Cultivating Clinical Judgement in Nursing: How to Think Critically and Make the Best Decisions

Clinical judgment is an essential skill for nurses. It is the ability to think critically and make decisions in the best interest of patients. This can be a challenge, especially when there are multiple options and no clear right or wrong answer. In this blog post, we will discuss how to cultivate clinical judgment and think critically in nursing. We will also provide tips for making the best decisions possible for your patients!

Table of Contents

What is clinical judgment and why is it important in nursing?

Clinical judgment is the ability to think critically and make decisions in the best interest of patients. This skill is essential for nurses, as they are often the ones who are responsible for making decisions about the patient’s care. Nurses need to be able to think critically in order to evaluate information, make sound decisions, problem-solve, and troubleshoot in difficult situations.

If the wrong decision is made about patient care, patients could potentially be harmed. For example, if a nurse decides to administer a medication based on faulty information such as an inaccurate weight, the patient could experience negative side effects from the medication. Alternatively, if a nurse fails to make a timely decision about a patient’s care, the patient could suffer from an illness or injury that could have been prevented.

Clinical judgment can be a challenge, especially when there are multiple options and no clear right or wrong answer.

What is the difference between critical thinking and analytical thinking?

Critical Thinking is a type of thinking that questions assumptions and looks at information in different ways by using reasoning to reach a conclusion. Many people use this kind of thinking to determine what is right and wrong. An example of critical thinking is a nurse who is questioning a doctor’s order to give a patient a certain medication. The nurse may not think that the medication is necessary and could potentially harm the patient, so she uses her critical thinking skills to question the doctor and get more information.

Analytical Thinking is a type of thinking that breaks down information into smaller parts in order to understand it better and find a solution. This type of thinking is often used in identifying cause-and-effect relationships and making connections between two factors. An example of analytical thinking is a nurse who is trying to figure out why a patient’s blood pressure is high. The nurse will look at all of the information she has about the patient’s condition and try to find a reason for the high blood pressure. She may look at the patient’s diet, stress levels, and medications to try to find a cause.

 

Critical thinking is a higher level of thinking than analytical thinking. It involves higher-level thinking skills such as interpretation, analysis, evaluation, and inference. You will use both versions of thinking in your ICU career.

Questions to ask when you are critically thinking

  1. What’s happening? Gather the basic information and begin to think of questions. For example, you note that the patient’s skin is yellow. You wonder if this is jaundice and begin to gather information about the patient’s history, current medications, and lab results.
  2. What does this mean? After you have gathered information, begin to interpret what it means. For example, you review the patient’s lab results and note that the bilirubin level is elevated. You think that this could be indicative of liver damage and begin to consider the possible causes.
  3. Why is it important? Ask yourself why it’s significant and whether or not you agree. For example, you think that the patient’s elevated bilirubin level is significant because it could be indicative of liver damage. You agree that this is a possibility and think that it’s important to monitor the patient closely.
  4. What don’t I see? Is there anything important missing? For example, you don’t see anything in the patient’s history that would explain the jaundice and you think that it’s important to find out more. Are there any other indications of liver damage such as an elevated AST or ALT?
  5. How do I know? Ask yourself where the information came from and how it was constructed. For example, you know that the bilirubin level is elevated because you reviewed the patient’s lab results. The lab results are reliable because they were taken by a certified lab technician and all other labs are consistent with their findings.
  6. What else? What if? What other ideas exist and are there other possibilities? For example, you think that the patient’s elevated bilirubin level could be due to liver damage, but it could also be due to hemolysis (breakdown of red blood cells), damage to the bile ducts, systemic infections such as bacterial sepsis, and cancer.
  7. What now? Now that you have considered all of the information, what are you going to do? For example, you decide to monitor the patient closely and order additional tests to rule out liver damage.
  8. What are the consequences if I’m wrong? Think about what could happen if you make the wrong decision. For example, if you don’t order additional tests and the patient does have liver damage, their condition could worsen and they could develop complications such as ascites (fluid in the abdomen) or encephalopathy (brain damage).

What are the 5 components of critical thinking in nursing?

The first step in critical thinking is problem recognition. This is when you become aware of a potential problem and begin to gather information about it.

For example, you note that the patient’s respiratory rate has increased significantly since your last assessment. You begin to gather information about the patient’s history, current medications, and lab results.

The second step is prioritization. This is when you prioritize the problems and decide which one needs to be addressed first.

In this case, you may decide that the patient’s increased respiratory rate is more important than the fact that their skin is yellow.

The third step is clinical decision-making. This is when you consider the possible causes of the problem and decide on the best course of action.

In this case, you may think that the patient’s increased respiratory rate could be due to a number of different things and order additional tests to help narrow down the possibilities. However, in the meantime, you call Respiratory Therapy for worsening symptoms and decreasing oxygen saturation.

The fourth step is clinical implementation. This is when you carry out the plan of care that you have decided on.

In this case, you would start to consider oxygen delivery devices and set up the patient on a non-rebreather mask at 15 L/min before moving to a BiPAP option. You may also want to order arterial blood gases to see how the patient is oxygenating and place a call out to the physician to get orders before the condition worsens.

The fifth and final step is reflection. This is when you reflect on the care that you have provided and consider what could have been done differently.

In this case, you may reflect on the fact that you could have called the physician sooner or placed the patient on a BiPAP sooner. You may also want to consider what other causes of respiratory distress there could be and how you would approach them in the future. For example, maybe the patient was receiving a blood transfusion that lead to Transfusion Associated Circulatory Overload (TACO) causing respiratory distress. We noted in an earlier example that the patient’s skin was starting to yellow, the patient may also be experiencing a delayed hemolytic transfusion reaction if they had an initial blood transfusion a few days ago.

Common barriers to critical judgment

Common barriers to critical judgment and thinking in nursing include time constraints, fatigue, lack of knowledge, and emotional stress. It is important to be aware of these barriers and how they can impact your decision-making.

For example, if you are working a 12-hour shift, you may be more likely to make a mistake due to fatigue. If you are caring for a patient with a rare disease, you may be more likely to make a mistake due to lack of knowledge. If you are caring for a patient who has just been diagnosed with cancer, you may be more likely to make a mistake due to emotional stress.

It is important to be aware of these barriers and how they can impact your decision-making. If you are feeling fatigued, take a break. If you are feeling stressed, take a few deep breaths. If you are unsure about something, ask a colleague or look it up in a reference book.

By being aware of the common barriers to critical thinking and judgment, you can make sure that they do not impact your ability to provide safe and effective care.

What are some of the barriers to critical thinking and judgment that you have experienced in your nursing career? How did you overcome them? Share your stories in the comments below!

How can you cultivate clinical judgment as a nurse?

  1. Understand the concept of clinical judgment: The first step to cultivating clinical judgment is understanding what it is and how it works.
  2. Identify common barriers to critical thinking and judgment: As a nurse, you will face many challenges that can impact your ability to think critically and make sound judgments. It is important to be aware of these barriers, understand how to overcome them, and how they can impact your decision-making.
  3. Practice using clinical judgment in different scenarios: The best way to learn how to use clinical judgment is to practice in different scenarios. You can do this by working through case studies, taking part in simulation exercises, or by discussing different cases with your colleagues.
  4. Reflect on your use of clinical judgment and learn from your experiences: After you have used clinical judgment in a real-life situation, it is important to reflect on the experience. What went well? What could you have done differently? What would you do in a similar situation in the future?
  5. Advocate for yourself and your patients when it comes to clinical decision-making: As a nurse, you are the expert when it comes to patient care. If you feel like a decision is being made that is not in the best interest of your patient, speak up. Advocate for yourself and your patients to ensure that they receive the best possible care.
  6. Stay up-to-date with the latest evidence-based practice guidelines: As a nurse, it is important to stay up-to-date with the latest evidence-based practice guidelines. This will ensure that you are providing the best possible care to your patients

How to improve critical thinking in nursing school

If you are a nursing student, there are a few things that you can do to improve your critical thinking skills.

First, make sure that you understand the concept of critical thinking. Read articles and books on the subject, and talk to your professors and classmates about it.

Second, practice “thinking out loud.” When you are working on a nursing clinical, take the time to verbalize your thought process. This will help you to identify any gaps in your reasoning, and it will also help you to learn from your mistakes.

Third, work on problem-solving skills. In nursing, you will often be presented with complex problems that do not have a clear-cut solution. Practice identifying the different components of the problem and brainstorming possible solutions.

Fourth, learn how to effectively communicate with patients and families. When you are able to communicate effectively, you will be better able to understand the patient’s perspective and needs. This, in turn, will help you to make better decisions.

Finally, stay up-to-date with the latest evidence-based practice guidelines. As a nursing student, you have access to a wealth of information. Use this to your advantage, and make sure that you are always using the most current evidence to guide your practice.