series:

8, 5, 4, 9, 1, 7, 6, 10, 3, 2, 0.

Did you solve the pattern this way? You may be asking why is this the right answer. Well, if you write the numbers out, you can see the list is an alphabetical one. Eight, Five, Four, Nine, One, Seven, Six, Ten, Three, Two, Zero. What point does this make? Nursing is all about recognizing patterns. What do we expect to see in a patient with CHF? What would be normal and what would not? What are the expected effects of a diuretic? What is an alarming effect? One must know the patterns to problem solve and act appropriately for the patient.

One could also use a short patient scenario or NCLEX-style question at the beginning of class as the “problem of the day.” Present this and ask each learner to record what he or she thinks the answer to the question before you lecture. Then stop every 20 minutes or so and ask your learners to individually think and write down if they have changed their initial choice. If so, write down why. What principles or information have you learned that has changed your answer or caused you to know your choice is correct? In the last segment of the class, have the learners share and discuss the answers they have and the correct answer with rationales. This makes it safe to make mistakes of judgment on paper, not on people. The only way one learns is to be involved in making situational choices. The number pattern and/or the patient scenario offer learner practice in critical thinking.

Might you use one or both of these ideas? What do you think of these teaching strategies? Are they useful to you? Which strategies do you currently use that gives you great learner results?

Michele Deck presents nationally and internationally on innovative teaching methods in the field of health care education and training. She is co-founder and chief executive officer of G.A.M.E.S., a company that specializes in seminars on adult learning and interactive training methods, and Tool Thyme for Trainers, a company which supplies innovative and creative presentation tools for educators worldwide. Honors include ANPD’s prestigious Belinda E. Puetz Award, election to Sigma Theta Tau National Nursing Honor Society, Business Woman of the Year by the National Business Council, and Best Over All Trainer by Creative Training Techniques Companies. She serves on ANPD’s Education committee and was a member of the Editorial board of the Journal for 8 years.

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