Clinical Reasoning and Critical Thinking: Integrated and Complementary

critical thinking and clinical reasoningWhen you hear the phrase “critical thinking” what usually comes to mind is having deep, insightful and analytical thoughts about an issue or phenomenon. Critical thinking is actually essential for nurses and doctors as it is the avenue through which complex cases are solved and appropriate medical care is provided for a patient’s specific healthcare needs.

What is Critical Thinking?

A lot of definitions have been provided for the term “critical thinking”. In the healthcare field, the National League of Nursing Accreditation Commission (NLNAC) in the US defines critical thinking as the “deliberate nonlinear process of collecting, interpreting, analysing, drawing conclusions about, presenting, and evaluating information that is both factually and belief-based as demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research.

In shorter (and much simpler terms), critical thinking in the context of healthcare is a process of collecting and examining information with the ultimate goal of correct clinical judgment.

How is Critical Thinking linked to Clinical Reasoning?

Critical thinking and clinical reasoning are intertwined. Critical thinking is actually an essential component of clinical reasoning, and without it, the process of clinical reasoning becomes ineffective.

Clinical reasoning is defined as all the cognitive processes involved in analysing facts, interpreting data, and evaluating a patient’s vital indices to reach an accurate diagnosis and institute a proper treatment plan.
In simple terms, to be able to have sound clinical reasoning, you must be a critical thinker. Your ability to think through details critically, as a doctor, nurse or other healthcare professional, makes for a sound clinical reasoning skill.

For example, critical thinking makes you quickly request for an ultrasound scan to confirm ectopic pregnancy in a teenager with severe abdominal pain, vaginal bleeding, and prior amenorrhea while another nurse or doctor may pass it on as a case of menstrual pain. Critical thinking places facts vis-à-vis generalizations and assumptions. You must have looked past the age and naivety to believe that the teenager might be pregnant.

Another example of how clinical thinking makes for a sound clinical judgment or reasoning is putting the cultural and religious backgrounds of your patient at the back of your mind while providing the necessary health care needs. For example, allowing a new Muslim mother to rest while her female relatives take care of the baby just after delivery, as recommended by Islam, instead of insisting that the mother does it alone like Western culture dictates. Considering such a religious belief may actually foster the health of the new mother.

The purpose of Critical Thinking

Why do you have to be a critical thinker as a healthcare professional? You need to be analytical in your thinking and approach to all patients for the following reasons:

To provide holistic care:

It will take a critical thinker, for example, to be aware of the cultural and religious background of a patient to provide cultural-sensitive care to a terminally-ill patient. This helps the patient psychologically and spiritually, thereby limiting the stress that comes with terminal illness.

To make quick decisions:

A patient of yours who has been managed for a particular condition suddenly develops new symptoms. Critical thinking helps you assess the facts, analyse his vital indices and correlate with treatment administered. This can help determine if the symptoms were a result of a certain treatment or lack of it, or perhaps a complication of the disease.

To make important decisions:

Critical thinking makes you decide, for example, which patients to prioritize when staff and resources limited. Do you give treatment first to a patient with a severe asthma attack, to one with a dog bite, or to another with a minor laceration in the upper limb, all arriving in the ER at the same time?

Doctors and nurses (and most everyone in the healthcare field) know that you are only as good as your clinical reasoning ability, which is hinged on strong critical thinking.

Training yourself to do critical thinking applied to clinical reasoning is one of the quintessential skills that any doctor, nurse or healthcare professional must have!

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