what is the importance of critical thinking in healthcare

The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

You are using an outdated browser

Unfortunately Ausmed.com does not support your browser. Please upgrade your browser to continue.

Cultivating Critical Thinking in Healthcare

Published: 06 January 2019

Critical thinking skills have been linked to improved patient outcomes, better quality patient care and improved safety outcomes in healthcare (Jacob et al. 2017).

Given this, it's necessary for educators in healthcare to stimulate and lead further dialogue about how these skills are taught , assessed and integrated into the design and development of staff and nurse education and training programs (Papp et al. 2014).

So, what exactly is critical thinking and how can healthcare educators cultivate it amongst their staff?

What is Critical Thinking?

In general terms, ‘ critical thinking ’ is often used, and perhaps confused, with problem-solving and clinical decision-making skills .

In practice, however, problem-solving tends to focus on the identification and resolution of a problem, whilst critical thinking goes beyond this to incorporate asking skilled questions and critiquing solutions .

Several formal definitions of critical thinking can be found in literature, but in the view of Kahlke and Eva (2018), most of these definitions have limitations. That said, Papp et al. (2014) offer a useful starting point, suggesting that critical thinking is:

‘The ability to apply higher order cognitive skills and the disposition to be deliberate about thinking that leads to action that is logical and appropriate.’

The Foundation for Critical Thinking (2017) expands on this and suggests that:

‘Critical thinking is that mode of thinking, about any subject, content, or problem, in which the thinker improves the quality of his or her thinking by skillfully analysing, assessing, and reconstructing it.’

They go on to suggest that critical thinking is:

• Self-directed
• Self-disciplined
• Self-monitored
• Self-corrective.

Key Qualities and Characteristics of a Critical Thinker

Given that critical thinking is a process that encompasses conceptualisation , application , analysis , synthesis , evaluation and reflection , what qualities should be expected from a critical thinker?

In answering this question, Fortepiani (2018) suggests that critical thinkers should be able to:

• Formulate clear and precise questions
• Gather, assess and interpret relevant information
• Reach relevant well-reasoned conclusions and solutions
• Think open-mindedly, recognising their own assumptions
• Communicate effectively with others on solutions to complex problems.

All of these qualities are important, however, good communication skills are generally considered to be the bedrock of critical thinking. Why? Because they help to create a dialogue that invites questions, reflections and an open-minded approach, as well as generating a positive learning environment needed to support all forms of communication.

Lippincott Solutions (2018) outlines a broad spectrum of characteristics attributed to strong critical thinkers. They include:

• Inquisitiveness with regard to a wide range of issues
• A concern to become and remain well-informed
• Alertness to opportunities to use critical thinking
• Self-confidence in one’s own abilities to reason
• Open mindedness regarding divergent world views
• Flexibility in considering alternatives and opinions
• Understanding the opinions of other people
• Fair-mindedness in appraising reasoning
• Honesty in facing one’s own biases, prejudices, stereotypes or egocentric tendencies
• A willingness to reconsider and revise views where honest reflection suggests that change is warranted.

Papp et al. (2014) also helpfully suggest that the following five milestones can be used as a guide to help develop competency in critical thinking:

Stage 1: Unreflective Thinker

At this stage, the unreflective thinker can’t examine their own actions and cognitive processes and is unaware of different approaches to thinking.

Stage 2: Beginning Critical Thinker

Here, the learner begins to think critically and starts to recognise cognitive differences in other people. However, external motivation  is needed to sustain reflection on the learners’ own thought processes.

Stage 3: Practicing Critical Thinker

By now, the learner is familiar with their own thinking processes and makes a conscious effort to practice critical thinking.

Stage 4: Advanced Critical Thinker

As an advanced critical thinker, the learner is able to identify different cognitive processes and consciously uses critical thinking skills.

Stage 5: Accomplished Critical Thinker

At this stage, the skilled critical thinker can take charge of their thinking and habitually monitors, revises and rethinks approaches for continual improvement of their cognitive strategies.

Facilitating Critical Thinking in Healthcare

A common challenge for many educators and facilitators in healthcare is encouraging students to move away from passive learning towards active learning situations that require critical thinking skills.

Just as there are similarities among the definitions of critical thinking across subject areas and levels, there are also several generally recognised hallmarks of teaching for critical thinking . These include:

• Promoting interaction among students as they learn
• Asking open ended questions that do not assume one right answer
• Allowing sufficient time to reflect on the questions asked or problems posed
• Teaching for transfer - helping learners to see how a newly acquired skill can apply to other situations and experiences.

(Lippincott Solutions 2018)

Snyder and Snyder (2008) also make the point that it’s helpful for educators and facilitators to be aware of any initial resistance that learners may have and try to guide them through the process. They should aim to create a learning environment where learners can feel comfortable thinking through an answer rather than simply having an answer given to them.

Examples include using peer coaching techniques , mentoring or preceptorship to engage students in active learning and critical thinking skills, or integrating project-based learning activities that require students to apply their knowledge in a realistic healthcare environment.

Carvalhoa et al. (2017) also advocate problem-based learning as a widely used and successful way of stimulating critical thinking skills in the learner. This view is echoed by Tsui-Mei (2015), who notes that critical thinking, systematic analysis and curiosity significantly improve after practice-based learning .

Integrating Critical Thinking Skills Into Curriculum Design

Most educators agree that critical thinking can’t easily be developed if the program curriculum is not designed to support it. This means that a deep understanding of the nature and value of critical thinking skills needs to be present from the outset of the curriculum design process , and not just bolted on as an afterthought.

In the view of Fortepiani (2018), critical thinking skills can be summarised by the statement that 'thinking is driven by questions', which means that teaching materials need to be designed in such a way as to encourage students to expand their learning by asking questions that generate further questions and stimulate the thinking process. Ideal questions are those that:

• Embrace complexity
• Challenge assumptions and points of view
• Question the source of information
• Explore variable interpretations and potential implications of information.

To put it another way, asking questions with limiting, thought-stopping answers inhibits the development of critical thinking. This means that educators must ideally be critical thinkers themselves .

Drawing these threads together, The Foundation for Critical Thinking (2017) offers us a simple reminder that even though it’s human nature to be ‘thinking’ most of the time, most thoughts, if not guided and structured, tend to be biased, distorted, partial, uninformed or even prejudiced.

They also note that the quality of work depends precisely on the quality of the practitioners’ thought processes. Given that practitioners are being asked to meet the challenge of ever more complex care, the importance of cultivating critical thinking skills, alongside advanced problem-solving skills , seems to be taking on new importance.

Additional Resources

• The Emotionally Intelligent Nurse | Ausmed Article
• Refining Competency-Based Assessment | Ausmed Article
• Socratic Questioning in Healthcare | Ausmed Article
• Carvalhoa, D P S R P et al. 2017, 'Strategies Used for the Promotion of Critical Thinking in Nursing Undergraduate Education: A Systematic Review', Nurse Education Today , vol. 57, pp. 103-10, viewed 7 December 2018, https://www.sciencedirect.com/science/article/abs/pii/S0260691717301715
• Fortepiani, L A 2017, 'Critical Thinking or Traditional Teaching For Health Professionals', PECOP Blog , 16 January, viewed 7 December 2018, https://blog.lifescitrc.org/pecop/2017/01/16/critical-thinking-or-traditional-teaching-for-health-professions/
• Jacob, E, Duffield, C & Jacob, D 2017, 'A Protocol For the Development of a Critical Thinking Assessment Tool for Nurses Using a Delphi Technique', Journal of Advanced Nursing, vol. 73, no. 8, pp. 1982-1988, viewed 7 December 2018, https://onlinelibrary.wiley.com/doi/10.1111/jan.13306
• Kahlke, R & Eva, K 2018, 'Constructing Critical Thinking in Health Professional Education', Perspectives on Medical Education , vol. 7, no. 3, pp. 156-165, viewed 7 December 2018, https://link.springer.com/article/10.1007/s40037-018-0415-z
• Lippincott Solutions 2018, 'Turning New Nurses Into Critical Thinkers', Lippincott Solutions , viewed 10 December 2018, https://www.wolterskluwer.com/en/expert-insights/turning-new-nurses-into-critical-thinkers
• Papp, K K 2014, 'Milestones of Critical Thinking: A Developmental Model for Medicine and Nursing', Academic Medicine , vol. 89, no. 5, pp. 715-720, https://journals.lww.com/academicmedicine/Fulltext/2014/05000/Milestones_of_Critical_Thinking___A_Developmental.14.aspx
• Snyder, L G & Snyder, M J 2008, 'Teaching Critical Thinking and Problem Solving Skills', The Delta Pi Epsilon Journal , vol. L, no. 2, pp. 90-99, viewed 7 December 2018, https://dme.childrenshospital.org/wp-content/uploads/2019/02/Optional-_Teaching-Critical-Thinking-and-Problem-Solving-Skills.pdf
• The Foundation for Critical Thinking 2017, Defining Critical Thinking , The Foundation for Critical Thinking, viewed 7 December 2018, https://www.criticalthinking.org/pages/our-conception-of-critical-thinking/411
• Tsui-Mei, H, Lee-Chun, H & Chen-Ju MSN, K 2015, 'How Mental Health Nurses Improve Their Critical Thinking Through Problem-Based Learning', Journal for Nurses in Professional Development , vol. 31, no. 3, pp. 170-175, viewed 7 December 2018, https://journals.lww.com/jnsdonline/Abstract/2015/05000/How_Mental_Health_Nurses_Improve_Their_Critical.8.aspx

Anne Watkins View profile

Help and feedback, publications.

Ausmed Education is a Trusted Information Partner of Healthdirect Australia. Verify here .

ANA Nursing Resources Hub

Search Resources Hub

Critical Thinking in Nursing: Tips to Develop the Skill

4 min read • February, 09 2024

Critical thinking in nursing helps caregivers make decisions that lead to optimal patient care. In school, educators and clinical instructors introduced you to critical-thinking examples in nursing. These educators encouraged using learning tools for assessment, diagnosis, planning, implementation, and evaluation.

Nurturing these invaluable skills continues once you begin practicing. Critical thinking is essential to providing quality patient care and should continue to grow throughout your nursing career until it becomes second nature. 

What Is Critical Thinking in Nursing?

Critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills.

Reflection comes next. Carefully consider whether your actions led to the right solution or if there may have been a better course of action.

Remember, there's no one-size-fits-all treatment method — you must determine what's best for each patient.

How Is Critical Thinking Important for Nurses? 

As a patient's primary contact, a nurse is typically the first to notice changes in their status. One example of critical thinking in nursing is interpreting these changes with an open mind. Make impartial decisions based on evidence rather than opinions. By applying critical-thinking skills to anticipate and understand your patients' needs, you can positively impact their quality of care and outcomes.

Elements of Critical Thinking in Nursing

To assess situations and make informed decisions, nurses must integrate these specific elements into their practice:

• Clinical judgment. Prioritize a patient's care needs and make adjustments as changes occur. Gather the necessary information and determine what nursing intervention is needed. Keep in mind that there may be multiple options. Use your critical-thinking skills to interpret and understand the importance of test results and the patient’s clinical presentation, including their vital signs. Then prioritize interventions and anticipate potential complications. 
• Patient safety. Recognize deviations from the norm and take action to prevent harm to the patient. Suppose you don't think a change in a patient's medication is appropriate for their treatment. Before giving the medication, question the physician's rationale for the modification to avoid a potential error. 
• Communication and collaboration. Ask relevant questions and actively listen to others while avoiding judgment. Promoting a collaborative environment may lead to improved patient outcomes and interdisciplinary communication. 
• Problem-solving skills. Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. Besides assessing patient conditions, you can apply these skills to other challenges, such as staffing issues . 

How to Develop and Apply Critical-Thinking Skills in Nursing

Critical-thinking skills develop as you gain experience and advance in your career. The ability to predict and respond to nursing challenges increases as you expand your knowledge and encounter real-life patient care scenarios outside of what you learned from a textbook. 

Here are five ways to nurture your critical-thinking skills:

• Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice . That knowledge helps you make informed decisions in stressful moments.  
• Practice reflection. Allow time each day to reflect on successes and areas for improvement. This self-awareness can help identify your strengths, weaknesses, and personal biases to guide your decision-making.
• Open your mind. Don't assume you're right. Ask for opinions and consider the viewpoints of other nurses, mentors , and interdisciplinary team members.
• Use critical-thinking tools. Structure your thinking by incorporating nursing process steps or a SWOT analysis (strengths, weaknesses, opportunities, and threats) to organize information, evaluate options, and identify underlying issues.
• Be curious. Challenge assumptions by asking questions to ensure current care methods are valid, relevant, and supported by evidence-based practice .

Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills.

Images sourced from Getty Images

Related Resources

Item(s) added to cart

• - Google Chrome

Intended for healthcare professionals

• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Critical thinking in...

Critical Thinking in medical education: When and How?

Rapid response to:

Critical thinking in healthcare and education

• Related content
• Article metrics
• Rapid responses

Rapid Response:

Critical thinking is an essential cognitive skill for the individuals involved in various healthcare domains such as doctors, nurses, lab assistants, patients and so on, as is emphasized by the Authors. Recent evidence suggests that critical thinking is being perceived/evaluated as a domain-general construct and it is less distinguishable from that of general cognitive abilities [1].

People cannot think critically about topics for which they have little knowledge. Critical thinking should be viewed as a domain-specific construct that evolves as an individual acquires domain-specific knowledge [1]. For instance, most common people have no basis for prioritizing patients in the emergency department to be shifted to the only bed available in the intensive care unit. Medical professionals who could thinking critically in their own discipline would have difficulty thinking critically about problems in other fields. Therefore, ‘domain-general’ critical thinking training and evaluation could be non-specific and might not benefit the targeted domain i.e. medical profession.

Moreover, the literature does not demonstrate that it is possible to train universally effective critical thinking skills [1]. As medical teachers, we can start building up student’s critical thinking skill by contingent teaching-learning environment wherein one should encourage reasoning and analytics, problem solving abilities and welcome new ideas and opinions [2]. But at the same time, one should continue rather tapering the critical skills as one ascends towards a specialty, thereby targeting ‘domain-specific’ critical thinking.

For the benefit of healthcare, tools for training and evaluating ‘domain-specific’ critical thinking should be developed for each of the professional knowledge domains such as doctors, nurses, lab technicians and so on. As the Authors rightly pointed out, this humongous task can be accomplished only with cross border collaboration among cognitive neuroscientists, psychologists, medical education experts and medical professionals.

References 1. National Research Council. (2011). Assessing 21st Century Skills: Summary of a Workshop. J.A. Koenig, Rapporteur. Committee on the Assessment of 21st Century Skills. Board on Testing and Assessment, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press. 2. Mafakheri Laleh M, Mohammadimehr M, Zargar Balaye Jame S. Designing a model for critical thinking development in AJA University of Medical Sciences. J Adv Med Educ Prof. 2016 Oct;4(4):179–87.

Competing interests: No competing interests

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What is Critical Thinking in Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

An official website of the Department of Health & Human Services

• Search All AHRQ Sites
• Email Updates

1. Use quotes to search for an exact match of a phrase.

2. Put a minus sign just before words you don't want.

3. Enter any important keywords in any order to find entries where all these terms appear.

• The PSNet Collection
• All Content
• Perspectives
• Current Weekly Issue
• Past Weekly Issues
• Curated Libraries
• Clinical Areas
• Patient Safety 101
• The Fundamentals
• Training and Education
• Continuing Education
• WebM&M: Case Studies
• Training Catalog
• Submit a Case
• Improvement Resources
• Innovations
• Submit an Innovation
• About PSNet
• Editorial Team
• Technical Expert Panel

Developing critical thinking skills for delivering optimal care

Scott IA, Hubbard RE, Crock C, et al. Developing critical thinking skills for delivering optimal care. Intern Med J. 2021;51(4):488-493. doi: 10.1111/imj.15272

Sound critical thinking skills can help clinicians avoid cognitive biases and diagnostic errors. This article describes three critical thinking skills essential to effective clinical care – clinical reasoning, evidence-informed decision-making, and systems thinking – and approaches to develop these skills during clinician training.

Medication use and cognitive impairment among residents of aged care facilities. June 23, 2021

COVID-19 pandemic and the tension between the need to act and the need to know. October 14, 2020

Choosing wisely in clinical practice: embracing critical thinking, striving for safer care. April 6, 2022

Scoping review of studies evaluating frailty and its association with medication harm. June 22, 2022

Countering cognitive biases in minimising low value care. June 7, 2017

'More than words' - interpersonal communication, cognitive bias and diagnostic errors. August 11, 2021

A partially structured postoperative handoff protocol improves communication in 2 mixed surgical intensive care units: findings from the Handoffs and Transitions in Critical Care (HATRICC) prospective cohort study. February 6, 2019

Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions. August 4, 2021

Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA. June 24, 2020

Developing and aligning a safety event taxonomy for inpatient psychiatry. July 13, 2022

Changes in unprofessional behaviour, teamwork, and co-operation among hospital staff during the COVID-19 pandemic. September 28, 2022

Pharmacists reducing medication risk in medical outpatient clinics: a retrospective study of 18 clinics. March 8, 2023

Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19. April 12, 2023

Barriers to accessing nighttime supervisors: a national survey of internal medicine residents. March 17, 2021

Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016 March 3, 2017

Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. September 23, 2020

Transforming the medication regimen review process using telemedicine to prevent adverse events. December 16, 2020

The MedSafer study-electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial. February 2, 2022

Perceived patient safety culture in a critical care transport program. July 31, 2013

Video-based communication assessment of physician error disclosure skills by crowdsourced laypeople and patient advocates who experienced medical harm: reliability assessment with generalizability theory. May 18, 2022

Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study. November 16, 2022

Patient harm from cardiovascular medications. August 25, 2021

Delays in diagnosis, treatment, and surgery: root causes, actions taken, and recommendations for healthcare improvement. June 1, 2022

Influence of opioid prescription policy on overdoses and related adverse effects in a primary care population. May 19, 2021

Evaluation of a second victim peer support program on perceptions of second victim experiences and supportive resources in pediatric clinical specialties using the second victim experience and support tool (SVEST). November 3, 2021

Diagnostic errors in hospitalized adults who died or were transferred to intensive care. January 17, 2024

Estimation of breast cancer overdiagnosis in a U.S. breast screening cohort. March 16, 2022

Multiple meanings of resilience: health professionals' experiences of a dual element training intervention designed to help them prepare for coping with error. March 31, 2021

Care coordination strategies and barriers during medication safety incidents: a qualitative, cognitive task analysis. March 10, 2021

TRIAD IX: can a patient testimonial safely help ensure prehospital appropriate critical versus end-of-life care? September 15, 2021

An act of performance: exploring residents' decision-making processes to seek help. April 14, 2021

Preventing home medication administration errors. March 14, 2022

A randomized trial of a multifactorial strategy to prevent serious fall injuries. July 29, 2020

Clinical predictors for unsafe direct discharge home patients from intensive care units. October 21, 2020

Association between limiting the number of open records in a tele-critical care setting and retract-reorder errors. July 21, 2021

Standardized assessment of medication reconciliation in post-acute care. April 27, 2022

Estimating the economic cost of nurse sensitive adverse events amongst patients in medical and surgical settings. June 16, 2021

Survey of nurses' experiences applying The Joint Commission's medication management titration standards. November 3, 2021

Effectiveness of acute care remote triage systems: a systematic review. February 5, 2020

Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers. September 23, 2020

Physician task load and the risk of burnout among US physicians in a national survey. December 2, 2020

Patient and physician perspectives of deprescribing potentially inappropriate medications in older adults with a history of falls: a qualitative study. May 5, 2021

We asked the experts: the WHO Surgical Safety Checklist and the COVID-19 pandemic: recommendations for content and implementation adaptations. March 17, 2021

Association between surgeon technical skills and patient outcomes. September 9, 2020

Influence of psychological safety and organizational support on the impact of humiliation on trainee well-being. June 8, 2022

Developing the Safer Dx Checklist of Ten Safety Recommendations for Health Care Organizations to address diagnostic errors. October 12, 2022

Comparison of health care worker satisfaction before vs after implementation of a communication and optimal resolution program in acute care hospitals. April 5, 2023

Not overstepping professional boundaries: the challenging role of nurses in simulated error disclosures. September 21, 2011

Temporal associations between EHR-derived workload, burnout, and errors: a prospective cohort study. July 20, 2022

Adherence to national guidelines for timeliness of test results communication to patients in the Veterans Affairs health care system. May 4, 2022

Deferral of care for serious non-COVID-19 conditions: a hidden harm of COVID-19. November 18, 2020

An observational study of postoperative handoff standardization failures. June 23, 2021

Content analysis of patient safety incident reports for older adult patient transfers, handovers, and discharges: do they serve organizations, staff, or patients? January 8, 2020

Exploring the impact of employee engagement and patient safety. September 14, 2022

Deprescribing for community-dwelling older adults: a systematic review and meta-analysis. September 16, 2020

The abrupt expansion of ambulatory telemedicine: implications for patient safety. February 9, 2022

Nurse's Achilles Heel: using big data to determine workload factors that impact near misses. April 14, 2021

A diagnostic time-out to improve differential diagnosis in pediatric abdominal pain. July 14, 2021

What safety events are reported for ambulatory care? Analysis of incident reports from a patient safety organization. October 21, 2020

Expert consensus on currently accepted measures of harm. September 9, 2020

The July Effect in podiatric medicine and surgery residency. July 14, 2021

Missed nursing care in the critical care unit, before and during the COVID-19 pandemic: a comparative cross-sectional study. June 22, 2022

The calm before the storm: utilizing in situ simulation to evaluate for preparedness of an alternative care hospital during COVID-19 pandemic. June 2, 2021

The association between nurse staffing and omissions in nursing care: a systematic review. July 11, 2018

Creating a learning health system for improving diagnostic safety: pragmatic insights from US health care organizations. June 22, 2022

Effect of pharmacist counseling intervention on health care utilization following hospital discharge: a randomized control trial. June 8, 2016

Impact of the initial response to COVID-19 on long-term care for people with intellectual disability: an interrupted time series analysis of incident reports. October 14, 2020

Pediatric surgical errors: a systematic scoping review. July 20, 2022

Racial bias in pulse oximetry measurement. December 20, 2020

Accuracy of practitioner estimates of probability of diagnosis before and after testing. May 5, 2021

Recommendations for the safe, effective use of adaptive CDS in the US healthcare system: an AMIA position paper. April 21, 2021

Impact of interoperability of smart infusion pumps and an electronic medical record in critical care. September 23, 2020

Decreased incidence of cesarean surgical site infection rate with hospital-wide perioperative bundle. September 29, 2021

Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative. May 18, 2022

Second victim experiences of nurses in obstetrics and gynaecology: a Second Victim Experience and Support Tool Survey December 23, 2020

Understanding the second victim experience among multidisciplinary providers in obstetrics and gynecology. May 19, 2021

eSIMPLER: a dynamic, electronic health record-integrated checklist for clinical decision support during PICU daily rounds. June 16, 2021

Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1). May 5, 2021

Organizational safety climate and job enjoyment in hospital surgical teams with and without crew resource management training, January 26, 2022

Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial. March 1, 2023

The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care.  August 24, 2005

Safety II behavior in a pediatric intensive care unit. August 1, 2018

Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. October 21, 2020

The working hours of hospital staff nurses and patient safety. January 9, 2005

Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation. April 20, 2022

Family Input for Quality and Safety (FIQS): using mobile technology for in-hospital reporting from families and patients. March 2, 2022

Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety. December 9, 2020

Improving self-reported empathy and communication skills through harm in healthcare response training. January 26, 2022

COVID-19: an emerging threat to antibiotic stewardship in the emergency department. October 21, 2020

Predicting avoidable hospital events in Maryland. December 1, 2021

Association between in-clinic opioid administration and discharge opioid prescription in urgent care: a retrospective cohort study. February 17, 2021

Why do hospital prescribers continue antibiotics when it is safe to stop? Results of a choice experiment survey. September 2, 2020

Specificity of computerized physician order entry has a significant effect on the efficiency of workflow for critically ill patients. April 21, 2005

COVID-19: patient safety and quality improvement skills to deploy during the surge. June 24, 2020

Patient safety skills in primary care: a national survey of GP educators. February 4, 2015

Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Difficult Airway Society and the Association of Anaesthetists. March 1, 2023

Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? June 8, 2011

Training in safe opioid prescribing and treatment of opioid use disorder in internal medicine residencies: a national survey of program directors. October 12, 2022

Diagnostic discordance, health information exchange, and inter-hospital transfer outcomes: a population study. June 20, 2018

What has been the impact of Covid-19 on safety culture? A case study from a large metropolitan healthcare trust. September 2, 2020

Racial and ethnic harm in patient care is a patient safety issue. May 15, 2024

All in Her Head. The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today. March 20, 2024

The racial disparities in maternal mortality and impact of structural racism and implicit racial bias on pregnant Black women: a review of the literature. December 6, 2023

A scoping review exploring the confidence of healthcare professionals in assessing all skin tones. October 4, 2023

Patient safety in palliative care at the end of life from the perspective of complex thinking. August 16, 2023

Only 1 in 5 people with opioid addiction get the medications to treat it, study finds. August 16, 2023

Factors influencing in-hospital prescribing errors: a systematic review. July 19, 2023

Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum. June 28, 2023

Context matters: toward a multilevel perspective on context in clinical reasoning and error. June 21, 2023

The good, the bad, and the ugly: operative staff perspectives of surgeon coping with intraoperative errors. June 14, 2023

Explicitly addressing implicit bias on inpatient rounds: student and faculty reflections. June 7, 2023

The time is now: addressing implicit bias in obstetrics and gynecology education. May 17, 2023

Listen to the whispers before they become screams: addressing Black maternal morbidity and mortality in the United States. May 3, 2023

Annual Perspective

Formalizing the hidden curriculum of performance enhancing errors. March 22, 2023

Implicit racial bias, health care provider attitudes, and perceptions of health care quality among African American college students in Georgia, USA. January 18, 2023

Structural racism and impact on sickle cell disease: sickle cell lives matter. January 11, 2023

The REPAIR Project: a prospectus for change toward racial justice in medical education and health sciences research: REPAIR project steering committee. January 11, 2023

Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning. January 11, 2023

Exploring the intersection of structural racism and ageism in healthcare. December 7, 2022

Calibrate Dx: A Resource to Improve Diagnostic Decisions. October 19, 2022

Improved Diagnostic Accuracy Through Probability-Based Diagnosis. September 28, 2022

Medical malpractice lawsuits involving trainees in obstetrics and gynecology in the USA. September 21, 2022

A state-of-the-art review of speaking up in healthcare. August 24, 2022

Skin cancer is a risk no matter the skin tone. But it may be overlooked in people with dark skin. August 17, 2022

Oxford Professional Practice: Handbook of Patient Safety. July 27, 2022

Narrowing the mindware gap in medicine. July 20, 2022

From principles to practice: embedding clinical reasoning as a longitudinal curriculum theme in a medical school programme. June 15, 2022

A call to action: next steps to advance diagnosis education in the health professions. June 8, 2022

Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study. April 27, 2022

Connect With Us

Sign up for Email Updates

To sign up for updates or to access your subscriber preferences, please enter your email address below.

Agency for Healthcare Research and Quality

5600 Fishers Lane Rockville, MD 20857 Telephone: (301) 427-1364

• Accessibility
• Disclaimers
• Electronic Policies
• HHS Digital Strategy
• HHS Nondiscrimination Notice
• Inspector General
• Plain Writing Act
• Privacy Policy
• Viewers & Players
• U.S. Department of Health & Human Services
• The White House
• Don't have an account? Sign up to PSNet

Submit Your Innovations

Please select your preferred way to submit an innovation.

Continue as a Guest

Track and save your innovation

in My Innovations

Edit your innovation as a draft

Continue Logged In

Please select your preferred way to submit an innovation. Note that even if you have an account, you can still choose to submit an innovation as a guest.

Continue logged in

New users to the psnet site.

Access to quizzes and start earning

CME, CEU, or Trainee Certification.

Get email alerts when new content

matching your topics of interest

in My Innovations.

Why Critical Thinking Is Important in Nursing

Most nursing professionals have natural nurturing abilities, a desire to give others support, and an appreciation for science and anatomy. Successful nurses also possess a skill that is often overlooked: they can think critically.

A critical thinker will identify the problem, determine the best solution, and choose the most effective method. Critical thinkers evaluate the execution of a plan to see if it was effective and if it could have been done better. 

The ability to think critically has multiple applications in your life, as you can see. But Why is critical thinking important in nursing? Learn why and how you can improve this skill by reading on.

Why Are Critical Thinking Skills in Nursing Important?

Critical thinking is an essential skill for nursing students to have. It’s not something that it can teach in a classroom, and it must be developed over time through experience and practice. 

Critical thinking is the process of applying logic and reason to make decisions or solve problems. The ability to think critically will help you make better decisions on your own and collaborate with others when solving problems – both are essential skills for nurses.

Nursing has always been a profession that relies on critical thinking. Nurses are constantly faced with new situations and problems, which they need to think critically about to solve. 

Critical thinking is essential for nurses because it helps them make decisions based on the available information and their past experiences and knowledge of the field. It also allows nurses to plan before making any changes to be most effective as possible.

It is an essential skill for nurses to have to provide the best care possible. Critical thinkers can comprehend a problem and think about how they can solve it, rather than reactively or automatically.

Critical thinking is a crucial skill for doctors, nurses, and other health care providers.

How can you develop your critical thinking skills?

As you know, learning doesn’t end when you graduate from nursing school. You must continue to grow as a professional and develop your critical thinking skills.

Critical thinkers are better problem solvers than others in the same situation because they examine all the facts before coming up with solutions. They can also take many different perspectives into account when solving problems.

It’s easy for people to come to conclusions too quickly, but those who think critically will avoid this trap by first looking at every possible angle.

When faced with difficult decisions, these nurses won’t just rely on their gut feelings or what seems right according to society’s norms; instead, they’ll analyze all available information carefully until they develop the best solution.

Critical thinking is also crucial because it helps nurses avoid making mistakes in their work by providing them with a way to examine each situation and identify any potential risks or problems that may arise from subsequent actions before they take place.

It’s not enough for you to have empathy if your compassion isn’t backed up by critical thought and understanding of how certain decisions might affect others in various circumstances, so keep learning ways to become more thoughtful about the world around you.

The skills involved in being a good nurse are many and varied, but one thing all nurses need, regardless of what specialty they choose, is critical solid thinking abilities.

Reasons Critical Thinking In Nursing Is Important

Nurses’ experiences often include making life-altering decisions, establishing authority in stressful situations, and helping patients and their loved ones cope with some of the most stressful and emotional times of their lives.  Critical thinking is an essential aspect of nursing.

Following are the reasons:

• Nurses’ critical thinking has a significant impact on patient care 
• Recognizing changes in patient status is essential 
• It’s essential to an honest and open exchange of ideas 
• It enables you to ensure patient safety 
• Nurses can find quick fixes with it 
• Improvements can be made through critical thinking 
• It Contributes to Rational Decision Making

Further critical thinking is essential to nursing because nurses can establish authority in a stressful situation, such as issuing orders or administering care when needed.

This can be difficult because it may require balancing medical expertise with empathy and compassion towards patients’ feelings, leading them to question your judgment at some point in time.

Another reason this skill set is crucial involves making decisions that will have life-changing effects on a patient’s health and well-being.

These are often irreversible choices that only you know how much weight they carry within the context of each situation, so you need to make sure all factors are carefully considered before deciding what action must be taken next without hesitation.

Skills that Critical Thinkers Need

When it comes to critical thinking, some skills are more important than others. Using a framework known as the Nursing Process, some of these skills are applied to patient care. The most important skills are:

Interpretation: Understanding and explaining a specific event or piece of information.

Analysis: Studying data based on subjective and objective information to determine the best course of action.

Evaluation: Here, you assess the information you received. Is the information accurate, reliable, and credible? The ability to determine if outcomes have been fully achieved requires this skill as well.

The nurse can then use clinical reasoning to determine what the problem is based on those three skills. 

The decisions need to be based on sound reasoning:

Provide a clear, concise explanation of your conclusions. Nurses should provide a rationale for their answers.

Self-regulation – You need to be aware of your thought processes. As a result, you must reflect on the process that led to your conclusion. In this process, you should self-correct as necessary. Keep an eye out for bias and incorrect assumptions.

Critical Thinking Pitfalls

It can fall by the wayside when it’s not seen as necessary or when there are more pressing issues.

• Critical thinking is important in nursing because it can fall by the wayside when it’s not seen as an essential or more pressing issue.
• It can be difficult to think critically about complex, ambiguous situations with a shortage of information and time in healthcare settings.
• If we don’t use critical thinking skills, problems might go undetected or unresolved, leading to further complications down the road.

Sometimes nurses can’t differentiate between a less acute clinical problem and one that needs immediate attention. When a large amount of complex data must be processed in a time-critical manner, errors can also occur.

Conclusion:

Nurses cannot overstate the importance of critical thinking. The clinical presentations of patients are diverse. To provide safe, high-quality care, nurses must make rational clinical decisions and solve problems. Nurses need critical thinking skills to handle increasingly complex cases.

• Why Is Research Important in Nursing?
• Why Is the Nursing Process Important?
• Why Compassion is Important in Nursing

Download Nurse Bingo Today!

Liven up any shift with a fun game of bingo. See who can fill a row first! Fill a whole card and lose grip with reality.

Your privacy is protected. We will never spam you.

About The Author

Brittney wilson, bsn, rn, related posts, shocking truth – nurses depend too much on charting.

Volunteer Nurse Options: Where To Volunteer As A Nurse

7 Awesome Nurse Fleece Jackets to Keep You Warm and Stylish

From White to Blue: Nursing Uniforms Evolve

Leave a comment cancel reply.

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

This site uses Akismet to reduce spam. Learn how your comment data is processed .

Start typing and press enter to search

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Scoping Review of Critical Thinking Literature in Healthcare Education

Affiliation.

• 1 Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
• PMID: 33571065
• DOI: 10.1080/07380577.2021.1879411

Critical thinking is the process of analyzing and evaluating thinking to make decisions. Critical thinking exposes assumptions, biases, and beliefs that influence clinical reasoning. This scoping review sought to explore instructional approaches for advancing students' critical thinking in healthcare education. Through analysis of 15 articles, no common definition of critical thinking emerged, nor consensus found on measurement or instructional methods. Some alternative instructional methods such as case-based learning, reflective guided questions, and multiple case exposures, when compared to lecture, did significantly impact learner critical thinking. To determine if critical thinking is an instructional method that would impact implicit biases and healthcare outcomes, five author recommendations are offered from gaps in the existing literature to provide a pathway for future research. To effectively prepare students for clinical practice, long term outcomes are necessary to assess if critical thinking skills can be taught and become part of a professional growth mindset.

Keywords: Critical thinking; healthcare education; scoping review.

PubMed Disclaimer

Similar articles

• Bachelor nursing students´ and their educators´ experiences of teaching strategies targeting critical thinking: A scoping review. Westerdahl F, Carlson E, Wennick A, Borglin G. Westerdahl F, et al. Nurse Educ Pract. 2022 Aug;63:103409. doi: 10.1016/j.nepr.2022.103409. Epub 2022 Jul 12. Nurse Educ Pract. 2022. PMID: 35868062 Review.
• Reflective writing in dental education to improve critical thinking and learning: A systematic review. Woldt JL, Nenad MW. Woldt JL, et al. J Dent Educ. 2021 Jun;85(6):778-785. doi: 10.1002/jdd.12561. Epub 2021 Feb 11. J Dent Educ. 2021. PMID: 33576055 Review.
• The influences of curriculum area and student background on mindset to learning in the veterinary curriculum: a pilot study. Armitage-Chan E, Maddison J. Armitage-Chan E, et al. Vet Med Sci. 2019 Aug;5(3):470-482. doi: 10.1002/vms3.174. Epub 2019 May 9. Vet Med Sci. 2019. PMID: 31070006 Free PMC article.
• Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol. MacKinnon K, Marcellus L, Rivers J, Gordon C, Ryan M, Butcher D. MacKinnon K, et al. JBI Database System Rev Implement Rep. 2015 Jan;13(1):14-26. doi: 10.11124/jbisrir-2015-1694. JBI Database System Rev Implement Rep. 2015. PMID: 26447004
• Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory. Kuiper RA, Pesut DJ. Kuiper RA, et al. J Adv Nurs. 2004 Feb;45(4):381-91. doi: 10.1046/j.1365-2648.2003.02921.x. J Adv Nurs. 2004. PMID: 14756832 Review.
• Critical Thinking and Clinical Reasoning in Undergraduate Medical Course: A Mixed-Methods Study in a Medical College in Kolkata, West Bengal, India. Mukhopadhyay DK, Choudhari SG. Mukhopadhyay DK, et al. F1000Res. 2024 Apr 11;13:259. doi: 10.12688/f1000research.146009.1. eCollection 2024. F1000Res. 2024. PMID: 38779311 Free PMC article.
• Preceptoring of Graduate Nursing Students in Iraq. Hamarash MQ, Yaas MH, Almushhadany OI, Ibrahim RH. Hamarash MQ, et al. Adv Med Educ Pract. 2023 Sep 22;14:1025-1034. doi: 10.2147/AMEP.S418824. eCollection 2023. Adv Med Educ Pract. 2023. PMID: 37766737 Free PMC article.
• Evaluating and comparing critical thinking skills of residents of Tehran University of Medical Sciences. Mehrpour SR, Hoseini Shavoun A, Kheiltash A, Masoomi R, Nasle Seraji R. Mehrpour SR, et al. BMC Med Educ. 2023 Feb 27;23(1):133. doi: 10.1186/s12909-023-04094-7. BMC Med Educ. 2023. PMID: 36849893 Free PMC article.
• Brazilian undergraduate nursing students' critical thinking need to be increased: a cross-sectional study. Nes AAG, Riegel F, Martini JG, Zlamal J, Bresolin P, Mohallem AGDC, Steindal SA. Nes AAG, et al. Rev Bras Enferm. 2022 Nov 28;76(1):e20220315. doi: 10.1590/0034-7167-2022-0315. eCollection 2022. Rev Bras Enferm. 2022. PMID: 36449978 Free PMC article.

Publication types

• Search in MeSH

LinkOut - more resources

Full text sources.

• Taylor & Francis

Other Literature Sources

• scite Smart Citations

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Acta Inform Med
• v.22(4); 2014 Aug

Critical Thinking: The Development of an Essential Skill for Nursing Students

Ioanna v. papathanasiou.

1 Nursing Department, Technological Educational Institute of Thessaly, Greece

Christos F. Kleisiaris

2 Nursing Department, Technological Educational Institute of Crete, Greece

Evangelos C. Fradelos

3 State Mental Hospital of Attica “Daphne”, Greece

Katerina Kakou

Lambrini kourkouta.

4 Nursing Department, Alexander Technological Educational Institute of Thessaloniki, Greece

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

1. INTRODUCTION

Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis, synthesis and evaluation of information collected or derived from observation, experience, reflection, reasoning or the communication leading to conviction for action ( 1 ).

So, nurses must adopt positions that promote critical thinking and refine skills of critical reasoning in order a meaningful assessment of both the previous and the new information and decisions taken daily on hospitalization and use of limited resources, forces you to think and act in cases where there are neither clear answers nor specific procedures and where opposing forces transform decision making in a complex process ( 2 ).

Critical thinking applies to nurses as they have diverse multifaceted knowledge to handle the various situations encountered during their shifts still face constant changes in an environment with constant stress of changing conditions and make important decisions using critical thinking to collect and interpret information that are necessary for making a decision ( 3 ).

Critical thinking, combined with creativity, refine the result as nurses can find specific solutions to specific problems with creativity taking place where traditional interventions are not effective. Even with creativity, nurses generate new ideas quickly, get flexible and natural, create original solutions to problems, act independently and with confidence, even under pressure, and demonstrate originality ( 4 ).

The aim of the study is to present the basic skills of critical thinking, to highlight critical thinking as a essential skill for nursing education and a fundamental skill for decision making in nursing practice. Moreover to indicate the positive effect and relation that critical thinking has on professional outcomes.

2. CRITICAL THINKING SKILLS

Nurses in their efforts to implement critical thinking should develop some methods as well as cognitive skills required in analysis, problem solving and decision making ( 5 ). These skills include critical analysis, introductory and concluding justification, valid conclusion, distinguishing facts and opinions to assess the credibility of sources of information, clarification of concepts, and recognition conditions ( 6 , 7 ).

Critical analysis is applied to a set of questions that relate to the event or concept for the determination of important information and ideas and discarding the unnecessary ones. It is, thus, a set of criteria to rationalize an idea where one must know all the questions but to use the appropriate one in this case ( 8 ).

The Socratic Method, where the question and the answer are sought, is a technique in which one can investigate below the surface, recognize and examine the condition, look for the consequences, investigate the multiple data views and distinguish between what one knows and what he simply believes. This method should be implemented by nurses at the end of their shifts, when reviewing patient history and progress, planning the nursing plan or discussing the treatment of a patient with colleagues ( 9 ).

The Inference and Concluding justification are two other critical thinking skills, where the justification for inductive generalizations formed from a set of data and observations, which when considered together, specific pieces of information constitute a special interpretation ( 10 ). In contrast, the justification is deduced from the general to the specific. According to this, nurse starts from a conceptual framework–for example, the prioritization of needs by Maslow or a context–evident and gives descriptive interpretation of the patient’s condition with respect to this framework. So, the nurse who uses drawing needs categorizes information and defines the problem of the patient based on eradication, nutrition or need protection.

In critical thinking, the nurses still distinguish claims based on facts, conclusions, judgments and opinions. The assessment of the reliability of information is an important stage of critical thinking, where the nurse needs to confirm the accuracy of this information by checking other evidence and informants ( 10 ).

The concepts are ideas and opinions that represent objects in the real world and the importance of them. Each person has developed its own concepts, where they are nested by others, either based on personal experience or study or other activities. For a clear understanding of the situation of the patient, the nurse and the patient should be in agreement with the importance of concepts.

People also live under certain assumptions. Many believe that people generally have a generous nature, while others believe that it is a human tendency to act in its own interest. The nurse must believe that life should be considered as invaluable regardless of the condition of the patient, with the patient often believing that quality of life is more important than duration. Nurse and patient, realizing that they can make choices based on these assumptions, can work together for a common acceptable nursing plan ( 11 ).

3. CRITICAL THINKING ENHANCEMENT BEHAVIORS

The person applying critical thinking works to develop the following attitudes and characteristics independence of thought, fairness, insight into the personal and public level, humble intellect and postpone the crisis, spiritual courage, integrity, perseverance, self-confidence, research interest considerations not only behind the feelings and emotions but also behind the thoughts and curiosity ( 12 ).

Independence of Thought

Individuals who apply critical thinking as they mature acquire knowledge and experiences and examine their beliefs under new evidence. The nurses do not remain to what they were taught in school, but are “open-minded” in terms of different intervention methods technical skills.

Impartiality

Those who apply critical thinking are independent in different ways, based on evidence and not panic or personal and group biases. The nurse takes into account the views of both the younger and older family members.

Perspicacity into Personal and Social Factors

Those who are using critical thinking and accept the possibility that their personal prejudices, social pressures and habits could affect their judgment greatly. So, they try to actively interpret their prejudices whenever they think and decide.

Humble Cerebration and Deferral Crisis

Humble intellect means to have someone aware of the limits of his own knowledge. So, those who apply critical thinking are willing to admit they do not know something and believe that what we all consider rectum cannot always be true, because new evidence may emerge.

Spiritual Courage

The values and beliefs are not always obtained by rationality, meaning opinions that have been researched and proven that are supported by reasons and information. The courage should be true to their new ground in situations where social penalties for incompatibility are strict. In many cases the nurses who supported an attitude according to which if investigations are proved wrong, they are canceled.

Use of critical thinking to mentally intact individuals question their knowledge and beliefs quickly and thoroughly and cause the knowledge of others so that they are willing to admit and appreciate inconsistencies of both their own beliefs and the beliefs of the others.

Perseverance

The perseverance shown by nurses in exploring effective solutions for patient problems and nursing each determination helps to clarify concepts and to distinguish related issues despite the difficulties and failures. Using critical thinking they resist the temptation to find a quick and simple answer to avoid uncomfortable situations such as confusion and frustration.

Confidence in the Justification

According to critical thinking through well motivated reasoning leads to reliable conclusions. Using critical thinking nurses develop both the inductive and the deductive reasoning. The nurse gaining more experience of mental process and improvement, does not hesitate to disagree and be troubled thereby acting as a role model to colleagues, inspiring them to develop critical thinking.

Interesting Thoughts and Feelings for Research

Nurses need to recognize, examine and inspect or modify the emotions involved with critical thinking. So, if they feel anger, guilt and frustration for some event in their work, they should follow some steps: To restrict the operations for a while to avoid hasty conclusions and impulsive decisions, discuss negative feelings with a trusted, consume some of the energy produced by emotion, for example, doing calisthenics or walking, ponder over the situation and determine whether the emotional response is appropriate. After intense feelings abate, the nurse will be able to proceed objectively to necessary conclusions and to take the necessary decisions.

The internal debate, that has constantly in mind that the use of critical thinking is full of questions. So, a research nurse calculates traditions but does not hesitate to challenge them if you do not confirm their validity and reliability.

4. IMPLEMENTATION OF CRITICAL THINKING IN NURSING PRACTICE

In their shifts nurses act effectively without using critical thinking as many decisions are mainly based on habit and have a minimum reflection. Thus, higher critical thinking skills are put into operation, when some new ideas or needs are displayed to take a decision beyond routine. The nursing process is a systematic, rational method of planning and providing specialized nursing ( 13 ). The steps of the nursing process are assessment, diagnosis, planning, implementation, evaluation. The health care is setting the priorities of the day to apply critical thinking ( 14 ). Each nurse seeks awareness of reasoning as he/she applies the criteria and considerations and as thinking evolves ( 15 ).

Problem Solving

Problem solving helps to acquire knowledge as nurse obtains information explaining the nature of the problem and recommends possible solutions which evaluate and select the application of the best without rejecting them in a possible appeal of the original. Also, it approaches issues when solving problems that are often used is the empirical method, intuition, research process and the scientific method modified ( 16 ).

Experiential Method

This method is mainly used in home care nursing interventions where they cannot function properly because of the tools and equipment that are incomplete ( 17 ).

Intuition is the perception and understanding of concepts without the conscious use of reasoning. As a problem solving approach, as it is considered by many, is a form of guessing and therefore is characterized as an inappropriate basis for nursing decisions. But others see it as important and legitimate aspect of the crisis gained through knowledge and experience. The clinical experience allows the practitioner to recognize items and standards and approach the right conclusions. Many nurses are sensing the evolution of the patient’s condition which helps them to act sooner although the limited information. Despite the fact that the intuitive method of solving problems is recognized as part of nursing practice, it is not recommended for beginners or students because the cognitive level and the clinical experience is incomplete and does not allow a valid decision ( 16 ).

Research Process / Scientifically Modified Method

The research method is a worded, rational and systematic approach to problem solving. Health professionals working in uncontrolled situations need to implement a modified approach of the scientific method of problem solving. With critical thinking being important in all processes of problem solving, the nurse considers all possible solutions and decides on the choice of the most appropriate solution for each case ( 18 ).

The Decision

The decision is the selection of appropriate actions to fulfill the desired objective through critical thinking. Decisions should be taken when several exclusive options are available or when there is a choice of action or not. The nurse when facing multiple needs of patients, should set priorities and decide the order in which they help their patients. They should therefore: a) examine the advantages and disadvantages of each option, b) implement prioritization needs by Maslow, c) assess what actions can be delegated to others, and d) use any framework implementation priorities. Even nurses make decisions about their personal and professional lives. The successive stages of decision making are the Recognition of Objective or Purpose, Definition of criteria, Calculation Criteria, Exploration of Alternative Solutions, Consideration of Alternative Solutions, Design, Implementation, Evaluation result ( 16 ).

The contribution of critical thinking in decision making

Acquiring critical thinking and opinion is a question of practice. Critical thinking is not a phenomenon and we should all try to achieve some level of critical thinking to solve problems and make decisions successfully ( 19 - 21 ).

It is vital that the alteration of growing research or application of the Socratic Method or other technique since nurses revise the evaluation criteria of thinking and apply their own reasoning. So when they have knowledge of their own reasoning-as they apply critical thinking-they can detect syllogistic errors ( 22 – 26 ).

5. CONCLUSION

In responsible positions nurses should be especially aware of the climate of thought that is implemented and actively create an environment that stimulates and encourages diversity of opinion and research ideas ( 27 ). The nurses will also be applied to investigate the views of people from different cultures, religions, social and economic levels, family structures and different ages. Managing nurses should encourage colleagues to scrutinize the data prior to draw conclusions and to avoid “group thinking” which tends to vary without thinking of the will of the group. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

CONFLICT OF INTEREST: NONE DECLARED.

We use cookies on our website to support technical features that enhance your user experience, and to help us improve our website. By continuing to use this website, you accept our privacy policy .

• Student Login
• No-Cost Professional Certificates
• Call Us: 888-549-6755
• 888-559-6763
• Search site Search our site Search Now Close
• Request Info

Skip to Content (Press Enter)

Why Critical Thinking Skills in Nursing Matter (And What You Can Do to Develop Them)

By Hannah Meinke on 07/05/2021

The nursing profession tends to attract those who have natural nurturing abilities, a desire to help others, and a knack for science or anatomy. But there is another important skill that successful nurses share, and it's often overlooked: the ability to think critically.

Identifying a problem, determining the best solution and choosing the most effective method to solve the program are all parts of the critical thinking process. After executing the plan, critical thinkers reflect on the situation to figure out if it was effective and if it could have been done better. As you can see, critical thinking is a transferable skill that can be leveraged in several facets of your life.

But why is it so important for nurses to use? We spoke with several experts to learn why critical thinking skills in nursing are so crucial to the field, the patients and the success of a nurse. Keep reading to learn why and to see how you can improve this skill.

Why are critical thinking skills in nursing important?

You learn all sorts of practical skills in nursing school, like flawlessly dressing a wound, taking vitals like a pro or starting an IV without flinching. But without the ability to think clearly and make rational decisions, those skills alone won’t get you very far—you need to think critically as well.

“Nurses are faced with decision-making situations in patient care, and each decision they make impacts patient outcomes. Nursing critical thinking skills drive the decision-making process and impact the quality of care provided,” says Georgia Vest, DNP, RN and senior dean of nursing at the Rasmussen University School of Nursing.

For example, nurses often have to make triage decisions in the emergency room. With an overflow of patients and limited staff, they must evaluate which patients should be treated first. While they rely on their training to measure vital signs and level of consciousness, they must use critical thinking to analyze the consequences of delaying treatment in each case.

No matter which department they work in, nurses use critical thinking in their everyday routines. When you’re faced with decisions that could ultimately mean life or death, the ability to analyze a situation and come to a solution separates the good nurses from the great ones.

How are critical thinking skills acquired in nursing school?

Nursing school offers a multitude of material to master and upholds high expectations for your performance. But in order to learn in a way that will actually equip you to become an excellent nurse, you have to go beyond just memorizing terms. You need to apply an analytical mindset to understanding course material.

One way for students to begin implementing critical thinking is by applying the nursing process to their line of thought, according to Vest. The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation.

“One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.”

Nursing students often find that there are multiple correct solutions to a problem. The key to nursing is to select the “the most correct” solution—one that will be the most efficient and best fit for that particular situation. Using the nursing process, students can narrow down their options to select the best one.

When answering questions in class or on exams, challenge yourself to go beyond simply selecting an answer. Start to think about why that answer is correct and what the possible consequences might be. Simply memorizing the material won’t translate well into a real-life nursing setting.

How can you develop your critical thinking skills as a nurse?

As you know, learning doesn’t stop with graduation from nursing school. Good nurses continue to soak up knowledge and continually improve throughout their careers. Likewise, they can continue to build their critical thinking skills in the workplace with each shift.

“To improve your critical thinking, pick the brains of the experienced nurses around you to help you get the mindset,” suggests Eileen Sollars, RN ADN, AAS. Understanding how a seasoned nurse came to a conclusion will provide you with insights you may not have considered and help you develop your own approach.

The chain of command can also help nurses develop critical thinking skills in the workplace.

“Another aid in the development of critical thinking I cannot stress enough is the utilization of the chain of command,” Vest says. “In the chain of command, the nurse always reports up to the nurse manager and down to the patient care aide. Peers and fellow healthcare professionals are not in the chain of command. Clear understanding and proper utilization of the chain of command is essential in the workplace.”

How are critical thinking skills applied in nursing?

“Nurses use critical thinking in every single shift,” Sollars says. “Critical thinking in nursing is a paramount skill necessary in the care of your patients. Nowadays there is more emphasis on machines and technical aspects of nursing, but critical thinking plays an important role. You need it to understand and anticipate changes in your patient's condition.”

As a nurse, you will inevitably encounter a situation in which there are multiple solutions or treatments, and you'll be tasked with determining the solution that will provide the best possible outcome for your patient. You must be able to quickly and confidently assess situations and make the best care decision in each unique scenario. It is in situations like these that your critical thinking skills will direct your decision-making.

Do critical thinking skills matter more for nursing leadership and management positions?

While critical thinking skills are essential at every level of nursing, leadership and management positions require a new level of this ability.

When it comes to managing other nurses, working with hospital administration, and dealing with budgets, schedules or policies, critical thinking can make the difference between a smooth-running or struggling department. At the leadership level, nurses need to see the big picture and understand how each part works together.

A nurse manager , for example, might have to deal with being short-staffed. This could require coaching nurses on how to prioritize their workload, organize their tasks and rely on strategies to keep from burning out. A lead nurse with strong critical thinking skills knows how to fully understand the problem and all its implications.

• How will patient care be affected by having fewer staff?
• What kind of strain will be on the nurses?

Their solutions will take into account all their resources and possible roadblocks.

• What work can be delegated to nursing aids?
• Are there any nurses willing to come in on their day off?
• Are nurses from other departments available to provide coverage?

They’ll weigh the pros and cons of each solution and choose those with the greatest potential.

• Will calling in an off-duty nurse contribute to burnout?
• Was this situation a one-off occurrence or something that could require an additional hire in the long term?

Finally, they will look back on the issue and evaluate what worked and what didn’t. With critical thinking skills like this, a lead nurse can affect their entire staff, patient population and department for the better.

Beyond thinking

You’re now well aware of the importance of critical thinking skills in nursing. Even if you already use critical thinking skills every day, you can still work toward strengthening that skill. The more you practice it, the better you will become and the more naturally it will come to you.

If you’re interested in critical thinking because you’d like to move up in your current nursing job, consider how a Bachelor of Science in Nursing (BSN) could help you develop the necessary leadership skills.

EDITOR’S NOTE: This article was originally published in July 2012. It has since been updated to include information relevant to 2021.

• Share on Facebook
• Share on Twitter
• Share on Pinterest
• Share on LinkedIn

Request More Information

Talk with an admissions advisor today. Fill out the form to receive information about:

• Program Details and Applying for Classes
• Financial Aid and FAFSA (for those who qualify)
• Customized Support Services
• Detailed Program Plan

There are some errors in the form. Please correct the errors and submit again.

Please enter your first name.

Please enter your last name.

There is an error in email. Make sure your answer has:

• An "@" symbol
• A suffix such as ".com", ".edu", etc.

There is an error in phone number. Make sure your answer has:

• 10 digits with no dashes or spaces
• No country code (e.g. "1" for USA)

There is an error in ZIP code. Make sure your answer has only 5 digits.

Please choose a School of study.

Please choose a program.

Please choose a degree.

The program you have selected is not available in your ZIP code. Please select another program or contact an Admissions Advisor (877.530.9600) for help.

The program you have selected requires a nursing license. Please select another program or contact an Admissions Advisor (877.530.9600) for help.

Rasmussen University is not enrolling students in your state at this time.

By selecting "Submit," I authorize Rasmussen University to contact me by email, phone or text message at the number provided. There is no obligation to enroll. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

About the author

Hannah Meinke

Posted in General Nursing

• nursing education

Related Content

Brianna Flavin | 05.07.2024

Brianna Flavin | 03.19.2024

Robbie Gould | 11.14.2023

Noelle Hartt | 11.09.2023

This piece of ad content was created by Rasmussen University to support its educational programs. Rasmussen University may not prepare students for all positions featured within this content. Please visit www.rasmussen.edu/degrees for a list of programs offered. External links provided on rasmussen.edu are for reference only. Rasmussen University does not guarantee, approve, control, or specifically endorse the information or products available on websites linked to, and is not endorsed by website owners, authors and/or organizations referenced. Rasmussen University is accredited by the Higher Learning Commission, an institutional accreditation agency recognized by the U.S. Department of Education.

Critical Thinking in Healthcare and Medicine: A Crucial Skill for Improved Outcomes

Critical thinking is a crucial skill for individuals working in various healthcare domains, such as doctors, nurses, lab assistants, and patients. It serves as the foundation for evidence-based practice in healthcare and education and is essential for making informed decisions while evaluating research findings, which may sometimes be mixed or even conflicting [ The BMJ ].

In healthcare and medicine, critical thinking facilitates a more in-depth understanding of patients’ situations, complex clinical scenarios, and the ability to integrate various sources of information to make informed decisions. Professionals with strong critical thinking skills can better evaluate options, weigh potential risks and benefits, and ultimately choose the most appropriate course of action for their patients [ NurseJournal ].

Developing critical thinking skills in the healthcare sector is vital not only for patient safety but also for the professional development and career advancement of clinical and administrative nursing leaders. Ensuring that these skills are continuously nurtured and improved is critical for the ongoing success of the healthcare industry and for delivering the highest quality of patient care [ PubMed ].

Critical Thinking in Healthcare and Medicine

Critical thinking in healthcare and medicine involves the application of evidence-based practices and analytical skills to make informed decisions about patient care. This process often requires healthcare professionals to reflect on their knowledge, collaborate with colleagues, and evaluate the validity of various sources of information, including medical research, clinical experience, and patient preferences.

Some key components of critical thinking in healthcare and medicine include:

The Role of Critical Thinking in Decision-Making

Critical thinking plays a pivotal role in healthcare and medicine, affecting every aspect of the decision-making process. In clinical practice, it serves a key function in assessing patients’ symptoms, interpreting diagnostic results, and choosing appropriate interventions. This cognitive skill involves questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity to guide professional judgments and actions ( source ).

In many medical situations, such as triage, critical thinking can be crucial to ensure appropriate prioritization of patients based on their medical needs. Healthcare professionals must quickly adapt and process an influx of information to efficiently make critical decisions ( Rasmussen University ). Some practical examples of critical thinking in decision-making include:

Developing Critical Thinking Skills in Healthcare Professionals

Education and training.

Formal education and specialized training programs play a vital role in developing critical thinking skills among healthcare professionals. These programs should emphasize the importance of honing these skills as an essential component of their professional growth. Incorporating interactive learning methods, such as case studies, group discussions, and problem-solving exercises, can encourage participants to engage in reflective and analytical thinking. Courses on clinical reasoning and decision making can further strengthen these abilities.

Continuing Professional Development

Critical thinking tools and techniques.

Critical thinking in healthcare and medicine is an essential skill for professionals to make well-informed decisions and provide quality care to patients. This process combines cognitive abilities with strategic skills to achieve specific objectives. This section will explore some common tools and techniques used to promote critical thinking in healthcare professionals.

2. Analysis : Critical thinking in healthcare requires professionals to assess the quality and relevance of information, such as research findings or clinical guidelines. By breaking down information into its constituent parts and evaluating its strengths and weaknesses, professionals can make informed decisions that are based on evidence and best practices (The BMJ) .

4. Inference : Drawing conclusions from available information is a crucial aspect of critical thinking in healthcare. Professionals must infer the best course of action, considering all relevant variables and factors, such as patient preferences, clinical guidelines, and ethical considerations. Inference requires professionals to weigh the potential benefits and harms and use their judgment to make sound decisions (Critical Thinking in Critical Care) .

Challenges in Implementing Critical Thinking in Healthcare

Another challenge is the risk of conflicting metrics. Healthcare professionals often need to balance various metrics and targets to provide the best possible care to patients. Sometimes, success in one area may come at the expense of another, making it difficult to find a balance conducive to critical thinking ( International Journal for Quality in Health Care ).

In terms of education, there is an ongoing need to identify the most effective strategies for teaching critical thinking in healthcare. A scoping review of critical thinking literature in healthcare education highlights the broad range of methods used to teach critical thinking, as well as the variability in research methodologies ( PubMed ). This suggests a need for further research and consensus to develop the most effective critical thinking educational methods for healthcare professionals.

The Impact of Critical Thinking on Patient Outcomes

Another impact of critical thinking on patient outcomes is seen through proper planning and administration of care. A healthcare professional who utilizes critical thinking skills can carefully examine all aspects of patient care and make informed decisions that minimize harm and improve outcomes (ScienceDirect) .

Furthermore, critical thinking skills can also enhance communication and collaboration among healthcare professionals. This can lead to more effective teamwork and coordinated care, ultimately benefiting the patient and improving their overall experience in the healthcare system.

Future Perspectives

Furthermore, the integration of new technologies like artificial intelligence (AI) and machine learning will necessitate a greater emphasis on critical thinking. Healthcare practitioners will need to adapt and learn how to effectively use these tools while maintaining their ability to think critically about diagnoses and treatment plans.

In summary, the future of critical thinking in healthcare and medicine holds promise for enhancing patient care and improving medical education. By fostering a culture of collaboration and embracing new technologies, healthcare professionals can leverage their critical thinking skills to navigate complex challenges and drive innovation in their field.

You may also like

Examples of critical thinking in everyday, critical reading strategies, critical thinking and emotional intelligence, critical thinking & language learning, download this free ebook.

Teaching Critical Thinking and Problem-Solving Skills to Healthcare Professionals

• Published: 27 October 2020
• Volume 31 , pages 235–239, ( 2021 )

Cite this article

• Jessica A. Chacon 1 &
• Herb Janssen   ORCID: orcid.org/0000-0001-8015-9369 1  

7871 Accesses

6 Citations

1 Altmetric

Explore all metrics

Avoid common mistakes on your manuscript.

Introduction

Determining approaches that improve student learning is far more beneficial than determining what can improve a professor’s teaching. As previously stated, “Lecturing is that mysterious process by which the contents of the note-book of the professor are transferred through the instrumentation of the fountain-pen to the note-book of the student without passing through the mind of either” [ 1 ]. This process continues today, except that the professor’s note-book has been replaced with a PowerPoint lecture and the student’s note-book is now a computer.

In 1910, the Flexner report noted that didactic lectures were antiquated and should be left to a time when “professors knew and students learned” [ 2 ]. Approximately 100 years later, the Liaison Committee on Medical Education (LCME) affirmed Flexner’s comment and suggested that student learning must involve active components [ 3 ]: It seems somewhat obscured that almost 100 years separated these two statements.

Our strategy requires the following: student engagement in the learning process; a curriculum that develops a foundation for each student’s knowledge acquisition; focusing primarily on student learning instead of professor teaching; helping enable students develop critical thinking skills; and encouraging students to develop “expertise” in their chosen discipline.

Six fundamental topics that play a role in the development of a health sciences student’s critical thinking ability will be described. In “Section I,” these topics will be discussed independently, highlighting the importance of each. In “Section II: Proposed Curriculum and Pedagogy to Improve Student Learning,” the topics will be united into a practical approach that can be used to improve student learning, curriculum, pedagogy, and assessment.

Foundation Knowledge

Students use mnemonics to provide a foundation for new information. Although mnemonics help students associate information that they want to remember with something they already know, students learn tads of information that is not placed into a practical, meaningful framework developed by the student [ 4 , 5 ]. This commentary highlights the problem of recalling facts when these facts are presented in isolation. The responsibility for this resides not with the student, but with a curriculum that teaches isolated facts, instead of integrated concepts.

A taxonomy for significant learning presented by Dr. Fink emphasizes the need to develop foundational knowledge before additional information can be learned in an effective manner [ 6 ]. He provides suggestions on developing specific learning goals in given courses. Two of his most important criteria are (1) the development of a foundation of knowledge and (2) helping students “learn how to learn” [ 6 ].

Learning Approaches and Abilities

Howard Gardner introduced the concept of multiple intelligences in the 1980s [ 7 ]. Gardner expanded this idea to include intelligence in the areas of (1) Verbal-linguistic, (2) Logical-mathematical, (3) Spatial-visual, (4) Bodily-kinesthetic, (5) Musical, (6) Interpersonal, (7) Intrapersonal personal, (8) Naturalist, and (9) Existential. He concluded that students gifted in certain areas will be drawn in that direction due to the ease with which they excel. While it is important to recognize these differences, it is crucial to not ignore the need for student development in areas where they are less gifted. For example, students gifted in mathematics who fail to develop intrapersonal and interpersonal skills will more likely become recluse, limiting their success in real-world situations [ 7 , 8 ]. Similar examples can also be found in the medical world [ 7 , 8 ].

Based on Gardner’s work, it seems evident that students admitted to our health sciences schools will arrive with different skills and abilities. Despite this, educators are required to produce graduates who have mastered the competencies required by the various accrediting agencies. Accomplishing this task demands sensitivity to the students’ different abilities. While the curriculum remains focused on the competencies students must demonstrate when training is complete. Creating this transition using a traditional lecture format is difficult, if not impossible.

Active Engagement

In 1910, Flexner suggested that didactic lecture is important; however, it should be limited only to the introduction or conclusion of a given topic [ 2 ]. Flexner stated that students should be given the opportunity to experience learning in a context that allowed them to use scientific principles rather than empirical observations [ 2 ]. Active engagement of the student in their learning process has been recently promoted by the LCME [ 3 ]. This reaffirmation of Flexner’s 1910 report highlights the incredibly slow pace at which education changes.

Critical Thinking

Critical thinking is an active process that, when applied appropriately, allows each of us to evaluate our own activities and achievements. Critical thinking also allows an individual to make minor, mid-course corrections in thinking, instead of waiting until disastrous outcomes are unavoidable.

Educators in Allied Health and Nursing have included critical thinking as part of their curriculum for many years [ 9 ]. Medical educators, on the other hand, have not fully integrated critical thinking as part of their curriculum [ 10 , 11 ].

Bloom’s taxonomy has often been used to define curriculum [ 12 ]. The usefulness and importance of Bloom’s taxonomy is not to be underestimated; however, its limitations must also be addressed. As Bloom and his colleagues clearly stated, their taxonomy describes behavioral outcomes and is incapable of determining the logical steps through which this behavior was developed [ 12 ]. Bloom highlights this shortcoming in his initial book on the cognitive domain. He described two students who solved the same algebra problem. One student does this by rote memory, having been exposed to the problem previously, while the other student accomplishes the task by applying mathematical principles. The observer has no way of knowing which approach was used unless they have prior knowledge of the students’ background [ 12 ]. The importance of this distinction becomes apparent in medical problem-solving.

Contextual Learning

Enabling students to learn in context is critical; however, trying to teach everything in context results in a double-edged sword [ 13 ]. On the one hand, learning material in context helps the student develop a solid foundation in which the new information can be built. On the other hand, the educator will find it impossible to duplicate all situations the student will encounter throughout his or her career as a healthcare provider. This dilemma again challenges the educator to develop a variety of learning situations that simulate real-world situations. It seems that “in context” can at best be developed by presenting a variety of patients in a variety of different situations.

In the clinical setting, the physician cannot use a strict hypothesis-driven study on each patient, but must treat patients using the best, most logical treatment selected based on his or her knowledge and the most reliable information.

Development of Expertise

Several researchers have studied the characteristics required of expert performance, the time required to obtain these traits, and the steps that are followed as an individual’s performance progresses from novice to expert.

Studies involving expert physicians have provided data that can be directly used in our attempt to improve curriculum and pedagogy in the healthcare profession. Patel demonstrated that medical students and entry-level residents can recall a considerable amount of non-relevant data while the expert cannot [ 14 ]. Conversely, the expert physician has a much higher level of relevant recall, suggesting they have omitted the non-relevant information and retained only relevant information that is useful in their practice. Using these methods, the expert physicians produce accurate diagnosis in almost 100% of cases, while the medical students can achieve only patricianly correct or component diagnosis only [ 14 ].

In the healthcare setting, both methods are used. The expert physicians will use forward reasoning when the accuracy of the data allows this rapid problem-solving method. When the patient’s conditions cannot be accurately described using known information, the expert diagnostician will resort to the slower hypothesis-driven, backward reasoning approach. In this manner, the highest probability of achieving an accurate diagnosis in the shortest time will be realized [ 14 ].

Section II: Proposed Curriculum and Pedagogy to Improve Student Learning

The following section will outline several distinct but interrelated approaches to accomplish the six educational principles discussed above. The topics will be highlighted as they apply to the specific topic and each section will be comprised of curriculum, pedagogy, and assessment.

Developing a Knowledge Base Using Active Learning Sensitive to Students’ Abilities

Students admitted into healthcare training programs come from various backgrounds. This is both a strength for the program and a challenge for the educator. The strength is recognized in the diversity the varied backgrounds bring to the class and ultimately the profession. The challenge for the educator is attempting to provide each student with the material and a learning approach that will fit their individual ability and knowledge level. The educator can provide prerequisite objectives that identify the basic knowledge required before the student attempts the more advanced curriculum. Scaffolding questions can also be provided that allow students to determine their mastery of these prerequisite objectives. Briefly, scaffolding questions are categorized based on complexity. Simple, factual questions are identified with a subscript “0” (i.e. 1. 0 , 2. 0 , etc.). Advanced questions have a subscript suggesting the estimated number of basic concepts that must be included/combined to derive the answer.

Using technology to provide these individual learning opportunities online allows each student to address his or her own potential deficits. Obviously, those who find their knowledge lacking will need to spend additional time learning this information; however, using technology, this can be accomplished without requiring additional class time. This approach will decrease learning gaps for students, while excluding unnecessarily repeating material known by others.

The curriculum is divided into two parts: (1) content and (2) critical thinking/problem-solving skills. The basic knowledge and factual content can be provided online. Students are expected to learn this by actively engaging the material during independent study. This saves classroom or small-group sessions for interaction where students can actively learn critical thinking/problem-solving skills.

The curriculum should be designed so that students can start at their own level of understanding. The more advanced students can identify the level appropriate for themselves and/or review the more rudimentary information as needed. As shown by previous investigators, experts omit non-relevant information so that they can focus on appropriate problem-solving. Requiring students to learn by solving problems or exploring case studies will be emphasized when possible.

Technology can be used to deliver the “content” portion of the curriculum. Voice-over PowerPoints and/or video clips made available online through WebCT or PodCast will allow each student to study separately or in groups at their own rate, starting at their own level of knowledge. The content delivered in this fashion will complement the handout and/or textbook information recommended to the students. This will provide the needed basic information that will be used as a foundation for the development of critical thinking and problem-solving. The flipped classroom and/or team-based learning can both be used to help facilitate this type of learning. [ 15 ]

Student Assessments

It is imperative for students to know whether they have mastered the material to the extent needed. This can be accomplished by providing online formative evaluations. These will not be used to determine student performance; however, the results will be provided to the educator to determine the class’s progress and evaluation of the curriculum.

Developing Critical Thinking Skills in the Classroom or Small-Group Setting

Critical thinking skills are essential to the development of well-trained healthcare professionals. These skills are not “taught” but must be “learned” by the student. The educator provides learning experiences through which the students can gain the needed skills and experience. Mastery of the content should be a responsibility placed on the student. Information and assistance are given to the students, but students are held accountable for learning the content. This does not indicate that the educator is freed from responsibility. In fact, the educator will most likely spend more time planning and preparing, compared to when didactic lectures were given; however, the spotlight will be placed on the student. Once the learning modules are developed, they can be readily updated, allowing the educators to improve their sessions with each evaluation.

Curriculum designed to help student students develop critical thinking/problem-solving skills should be learned in context. During the introductory portions of the training, this can be accomplished by providing problem-based scenarios similar to what will be expected in the later clinical setting. The transition to competency-based evaluation in many disciplines has made this a virtual necessity. Critical thinking/problem-solving skills should emphasize self-examination. It should teach an individual to accomplish this using a series of steps that progress in a logical fashion, stressing that critical thinking is a progression of logical thought, not an unguided process.

The methods of teaching critical thinking can be traced back to the dialectic methods used by Socrates. Helping the students learn by posing questions remains an effective tool. Accomplishing this in a group setting also provides each student with the opportunity to learn, not only from their mistakes and accomplishments, but from the mistakes and accomplishments of others. Scenario questions can be presented in a manner similar to those found in many board and licensure exams. This exposes students to material in a format relevant to the clinical setting and to future exams. In larger groups, PowerPoint presentation of scenario questions can be used. Team-based learning (TBL) is useful in encouraging individual self-assessment and peer-peer instruction, while also providing an opportunity for the development of critical thinking and problem-solving skills. After the Individual Readiness Assurance Test (iRAT) exam, students work together to answer the Group Readiness Assurance Test (gRAT). Following this, relevant material is covered by clinicians and basic scientists working together and questions asked using an audience response system. This has been useful in encouraging individual self-assessment and peer-peer instruction while also providing an opportunity for the development of critical thinking and problem-solving skills.

Formative assessment of the students will be given in the class session. This can be accomplished using an audience response system. This gives each individual a chance to determine their own critical thinking skill level. It will prevent the “Oh, I knew that” response from students who are in denial of their own inabilities. Summative assessment in the class will be based on the critical thinking skills presented in the classroom or small-group setting. As mentioned earlier, the students will be evaluated on their ability to think critically and to problem-solve. This will by necessity include evaluation of content knowledge—but only as it pertains to the critical thinking and problem-solving skills. This will be made clear through the use of objectives that describe both content and critical thinking.

Enhancing Critical Thinking Skills in Simulation Centers and Clinics

The development of critical thinking skills in healthcare is somewhat unique. In chess, students can start playing using the same tools employed by the experts (the chess board); however, in healthcare, allowing students to make medical decisions is ethically inappropriate and irresponsible. Simulations centers allow students to gain needed experience and confidence without placing patients at risk. Once the students have mastered simulation center experiences and acquired the needed confidence, they can participate in patient diagnosis under the watchful eye of the expert healthcare professional.

The student’s curriculum now becomes the entire knowledge base of each healthcare discipline. This includes textbooks and journal articles. Students are required to come well prepared to the clinics and/or hospital having developed and in-depth understanding of each patient in their care.

Each day, the expert healthcare provider, serving as a mentor, will provide formative evaluation of the student and his/her performance. Mentors will guide the student, suggesting changes in the skills needed to evaluate the patients properly. In addition, standardized patients provide an excellent method of student/resident evaluation.

Summative evaluation is in the form of subject/board exams. These test the student’s or resident’s ability to accurately describe and evaluate the patient. The objective structured clinical examination (OSCE) is used to evaluate the student’s ability to correctly assess the patient’s condition. Thinking aloud had been previously shown as an effective tool for evaluating expert performance in such settings [ 16 ]. Briefly, think aloud strategies require the student to explain verbally the logic they are using to combine facts to arrive at correct answers. This approach helps the evaluator to determine both the accuracy of the answer and if the correct thought process was followed by the student.

If the time required to develop an expert is a minimum of ten years, what influence can education have on the process?

Education can:

Provide the student with a foundation of knowledge required for the development of future knowledge and skills.

Introduce the student to critical thinking and problem-solving techniques.

Require the student to actively engage the material instead of attempting to learn using rote memory only.

Assess the performance of the student in a formative manner, allowing the lack of information of skills to be identified early, thus reducing the risk of failure when changes in study skills are more difficult and/or occur too late to help.

Provide learning in a contextual format that makes the information meaningful and easier to remember.

Provide training in forward reasoning and backward reasoning skills. It can relate these skills to the problem-solving techniques in healthcare.

Help students develop the qualities of an expert healthcare provider.

Data Availability

Maguire ER. The group-study plan: a teaching technique based on pupil participation: Sharles Charles Scribner’s Sons; 1928.

Flexner A. Medical education in the United States and Canada. From the Carnegie Foundation for the Advancement of Teaching, bulletin number four, 1910. Bull World Health Organ 2002;80(7):594–602.

Liaison Committee on Medical Education [Available from: https://lcme.org/ .

Learning WC. Chapter 6: Kinds of mnemonics [Available from: http://college.cengage.com/collegesurvival/wong/essential_study/6e/assets/students/protecte d/wong_ch06_in-depthmnemonics.html.

Wong L. Essential study skills. Boston: Wadsworth, Inc.; 2015.

Google Scholar  

Fink LD. Creating significant learning experiences. San Francisco: Jossey-Bass; 2003.

Gardner H. Frames of mind: the theory of multiple intelligences. New York: Basic Books; 1983.

Gardner H. Multiple intelligences: the theory in practice. New York: Basic Books; 1993.

Alfaro-LeFevre R. Critical thinking in nursing: a practical approach. 2, illustrated ed: Saunders, 1999.

Sharple JM, Oxman AD, Mahtani KR, Chambers I, Oliver S, Colins K, et al. Critical thinking in healthcare and education. BMJ. 2017;357:2234.

Article   Google Scholar  

Kahlke R, Kevin E. Constructing critical thinking in health professional education. Perspect Med Educ. 2018;7(3):156–65.

Bloom BS, MD E, Furst E, Hill W, Krathwohl DR. Taxonomy of educational objectives. Handbook I: cognitive domain. New York: David McKay Co Inc.; 1956.

Laurillard D. Rethinking university teaching. New York: London: Routledge Falmer; 2002.

Book   Google Scholar  

Patel V, Groen G. The general and specific nature of medical expertise: a critical look. In: Ericsson KA, Smith J, editors. Toward a general theory of expertise. New York: Cambridge. University Press; 1991.

Khe Foon HEW, Chung KLO. Flipped classroom improve students learning in health professions education: a meta-analysis. BMC Medical Education. 2018;18:38.

Brown JL, Ilgen JS. Now you see it, now you don’t: what thinking aloud tells us about clinical reasoning. J Grad Med Educ. 2014;6(4):783–5.

Download references

Author information

Authors and affiliations.

Department of Medical Education, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA

Jessica A. Chacon & Herb Janssen

You can also search for this author in PubMed   Google Scholar

Contributions

The authors wrote and contributed to the final manuscript.

Corresponding author

Correspondence to Herb Janssen .

Ethics declarations

Conflict of interest.

The authors declare that they have no conflict of interest.

Ethics Approval

Code availability, additional information, publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Chacon, J.A., Janssen, H. Teaching Critical Thinking and Problem-Solving Skills to Healthcare Professionals. Med.Sci.Educ. 31 , 235–239 (2021). https://doi.org/10.1007/s40670-020-01128-3

Download citation

Accepted : 15 October 2020

Published : 27 October 2020

Issue Date : February 2021

DOI : https://doi.org/10.1007/s40670-020-01128-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Find a journal
• Publish with us
• Track your research

Election latest: Minister criticises 'celebrating' of Banksy migrant boat inflatable at Glastonbury - as campaign enters final straight

Sir Keir Starmer and Rishi Sunak are beginning a frantic final few days of campaigning as polling day rapidly approaches. On the morning media round for the Tories, James Cleverly is asked about Banksy's migrant boat artwork at Glastonbury.

Monday 1 July 2024 10:17, UK

• General Election 2024
• Leaders ramp up attacks as final days of campaigning begin
• Minister criticises 'celebrating' of Banksy migrant boat inflatable
• Labour: It's not over until the final whistle blows
• Ed Conway: The science and security of the exit poll
• Polls open in three days on Thursday
• Live reporting by Faith Ridler

Election essentials

• Manifesto pledges: Conservatives | Greens | Labour | Lib Dems | Plaid | Reform | SNP
• Trackers:  Who's leading polls? | Is PM keeping promises?
• Campaign Heritage:  Memorable moments from elections gone by
• Follow Sky's politics podcasts:  Electoral Dysfunction | Politics At Jack And Sam's
• Read more:  Who is standing down? | Key seats to watch | What counts as voter ID? | Check if your constituency is changing | Guide to election lingo
• How to watch election on Sky News

Taking questions from the media, Sir Keir Starmer is asked by our political editor Beth Rigby whether he worries about his own popularity if he enters Number 10.

Is he worried that his mandate could be wide - but shallow?

The Labour leader says he "stands by" his record.

He adds: "I stand on my record - four and a half years ago when I took over as leader of the Labour Party I got similar questions.

"Which is - your party has lost really badly, it may never win an election again... are you capable as leader of the Labour Party of pulling it around and seriously putting it before the electorate as a credible force for change.

"And I said yes."

He says Labour is a changed party, claiming his "track record as a leader is clear".

Beth comes back, asking if a pillow handed out to journalists by the Labour Party today is what he sleeps on at night.

The pillows are printed with a mocked-up photo of the prime minister in bed and the words "Don't wake up to five more years of the Tories".

Sir Keir laughs: "No."

He goes on to say: "A very, very good pillow for us to have across the country."

Labour leader Sir Keir Starmer is in Hertfordshire today, where he is addressing those gathered at a campaign event.

He says: "We have one job - which is to make this a summer of change."

The Labour leader says the Labour campaign, this "fight for change", is for the people of the UK - but "change only happens if you vote for it".

"This is the final mile, these are the last hard yards - but the last steps are always the hardest," Sir Keir adds. 

"We have to remember that people need convincing, there are undecided voters out there.

"We need to convince people that change is possible."

Sir Keir was joined by Alistair Strathern, the Labour candidate for Hitchin.

The Labour leader says: "The choice is stark, the prize is huge in terms of taking our country forward - but it will only happen if you vote for it."

The other candidates for Hitchin are:

• Bim Afolami, Conservative Party 
• Charles Bunker, Reform UK 
• Chris Lucas, Liberal Democrats 
• Sid Cordle, Christian People's Alliance 
• Will Lavin, Green Party

Sir Ed Davey has continued his out-of-the-box campaigning by bungee-jumping from a crane this morning. 

The Liberal Democrat leader has helped raise the party's profile by taking part in a series of stunts - including falling off his paddle board and riding on a roller coaster.

Interestingly, Henry Morris, who runs the Secret Tory parody X account, posted weeks ago predicting this very stunt...

You can see how the polls are looking ahead of the election here...

Adrian Ramsay, the co-leader of the Green Party, says his MPs would "push" a potential Labour government "to be bolder" on climate.

He says the party is expecting a "record" result at the election on 4 July.

Mr Ramsay adds: "We are on track to having a Labour government with a big majority. 

"Well, rather than adding to that majority further or electing another Conservative MP to add to their numbers, it would make a far bigger difference if people elect green MPs who can bring diversity of views into this next parliament."

The party co-leader insists that this would push the next government "to be bolder".

He says the Greens would "move Keir Starmer beyond the U-turns he's been making on climate and on funding for public services".

"And that's why we're on track to having a record green result of this election."

The Institute for Fiscal Studies (IFS) says there's a conspiracy of silence at this election - that all of the major political parties aren't being honest enough about their fiscal plans.

And it has a point. Most obviously (and this is the main thing the IFS is complaining about) none of the major manifestos - from  Labour , the  Liberal Democrats  and the  Conservative  parties - have been clear about how they will fill an impending black hole in the government's spending plans.

No need to go into all the gritty details, but the overarching point is that all government spending plans include some broad assumptions about how much spending (and for that matter, taxes and economic growth) will grow in the coming years. Economists call this the "baseline".

But there's a problem with this baseline - it assumes quite a slow increase in overall government spending in the next four years, an average of about 1 per cent a year after accounting for inflation. 

Sky News' deputy political editor Sam Coates and Politico's Jack Blanchard with their guide to the election day ahead. 

This is day 40 of the campaign. Jack and Sam look at where the parties are now as the election approaches, with Labour’s attack ads and the Conservatives pushing back against Reform UK. Plus, the reaction to the first round of the French elections which has seen the far-right make significant headway.

Email Jack and Sam: [email protected]

👉 Tap here to follow Politics at Jack and Sam's wherever you get your podcasts 👈

Jonathan Ashworth, the shadow paymaster general, has insisted that the election isn't over until "the final whistle blows" as politicians gear up for polling day.

Labour has consistently been 20 points ahead of the Conservatives throughout the six-week campaign, with all pollsters pointing to a victory on Thursday.

But despite this, the party has continued to emphasise that it will fight for every vote.

Mr Ashworth said: "There's an election on Thursday, and if people want to bring an end to the chaos, to the scandals from the party in Number 10 to the insider gambling scandals, if people have had enough of being stuck on an NHS waiting list, if people who've had enough of having their family finances hammered and pay more on their mortgage, they've got to come out and vote Labour.

"Don't wake up, don't switch on Sky News on Friday morning and hear that Rishi Sunak has been re-elected. 

"If you don't want that, we don't want that feeling in the pit of your stomach."

He does on to explain that there are still "a lot of undecided voters".

"But let me give you some meat," Mr Ashworth adds.

"We're going to deliver 40,000 extra appointments in the National Health Service. 

"We are going to help young people get on the housing ladder by significant reforms to planning."

By Tom Cheshire , online campaign correspondent 

If you want a good idea of what matters to each party - its deepest desires, its darkest fears - look at where it's spending money.

What it shows is a story of Labour spending big and spending everywhere, as it pursues a plausible supermajority, while the Conservatives retreat to fight for some of their heartland constituencies, and spend much less. 

It shows the current state of play for all parties across the country. The map shows which is the biggest spender in each constituency - which parts of the country they're fighting to win, or not to lose.

The map was created by Who Targets Me (WTM), which tracks digital political advertising and has partnered with Sky News as part of our online campaign team.

"Our map of advertising activity shows where the parties have targeted their Facebook and Instagram ads in the last week," Sam Jeffers, executive director of WTM, says.

Steve Reed, the shadow environment secretary, just handed out pillows to journalists on the Labour campaign bus - emblazoned with Rishi Sunak's face.

By Nick Martin , people and politics correspondent

"We eat according to price rather than enjoyment," Sarah Bowmer tells me when we meet on the high street of her hometown of Bakewell, Derbyshire.  

It's a sunny day and the tourists have flocked to this picturesque market town in the heart of the Peak District.

Day-trippers wander around the souvenir shop and queues have formed to buy the famous Bakewell pudding, which has made this town famous since the 1820s.

But Sarah isn't feeling it.

Food prices are still 25% more expensive than when I first met Sarah and Paul in 2022. She calls that period the "dark days".

Be the first to get Breaking News

Install the Sky News app for free