Critical Thinking in Nursing Practice


It is a direct responsibility of a nursing professional to make decisions, which require a certain level of critical thinking. A nurse faces numerous types of clinical scenarios, all of which demand their full attention and competence to deal with the issues a patient or their family might have. To respond to such challenges confidently and efficiently, a medical practitioner has to continuously develop and utilize critical thinking skills. Under pressure, which is usually a part of a nurse’s day-to-day responsibilities, it is exceptionally important to make sensible decisions. They require a critical approach, which implies prior reflection, knowledge base, experience, and interpretive skills. The purpose of this paper is to examine the relationship between critical thinking and clinical decision-making, focusing on various aspects of the nursing process.

A Nurse’s Responsibility in the Clinical Decision-Making Process

One of the primary tasks of every nursing practitioner is to enhance patient care, which is why clinical decision-making is their direct responsibility. After all, the ability to utilize the skills of situational awareness and self-reflection to make decisions is what separates nurses from machines or technical personnel (Nibbelink & Brewer, 2018). In comparison to professional medical staff such as nurses, technical personnel simply follow orders. Thus, it is apparent nurses have the independence to make the decisions themselves, which promotes them to amass knowledge, experience, and a variety of critical thinking skills over the years. Nursing professionals understand that each patient presents a unique combination of health issues, cultural distinctions, and preferences. Therefore, there is rarely an opportunity to use the same set of solutions for different people.

A nurse must have the competence and confidence necessary to think creatively and analyze existing challenges to then offer an enduring and highly effective solution. Nursing responsibilities include recognizing an issue, assessing a patient’s needs, facilitating a discussion with their family, engaging in the process of creating a solution, and so on. Each of these steps has nothing in common with simply following directions. All of them depend on independent thinking and awareness, which is why critical decision-making is a part of nursing.

Clinical Decision-Making and Reflection

One of the most important aspects of critical decision-making is reflection, which combines the utilization of prior knowledge and experience, as well as basic analytical skills. Reflection allows a nurse to examine their prior experiences under intense scrutiny to find a solution to an existing problem. It helps nursing practitioners to make better decisions in the future as they try to assess the events of the past. Every nurse has to be aware of the benefits of reflective decision-making and make it become a part of their daily practice. Describing and evaluating prior assumptions and behaviors facilitates a chain reaction and prompts a nurse to explore a fresh perspective on an issue or a scenario (Razieh, Somayeh, & Fariba, 2018). Through reflective thinking and analysis, nursing professionals gain an opportunity to question the validity and efficiency of their actions.

Studies demonstrate the need nursing practice has for reflection and self-assessment. For instance, research conducted by Razieh et al. (2018) showed that using reflection “could significantly increase the mean score and level of clinical decision-making” (p. 7). Moreover, intuitive interpretive decisions become more frequent with the implementation of a well-structured reflective practice framework. Scientists claim that reflection urges nurses to explore different scenarios and solutions, which then encourages them to engage in the creative decision-making process (Razieh et al., 2018). In addition, reflection “suits clinical environments, facilitates learning from nurses’ clinical experiences, and enhances deep and critical thinking” (Razieh et al., 2018, p. 8). It allows nurses to develop their critical thinking skills as they analyze and evaluate their prior experiences. Apart from promoting critical thinking, reflection also encourages the use of intuition, which is another important aspect of nursing competency. All in all, reflection provides nurses with an opportunity to develop the skills needed to become both intuitive and interpretive in their practice.

Critical Thinking Skills Used in Nursing Practice

The significance of critical thinking as it relates to nursing practice is hard to overestimate. Papathanasiou et al. (2014) define critical thinking as “perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision in action” (p. 283). Certain critical thinking skills, however, tend to be more integral to nursing practice than others. The majority of such skills are associated directly with patient care through the nursing process, which is a framework utilized by nursing practitioners. Thus, one of the most crucial skills is interpretation of information related to a healthcare issue or a particular event. Another important skill is analysis, which implies an in-depth examination of objective and subjective data. Papathanasiou et al. (2014) define critical analysis as “a set of criteria to rationalize an idea where one must know all the questions but to use the appropriate ones in this case” (p. 284). Nurses also have to possess the skills of evaluation to determine whether the information they receive is valuable or not. Through the utilization of each of these skills, a nursing professional can engage in clinical reasoning.

Apart from critical analysis and interpretative skills, nurses have to deploy the skills of inference and concluding justification to eliminate the chance for making inaccurate generalizations. Through critical observation of data, nursing practitioners have to deduce from the general to the unique and specific experiences of a patient. Papathanasiou et al. (2014) note that nurses usually do this by using Maslow’s hierarchy of needs or another context-evident framework. This ensures that they efficiently categorize the information they receive to then define the issue and offer appropriate solutions.

Relationship between Clinical Experience and Critical Thinking

While critical thinking skills allow a nurse to assess the problem and form informed conclusions, the experience they might have played a key role in supporting these findings and conclusions. Experience tends to have a positive impact on the quality of care provided by a nurse. Firstly, it increases a professional’s confidence by encouraging them to strengthen their belief in the ability “to ask questions, consider options for patient care, implement interventions and trust their competence in nursing practice” (Nibbelink & Brewer, 2018, p. 923). However, it is crucial to acknowledge that some nursing practitioners tend to utilize their experience as a primary decision-making factor instead of prioritizing specific nuances of the current clinical scenario. For example, studies demonstrate that experience alone is “a weak indicator of best clinical decision-making when identifying interventions, activating of team support, or improving situation awareness” (Nibbelink & Brewer, 2018, p. 924). Thus, critical thinking skills should remain a priority for nurses to balance out their over-reliance on prior experience.

The Importance of Managing Stress

Stress is often a huge contributor to flawed decision-making and medical mistakes. As nurses start to feel overwhelmed with the amount of pressure they are under, patients suffer. It is even more alarming that a recent study by Jordan, Khubchandani, and Wiblishauser (2016) demonstrates that the percentage of nurses experiencing daily stress on moderate to high levels is 92 percent. Thus, the majority of nurses need to find the ways to manage stress when they are making clinical decisions. Critical thinking is an integral part of clinical decision-making. Stress leads to nurses neglecting the principles of rationality band critical analysis. This is why nursing professionals and healthcare organizations have to collaborate on implementing the most effective practices to keep the levels of stress low for nurses.


In conclusion, critical decision-making is an inevitable part of a professional nurse’s set of responsibilities. As a competent clinical practitioner, a nurse must go beyond the limited skill set of technical personnel and make clinical decisions independently. To do that, one needs to utilize the skills of critical analysis, reflection, inference, evaluation, and many others. In addition, a nurse has to find a balance between situational awareness, which is a part of critical thinking, and prior clinical experience. Most importantly, there is a constant need to eliminate the sources of stress for nurses, as stress tends to influence their ability to respond rationally to clinical scenarios.


Jordan, T. R., Khubchandani, J., & Wiblishauser, M. (2016). The impact of perceived stress and coping adequacy on the health of nurses: A pilot investigation. Nursing research and practice, 5843256, 1–11. Web.

Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of clinical nursing, 27(5-6), 917–928. Web.

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: the development of an essential skill for nursing students. Acta informatica medica: AIM: Journal of the Society for Medical Informatics of Bosnia & Herzegovina, 22(4), 283–286. Web.

Razieh, S., Somayeh, G., & Fariba, H. (2018). Effects of reflection on clinical decision-making of intensive care unit nurses. Nurse Education Today, 66, 1–12. Web.

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