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Outline
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.
Why?
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.
- Suspend ALL Judgement
- Collect ALL Information
- Balance ALL Information
- Make a Complete and Holistic Decision
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.
- Suspend All Judgement
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.
- Collect All Information
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.
- Balance All Information
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?”
Or
“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.
- Make a Holistic Decision
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.
Resources
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.
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