Critical or reflective thinking has been widely promoted in nursing management and health care education as an effective approach for improving clinical decision-making, analytical and problem-solving skills of health care professionals.
Fero, Witsberger, Wesmiller, Zullo and Hoffma (2009) define critical thinking (CT) as a subjective thought process that involves assessment, analysis and interpretation of clinical events and scenarios. CT, at the health care administration level, has been associated with safe patient care, and better patient and staff outcomes.
In Fero et al.’s (2009) study, it was recommended that nurse educators develop instructional strategies that improve critical thinking in nursing students by training them to be critical in their judgment, continue inquiry, and handle complex clinical situations. This would prepare nursing students to become effective nurse leaders later in their career.
To achieve these results, the study identified “the initiation of independent nursing interventions, differentiation of urgency, clinical data reporting, providing relevant rationales and problem recognition” (Fero et al., 2009, p. 145), as the core training areas.
On his part, Drennan’s (2010) study explores the impact of Master’s training on the critical thinking of medical graduates. He reported that, compared to students taking undergraduate medical programs, postgraduate nursing students have better CT skills in “reflection, evaluation, inference and clinical reasoning” (2010, p. 429).
This finding reinforces Fero et al’s (2009) assertion that teaching strategies, which focus on essential CT skills help prepare students for clinical decision-making in the complex and dynamic clinical environment. It also underscores the benefits of exposure to reflective thinking during nursing education as a way of acquiring self-directed learning and reflective practice.
In this study, the medical graduates with a Master’s degree recorded higher CT scores compared to graduates from other levels (undergraduate diploma). This implies that the instructional strategies employed in Master-level training to improve the critical thinking of students. In view of this, Fero et al. (2009) write that better CT skills improve patient and staff outcomes. Experienced nurses make good managers due to their reflective practice and critical thinking skills.
Building on this premise, a systematic review of studies on critical thinking skills by Robert and Petersen (2013) found that reflective practice fosters safe and quality care delivery among health care professionals. This study found that professionals with effective CT skills use a case-based approach (model, borderline, related and contrary cases) in their practice. This approach is effective in clinical decision-making and problem-solving.
Compared to Fero et al.’s (2009) key CT skills of autonomous interventions, clinical judgment, and analysis and interpretation of problems, Robert and Petersen (2013) identify risk estimation, and analysis and evaluation of diagnosis as the key aspects of CT. Two sets of CT skills that are important to nurse managers have been identified in these studies. The first skill is autonomy in relation to medical interventions, problem identification and data reporting (Fero et al., 2009).
This skill fosters safe patient care and evidence-based practice. Reflective practice is another important CT skill for nurse managers whose outcomes include patient-focused care and better intervention choice (Robert & Petersen, 2013). These skills can be acquired through learning (the postgraduate training) and experience.
The two studies by Zori and Morrison (2009), and Zori, Nosek and Musil (2010) focus on the outcomes of critical thinking in clinical environments. One of the outcomes of CT is effective leadership. Besides clinical expertise, clinical nurse leaders (CNLs) have essential CT skills such as analytical, managerial, inductive, collaborative and problem-solving skills that make them effective leaders in clinical settings.
Zori and Morrison (2009) note that such skills, which are acquired through formal education and clinical experience, enhance the leaders’ outcome and situation awareness. Such leaders promote quality care and on-budget spending, which leads to better patient and staff satisfaction.
The second outcome of CT is low staff turnover. CT skills allow nurse managers to create a positive work environment that increases the nurses’ job satisfaction and retention. The third outcome of CT is quality care delivery. CNLs encourage evidence-based practice among health care professionals, which leads to quality patient care.
By increasing job satisfaction, CNLs are able to attract and retain experienced RNs in their workforce (Zori, Nosek & Musil, 2010). The study found that the perceptions of the nursing staff improve when the nurse manager employs critical thinking in his or her decisions and practice. The authors identify three ways that critical thinking among leaders contribute to better patient and staff outcomes.
First, nurse managers with critical thinking skills are open-minded, confident and great problem solvers (Zori, Nosek & Musil, 2010). They collect patient-related data, analyze and interpret it to develop and implement patient-centered care plans that improve patient outcomes.
They ensure balanced workloads for the nursing staff, which improves patient care delivery, job satisfaction and staff retention. Second, such nurse leaders emphasize on quality improvement. A quality-oriented care environment allows the health care professionals to embrace evidence-based practice. CLNs also mentor/train new nurses and create an environment of learning and skill development.
References
Drennan, J. (2010). Critical thinking as an outcome of a Master’s degree in Nursing programme. Journal of Advanced Nursing, 66(2), 422–431.
Fero, L., Witsberger, C., Wesmiller, S., Zullo, T., & Hoffma, L. (2009). Critical thinking ability of new graduate and experienced nurses. Journal of Advanced Nursing, 65(1), 139–148.
Robert, R. & Petersen, S. (2013). Critical Thinking at the Bedside: Providing Safe Passage to Patients. MEDSURG Nursing, 22(2), 85-118.
Zori, S. & Morrison, C. (2009). Critical Thinking in Nurse Managers. Nursing economics, 27(2), 75-80.
Zori, S., Nosek, L. & Musil, C. (2010). Critical Thinking of Nurse Managers Related to Staff RNs’ Perceptions of the Practice Environment. Journal of Nursing Scholarship, 42(3), 305–313.