Importance of Critical Thinking Judgement in the Nursing Practice

Holly Stelter

Senior Capstone

Dr. Bellone & Mrs. Thompson

13 March, 2017

Abstract
Importance of Critical Thinking Judgement in the Nursing Practice 2

This short research paper focuses on what clinical thinking judgement

is and how it is a critical aspect of the nursing practice. The articles found

and the following discussions focus on the evaluation of critical thinking skills

found I both the real world clinical setting and simulation nursing school

setting. Ellis (2017) takes a look at what is clinical judgement and all the

aspects that go into good, properly executed clinical thinking. Also in this

study, there is evaluation of the importance of involving the patient in their

plan of care. Grasn, Williams, and Koen (2015) focus on professional nurses

and their views, understanding, and implementation of critical thinking in

their everyday careers. Finally, Cazzell and Anderson (2016) analyze the

effects of simulation seniors during senior year of during school and what the

impact is on the students critical thinking skills.

Importance of Critical Thinking Judgement in the Nursing Practice 3

Importance of Critical Thinking Judgement in the Nursing Practice

When students first embark into nursing school one the very first skills

they learn is how to perform a head to toe assessment on a patient. The

head-to-toe may be, in my opinion, the single most important skill learned

during nursing school. The head-to-toe assessment allows a nurse in the

clinical setting to fluently evaluate the current condition of their patient in

order to form a baseline for later assessments to be compared too. Another

important reason for a head-to-toe assessment is to pick up on any major

changes in your patient and to evaluate your plan of care, which is where

critical thinking judgement comes into play. In nursing school, you learn

what the norm is for the human body; what the ideal perfect body should

look, sound, feel, and behave as. Combined with the knowledge of disease

processes and medications uses, nursing students learn how to treat and

care for their patients in ethical manners.

Critical thinking is defined as the objective analysis and evaluation of

an issue in order to form a judgement. This definition pretty much

describes every nurses job when caring for their patient. Nurses

continuously evaluate and rationalize between their patients current state of

health and the orders placed by the physician for the patients; comparing

what is expectable and safe to administer to the patient at the current time.

According to Graan, Williams, and Koen (2015), the professional nurse must

be able to critically think in order to efficiently make sound judgements in

planning, managing, and evaluating the health care of the patient. Graan et
Importance of Critical Thinking Judgement in the Nursing Practice 4

al. (2015) performed a study in South Africa focusing on how nurses critical

think and how best students should learn to critical think. Its no secret that

over the years, as the nursing practice has developed and evolved, nursing

focus has shifted from solely caring for the patient in a sick condition, into

more of a problem solving profession. What is meant by this is that nurses

no longer are just blindly caring for sick patients, but are instilled with a

knowledge and a skill set focused around an understanding of disease

process and critical analysis of current patient conditions to better improve

patient health outcomes (Graan et al., 2015).

It is known that in the nursing world there is no better knowledge then

that of experience. Nurses who have been practicing for years only

continually refine their skills and build their knowledge base through the

experiences they have during their career (Ellis, 2017). Ellis (2017) feels that

even though real-life experience in the nursing field is invaluable knowledge

and experience, it often is not being successfully implemented during in the

moment situations. What is meant by this is that without proper reflection

on situation and experience that nurses are presented with, primarily in

nursing school, a positive skill base and successful implementation of critical

thinking judgement cannot happen at future dates. Reflective practice is

fundamental to self-empowerment, to reflect on ones self, analyze the

experience and learn from it (Ellis 2017). Adding in decision making models

to the real-life scenarios that nursing students are having, is one way Ellis

(2017) believes will help to better shape and refine the critical thinking skill
Importance of Critical Thinking Judgement in the Nursing Practice 5

of students when they enter into the professional nurse arena. As much as

professional nurses try and be unbiased in their critical thinking and clinical

judgment, sometimes bias unintentionally occurs, and bias in the clinical

setting can lead to human error (Ellis, 2017). Establishing solid bases for

critical thinking during the training of nursing students is believe by Ellis

(2017) to carry over into the professional world and benefit not only the

critical thinking judgement skills of the nurse, but also improve the care of

the patients in the acute care setting.

Critical thinking and clinical judgement have been identified as

essential skills for practicing nurses. While essential to nursing practice,

research has indicated that the majority of graduate nurses are not capable

of meeting entry-level expectations for clinical judgement (Mann, 2012).

When critical thinking is being presented as such an important skill to have

for professional nurses, as important as knowing how to perform proper

head-to-toe assessments, why are our nursing schools failing to instill this

skill set properly into their nursing students?

Mann (2012) states that through her research, she has found that the

primary focus of preparation programs has traditionally been on mastering

content rather than applying critical thinking to situations. Mann (2012)

recognizes that often there is very little and limited clinical opportunity to

refine critical thinking judgement. Implantation of simulations and group

analyze of reactions to simulation scenarios showed positive reactions from

the students and some increased knowledge base of critical thinking

Importance of Critical Thinking Judgement in the Nursing Practice 6

judgement (Mann, 2012). Simulations allows for sceneries to be presented

to students in real life manners, but in safe, secure, and controlled

environments. Coupled with post-group analyses, simulations allow for

students to build, grow, and create their bases for critical thinking. If nursing

schools include simulation scenarios more into their curriculum, Mann (2012)

feels this will intern improve the graduate nurses preparation for adequate

professional nursing level critical thinking judgement. Personally for me, I

know the simulation labs we have done here at YSUs BSN Nursing Program

have helped better understand common real life situation that I have never

experienced in the clinical setting, and I feel that YSU should continue to

implement these simulations and use them even more in future nursing

classes.

I have used critical nursing judgement in the clinical setting during my

time as a nursing student. Many medications are prescribed for patients in

the acute care setting which parameters are set for the administration of the

medications. For example, a patient may be prescribed lopressor

(Metoprolol) with the parameters to hold the medication if the patients

systolic blood pressure in below 100 or their heart rate is below 60. While

checking the blood glucose level of a diabetic patient, I choose to hold their

nightly does of Humulog. The reason I choose to do this was because the

patient was NPO for a procedure the following morning. If I was to give the

patient their prescribed insulin dose, they would of run the risk of becoming

hypoglycemic due to the fact that they were NPO and not eating anything.
Importance of Critical Thinking Judgement in the Nursing Practice 7

References

Ellis, N. (2017). Decision making in practice: influences, management and

reflection. British Journal of Nursing, 26(2), 109-112. Retrieved March 4,

2017, from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?

sid=820a7613-543f-49fa-a7a0-

2dec72ab8d49%40sessionmgr4006&vid=13&hid=4208

Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses'

understanding of clinical judgement: A contextual inquiry . Health

SA Gesondheid, 21(28), 280-293. Retrieved March 4, 2017.

Importance of Critical Thinking Judgement in the Nursing Practice 8

Mann, J. (2012). Critical Thinking and Clinical Judgement Skills Development

in Baccalaureate Nursing Students. The Kansas Nurse, 87(1), 26-31.

Retrieved March 4, 2017, from

http://eps.cc.ysu.edu:2085/ehost/pdfviewer/pdfviewer?

vid=7&sid=39411e1a-098c- 4384-8aa3-

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