Nursing is a profound profession which requires professional skills and knowledge, high level of expertise and managerial skills. Following Parker & Clare (2006): “Critical thinking is a vital skill to have as a nurse. Nurses are engaged in providing care to people who have a right to high quality professional conduct and health services (p296).Applied to nursing profession, critical thinking aims to improve healthcare services through new methods and self-developed professional skills of nurses.
Critical thinking combines the ability to meet the requirement of a new age and respond effectively to technological innovations and scientific discoveries. Changing economic environment and globalization process has a great impact on the nursing science, and compel to specify concepts of management and its fields.
During the last decades, the definitions of critical thinking in nursing have been changes. For instance, Ennis & Milman in 1985 defined critical thinking in nursing as “reasonable, reflective thinking focused on what to believe or do” (Critical Thinking in Nursing 2007). In five years, McPeck, (1990) defined it as: “the propensity to engage in an activity with reflective skepticism” (Critical Thinking in Nursing 2007). Monitoring was an important method that helped to search for new trends in nursing.
Today, nurses take into account internal and external factors that influence a patient. The most recent explanation of critical thinking is proposed by the University of New Mexico (2007): “nursing utilizes critical thinking as diagnostic reasoning and professional or clinical judgment. Critical thinking in nursing is based on a triggering event or situation, a starting point, scaffolds, processes, and outcomes that make up a continuous or iterative feedback loop” (Critical Thinking in Nursing 2007).
In modern world, critical thinking in nursing is a broad concept with include advanced knowledge and discovering, creativity and passion, authenticity and ability to foresee coming changes. Critical thinking in nursing aims to extend traditional nursing roles in order to keep abreast of time and rapidly changing technology. Daniels (2004) underlines that it may be exercised as an attribute of position or because of personal knowledge or wisdom. Modern nurses see themselves more as conservators and regulators of the existing order of affairs with which they identify, and from which they gain rewards. Critical thinking helps to create a sense of identity which does not depend upon membership or work roles.
On the one hand, nursing gendered identity and cultural identity has a great impact on their skills and ability to deliver high quality service. Many problems associated with the relationships between people of different cultures stem from variations in norms and values. Modern society is marked by cultural diversity problems which influence healthcare services and service delivery. Critical thinking is crucial for culturally competent nurse because it helps to communicate with diverse clients and meet their needs. For instance, Hindus and Asians share specific beliefs as for parts of the body and health, and in this case a nurse should take into account cultural and religious practices of these patients.
Following Dreher and Macnaughton (2002): “the health care system has nested the accountability for cultural competency with the clinician who provides direct services to individuals, where the application of cultural information is likely to be least useful” (p181). For a nurse, the key advantages of convergence are that ideas and techniques developed in one cultural or national setting may be transferred to another and used effectively. These variables shape the values and hence the behavior of people (Potter & Perry, 2005).
Critical thinking determines the quality of decisions and actions of a nurse. A higher level of professional autonomy and shared governance should be seen as the main features of critical thinking. Critical thinking is exercised through greater knowledge and expertise. It may also be based on the personal qualities of the nurse and the manner in which authority is exercised. In contrast to traditional theories of nursing leadership, nursing expert power is based on new knowledge about technology and critical thinking used in nursing profession. Critical thinking is based on credibility and clear evidence of knowledge or expertise; for example, the expert knowledge of ‘functional’ specialists.
Stone (2000) states that if the information is satisfactorily ascertained from secondary sources, the nurse opts to complete this component of the assessment by relying on past records. Documentary data obtained from patients’ records is often termed ‘secondary’ because the information has originally been collected by other people and for other purposes.
Thus, critical thinking determines further actions and behavior patterns which support clinical and service development. In several decades ago, nurses were limited by strict rules and tasks which prevented them to respond effectively to changing environment (Potter & Perry 2005). Today, technology and information technology demands critical thinking and decision making in nursing (Sharp, 2000). Also, there is a great shift in organizational values and personal traits of the nurses. Changing social environment influences human values and conflicts with human dignity and importance (Sullivan & Decker, 2005).
The balance of power has undoubtedly shifted to nurses who have more choice over how to conducts relationships with their administration, colleagues and patients. Critical thinking in nursing is aimed to improve influences on the environment and determine perspectives of further development on the macro- and micro- level. In this situation, to be an effective and professional nurse, it is necessary to exercise the role of critical thinker based on advanced knowledge and expertise (Durgahee, 2003).
A common view is that the job of the nurse requires the ability of critical thinking and that leadership is in effect a sub-set of management. In terms of critical thinking, there is a need to be flexible and be ready to innovate and to adopt new technologies as they come along. The way in which healthcare organization has to employ the latest technology can be an important determinant of its competitive advantage. For instance, increased role of computers and technological solutions require new skills and decision making practices in medicine. For instance, if technology does not work properly and it threatens life of a patient, a nurse should react accordingly to the situation and replace it with alternative solution (Kozier et al 2004).
Critics (Sullivan & Decker, 2005) admit that three decades ago nurses were not ready and prepared to apply critical thinking to their work and this led to high death rates caused by technology failure. Healthcare is one of the main industries responsible for exceptional service quality and interpersonal communication. Service quality is determined by technological processes and innovations in its field.
Critical thinking has speeded up health delivery processes, transformed working practices and increased the efficiency of healthcare services. Interestingly, it is in the technological environment that it is sometimes possible for large healthcare organizations to actually exert influence rather than be the recipients of it. Respect and personal worth of every patient are the core human-related factors employed by the nurses (Garrison 2004).
Nursing staff is responsible for communication and interaction with the patients. For this reason, nurses should be flexible to respond effectively to changing environment and customers groups. As a result, high degree of autonomy cannot be effectively used by all nursing staff. Healthcare organizations start to apply ‘critical thinking’ into practice seeing it as a high level of specialist practice and competitive advantage in healthcare services.
Also, critical thinking in nursing is concerned with those activities involved in recruiting of professional staff, training, and development within the healthcare infrastructure, namely the systems of planning, finance, medical service control, etc. which are crucially important to an strategic capability in all healthcare activities (Potter & Perry, 2005). Today, a special attention is given to proper function of medical staff and empowerment which helps to improve efficiency of medical practice.
Critical thinking is one of the main requirements in modern service learning. In learning, “critical thinking [is] a reasoning process reflecting on ideas, actions, and decisions in clinical experience by the nursing student and others (Anaya et al 2003, p99). The advantages of critical thinking in nursing are fast response to changing conditions and environment and ability to apply recent technologies into practice. It increases confidence of nurses and level of healthcare services.
Using critical thinking approach, nurses are able to shift the situation using these new creative approaches based on advanced relationships and inquiry. Also, it is strongly influenced by resources outside the healthcare organization which are an integral part of the chain of activities between the healthcare service design and the level of medial treatment (Sharp, 2000). Change is a threat to routine and their role in healthcare management. It is also true that many nurses do not know what their role is, and in recent years attempts have been made to clarify individual roles.
Critical thinking is ‘a vital skill’ for nurses because it determines the style of management and leadership. Critical thinking can be interpreted as a response to the need to meet heightened customer expectations and face intensified technology solutions. Critical thinking encourages nurses to adopt a positive attitude and have personal involvement in service delivery. Also, it allows healthcare organization to expose nursing staff to new forms of service and management. Critical thinking is constructed on a rational basis and allows nurses respond to patients’ needs in an appropriate manner. For a modern nurse, it is crucial to be accountable to patients’ families, and close friends who come to visit them.
1. Anaya, A., Doheny, M.O., Panthofer, N., Sedlak, C.A. (2003). Critical Thinking in Students’ Service-Learning Experiences. College Teaching, 51 (3), 99-104.
2. Critical Thinking in Nursing The University of New Mexico (2007). Retrieved 31 May 2007, from http://hsc.unm.edu/consg/conct/whatis.shtml
3. Daniels, R. (2004). Nursing Fundamentals: Caring and Clinical Decision Making, Thomas Learning, Oregon.
4. Dreher, N., Macnaughton, N. (2002). Cultural competency in nursing: foundation or fallacy? Nursing Outlook, Sep-Oct; 50 (5):181-6.
5. Durgahee, T. (2003). Higher level practice: degree of specialist practice?
Nurse Education Today. Apr; 23 (3), 191-201.
6. Garrison, D.R., Morgan, D.H., Johnson, J.G. (2004). Thriving in chaos: Educating the nurse leaders of the future. Nursing Leadership Forum. Fall; 9 (1), 23-27.
7. Kozier B., Erb G., Berman A. & Snyder S. (2004). Fundamentals of Nursing: Concepts, Process and Practice, New Jersey, Pearson Education Inc.
8. Potter, P. & Perry, A. (2005). Fundamentals of Nursing. Elsevier PTE LTD, Singapore.
9. Sharp, Nancy. (April 2000). The 21st century belongs to nurse practitioners. Nurse Practitioner, p. 56
10. Sullivan, E.J., Decker, Ph. J. (2005). Effective leadership & Management in Nursing 6th ed. Pearson Hall.