good nurse critical thinking

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.

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?

Critical Thinking in Nursing

• First Online: 02 January 2023

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• Şefika Dilek Güven 3  

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Critical thinking is an integral part of nursing, especially in terms of professionalization and independent clinical decision-making. It is necessary to think critically to provide adequate, creative, and effective nursing care when making the right decisions for practices and care in the clinical setting and solving various ethical issues encountered. Nurses should develop their critical thinking skills so that they can analyze the problems of the current century, keep up with new developments and changes, cope with nursing problems they encounter, identify more complex patient care needs, provide more systematic care, give the most appropriate patient care in line with the education they have received, and make clinical decisions. The present chapter briefly examines critical thinking, how it relates to nursing, and which skills nurses need to develop as critical thinkers.

Graphical Abstract/Art Performance

Critical thinking in nursing.

This painting shows a nurse and how she is thinking critically. On the right side are the stages of critical thinking and on the left side, there are challenges that a nurse might face. The entire background is also painted in several colors to represent a kind of intellectual puzzle. It is made using colored pencils and markers.

(Adapted with permission from the Association of Science and Art (ASA), Universal Scientific Education and Research Network (USERN); Painting by Mahshad Naserpour).

Unless the individuals of a nation thinkers, the masses can be drawn in any direction. Mustafa Kemal Atatürk

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Güven, Ş.D. (2023). Critical Thinking in Nursing. In: Rezaei, N. (eds) Brain, Decision Making and Mental Health. Integrated Science, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-031-15959-6_10

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The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.

The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.

As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier

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Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.

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Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465

Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)

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15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)

Last updated on August 19th, 2023

Critical thinking is a powerful tool that nurses use to make informed decisions, provide top-notch care, and untangle complex problems.

Think of it as a toolbox filled with skills that let nurses dig deeper, understand better, and think smarter.

In this article, we’re going to explore the 15 super-important attitudes of critical thinking in nursing .

Each attitude is like a special key that helps nurses unlock the best care for their patients. Let’s dive in and learn about each attitude.

How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples

15 Attitudes of Critical Thinking in Nursing

1. Independence

Independence is like thinking for yourself and making your own choices. Imagine you’re deciding what book to read, and you pick one that interests you, not just what others like – that’s being independent.

In nursing, independence means using your own judgment to provide the best care.

For, example, consider Rachel, a nurse, who considers various options to treat a patient’s pain, not just following what others do. Rachel’s independence helps her find solutions tailored to each patient’s needs.

 Just like choosing your own book, independent nurses think critically and make decisions based on what’s best for their patients.

2. Confidence

Confidence is like believing in yourself and your abilities, even when faced with challenges. Imagine you’re trying a new activity, and you trust that you can learn and do well – that’s having confidence.

In nursing, confidence means having faith in your skills and judgment to provide excellent care. Example: For instance, think of Ava, a nurse, who remains composed when a patient’s condition suddenly worsens.

She knows she can handle the situation because of her training and experience. Ava’s confidence allows her to make quick and effective decisions during critical moments.

Just like trusting yourself in a new activity, confident nurses trust their expertise to deliver top-notch care to their patients.

3. Fair-Mindedness

Fair-mindedness is like treating everyone equally and making judgments based on facts, not personal feelings. Imagine you’re playing a game, and you give every player the same chance to win – that’s being fair-minded.

In nursing, fair-mindedness means being impartial and considering all viewpoints without bias.

For example, picture Liam, a nurse, who listens to both the patient and the family when making a decision about treatment.

He doesn’t let his own opinions influence his judgment. Liam’s fair-mindedness ensures that he provides balanced and patient-focused care.

Just like being fair in a game, fair-minded nurses make decisions that are just and unbiased, promoting the best outcomes for their patients.

4. Insight into Personal Biases

Insight into personal biases is like looking at yourself from the outside to see if your own feelings might affect your decisions. Imagine you have a favorite color, and you realize you tend to choose things in that color even if other options might be better – that’s being aware of your bias.

In nursing, insight into personal biases means being mindful of your own preferences and not letting them cloud your judgment.

For instance, think of Maya, a nurse, who knows she might prefer a particular treatment because it worked for her family member.

However, she steps back and considers what’s truly best for her patient’s situation. Maya’s insight helps her provide care that’s unbiased and patient-centered.

Just like being aware of your color preference, insight into personal biases helps nurses make decisions that are based on what’s right for their patients, not influenced by their own feelings.

5. Intellectual Humility

Intellectual humility is like knowing that you don’t have all the answers and being open to learning from others. Imagine you’re playing a video game, and you ask a friend for tips because they’re better at it – that’s being humble about your skills.

In nursing, intellectual humility means recognizing that you can always learn more and considering others’ expertise.

Picture James, a nurse, who seeks advice from experienced colleagues when faced with a complex case.

He knows that learning from others can lead to better patient care. James’s intellectual humility helps him grow as a nurse and keeps him open to new perspectives.

Just like seeking gaming tips, intellectual humility encourages nurses to value knowledge from various sources and continuously improve their practice.

6. Intellectual Courage to Challenge the Norms

Intellectual courage to challenge the norms is like having the bravery to question things that everyone believes are true. Imagine you’re playing a game with your friends, and everyone agrees on the rules – but you speak up and suggest a new way to play.

In nursing, intellectual courage means daring to question established practices and seeking innovative solutions.

For instance, think of Sarah, a nurse, who notices that a routine procedure might be improved for patient comfort.

Instead of staying silent, she speaks up and proposes a change, backed by research and careful thought. Sarah’s intellectual courage drives her to challenge the status quo for the sake of better patient care.

Just like suggesting a new game rule, nurses with this attitude challenge norms to advance healthcare practices and outcomes.

7. Integrity

Integrity is like being honest and doing the right thing, even when nobody’s watching. Imagine finding a lost wallet on the street – instead of keeping it, you return it to its owner because it’s the right thing to do.

In nursing, integrity means always acting ethically and responsibly, even in challenging situations.

Picture Emma, a nurse, who follows protocols and makes decisions based on what’s best for her patients, not personal gain.

 Emma’s integrity shines when she prioritizes honesty, fairness, and patient well-being in every action she takes.

Just like returning that wallet, integrity is a nurse’s commitment to uphold high moral standards and maintain the trust placed in them by patients and their families.

8. Perseverance

Perseverance is like having a never-give-up attitude, even when things get tough. Imagine you’re trying to solve a challenging puzzle – even if it takes time and effort, you keep going until you find the solution.

In nursing, perseverance means facing obstacles and difficulties head-on without giving up.

For example, consider Mark, a nurse, who’s dealing with a complex patient case. Despite encountering roadblocks and uncertainties, Mark doesn’t lose hope.

He keeps researching, consulting colleagues, and trying different approaches until he finds the right solution for his patient.

Just like working through a tough puzzle, perseverance empowers nurses to keep pushing forward and find the answers that lead to the best care outcomes.

9. Curiosity

Curiosity is like having a hunger for knowledge that never goes away. Imagine you’re exploring a new place, and every corner seems to hide something interesting – you want to know what’s around the next bend.

In nursing, curiosity means having a strong desire to learn and discover.

Picture Anna, a nurse, who’s always asking questions like “Why?” and “How?” She’s not content with just knowing the basics; she wants to dive deeper and understand the “whys” behind patient conditions and treatments.

Anna’s curiosity drives her to stay updated with the latest research and innovative methods. Just like an explorer seeking new horizons, curious nurses seek new ways to provide better care for their patients.

10. Open-Mindedness

Open-mindedness is like having a door in your mind that’s always ready to welcome new ideas. Imagine you’re reading a book, and suddenly you come across a different way of thinking – instead of dismissing it, you consider it with interest.

In nursing, open-mindedness means being willing to listen to various viewpoints and explore different approaches.

For instance, think of Rachel, a nurse, who’s used to a specific way of treating wounds. But when a colleague suggests a new method, Rachel doesn’t shut the idea down.

Instead, she’s open to trying it out and seeing if it might work better for her patients. Just like being curious about new stories, open-minded nurses are curious about new ways to improve patient care.

11. Skepticism

Skepticism is like being a curious investigator who asks questions to make sure things are true. Imagine you hear about a magical potion that promises to make you fly – you might be skeptical and ask, “Is that really possible?”

In nursing, skepticism means not accepting things blindly but investigating to find the truth.

Picture Sarah, a nurse, who reads about a new treatment for pain relief. Instead of immediately believing it, she looks for evidence and checks if other experts agree.

Sarah’s skepticism helps her make sure that the treatments she uses are safe and effective for her patients.

Just like asking questions about that magical potion, nurses use skepticism to make informed decisions based on facts.

12. Reflective Thinking

Reflective thinking is like looking back at your day and thinking about what went well and what you could improve. Imagine you finished playing a game and you think about how you did – that’s reflective thinking!

In nursing, it’s when nurses take a moment to think about their actions, decisions, and interactions with patients.

For example, let’s say Jessica, a nurse, had a challenging day where she had to juggle multiple tasks. At the end of her shift, she takes a few minutes to reflect.

She thinks about what she did right, like comforting a worried patient, and what she could do better, like managing her time more efficiently.

This reflection helps Jessica learn from her experiences and become an even better nurse.

Just like looking in a mirror to see yourself, reflective thinking helps nurses see their actions and grow from them.

13. Logical Reasoning

Logical reasoning is like putting together the pieces of a puzzle to see the bigger picture. It’s about thinking step by step to reach a smart conclusion.

Imagine you have a math problem to solve. You start with the information you know and use logical steps to find the answer.

Similarly, nurses use logical reasoning to understand their patients’ situations

Let’s say Emily, a nurse, has a patient with a high fever and a sore throat. She gathers information about the symptoms, asks questions, and puts all the clues together.

By using logical steps, Emily figures out that the patient might have a throat infection and can recommend the right treatment.

Just like solving a puzzle, logical reasoning helps nurses connect the dots and make decisions that make sense for their patient’s health.

14. Evidence-Based Decision Making

Evidence-based decision-making is like being a detective who gathers clues before solving a mystery.

For instance, imagine Alex, a nurse, who wants to find the best way to help patients with diabetes manage their blood sugar levels.

Instead of guessing, he reads research studies and talks to experts in the field. Alex uses the facts he collects to choose treatments that are proven to work.

Just like a detective uses evidence to solve a case, Alex uses evidence to make informed decisions that lead to better patient outcomes.

15. Problem-Solving

Problem-solving is like being a detective on a mission. Think of it like when you have to figure out how to fix a broken toy.

For instance, Linda, a nurse, faces a challenge when a patient’s pain medication isn’t working well. Instead of giving up, she gathers information, talks to the patient, and works with the medical team to find a better solution.

Linda’s problem-solving skills help her piece together the right treatment plan, just like solving a tricky puzzle.

• What is Critical Thinking in Nursing? (Explained W/ Examples)
• What is the “5 Whys” Technique?
• What Are Socratic Questions?
• Clinical Reasoning In Nursing (Explained W/ Example)
• 8 Stages Of The Clinical Reasoning Cycle

Critical thinking is a powerful tool that nurses use every day. These 15 attitudes are like a treasure map that guides nurses through the world of healthcare.

From being independent thinkers to having the courage to challenge norms, these attitudes help nurses provide the best care possible.

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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.

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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

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Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Affiliations.

• 1 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group Quantitative Psychology (2017-SGR-269), University of Barcelona, Barcelona, Spain.
• 2 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group on Gender, Identity and Diversity (2017-SGR-1091), University of Barcelona, Barcelona, Spain.
• 3 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.
• 4 Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain.
• PMID: 33029860
• DOI: 10.1111/nup.12332

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.

© 2020 John Wiley & Sons Ltd.

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Critical thinking skills of nursing students: Observations of classroom instructional activities

Christian makafui boso.

1 Department of Nursing and Midwifery, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town South Africa

2 School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast Ghana

Anita S. van der Merwe

Janet gross.

3 Peace Corps Liberia, Mother Patern College of Health Sciences, Stella Maris Polytechnic, Monrovia Liberia

Critical thinking (CT) is vital for nursing practice. Nursing schools should provide learning experiences that enable nursing students to acquire CT skills. Yet, these authors are not aware of any study that has directly observed instructional activities related to CT skills acquisition in the classroom environment. The aim of this study was to explore instructional activities in the classroom environment in relation to acquisition of CT skills of students.

Qualitative non‐participant observation.

Using a purposive sampling, 10 classroom teaching sessions were observed and mediating factors of CT skills acquisition of students noted. Data were analysed thematically. Data were collected from October–December 2017. 

Three key themes of instructional activities relating to acquisition of CT skills of students emerged, namely educators’ behaviour, students’ characteristics and university‐wide factors/administrative support. Class sizes ranged from 34–162 students with an average of 95.

1. INTRODUCTION

The ever‐changing and complex healthcare environment requires that nurses acquire critical thinking (CT) skills to meet the complex challenges of the environment (Von Colln‐Appling & Giuliano, 2017 ). Nurses should be able to select and use data for effective clinical judgements to promote good health outcomes (Nelson, 2017 ; Von Colln‐Appling & Giuliano, 2017 ). Consequently, nursing schools must offer learning experiences that assist students to think critically about complex issues instead of just merely becoming receptacles for information (Toofany, 2008 ; Von Colln‐Appling & Giuliano, 2017 ). It is the duty of nurse educators to help students to acquire CT skills (Nelson, 2017 ; Von Colln‐Appling & Giuliano, 2017 ).

Attempts have been made to conceptualize CT to guide the facilitation of CT skills of students. Worth noting are Dwyer, Hogan, and Stewart ( 2014 ) and Duron, Limbach, and Waugh’s ( 2006 ) frameworks, which could be relevant in the classroom setting. Focusing on learning outcomes, Dwyer et al. ( 2014 ) posited that long‐term memory and comprehension are foundational processes for CT application. The framework incorporates both reflective judgement and self‐regulatory functions of metacognition as a requirement for CT. Self‐regulation refers to an individual's ability, willingness and the perceived need to think critically when solving specific problems. Therefore, factors that influence the interrelationship between short‐term and long‐term memory (the bedrock of CT), comprehension, reflective judgement and self‐regulation functions of metacognition will influence CT skills of the students. On the other, Duron et al.’s model focused on practical instructional activities needed to guide students in acquiring CT skills. The five‐step framework requires that educators: (a) determine learning objectives; (b) teach through questioning; (c) practice before assessing; (d) review, refine and improve; and (e) provide feedback and assessment of learning.

Nursing literature is replete with studies demonstrating that adopting appropriate teaching methods/strategies, such as active learning, improves the CT scores of students. Examples of such approaches include problem‐based learning (Jones, 2008 ; Jun, Lee, Park, Chang, & Kim, 2013 ), concept mapping (Wheeler & Collins, 2003 ) and simulation (Sullivan‐Mann, Perron, & Fellner, 2009 ). Furthermore, based on a systematic review, Chan ( 2013 ) suggested three strategies to facilitate CT skills of nursing students, which include appropriate questioning strategy, reflective writing on learning experiences and discussion of case study.

The classroom environment provides a vital opportunity for educators to create the necessary milieu to encourage students to develop their CT skills. It is therefore required that negative factors to the development of CT are minimized or removed and those factors that enhance the development of CT skills are accentuated. However, these factors that influence CT have received less attention in nursing education (Raymond, Profetto‐McGrath, Myrick, & Strean, 2018 ). Furthermore, no direct observations have been made to identify specific factors influencing CT in the classroom setting.

Studies such as those of Mangena and Chabeli ( 2005 ) and Shell ( 2001 ) assessed factors that inhibit CT acquisition of nursing students. Mangena and Chabeli's study focused on educators and students’ perspectives. They found that educators’ lack of knowledge of CT teaching methods and evaluation, negative attitudes of educators, student selection and educational background, socialization, culture and language inhibited the development of CT skills of students. Shell also found negative student factors, demand to cover content and time constraints both on class time and on educators’ development that hindered CT skills development of students.

Raymond and Profetto‐McGrath ( 2005 ) also identified internal and external factors of educators that had an impact on their CT. These factors included physical and mental well‐being, the view of leadership on CT and collegial relationships that existed in the educators’ environment. Similarly, Raymond et al. ( 2018 ) identified personal (elements/conditions originating from the educator), interpersonal (elements originating from the student–educator relationship) and broader environmental factors (conditions evident in the larger physical setting or political milieu) that influenced educators’ CT and influenced their abilities to role model CT skills.

The above authors focused on factors influencing CT from different perspectives. Shell ( 2001 ) and Mangena and Chabeli ( 2005 ) focused on barriers to student development of CT. Also, Shell examined educators’ perspectives. Mangena and Chabeli examined both educators’ and students’ views. Raymond and Profetto‐McGrath ( 2005 ) and Raymond et al. ( 2018 ) specifically focused on nurse educators' CT skills. None of the above studies directly observed classroom teaching though similar factors were identified.

2. BACKGROUND

The “greatest healthcare resource is the healthcare personnel, of which nurses are a primary component” (Talley, 2006 , p. 50). However, limited resources in nursing schools especially in developing countries where this study was undertaken (Talley, 2006 ) impede the experiences required for the students to develop CT skills. For example, studies have identified lack of qualified educators (Bell, Rominski, Bam, Donkor, & Lori, 2013 ; Salifu, Gross, Salifu, & Ninnoni, 2018 ) as well as infrastructural and logistical constraints (Talley, 2006 ), large class sizes and absenteeism (Wilmot, Kumfo, Danso‐Mensah, & Antwi‐Danso, 2013 ) as some of the challenges affecting nursing education. These challenges have led to the dominance of inappropriate teaching approaches (Boso & Gross, 2015 ; Wilmot et al., 2013 ).

Similarly, studies regarding CT have reported the negative influence of sociocultural norms such as the seniority tradition (Chan, 2013 ; Jenkins, 2011 ; Kawashima, 2003 ; Mangena & Chabeli, 2005 ). In such cultures, students are not encouraged to speak out openly (Chan, 2013 ). For example, an individual is not expected to disagree nor question an authority figure in public. In the context of this study, the seniority tradition could have been manifested in the classroom where the faculty is regarded as an authority whose ideas may be seen as sacrosanct by students. These authors argue that it is necessary to identify the factors through direct observation that might hinder or enhance the facilitation of CT of students in the classroom setting. Notwithstanding, the authors of this paper had not found any publication in the nursing literature where direct observation for CT teaching methods/strategies had been carried out in the classroom setting. Therefore, this study explored factors that might influence students’ ability to memorize and comprehend content towards CT skills acquisition. Also, educators’ instructional activities that either enhanced or inhibited students’ CT facilitation in the classroom context were explored.

3. THE AIM OF THE STUDY

The aim of this study was to explore instructional activities towards the development of CT skills of students in a classroom environment. This study was part of a larger research project aimed at developing a CT‐based curriculum framework of students.

4. RESEARCH DESIGN

Qualitative non‐participant observation design was used. This design was to allow for the observation of first‐hand (Patton, 2015 ) and unusual aspects (Creswell & Creswell, 2018 ) real‐time classroom practices whilst being present. Also, qualitative observation has been noted as a primary means of understanding the experiences of users (Reddacliff, 2017 ).

5.1. Setting

The study was conducted in classroom settings of an undergraduate nursing programme in a public university in Ghana. As a school in a developing country, there are constraints such as logistical inadequacies and lack of adequate qualified faculty, which could inhibit meaningful learning experience towards CT skills development of students existed. The classes are scheduled based on the demands of the various departments of the university. The university runs several programmes, and each programme is allocated with venues as demanded.

5.2. Sampling

Through a purposive method ten (10) teaching sessions from class levels 200 to 400 were observed from October to December 2017. Educators who had lectures within the period were approached face‐to‐face. Ten out of 16 educators agreed to participate. They provided informed consent. The 10 sessions provided rich data to be able to deduce current practices of instruction as occurring in the classroom environment. The main selection criterion was a full teaching session (1–3 hr) of B.Sc. nursing undergraduate programme taught by an educator in the selected nursing school.

5.3. Data collection and instrumentation

Data were collected between October and December 2017. The observations were from five level 200, three level 300 and two level 400 classes; six medical–surgical, one maternal health, one biomedical and two nursing fundamental/theoretical courses were taught. Two individuals—first author and an assistant, consistent with Winter and Munn‐Giddings’ ( 2001 ) recommendation for observation, observed the teaching sessions. A six‐item semi‐structured observation guide/protocol using Billing and Halstead's ( 2005 ) six steps of designing learning experiences for developing CT skills was employed for data collection. Billing and Halstead's six steps of designing experiences for developing CT skills were consistent with identifying factors that enhance or inhibit memory, comprehension, reflective judgement and instruction identical to Dwyer et al. ( 2014 ) and Duron et al.’s ( 2006 ) frameworks. The protocol was pre‐tested in a classroom at an analogous nursing school. Though the sixth step of Billing and Halstead's ( 2005 ) six steps of designing learning experiences for developing CT skills proposes both summative and formative assessments, in the context of this observation, only formative assessment methods used by the educators could be observed.

Billing and Halstead's six steps of designing experiences for developing CT skills are as follows. Step 1 involved determining the learning outcome for the specific class. These learning objectives should be explicitly clear to students and fit for purpose. Step 2 involved creating an anticipatory set. The educator's strategies that generate students’ interest in content, encourage their participation and create collegial environment for students were observed. Step 3 consisted of selecting teaching and learning strategies. Observation focused on identifying active learning methods of teaching against passive teaching methods. Also, whether the educator or students dominated the class was explored. Whether the nurse educator combined different teaching methods/strategies were explored. Step 4 considered implementation issues. Class size, involvement of students, classroom arrangement, use of teaching aids and materials and instructional media were observed. Step 5 involved the observation of how the learning experience was closed. This included how the educator summarized the lesson and related lessons to next class period. Step 6 involved how students’ learning experiences were evaluated. The educator's strategies for the assessment and evaluation of student learning experience during class period were observed.

The observers positioned themselves at the back of the classrooms throughout each period of teaching. Participants did not appear distracted or uncomfortable during the periods of observation. Thoughts and feeling of the observers relative to observed situations were captured as field notes. In order not to distract and cause discomfort to participants, the observers took minimal notes and expanded them immediately after the observations. Transcripts from the observations were compared and agreed on by the two observers. Differences were resolved through discussion. Also, the educators whose teaching sessions were observed were asked to provide feedback and revision made based on educators' comment(s). This was to minimize observers’ bias.

5.4. Data analysis

Bryman's ( 2010 ) four stages of qualitative analysis as described by Gibbs ( 2010 ) were used to analyse the data. The first author and an assistant described each observation. Later, the first author read the transcript at least four times to enable a meaningful content analysis. Data were coded, and themes and sub‐themes were derived. Subsequently, the second and third authors who are the supervisors of this research project cross‐checked the themes and sub‐themes with the observational transcripts for validation.

5.5. Ethical consideration

This study was approved as one part of a doctoral project by the Health Research Ethics Committee of Stellenbosch University (Ref. no S17/05/106) and the university where the study was done. Permission was also sought from the dean of the selected school. The first author visited the students at their various classrooms to explain the nature and purpose of the study to them. Likewise, the nurse educators were provided with information on the purpose and nature of the study. They were provided individually with informed consent forms for signing before data were collected. They were assured of their rights to opt out at any stage of the study. Confidentiality and anonymity were also assured. Individual participants were not identified with the data (during data collection, analysis and reporting).

Three overall themes were deduced from the classroom observation data, namely educators’ behaviour, students’ behaviour and university‐wide factors/administrative support. These themes related to the Dwyer et al. ( 2014 ) and Duron et al.’s ( 2006 ) frameworks of CT development. To reiterate, these factors could either enhance or inhibit memory (foundation of CT development), comprehension, reflective judgement and self‐regulatory functions of metacognition as a requirement for CT.

6.1. Theme I: Educators’ classroom behaviour

Educators’ behaviour includes actions and inactions of the educators that might either enhance or inhibit students’ positive learning experiences towards the acquisition of CT skills. Four sub‐themes under this theme were identified namely beginning and ending on time; creating a conducive and participatory environment; and teaching methods and styles and managing the class.

6.1.1. Subtheme A: Beginning and ending on time

Only one (observation 6) started on time. The lecturer was in the class before scheduled time waiting for students. However, nine of the classes started late. The lateness ranged from 10 min (observations 2 and 7) to 44 min (observation 3). In one case (observation 5), the lecturer was on time but students were not available because they were moving immediately from another lecture. In other words, the ending time from the other lecture overlapped with the starting time of the new lecture. In another case (observation 8), the lecturer was engaged in an analogous official duty and therefore reported late.

6.1.2. Subtheme B: Creating a conducive and participatory environment

Some attitudes demonstrated by the educators appeared to have encouraged collegiality. For example, one lecturer's statement, "no answer is wrong, it could only be a right answer to a different question" (observation 2) caused students to participate in the teaching/learning process, which is consistent with CT teaching strategies. Also, some lecturers demonstrated a good sense of humour that was appreciated by students. For example, in observation 3, the lecturer asked a question and after the question, jokingly said, "my question to those in spectacles", which generated laughter from the students. The same lecturer appeared receptive to students’ views—allowed students to disagree with his views and even thanked students for asking questions. These strategies also demonstrated modelling of open‐mindedness (an attribute of CT) on part of the educators.

Active participation in the teaching and learning process is required to facilitate CT skills of students. However, some actions taken by some lecturers appeared to have resulted in students not fully participating in the learning process. For example, students appeared tense or nervous after the lecturer made the statements that "they [students] must respect and not make offensive statements; some of you are still adolescents. You must respect, I have always told you" (observation 8). This statement was in reaction to a comment from a student that the lecturer found to be offensive.

6.1.3. Subtheme C: Teaching methods and styles

The most frequent teaching method used was student presentation. In one case (observation 6), students were given case studies from which they were requested to draw a plan of care. However, students themselves used lectures whilst presenting. General discussions followed students' presentations led by the lecturer. The presentation encouraged students to share their views freely. However, during student presentations, several students appeared disinterested and were passive in the process. Some presenters just read from the power point slides verbatim. In cases where lecturers taught, they often used the lecture method interspersed with periods of questions and answers (observations 2, 3, 4 and 8).

In one lecture (observation 3), the lecturer related lessons to real life situations (stories from the clinical settings) that appeared to have sustained the interest of the students. The lecturer also frequently moved up and down the aisles during the class session. These actions appeared to have caused students to be more attentive (which enhances memory) throughout the session.

6.1.4. Subtheme D: Managing the class

Management of the class appeared to be challenging to some lecturers. For example, in observation 10, the lecturer did not act even when students were engaged in distractive behaviours. Most students generally appeared interested in the lesson. However, several students appeared indifferent with what was happening, and some conversed throughout the session (observation 10).

6.2. Theme II Students' characteristics

Students’ characteristics refer to actions and inactions of the students during observations that might either enhance or inhibit students’ positive learning experiences towards the acquisition of CT skills. Two sub‐themes under this theme were identified, namely distractive student behaviour and punctuality.

6.2.1. Subtheme A: Distractive student behaviour

Attention/perception processing is needed to enhance short‐term memory, which leads to long‐term memory (Dwyer et al., 2014 ). In all classes observed, several students were engaged in distractive behaviours that might hinder memory, namely fidgeting with phones, beeping/ringing phones, petty chatting and whispering—especially those sitting at the back roll of the class. However, what appeared to be the source of most distractive behaviour—the mobile phone—was useful in helping students in some of the presentations. Students sitting in front appeared more attentive. Movement of lecturers up and down the aisles appeared to limit distractive behaviours.

6.2.2. Subtheme B: Punctuality

Students arrived to lectures late. For example, during observation 2, approximately 70 students were late, with some more than 1 hr late. Also, another class session began with 62 students and ended with 117 (about 55 students late). In another instance, at a pre‐scheduled time, only 29 students were present. One student came after about 1 hr 21 min (observation 5), whilst some students left before the classes concluded.

6.3. Theme III: University‐wide factors/administrative support

University‐wide factors/administrative support relate to administrative factors in the university or school that might either enhance or inhibit students’ positive learning experiences towards the acquisition of CT skills. Three sub‐themes under this theme were identified: class size; scheduling of classes; and classroom layout and equipment.

6.3.1. Subtheme A: Class size

Class sizes observed for the 10 sessions ranged from 34–162 with an average of 95 students. Most classes (7) were above 90 students.

6.3.2. Subtheme B: Scheduling of classes

Some students who were to have a lecture immediately after the session were packed at the entrance to the lecture hall whilst engaging in conversation apparently causing distraction (observation 4). Also, some lectures started immediately after a lecture had ended with no time to move from one lecture hall to another.

6.3.3. Subtheme C: Classroom layout and equipment

Classrooms’ arrangements/layouts are rectangular with desks and chair bolted down. Most ceiling mounted projectors in classrooms were dysfunctional forcing lecturers to use movable projectors which were placed too close to screens. This made power point font sizes small. Some screens were torn and dirty making projected content unclear (observation 3). Also, some public address systems were dysfunctional, and therefore, some students could not hear the lecturers. For example, during a lecture (observation 4) on three different occasions, students drew the attention of the lecturer to the fact that they could not hear him. At a point, rain stopped the lecture because students could not hear the lecturer.

7. DISCUSSION

Based on the observation of classroom environment in relation to instructional activities, several factors need to be considered to provide students with the desired learning experiences to the development of their CT skills. Educators’ positive behaviour which served as factors towards the enhancement of CT skills of students identified in this study is worth noting. These factors including educators’ good sense of humour and open‐mindedness appeared to inspire students to engage in the teaching–learning process were encouraging. The learning and learning process were also made entertaining. This finding is consistent with Ulloth's ( 2002 ) study which found humour to be useful in holding students’ attention, relieving anxiety, establishing rapport and making learning fun. Froneman, Du Plessis, and Koen's ( 2016 ) study on student–educator relationship identified similar characteristics needed for meaningful learning experiences of students. Similarly, other studies (Mangena & Chabeli, 2005 ; Raymond & Profetto‐McGrath, 2005 ; Raymond et al., 2018 ) buttress the need for nurse educators to create a conducive environment for students to develop CT skills.

Another finding worth highlighting in this study was negative educators’ factors such as being unfriendly in correcting students, using inappropriate teaching methods and poor class management skills. Similar factors were identified among educators in South Africa (Mangena & Chabeli, 2005 ) and Canada (Raymond & Profetto‐McGrath, 2005 ; Raymond et al., 2018 ). Mangena and Chabeli ( 2005 ) found that educators’ lack of knowledge, inappropriate teaching and assessment methods and educators’ negative attitude as barriers to the facilitation of CT skills of students.

A further noteworthy finding is the inappropriate implementation of CT teaching methods by educators. Notably, the incongruous implementation of students’ presentation and discussion methods need to be highlighted. This finding is similar to Boso and Gross' ( 2015 ) study among nurse educators in Ghana and inappropriate teaching and assessment methods identified in Mangena and Chabeli’s ( 2005 ) study.

Students’ lateness to lectures (lack of punctuality) identified in this study is worth highlighting. This finding indicates loss of valuable time which may be needed to engage with the content which may hinder the development of students’ CT skills. Also, students’ lateness to lectures appears to correspond with educators’ own late start to lectures. This appears to agree with Jack, Hamshire and Chambers' ( 2017 ) findings which highlight the influence of educator's behaviour on students. This is similar to Cruess, Cruess, and Steinert ( 2008 ) and Billings and Halstead's ( 2005 ) assertions about role modelling.

Another important finding of this study was students’ distractive behaviour. Some students engaging in distractive behaviours are not unexpected, but the degree and extent of these distractive behaviours were unanticipated. Shell ( 2001 ) identified students’ behaviour as the highest barrier to the development of CT skills of students. Also, this finding may be indicative of nurse educators’ apparent lack of appropriate classroom management skills required for meaningful learning experience of students. For example, as seen in this study, educator's movements up and down the aisles aided in the minimization of distractive behaviours of students.

The use of mobile phone during class time as an example of distractive behaviours is worth highlighting. These students may have been engaged on social media platforms such as WhatsApp, Facebook and Twitter during class sessions underscoring the penetration of social media into every facet of the students’ lives. The risk of the use of technology or social media has been noted (Ferguson, 2013 ). Inappropriate use of social media by students found in this study may highlight the absence of social media guidelines for students and educators. Peck ( 2014 ) suggests a purposeful use of social media to improve learning. Schools of higher learning have used social media to improve connectedness, increase access to academic libraries, create virtual classrooms and create student learning experiences to achieve desired academic outcomes (Peck, 2014 ). Evidence supports increased knowledge and flexibility of learning when technology is introduced into the classroom such as blended‐learning (Strickland, Gray, & Hill, 2012 ) and flipped‐classroom (Missildine, Fountain, Summers, & Gosselin, 2013 ) approaches. A purposeful use of social media should reflect the availability of social media guidelines/policy, which will likely minimize the risk or abuse of social media use.

Large class sizes were observed in this study. Pressure to increase student intake appears to overwhelm the school's capacity in terms of space and the number of qualified nurse educators at post (Bell et al., 2013 ; Hornsby, Osman, & Matos‐Ala, 2013 ). This is similar to Raymond and Profetto‐McGrath, ( 2005 ) and Raymond et al.’s ( 2018 ) studies that highlight environmental factors that influence facilitation of CT in a school. The large class sizes appear to influence teaching methods/strategies (Hornsby et al., 2013 ) that could be adopted by educators as identified in Gibbs, Lucas, and Spouse's ( 1997 ) study.

Another finding of this study was scheduling of classes. Classes were sometimes beginning immediately after another for the same students. This was partly accounting for late arrival of students to the next class. The late arrival of students to class may reduce their contact hours and may influence the introduction of the appropriate learning methods/strategies. Given that found time as a factor in CT development of students, reduced contact hours could inhibit the facilitation of CT of the students.

Issues relating to classroom features were observed in this study. These findings primarily relate to logistical and design issues. Logistical issues included dysfunctional ceiling mounted projectors, torn/dirty screens and inadequate public address systems. These logistical constraints may impede meaningful learning experience and consequently hinder the development of CT skills acquisition of students. This finding is consistent with other reports on challenges in the Ghanaian nursing educational system (Bell et al., 2013 ; Talley, 2006 ; Wilmot et al.,  2013 ). The traditional rectangular classroom physical layouts with desks and chairs bolted down is inconsistent with CT skills tenets which require that physical features of classrooms involve small or large circle arrangements to allow for students to make eye contact with each other and the educator to facilitate open dialogue (Billings & Halstead, 2005 ).

8. LIMITATIONS

Given that this was a direct non‐participatory observational study, some observations might have been missed by the researchers (Creswell & Poth, 2018 ; Patton, 2015 ), especially when an attempt to minimize interruption of the teaching process, the observers of this observational study positioned themselves at the back of the classroom throughout each session. Also, there could have been observer bias. As noted by Creswell and Poth, there could have been impression management and potential deception on the part of the participants, especially the educators which might have influenced the data obtained. Several observations (10) were purposefully conducted to minimize this potential Hawthorne effect. In addition, some accounts might have been misinterpreted. However, this was minimized to some extent by reviewing the accounts with participants involved in the study.

9. RECOMMENDATION

Based on this study, further studies are recommended. The exploration of the experiences of nursing students and educators of instructional practices towards the development of CT skills in Ghana is highly recommended. Both quantitative and qualitative studies on how social media or technology in general could be used to facilitate meaningful learning are recommended.

This study also has implications for nurse educators and nursing school authorities who need to create a conducive environment for students for CT skills of students. Nurse educators should examine their own instructional methods/strategies with the view to adopting appropriate CT methods. In this regard, educators should aim at making learning fun and enjoyable. Educators should see themselves as role models to students regarding the demonstration of CT skills. School authorities should institute continuous faculty development programmes to help educators update their teaching skills regarding CT skills of students. School managers should provide the needed logistics needed for meaningful learning and commensurate to learning space, available faculty and other resources.

10. CONCLUSIONS

This study sought to observe instructional practices that influence the acquisition of CT skills of students in a classroom environment. The findings suggest that the educators’ teaching strategies have influence on learning atmosphere for CT skills facilitation of students. Also, several inhibiting and enhancing factors relating to students, university‐wide/administrative support were identified. It is therefore important that inhibiting factors are minimized or removed and enhancing factors are maintained or accentuated to help students engage in meaningful and purposeful learning experience with the view of developing their CT skills. Particularly, the role of the educators must be stressed to ensure that a conducive and participatory environment is created for student learning.

CONFLICT OF INTEREST

We do not have any conflict of interest to report.

AUTHOR CONTRIBUTIONS

CMB, ASVDM and JG: Conceptualization and designing of the study. CMB: Data collection, analysing and drafting of the manuscript. ASVDM and JG: Study supervision and made critical revisions on the paper. All the authors made substantial contributions to the manuscript.

ACKNOWLEDGEMENTS

We wish to acknowledge Victor Angbah for assisting in data collection. We also express our gratitude to the study participants.

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The Crucial Role of Critical Thinking in Nursing Practice

Blog   |  March 11, 2024 by 1NURSE

Critical thinking is like the backbone of good nursing. It's the thinking tool that helps healthcare professionals make smart choices, offer the best care to patients, and handle the complexities of the healthcare world. For nurses, critical thinking is super important because it plays a key role in providing top-notch patient care and dealing with the challenges of healthcare.

Understanding Critical Thinking in Nursing Practice

Critical thinking in nursing refers to the intellectual process through which healthcare professionals assess, analyze, and interpret information to make well-informed decisions in the context of patient care. It goes beyond the acquisition of knowledge, emphasizing the ability to actively question, evaluate, and synthesize data to arrive at logical conclusions. In nursing, critical thinking involves a dynamic and systematic approach to problem-solving, clinical judgment, and decision-making. Nurses with strong critical thinking skills can navigate complex healthcare scenarios, anticipate patient needs, and adapt to ever-evolving medical practices. This cognitive skill is the cornerstone of effective nursing practice, enabling professionals to provide personalized and evidence-based care while addressing the diverse challenges inherent in healthcare.

Why Critical Thinking Matters in Nursing

Patient-Centered Care: Critical thinking enables nurses to assess, analyze, and prioritize patient needs effectively. By considering a patient's unique circumstances, medical history, and current condition, nurses can tailor care plans to individual requirements, ensuring a more personalized and patient-centered approach.

Clinical Decision-Making: In the fast-paced and dynamic healthcare setting, nurses often face situations that require swift and informed decision-making. Critical thinking allows nurses to evaluate available information, anticipate potential outcomes, and make sound decisions that directly impact patient well-being.

Problem Solving: Nurses encounter diverse challenges, ranging from medical emergencies to operational issues within healthcare facilities. Critical thinking equips nurses with the ability to identify problems, assess underlying causes, and develop effective solutions. This problem-solving capacity contributes to smoother healthcare delivery and improved patient outcomes.

Adaptability to Change: Healthcare is constantly evolving, with new research, technologies, and treatment modalities emerging regularly. Nurses with strong critical thinking skills are better equipped to adapt to these changes, assimilating new information, adjusting their approaches, and ensuring that patient care remains up-to-date and evidence-based.

Patient Safety: Critical thinking is closely linked to patient safety. Nurses must evaluate situations, detect subtle changes in a patient's condition, and respond promptly to prevent adverse events. The ability to think critically enhances a nurse's capacity to identify and mitigate potential risks, ultimately ensuring a safer healthcare environment . Effective Communication: Communication is integral to nursing practice. Critical thinking enables nurses to articulate their thoughts, concerns, and observations effectively. Clear and precise communication with colleagues, patients, and other healthcare professionals is essential for coordinated care and positive patient outcomes.

Interdisciplinary Collaboration: In today's healthcare landscape, collaboration among various healthcare professionals is crucial. Critical thinking fosters effective interdisciplinary collaboration, allowing nurses to contribute valuable insights, ask relevant questions, and work cohesively with a diverse team to address complex patient care needs.

Evidence-Based Practice: Critical thinking is essential for evaluating and applying evidence-based practices. Nurses must critically assess research findings, clinical guidelines, and best practices to make informed decisions about patient care. This commitment to evidence-based practice enhances the quality and effectiveness of nursing interventions.

Continuous Learning: Nursing is a lifelong learning journey. Critical thinking encourages nurses to seek out new knowledge, stay informed about advancements in healthcare, and engage in ongoing professional development. This commitment to continuous learning ensures that nurses remain competent and capable throughout their careers.

Ethical Decision-Making: Critical thinking is instrumental in ethical decision-making. Nurses often encounter ethical dilemmas, and the ability to critically analyze ethical considerations, weigh consequences, and make morally sound decisions is vital for maintaining professional integrity and ensuring patient well-being.

Ways Nurses Can Improve Critical Thinking Skills

Here are several ways nurses can actively enhance their critical thinking skills:

Continuing Education: Engage in continuous learning by attending workshops, seminars, and training sessions. Stay updated on the latest medical research, technological advancements, and evidence-based practices. Continuous education broadens your knowledge base, fostering critical thinking development.

Case Studies and Simulation: Participate in case studies and simulation exercises to simulate real-life patient scenarios. This hands-on approach allows nurses to apply theoretical knowledge to practical situations, honing their ability to analyze and make decisions under various conditions.

Reflective Practice: Cultivate a habit of reflection on your experiences. Regularly assess your actions, decisions, and outcomes. Consider what worked well and what could be improved. This introspective process promotes self-awareness and enhances critical thinking by identifying areas for growth.

Collaboration and Discussion: Actively engage in discussions with colleagues, healthcare professionals, and interdisciplinary teams. Collaborative environments encourage the exchange of ideas and perspectives, challenging your own thinking and promoting a more comprehensive understanding of patient care situations.

Problem-Solving Exercises: Participate in problem-solving exercises or case reviews within your healthcare facility. These exercises encourage nurses to analyze complex situations, identify potential issues, and propose effective solutions. Regular practice in problem-solving enhances critical thinking abilities.

Mentorship: Seek mentorship from experienced nurses or healthcare professionals. Learning from their experiences and insights can provide valuable perspectives and guidance. Mentors can share their problem-solving approaches, helping you refine your critical thinking skills.

Critical Thinking Courses: Explore formal courses or workshops specifically designed to enhance critical thinking skills. Many educational institutions and online platforms offer courses focused on critical thinking in healthcare. These courses can provide structured learning and practical exercises.

Read Clinical Journals: Regularly read clinical journals, research articles, and evidence-based practice publications. Keeping up with the latest literature exposes nurses to diverse perspectives, innovative practices, and critical analyses of healthcare issues, fostering a more informed and critical mindset.

Ask Thoughtful Questions: Develop a habit of asking thoughtful and probing questions. When facing a patient care situation or making decisions about treatment plans, asking questions helps uncover relevant information, consider alternative solutions, and refine your thought processes.

Stay Open-Minded: Embrace a mindset of openness to new ideas and perspectives. Avoid assumptions and be willing to reconsider your opinions based on new information. An open-minded approach enhances adaptability and encourages critical thinking growth.

In the dynamic and demanding field of nursing, critical thinking is not merely a skill but a cornerstone of effective practice. As nurses continue to navigate the complexities of healthcare, honing their critical thinking abilities is paramount. The crucial role of critical thinking in nursing practice cannot be overstated—it is the catalyst for informed decision-making, problem-solving, and the delivery of patient-centered, evidence-based care that defines the essence of exceptional nursing practice.

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How nursing is changing in the age of AI

T he healthcare industry has gone through a lot of transformation in the past century. But what has always remained unchanged, or has been the heart of this profession, is the care provided by nurses – anywhere in the world. 

Artificial Intelligence (AI) has been the buzzword since 2023. Experts predict sweeping changes in the way the world functions going ahead. The nursing profession will also see a lot of changes. 

But at its heart, nurses are the first point of contact when a patient is admitted to a hospital, and the last contact when a patient is discharged. The bond that nurses share with their patients will remain unchanged.

NURSING IN THE AGE OF AI

What AI is going to change, and the process has already started, are healthcare delivery methods, and the incorporation of AI-based solutions into clinical care. Nurses are trained to adapt quickly to any changing environment.

We saw that when a pandemic affected the world. Nurses, all around the world, rose to the challenge and conquered it with not just their medical expertise but their empathy and humanity. What AI will do is ease the burden of daily tasks of nurses by redefining some old positions, while improving patient care results.

AI-driven technologies like EHRs, clinical decision support systems, and predictive analytics help simplify administrative tasks, improve productivity, and lessen the manual documentation workload for nurses. 

Automating routine tasks allows nurses to focus more on providing direct patient care, critical thinking, and making complex decisions.

AI-powered tools are also enabling nurses to provide patients with more customised care and changing the landscape of preventive healthcare too. 

HOW IS AI MAKING NURSING BETTER?

Machine learning algorithms review extensive patient data, such as medical history, diagnostic tests and treatment results to pinpoint patterns and risk factors. This allows nurses to predict patient needs, act proactively, and customise care plans based on personal preferences and situations.

The field of nursing education and training will also see positive changes. Virtual simulation technology and immersive educational opportunities can replicate real-life situations, giving nursing students the chance to improve clinical abilities, boost critical thinking, and build self-assurance. 

AI could also enhance nurses' ability to conduct research - natural language, processing algorithms, analyse large amounts of scientific literature, extract important insights, combine evidence, and recognise top strategies. 

The future of nursing in India looks bright and promising. AI will continue to evolve, and it has the potential to redefine nursing not just as a profession but as a cornerstone of innovative, patient-centred healthcare.

However, nursing, at its core, comes from the heart. As legendary American poet May Angelou once said, "As a nurse, we have the opportunity to heal the mind, soul, heart, and body of our patients. They may forget your name, but they will never forget how you made them feel."

(Disclaimer: This is an authored article. The views and opinions expressed by the doctors and experts are their independent professional judgement, and we do not take any responsibility for the accuracy of their views.)

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An expert's takeaways from day 1 of Michael Cohen's testimony

Katia Riddle

Ailsa Chang

NPR's Ailsa Chang talks with author and attorney Andrew Weissman about former President Trump's hush money trial in New York and the testimony of Michael Cohen, Donald Trump's former fixer and lawyer.

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