Relationship Between Critical Thinking and Clinical Decision Making

Critical thinking skills can assist with sorting out the aforementioned complexities. In a 1990 consensus statement on critical thinking, Facione (1990) defines critical thinking as a tool of inquiry characterized by "purposeful, self-regulatory judgment" resulting in "interpretation, analysis, evaluation, and inference" (p. 3). It is not "rote, mechanical, unreflective" (p. 8) or disconnected from other thought activities. Critical thinkers are able to examine and evaluate their own reasoning processes and apply critical thinking skills in a variety of contexts. The consensus components of critical thinking are provided in Table 8.2.

Scheffer and Rubenfeld (2000) used a Delphi method to develop a consensus statement on critical thinking in nursing, describing both

TABLE 8.2 Consensus Components of Critical Thinking






Clarifying meanings

Assessing claims and arguments


Examining evidence

Drawing conclusions

Proposing alternatives


Stating results

Presenting arguments

Justifying procedures




Dispositional skills


Eagerness for reliable information

its affective and cognitive components. In addition to the components described by Facione (1990), the nursing study identified creativity and intuition as two additional affective components.

Although critical thinking is defined by educators as a broad set of cognitive skills and habits of mind, applying these skills in clinical practice requires large amounts of discipline-specific knowledge. Research-based understandings of relationships between critical thinking and clinical decision making are not yet well developed. Clearly, however, the skills of interpretation, analysis, evaluation, and inference are highly necessary in advanced clinical practice, where both nursing and medical knowledge must be distinguished and applied. Well-developed critical thinking skills and habits of mind are an important foundation for the discipline-specific processes of clinical thinking required in advanced practice nursing.

Thinking Clinically

As suggested earlier, the meaning of thinking clinically will vary widely from one advanced practice nursing clinical setting and role to another. General elements can be described, however. From these elements it becomes incumbent upon nurses in advanced practice who are pursuing future research agendas to discern the particulars for their practice areas.

Organizing Clinical Knowledge for Practice

Ultimately, cognitively organizing diagnostic and treatment concepts for clinical practice is hard work that individual practitioners must do for themselves (Carnevali & Thomas, 1993). A systematic approach is recommended, based on building a repertoire of specific diagnostic/prognostic/ treatment concepts and exemplars from practice. For knowledge from nursing, such cognitive categories could be built around human response categories, broad nursing diagnostic categories, functional health patterns, or population health needs. As the depth of knowledge increases with various phenomena, increasing expertise is developed relating to manifestations, underlying mechanisms, risk factors and complications, prognostic variables and anticipated trajectories, and efficacy of treatment options. Increasing depth of medical knowledge, on the other hand, relates to the complexity of pathophysiologic explanations and relationships, variations in disease attributes and manifestations, use and interpretation of diagnostic tests, increasingly precise probabilistic and prognostic thinking, and increasingly sophisticated risk-benefit analyses. Building interprofessional and nursing knowledge for advanced clinical practice is an ongoing process of study and practice.

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