how to pass critical thinking in nursing school

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?

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.

The Key to Passing the NCLEX? Critical Thinking

There are only two real keys to passing the NCLEX.

First and obviously, you must know the content and understand the concepts you’ll be tested on and secondly, you must sharpen your critical thinking skills to apply your knowledge effectively, so you answer NCLEX questions correctly. I find that most students generally have much less trouble with the former than the latter. They also sometimes incorrectly assume that if they are learning and understanding nursing concepts in their degree program, they are naturally building the skills required to pass the NCLEX. But this is not completely true. There is a different between understanding the concepts and building the critical thinking skills required to apply them when you are taking the NCLEX.

For example, the National Council of the State Boards of Nursing published what is tested on the NCLEX in its Basic Test Plan . So, it’s straight forward to understand what will be on the exam and ensure you study the appropriate topics, which are:

• Management of Care 17-23%
• Safety and Infection Control 9-15%
• Health Promotion and Maintenance 6-12%
• Psychosocial Integrity 6-12%
• Basic Care and Comfort 6-12%
• Pharmacological and Parenteral Therapies 12-18%
• Reduction of Risk Potential 9-15%
• Physiological Adaptation 11-17%

The NCSBN also tells you that, across these content areas, a series of processes fundamental to effective nursing will be tested: Clinical nursing processes, caring, communication and documentation, teaching/learning, and culture.

This content is what you’ve studied in nursing school and if you’ve been successfully able to earn As and Bs in nursing classes, you’ll probably have a very good handle on this material.   But so many NCLEX takers fail one or more times and start to really have trouble understanding what is going on and why they aren’t passing.

The fact is, the NCLEX is not a test of your ability to remember facts. It requires understanding facts, but then going beyond that to determine what’s important and making the most informed choice possible about what to do next given the available facts.

The real key to passing the NCLEX is sharpening your critical thinking skills to successfully apply what you know to fluid, complex, and sometimes confusing nursing situations presented to you during the NCLEX exam.

What does critical thinking mean in the context of functioning as a nurse? Well, it covers the ability to, for example:

• Decide what’s important
• Look for important patterns
• Find linkages across situations such that knowledge gained in one area can be applied to another
• Choose the best course of action amongst several feasible alternatives
• Evaluate situations using the right set of criteria
• Communicate using appropriate methods for the situation

The above are the same types of skills and capabilities required to successfully answer NCLEX questions. Here is a super simple formula for “thinking critically” on the NCLEX:

• First, make sure you understand exactly what the question is asking. Many NCLEX questions provide more facts than you need, and it can be easy to get confused about what is being asked.
• Second, eliminate obviously incorrect answers. This is a time-tested test taking strategy that’s just as important for the NCLEX as it is for the ACT or SAT. Even if you don’t know what the right answer is, randomly choosing between two potentially correct answers gives you a much better chance of answering correctly than choosing between all four or five given answers.
• Last, prioritize and choose. There will be many NCLEX questions where the elimination of incorrect answers will lead you directly to the correct answer. However, in most cases, you’ll be left with 2 or maybe 3 choices that seem correct. So, you are left needing to think about what’s most important or identify a linkage that helps you prioritize the possible answers and choose the one that much be “more correct.” For example, you might be analyzing a situation involving a child in the emergency room, where you know you must address he fact that the child is having trouble breathing (that’s one answer), and you know there are critical follow up questions to ask the parent about what lead to this trouble breathing (that’s another answer). It might pop into your mind how important it is to understand what caused this situation to avoid it in the future. But, thinking critically, you realize what’s most important is ensuring the child begins breathing normally again so the situation doesn’t get worse or life threatening right now.

The NCLEX tests your ability to think through and manipulate facts, not your ability to memorize them. You must embrace the idea of building critical thinking skills to be successful on your next NCLEX attempt. This will serve you well on the NCLEX and as a nurse.

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How To ACE Nursing Fundamentals (+ Critical Thinking Tips!)

Skills , Study Tips and Getting Organized , Test Taking Tips , Uncategorized

Are you worried about nursing school and not sure how to tackle it?

This video will walk you through, step-by-step, how to ACE nursing fundamentals.

The study tips I will share will help you figure out exactly what you need to focus on to save time studying!

You are going to LOVE these nursing study tips to help you ACE this term in nursing school!

Here’s a quick breakdown of the Nursing School Critical Thinking Model (DRC):

D:  Definition/Description What is it? What’s the description of it?

R: Reason/Rationale Why does it happen? Why does it matter?

C: Connection How does it connect to everything else you’re learning?

Oxygen Administration:

D: Giving supplemental oxygen to your patient. Can be at various concentrations and flow rates based on patient needs.

R: Oxygen is given when the patient can’t get enough oxygen themselves. Possibly because they aren’t able to get oxygen in (ventilation), or they can’t circulate it through their body (perfusion).

C: Nursing Assessment: assess mucous membranes, lips and skin, check respiratory rate, look for labored or trouble breathing, listen to lungs.

RELATED VIDEOS: 

How To PASS Nursing School

How I Got Straight A’s in Nursing School

How To Take Notes

How I Made Nursing School Easier

VIDEO TRANSCRIPT: 

Are you freaked out about nursing school and not sure what to expect or how to pass? In this video, I’m going to walk you through my step-by-step process for how to ace your nursing fundamentals class. I’m not kidding you, these tips I’m going to share will help you figure out exactly WHAT to focus your study time on, how to learn it faster, and how to critically think along the way. This might just be the most important video you ever watch in nursing school, so be sure to stick around until the end, because I’m about to blow your mind. Now like this video, hit that subscribe button, click the notification bell, and let’s dive in.

So if you remember from THIS video, I shared my top tips for how I got straight A’s in nursing school. But being honest, that wasn’t an easy road. There was a LOT of trial and error that went into figuring out exactly how to study. I came home much every day with a headache, and felt like quitting pretty much all the time in that first term of nursing school. I cried all those tears, so you don’t have to.

I’ve spent a lot of time thinking about WHY I got straight A’s in nursing school, when other students struggled to make it. It’s not that I’m special, gifted, or super talented. I know my husband can give you a whole LIST of things I’m terrible at. Starting with keeping ANY plant alive for an extended period of time…

And those are just a few of the casualties we’ve had over the years…

I am not special. But here’s what I DO know.

I followed a particular critical thinking model, even before I created it and recognized what it was. This is a Model that I created to help walk you through, step-by-step, how to critically think in nursing school. In a few minutes, I’m going to walk you through this Model for how to study in nursing school so that you can ACE your fundamentals class.

But first, I want to put your mind at ease and walk through exactly what you can expect in your fundamentals class. I’ve received a LOT of questions about this over the past few weeks from our NursingSOS Members, and I know you’re probably a little freaked out about it too. So if you’re heading into nursing fundamentals, listen up.

Here’s how it will go: you’ll have your main lecture class where you’ll learn all of the basic concepts. The main thing you’ll learn about is the nursing assessment and the nursing process. I have a deep dive video on the nursing process HERE for you to check out after this video.

So along with the nursing process, you’ll learn about things like fluid and electrolyte balance, how to take vital signs, infection control practices, how to write care plans and how to document in a patient’s chart.

Don’t worry, we cover many of those topics here on our YouTube channel. I’ll put all the links in the description for you to check out.

Now along with this lecture class, you’ll also most likely have a skills lab class and a clinical class that go along with it for you to be able to practice all of these things. During skills lab, you’ll probably get to use mannequins and supplies in your school’s simulation lab so it’s like you’re taking care of real patient’s, without the fear of a real patient judging you or putting you at risk to hurt someone. It’s important to practice your skills FIRST before doing them in real life. You’ll practice your nursing assessment, learn how to give medications, and maybe practice some basic skills like giving vaccines.

And then during your clinical class, you’ll finally be able to practice all of your assessment skills on a REAL LIVE PERSON. How exciting!!! So don’t worry, friend, take a breath, trust yourself, and do the best you can.

It took me the better part of a clinical day to assess my first patient in nursing school, because I kept forgetting things and having to go back into her room and ask her more questions. Man, that was rough. So don’t worry, if you’re super nervous, you are NOT alone. I was right there with you!

So that is generally what you can expect for your nursing fundamentals. Make sure you practice as much as you can in the skills lab so that you’re prepared for clinical.

Now, let’s talk about how to study in your nursing fundamentals class. I’ve created a Critical Thinking Model that you can use again and again for every topic you’re studying. It will walk you through, step-by-step, how to study in nursing school.

Following this Model will be the difference between getting a C on an exam and getting an A. So pay attention, take notes, and let’s change your life.

The Critical Thinking Model goes like this: DRC. The “D” stands for definition or description. The “R” stands for reason or rationale, and the “C” stands for connection.

So let’s write this out and go through and example to help it all come together. Because seriously, friend, this is the KEY to success in nursing school. Follow this Model, and you will be GOLDEN.

The “D” stands for description or definition. What is it? What is it that you need to know about? What’s the description of it?

This is the high level stuff. Don’t worry, we’ll get to the critical thinking and the deep stuff in a minute. So stay with me.

So let’s take an example of giving oxygen to a patient. Giving oxygen and oxygen administration is absolutely something you’ll study during your fundamentals class. You HAVE to know it for nursing school and your clinicals.

So the definition and description of oxygen administration is that you are actually GIVING oxygen to your patient. You may give it at different levels or concentrations and through different ways. And if you want, you can write all of those down here as well in this category.

Now the second part of this process is the R, which stands for reasoning or rationale. This is where you’ll write about the WHY. Why does it happen, or why does it matter? This is the reasoning behind it. And in this section, I really want you to dig deep and focus on the underlying reason. This is the first step of critical thinking here. I’ll walk you through the next step in a minute, so stay with me, we’ll get there.

So in our example of giving oxygen, WHY do we give oxygen to a patient? Well, we give oxygen if a patient isn’t able to oxygenate themselves, either they aren’t able to get enough oxygen in, or they aren’t able to circulate it as well. So here I want you to dive into the pathophysiology behind it.

Listen, friend. If there is ONE reason that I got straight A’s in nursing school, it’s this: I dug deep. Constantly. I didn’t just learn the surface level stuff like everyone else. I used this model and practiced my critical thinking skills over and over again. And THAT is what made me successful. Because when I got to my exam and it gave me a case scenario about oxygen administration, I didn’t just memorize the surface level stuff that the rest of my class focused on. I was way more prepared because I did the critical thinking and learned WHY it matters.

And that’s what I want you to do, too. To really dig deep and ask yourself WHY. Why do we give oxygen, why does it matter, and why is it important.

So that’s step number 2: reasoning or rationale. Why do we do it?

And now the 3rd step is the ultra critical thinking part, and this is the C: Connection. This is where you’ll write how it connects to the other things you’re learning. This is the HOW: How does it connect to everything else?

This is where you’ll really shine at your critical thinking skills, and where it will really start to show to your instructors that you know you stuff: when you can connect the dots and put it all together.

So in our example of giving oxygen, how does that connect to other things you’re learning about? So in your fundamentals class, you’ll be learning about the nursing assessment, and you’ll also learn about oxygenation and perfusion: how the body gets oxygen and how it circulates through the body to keep us alive.

If you want a deep dive into the nursing process and what the nursing assessment is, be sure to check THIS video out after you finish this video.

So this is the final part of critical thinking, being able to connect it all together with everything that you’re learning about. Don’t worry, I’m not going to leave you guessing on how to do this. Let’s keep our same example and walk through it together.

So when you give oxygen to a patient, there are a LOT of things you need to assess for before, during and after. You’ll look at things like their lips and mucous membranes to see if they have a blue tint to them, which could indicate a lack of oxygen. You’ll look at how they’re breathing and listen to their lungs. If they’re having difficulty breathing they may need to be on oxygen to increase their blood oxygen level. So walk through each of the nursing assessment components that relate to giving oxygen. How does giving oxygen affect the body?

You’ll also learn about oxygenation and perfusion in your fundamentals class, so how does giving oxygen affect that? Well, giving a patient oxygen will hopefully increase the amount of oxygen in their blood, it will get more oxygen to their brain and other vital organs to keep them happy.

Are you seeing how all of this connects together? This Critical Thinking Model is VITAL to follow in nursing school. Like I said before, practicing this will be the difference between getting an A and getting a B or a C on your exam.

Now I have a series of critical thinking questions for you to follow as you study as well. These will really help guide your learning and help you focus your studying even more. I do a deep dive into these question in THIS video here, and I’ve also got a free cheat sheet that outlines them too. So be sure to download that, the link is in the description below.

Phew, friend, I know that was a LOT of information right here. I really wanted to do a deep dive video for you to give you everything you needed to succeed in your Fundamentals Class.

So if you found this deep dive training SUPER helpful, write LOVE in the comments to let me know, and tell me the date your start your nursing program, or if you’re already in nursing school, tell me the month and year you’ll be graduating. I am super pumped for you and your nursing school journey, and I feel so blessed to have the opportunity to help you through it.

And of course, if you want more help with Nursing Fundamentals, make sure to join the NursingSOS Membership Community where we are currently releasing a brand new fundamentals course. I’m so excited! You are going to LOVE it!

Now click on the next video to help you keep rocking nursing school, and go become the nurse that God created only YOU to be. I’ll see you over there friend. Take care!

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Enrollment open until friday, get better grades and have more free time, pass nursing school or get your money back.

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How to Pass the Fundamentals of Nursing

• Outline the core subjects in the Fundamentals of Nursing as well as the underlying foundation of theory, practice, and critical thinking skills that prepared nursing students for their careers.
• Learn Bloom’s Taxonomy as a methodology of applying the knowledge that you learn in the Fundamentals of Nursing to really life circumstances that you will encounter as a nurse.
• Build productive habits and explore online resources that target your preferred style of learning to ensure you’re ensuring your best chance at success.

Tracey Long

PhD, MS, MSN, RN, APRN-BC, CCRN, CDCES, CNE

So, you’re in nursing school and feeling a bit frustrated? The first step towards reaching your goal of becoming a nurse, and adding RN behind your name, begins with passing nursing fundamentals. If all it takes to be a nurse is sitting mindlessly in a nursing lecture while scrolling through your social media feed then anyone could be a nurse, but it takes much more than that! This blog will give you a checklist for success so that you can evaluate your own behavior and create your plan for passing.

What do I Need to Know to Pass Fundamentals of Nursing?

The first thing to know is that you are smart enough to pass. As a nursing professor, I have seen very smart nursing students fail nursing fundamentals because they didn’t realize they needed to actually study, or even show up to class. Often what makes the difference is dedication and learning to study effectively. There is often attrition from nursing school in the first semester, as some students don’t realize nursing school is going to be hard and that being a nurse is more than the dramatized love affairs seen in Grey’s Anatomy. They don’t realize that nurses have to clean up poop and vomit. These students were smart enough to become nurses, but they came to the realization that nursing is not for them, and that’s ok. If you’re the kind of student who really wants to be a nurse and you’re ready to work hard, then you are smart enough to become a nurse. Being smart doesn’t automatically mean you know how to study effectively, and this post will help you understand the skills necessary to succeed not just in passing the fundamentals of nursing but also in succeeding in your future studies.

Some nursing schools will call the first core class of a nursing program Nursing Fundamentals , or the Fundamentals of Nursing . A Fundamentals of Nursing class typically covers a wide range of essential knowledge and skills necessary for beginning a nursing career. The specific content may vary depending on the curriculum and institution, but here are some common topics that are typically included in nursing fundamentals that you must learn.

• Introduction to Nursing: Understanding the history, roles, and scope of nursing practice, as well as the ethical and legal responsibilities of nurses.
• Nursing Process: Learning the steps of the nursing process, which include assessment, diagnosis, planning, implementation, and evaluation of patient care.
• Communication and Interpersonal Skills: Developing effective communication skills to establish therapeutic relationships with patients, families, and the healthcare team.
• Vital Signs Assessment: Learning to measure and interpret vital signs, including temperature, pulse, respiration rate, blood pressure, and pain assessment.
• Infection Control: Understanding principles of infection control, hand hygiene, standard precautions, and proper use of personal protective equipment (PPE).
• Medication Administration: Learning the fundamentals of medication administration, including dosage calculation, routes of administration, and safe medication practices.
• Basic Nursing Skills: Mastering foundational nursing skills such as bed baths, positioning and transferring patients, feeding assistance, and wound care.
• Health Assessment: Learning to perform a comprehensive health assessment, including physical examination techniques, documentation, and health history taking.
• Patient Safety: Understanding principles of patient safety, fall prevention, infection prevention, and risk assessment.
• Documentation and Electronic Health Records (EHR): Developing skills in accurate and timely documentation, including the use of electronic health records (EHR) systems.
• Professionalism and Ethical Practice: Understanding professional nursing standards, ethical principles, cultural competence, and the importance of maintaining patient confidentiality.
• Basic Anatomy and Physiology: Gaining knowledge of basic human anatomy and physiology, including body systems, organs, and their functions.
• Patient Education: Learning to provide patient education and health promotion strategies to empower patients in managing their health.
• Emergency and Disaster Preparedness: Understanding emergency response protocols, recognizing, and responding to common emergencies, and disaster preparedness.
• Introduction to Nursing Research: Developing an understanding of the research process, evidence-based practice, and the importance of using current research findings in nursing care.

These are some of the core topics typically covered in a nursing fundamentals class. The course aims to provide students with a strong foundation in nursing theory, practice, and critical thinking skills to prepare them for more advanced nursing courses and clinical experiences. Having, or creating a study guide for these topics can be helpful. Better yet, ask your instructor if one is already available. If not, create your own using the instructor’s notes, PowerPoint slides, and textbook.

But How do I Pass the Tests?

You may feel like you know the content but applying it to a patient scenario on an exam is a new level in nursing school. Knowledge isn’t enough- but being able to apply that knowledge to patient care is what matters. Bloom’s taxonomy can be a helpful visual aid to understand the different applications of learned information. Dr. Bloom wondered why some students didn’t do well on exams when they seemed to know the information. He concluded in his pyramid model that if you are only studying at the knowledge level but being tested at the higher application and analysis model you won’t do well. Studying with the goal of being able to apply it to patient care to achieve positive outcomes can make a difference. Practicing higher-level questions with patient scenarios is helpful.

Bloom’s taxonomy is a hierarchical framework that categorizes different levels of cognitive learning and understanding. It was developed by educational psychologist Benjamin Bloom and his colleagues in the 1950s. The taxonomy is often used as a guide to design educational objectives, assessments, and instructional strategies. Bloom’s taxonomy consists of six levels, listed in ascending order of complexity:

Knowledge: This level involves recalling or recognizing facts, information, or concepts. It includes remembering specific details, definitions, or simple explanations.

Comprehension: Comprehension focuses on understanding and interpreting information. It involves grasping the meaning of ideas, concepts, or principles and being able to explain them in one’s own words.

Application: At the application level, learners demonstrate their ability to use knowledge and concepts in new situations. This includes applying learned principles, methods, or theories to solve problems or complete tasks.

Analysis: The analysis level involves breaking down complex information into its constituent parts and examining the relationships between them. It requires identifying patterns, organizing information, and making inferences or drawing conclusions.

Synthesis: Synthesis refers to the ability to integrate or combine information from different sources or ideas to create something new. This level involves generating original solutions, designing projects, or creating new perspectives or interpretations.

Evaluation: The highest level of Bloom’s taxonomy, evaluation, focuses on critical thinking and making judgments about the value or worth of information, ideas, or methods. It involves assessing evidence, comparing viewpoints, and making informed decisions based on criteria or standards.

How Bloom’s taxonomy can help a student when preparing for exams is to focus on higher-order thinking skills rather than just memorization. By integrating Bloom’s taxonomy into your study approach, you can deepen your understanding of course material, enhance critical thinking skills, and better align your preparation with the cognitive demands of the test. The NCLEX is written above the comprehension level so learning to study at the higher levels will help you prepare to pass the national certification exam as well. No more rote memorization. Healthcare doesn’t need robots, but rather higher-level thinking nurses!

What Should I Do to Pass Nursing Fundamentals?

To successfully pass a nursing fundamentals class, it’s important to approach it with dedication, organization, and a proactive mindset. Here are some tips to help you excel in your nursing fundamentals class:

Attend Classes and Be Actively Engaged: Regularly attend all class sessions and actively participate in discussions, group activities, and hands-on demonstrations. Pay attention to the instructor’s explanations and ask questions when you need clarification.

Review Course Material: Consistently review the course material, including textbooks, lecture notes, and assigned readings. Take thorough notes during class and review them regularly to reinforce your understanding of the concepts.

Create a Study Plan: Develop a study plan that includes dedicated study time for nursing fundamentals. Break down the topics into manageable sections and allocate specific study time for each. Set realistic goals and stick to your schedule to ensure you cover all the necessary material.

Utilize Additional Resources: Supplement your learning with additional resources such as nursing fundamentals textbooks, online tutorials, videos, and practice quizzes. These resources can provide different perspectives and explanations that complement your class materials.

Actively Participate in Clinical Practice: Nursing fundamentals often involve practical clinical experiences. Take full advantage of these opportunities to apply what you have learned in class. Actively engage with patients, follow proper procedures, and seek feedback from your clinical instructors to enhance your skills.

Practice Critical Thinking: Nursing fundamentals class focuses on developing critical thinking skills. Practice applying these skills by analyzing case studies, patient scenarios, and practice questions. Think critically about the information, prioritize care, and consider potential nursing interventions.

Form Study Groups: Collaborate with classmates to form study groups. Discuss concepts, share study notes, and quiz each other to reinforce learning. Explaining concepts to others can solidify your understanding and help identify any gaps in your knowledge. Be careful not to waste time in a study group as your study time is precious. Take breaks and have some fun snacks but set a realistic timeframe and goal with your peers in the group to maximize your time together. Ideally, study with people who are doing well in the class and not those that are also struggling, so it’s not the blind leading the blind.

Seek Assistance When Needed: If you encounter challenges or have difficulty understanding specific topics, don’t hesitate to seek help. Reach out to your instructor, classmates, or tutoring services provided by your institution for additional support.

Utilize Practice Questions and Exams: Familiarize yourself with the types of questions that may appear on exams. Complete practice questions and take advantage of any practice exams provided by your instructor or available resources. This can help you identify areas of weakness and strengthen your test-taking skills.

Take Care of Yourself: Maintain a healthy lifestyle during your nursing fundamentals class. Get sufficient sleep, eat well-balanced meals, and engage in physical activity to keep yourself energized and focused. Taking care of your well-being will contribute to your overall success in the course. We need healthy nurses.

Remember that nursing fundamentals is the foundational knowledge for your nursing career, so it’s crucial to grasp the concepts and skills taught in this class. By approaching the class with dedication, consistent effort, and utilizing effective study strategies, you can increase your chances of passing

What Online Resources Can Help Me Pass Nursing School?

There are numerous online resources available to support nursing students in passing nursing fundamentals. These resources provide a wide range of study materials, practice questions, interactive modules, and helpful tips. Often, students say they know the material but then struggle on an exam. Test-taking is a skill in itself and will improve with lots of practice. There are many free sample nursing test questions available and it’s worth your time practicing. Soon, you’ll begin to identify patterns and trends and conquer test-taking anxiety because your confidence to pass practice tests will increase.

Here are some examples of online resources:

Nursing Websites and Forums:

AllNurses : An online community and forum for nursing students and professionals. It offers discussion boards, study tips, and resources specific to nursing fundamentals.

RegisteredNurseRN : A website with free video tutorials, practice quizzes, and study guides covering various nursing topics, including nursing fundamentals.

Nurse.plus : Provides a comprehensive collection of nursing practice questions and quizzes to reinforce knowledge and test readiness.

Open Educational Resources (OER):

OpenStax : Offers free, peer-reviewed textbooks and resources for nursing education. Their “Anatomy and Physiology” textbook can be beneficial for understanding the foundational knowledge needed for nursing fundamentals.

Khan Academy : Provides video lessons and interactive modules on various healthcare and science topics that may be relevant to nursing fundamentals.

YouTube Channels:

Simple Nursing : A YouTube channel with video lessons covering nursing fundamentals and other nursing topics in an engaging and simplified manner.

Level Up RN : Offers animated video tutorials, mnemonics, and tips for nursing students, including content related to nursing fundamentals.

Mobile Apps:

NCLEX RN Mastery : A mobile app that offers practice questions, quizzes, flashcards, and detailed rationales for nursing fundamentals and other nursing topics.

Pocket Prep Nursing : Provides a variety of nursing practice questions, flashcards, and study materials to help reinforce nursing fundamentals knowledge.

Online Learning Platforms:

Coursera : Offers online courses related to nursing fundamentals and other healthcare topics from reputable institutions. These courses can provide additional resources and in-depth understanding.

Educational Institutions’ Websites:

Many nursing schools and programs provide online resources, study guides, practice questions, and lecture notes specific to their nursing fundamentals curriculum. Check your institution’s website or online learning platforms for resources tailored to your program.

Remember to utilize these online resources in conjunction with your nursing fundamentals textbooks, class notes, and guidance from your instructors. Developing a well-rounded study approach that includes a combination of resources and consistent practice will enhance your understanding and help you succeed in nursing fundamentals.

How to Fail Nursing School

Your nursing school may have already outlined behaviors that will cause you to fail. Although this blog is focusing on helping you succeed in your nursing fundamentals class, it is still worth clarifying to help you avoid making dumb mistakes.

It is always advisable to seek support and resources to overcome any difficulties you may encounter. As a nursing instructor of Nursing Fundamentals classes for many years, I have seen smart students fail because they neglected these basics. Here are some avoidable actions that can contribute to academic failure in nursing school.

Lack of Attendance and Engagement: Consistently skipping classes, clinicals, or not actively participating in discussions and activities can hinder your understanding of the material and lead to falling behind. Some schools have attendance policies where a no-call, no-show to clinical will cause you to fail. Just show up!

Poor Time Management: Inadequate time management skills can result in procrastination, cramming, and an inability to keep up with coursework and study effectively. I remember failing a paper because I chose to get a 3-hour perm for my hair (yes, it was the 80s) instead of working on a paper. I couldn’t fool my instructor when I showed up with a new perm and no paper. No excuse.

Inadequate Preparation: Failing to adequately prepare for exams and assignments can result in poor performance and lower grades. It’s crucial to allocate sufficient study time and review materials regularly. I had a student who had to repeat nursing fundamentals who finally learned to crack open the book and tell me “Wow the answers really are in the textbook!”

Insufficient Study Strategies: Using ineffective study strategies, such as passive reading or memorization without understanding, can limit your ability to retain and apply the information effectively. Nurses need to understand the pathophysiology and not just robotically pass out medications.

Lack of Organization: Disorganization can lead to missed deadlines, incomplete assignments, and difficulty prioritizing tasks. Developing organizational skills is essential to stay on top of coursework.

Inadequate Utilization of Resources: Failing to seek help when needed, such as not utilizing tutoring services, academic advisors, or faculty support, can hinder your ability to overcome challenges and understand difficult concepts.

Poor Self-Care: Neglecting self-care, such as lack of sleep, poor nutrition, and high-stress levels, can impact your overall well-being and academic performance. Nursing school is a marathon so feed it and rest it. Don’t feed yourself plastic food and expect your body to make a body of steel out of junk.

Ineffective Communication: Struggling to communicate with instructors or clinical preceptors about your challenges or seeking clarification when needed can contribute to academic difficulties. A student failed nursing school during the last semester because she didn’t show up for a mandatory clinical. She never called her instructor and only notified the instructor when she got the failed class notice. She admitted she wasn’t even sick, but just tired. Not a good choice.

Lack of Collaboration: Avoiding collaboration with classmates for group study sessions, sharing resources, or seeking peer support can limit your learning opportunities.

Plagiarism and Academic Integrity Violations: Engaging in academic dishonesty, such as plagiarism or cheating, can result in severe consequences and potentially lead to academic failure or dismissal. Another student turned in not one but two papers that were completely copied and pasted from the internet. She failed.

If you find yourself facing challenges or feeling overwhelmed, it is important to seek support from your instructors, classmates, or academic support services provided by your school. They can offer guidance, resources, and strategies to help you navigate difficulties and improve your academic performance.

The Bottom Line

You are smart enough to pass nursing fundamentals. The question is are you dedicated and self-disciplined enough?

Becoming a nurse doesn’t just happen as you walk across a stage to collect your diploma. It is a process that takes time throughout nursing school as you begin to think like a nurse. Understanding the fundamentals of nursing will help you as you advance to subsequent classes because the nursing process (yes, ADPIE, or SOAPIER) will help you become a critical thinker.

Knowledge isn’t enough, but rather learning to be a higher level thinker from knowledge, to comprehension, to assessment, analysis, and evaluation will help you pass nursing exams. Regurgitation of content from a textbook isn’t enough. When you’ve done all of these positive habits, nothing will hold you back from passing Nursing Fundamentals. Good luck! You’ve got this!

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Critical Thinking on the Nursing Floor

Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.

The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!

Critical Thinking in Nursing: Example 1

I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs for the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90s on oxygen.

I stopped. And thought. What the heck is going on?

I looked at his history. Congestive heart failure.

I looked at his intake and output. He was positive 1.5 liters.

I thought about how he’s got extra fluid in general, and because of his CHF, he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..

His lungs were clear earlier. I heard crackles throughout both lungs.

OK, so he’s got extra fluid that he can’t get out of his body. What do I know that will get rid of extra fluid and make him pee? Maybe some Lasix?

I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said “Give him 20 mg IV Lasix one time, and I’ll put the order in.” CLICK.

I gave the Lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.

Badda Bing Bada Boom!

Critical Thinking in Nursing: Example 2

My patient just had her right leg amputated above her knee. She was on a Dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. She told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with the goal of weaning off PCA.

“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?

I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.

I thought about nerve pain. I thought about other patients that report similar pain. Diabetics with neuropathy would talk about similar pain… “What did they do for it? ” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.

“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.

I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain after I described my patient’s type of pain and thought process.

“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner. ”

She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort were significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.

And that we did!

She was able to work with therapy more because her pain was tolerable and was finally able to get rest.

What the HELL is Critical Thinking . . . and Why Should I Care?

What your nursing professor won’t tell you about critical thinking .

by Ashely Adkins RN BSN

When I started nursing school, I remember thinking,   “how in the world am I going to remember all of this information, let alone be able to apply it and critically think?”   You are not alone if you feel like your critical thinking skills need a little bit of polishing.

Let’s step back for a moment, and take a walk down memory lane. It was my first semester of nursing school and I was sitting in my Fundamentals of Nursing course. We were learning about vital signs, assessments, labs, etc. Feeling overwhelmed with all of this new information (when are you   not   overwhelmed in nursing school?), I let my mind wonder to a low place…

Am I really cut out for this? Can I really do this? How can I possibly retain all of this information?  Do they really expect me to remember everything AND critically think at the same time?

One of my first-semester nursing professors said something to me that has stuck with me throughout my nursing years. It went a little something like this:

“Critical thinking does not develop overnight . It takes time. You don’t learn to talk overnight or walk overnight. You don’t   learn to critically think overnight .”

My professor was absolutely right.

As my journey throughout nursing school, and eventually on to being a “real nurse” continued, my critical thinking skills began to BLOSSOM. With every class, lecture, clinical shift, lab, and simulation, my critical thinking skills grew.

You may ask…how?

Well, let me tell you…

• Questioning

These are the key ingredients to growing your critical thinking skills.

Time.   Critical thinking takes time. As I mentioned before, you do not learn how to critically think overnight. It is important to set   realistic   expectations for yourself both in nursing school and in other aspects of your life.

Exposure.   It is next to impossible to critically think if you have never been exposed to something. How would you ever learn to talk if no one ever talked to you? The same thing applies to nursing and critical thinking.

Over time, your exposure to new materials and situations will cause you to think and ask yourself, “why?”

This leads me to my next point.   Questioning.   Do not be afraid to ask yourself…

“Why is this happening?”

“Why do I take a blood pressure and heart rate before I give a beta-blocker?”

“Why is it important to listen to a patient’s lung sounds before and after they receive a blood transfusion?”

It is important to constantly question yourself. Let your mind process your questions, and discover answers.

Confidence.   We always hear the phrase, “confidence is key!” And as cheesy as that phrase may be, it really holds true. So many times, we often times sell ourselves short.

YOU KNOW MORE THAN YOU THINK YOU KNOW.

In case you did not catch it the first time…

Be confident in your knowledge, because trust me, it is there. It may be hiding in one single neuron in the back of your brain, but it is there.

It is impossible to know everything. Even experienced nurses do not know everything.

And if they tell you that they do…they are wrong!

The   key   to critical thinking is   not about knowing everything ; It is about   how you respond when you do not know something .

How do you reason through a problem you do not know the answer to? Do you give up? Or do you persevere until you discover the answer?

If you are a nursing student preparing for the NCLEX, you know that the NCLEX   loves   critical thinking questions. NRSNG has some great tips and advice on   critical thinking when it comes to taking the NCLEX .

There are so many pieces to the puzzle when it comes to nursing, and it is normal to feel overwhelmed. The beauty of nursing is when all of those puzzle pieces come together to form a beautiful picture.

That is critical thinking.

Critical thinking is something you’ll do every day as a nurse and honestly, you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution, and trying it out. Critical thinking in nursing is just that but in a clinical setting.

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Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

Associated data.

Data are contained within the article.

Background: Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students. Methods: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies. Results: Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies. Conclusions: This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning and improve their clinical reasoning and cognitive skills.

1. Introduction

Clinical reasoning (CR) is a holistic cognitive process. It allows nursing students to accurately perceive patients’ situations and choose the best course of action among the available alternatives. This process is consistent, dynamic, and flexible, and it helps nursing students gain awareness and put their learning into perspective [ 1 ]. CR is an essential competence for nurses’ professional practice. It is considered crucial that its development begin during basic training [ 2 ]. Analysing clinical data, determining priorities, developing plans, and interpreting results are primary skills in clinical reasoning during clinical nursing practise [ 3 ]. To develop these skills, nursing students must participate in caring for patients and working in teams during clinical experiences. Among clinical reasoning skills, we can identify communication skills as necessary for connecting with patients, conducting health interviews, engaging in shared decision-making, eliciting patients’ concerns and expectations, discussing clinical cases with colleagues and supervisors, and explaining one’s reasoning to others [ 4 ].

Educating students in nursing practise to ensure high-quality learning and safe clinical practise is a constant challenge [ 5 ]. Facilitating the development of reasoning is challenging for educators due to its complexity and multifaceted nature [ 6 ], but it is necessary because clinical reasoning must be embedded throughout the nursing curriculum [ 7 ]. Such being the case, the development of clinical reasoning is encouraged, aiming to promote better performance in indispensable skills, decision-making, quality, and safety when assisting patients [ 8 ].

Nursing education is targeted at recognising clinical signs and symptoms, accurately assessing the patient, appropriately intervening, and evaluating the effectiveness of interventions. All these clinical processes require clinical reasoning, and it takes time to develop [ 9 ]. This is a significant goal of nursing education [ 10 ] in contemporary teaching and learning approaches [ 6 ].

Strategies to mitigate errors, promote knowledge acquisition, and develop clinical reasoning should be adopted in the training of health professionals. According to the literature, different methods and teaching strategies can be applied during nursing training, as well as traditional teaching through lectures. However, the literature explains that this type of methodology cannot enhance students’ clinical reasoning alone. Therefore, nursing educators are tasked with looking for other methodologies that improve students’ clinical reasoning [ 11 ], such as clinical simulation. Clinical simulation offers a secure and controlled setting to encounter and contemplate clinical scenarios, establish relationships, gather information, and exercise autonomy in decision-making and problem-solving [ 12 ]. Different teaching strategies have been developed in clinical simulation, like games or case studies. Research indicates a positive correlation between the use of simulation to improve learning outcomes and how it positively influences the development of students’ clinical reasoning skills [ 13 ].

The students of the 21st century utilise information and communication technologies. With their technological skills, organisations can enhance their productivity and achieve their goals more efficiently. Serious games are simulations that use technology to provide nursing students with a safe and realistic environment to practise clinical reasoning and decision-making skills [ 14 ] and can foster the development of clinical reasoning through an engaging and motivating experience [ 15 ].

New graduate nurses must possess the reasoning skills required to handle complex patient situations. Aware that there are different teaching methodologies, with this systematic review we intend to discover which RCTs published focus on CR in nursing students, which interventions have been developed, and their effectiveness, both at the level of knowledge and in increasing clinical reasoning skills. By identifying the different techniques used during the interventions with nursing students in recent years and their effectiveness, it will help universities decide which type of methodology to implement to improve the reasoning skills of nursing students and, therefore, obtain better healthcare results.

This study aims to identify and analyse randomised controlled trials concerning clinical reasoning in nursing students. The following questions guide this literature review:

Which randomised controlled trials have been conducted in the last eleven years regarding nursing students’ clinical reasoning? What are the purposes of the identified RCTs? Which teaching methodologies or strategies were used in the RCTs studies? What were the outcomes of the teaching strategies used in the RCTs?

2. Materials and Methods

This review follows the PRISMA 2020 model statement for systematic reviews. That comprises three documents: the 27-item checklist, the PRISMA 2020 abstract checklist, and the revised flow diagram [ 16 ].

2.1. Search Strategy

A systematic literature review was conducted on PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) up to 15th October 2023.

The PICOS methodology guided the bibliographic search [ 17 ]: “P” being the population (nursing students), “I” the intervention (clinical reasoning), “C” comparison (traditional teaching), “O” outcome (dimension, context, and attributes of clinical reasoning in the students’ competences and the results of the teaching method on nursing students), and “S” study type (RCTs).

The search strategy used in each database was the following: (“nursing students” OR “nursing students” OR “pupil nurses” OR “undergraduate nursing”) AND (“clinical reasoning” OR “critical thinking” OR “clinical judgment”). The filters applied were full text, randomised controlled trial, English, Spanish, and from 1 January 2012 to 15 October 2023. The search strategy was performed using the same process for each database. APP performed the search, and AZ supervised the process.

During the search, the terms clinical reasoning, critical thinking, and clinical judgement were used interchangeably since clinical judgement is part of clinical reasoning and is defined by the decision to act. It is influenced by an individual’s previous experiences and clinical reasoning skills [ 18 ]. Critical thinking and clinical judgement involve reflective and logical thinking skills and play a vital role in the decision-making and problem-solving processes [ 19 ].

The first search was conducted between March and September 2022, and an additional search was conducted during October 2023, adding the new articles published between September 2022 and September 2023, following the same strategy. The search strategy was developed using words from article titles, abstracts, and index terms. Parallel to this process, the PRISMA protocol was used to systematise the collection of all the information presented in each selected article. This systematic review protocol was registered in the international register PROSPERO: CRD42022372240.

2.2. Eligibility Criteria and Study Selection

The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary aim; (b) articles published in the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) RCTs. On the other hand, the exclusion criteria were studies conducted with students from other disciplines other than nursing, not random studies or review articles.

2.3. Data Collection and Extraction

After this study selection, the following information was extracted from each article: bibliographic information, study aims, teaching methodology, sample size and characteristics, time of intervention, and conclusions.

2.4. Risk of Bias

The two reviewers, APP and AZ, worked independently to minimise bias and mistakes. The titles and abstracts of all papers were screened for inclusion. All potential articles underwent a two-stage screening process based on the inclusion criteria. All citations were screened based on title, abstract, and text. Reviewers discussed the results to resolve minor discrepancies. All uncertain citations were included for full-text review. The full text of each included citation was obtained. Each study was read thoroughly and assessed for inclusion following the inclusion and exclusion criteria explained in the methodology. The CASP tool was utilised to appraise all included studies. The CASP Randomized Controlled Trial Standard Checklist is an 11-question checklist [ 20 ], and the components assessed included the appropriateness of the objective and aims, methodology, study design, sampling method, data collection, reflexivity of the researchers, ethical considerations, data analysis, rigour of findings, and significance of this research. These items of the studies were then rated (“Yes” = with three points; “Cannot tell” = with two points; “No” = with one point). The possible rates for every article were between 0 and 39 points.

2.5. Ethical Considerations

Since this study was a comprehensive, systematic review of the existing published literature, there was no need for us to seek ethical approval.

3.1. Search Results

The initial search identified 158 articles using the above-mentioned strategy (SCOPUS ® n = 72, PUBMED ® n = 56, CENTRAL ® n = 23, and EMBASE ® n= 7), and the results are presented in Figure 1 . After retrieving the articles and excluding 111, 47 were selected for a full reading. Finally, 17 articles were selected. To comply with the methodology, the independent reviewers analysed all the selected articles one more time after the additional search, and they agreed to eliminate two of them because this study sample included nursing students as well as professional nurses. Therefore, to have a clear outcome focused on nursing students, two articles were removed, and the very final sample size was fifteen articles, following the established selection criteria ( Figure 1 ). The reasons for excluding studies from the systematic review were: nurses as targets; other design types of studies different from RCTs; focusing on other health professionals such as medical students; review studies; and being published in full text in other languages other than Spanish or English.

Flowchart of screening of clinical reasoning RCTs that underwent review.

3.2. Risk of Bias in CASP Results

All studies included in the review were screened with the CASP tool. Each study was scored out of a maximum of 39 points, showing the high quality of the randomised control trial methodology. The studies included had an average score of 33.1, ranging from 30 to 36 points. In addition, this quantitative rate of the items based on CASP, there were 13 studies that missed an item in relation to assessing/analysing outcome/s ‘blinded or not’ or not, and 11 studies that missed the item whether the benefits of the experimental intervention outweigh the harms and costs.

3.3. Data Extraction

Once the articles had undergone a full reading and the inclusion criteria were applied, data extraction was performed with a data extraction table ( Appendix A ). Their contents were summarised into six different cells: (1) CASP total points result, (2) purpose of this study, (3) teaching strategy, (4) time of intervention, (5) sample size, and (6) author and year of publication. After the review by the article’s readers, fifteen RCTs were selected. Of the fifteen, the continent with the highest number of studies was Asia, with 53.33% of the studies (n = 8) (Korea n = 4, Taiwan n = 2, and China n = 2), followed by Europe with 26.66% (n = 4) (Turkey n = 2, Paris n = 1, and Norway n = 1), and lastly South America with 20% (n = 3), all of them from Brazil.

3.4. Teaching Strategies

Different teaching strategies have been identified in the reviewed studies: simulation methods (seven articles) and learning programmes (eight articles). There are also two studies that focus on comparing different teaching methodologies.

3.4.1. Clinical Simulation

The simulation methods focused on in the studies were virtual simulation (based on mobile applications), simulation games, and high-fidelity clinical simulation. Of the total number of nursing students in the studies referring to clinical simulations, 43.85% were in their second year, while 57.1% were senior-year students. The most used method in the clinical simulation group was virtual simulation, and 57.14% of studies included only one-day teaching interventions.

Virtual simulations were used to increase knowledge about medication administration and nasotracheal suctioning in different scenarios [ 21 ], to evaluate the effect of interactive nursing skills, knowledge, and self-efficacy [ 11 ], and to detect patient deterioration in two different cases [ 22 ]. Simulation game methodology was used to improve nursing students’ cognitive and attention skills, strengthen judgment, time management, and decision-making [ 14 ].

Clinical simulation was used to develop nursing students’ clinical reasoning in evaluating wounds and their treatments [ 12 ], to evaluate and compare the perception of stressors, with the goal of determining whether simulations promote students’ self-evaluation and critical-thinking skills [ 23 ], and also to evaluate the impact of multiple simulations on students’ self-reported clinical decision-making skills and self-confidence [ 24 ].

3.4.2. Learning Programs

Different types of learning programmes have been identified in this systematic review: team-based learning, reflective training programs, person-centred educational programmes, ethical reasoning programmes, case-based learning, mapping, training problem-solving skills, and self-instructional guides. Of the total number of nursing students in the studies referring to learning programs, 57.1% were junior-year students, while 43.85% were in their senior year.

Team-based learning is a learner-centred educational strategy that promotes active learning to improve students’ problem-solving, knowledge, and practise performance. It can be implemented in small or large groups divided into teams with an instructor and reading material based on case scenarios [ 25 ]. Reflective training is based on a new mentoring practise to explore, think about, and solve problems actively during an internship. During the reflective training program, the mentors lead students to uncover clinical nursing problems through conversations with them and discussing feedback for their professional portfolios [ 26 ]. The person-centred educational programme focuses on how nursing students perceive individualised care, using design thinking to improve their perception. The use of design thinking gave the students opportunities to apply their theoretical knowledge of the person-centred program to plan innovative solutions that may effectively resolve real-life situations [ 27 ]. Another educational programme identified is the ethical reasoning program, and the aim of this is to improve nursing students’ handling of ethical decision-making situations [ 28 ], engaging the students in complex ethical clinical situations based on real cases.

Case-based learning was used to explore and demonstrate the feasibility of implementing unfolding cases in lectures to develop students’ critical-thinking abilities [ 29 ]. The web-based concept mapping of nursing students was also investigated to determine its impact on critical-thinking skills [ 30 ]. Training problem-solving skills were used to find out how it affected the rate of self-handicapping among nursing students [ 31 ]. And the last article evaluated the effect of the self-instructional guide to improve clinical reasoning skills on diagnostic accuracy in undergraduate nursing students [ 32 ].

4. Discussion

Although 158 studies were initially identified, only 15 articles were finally included in this review. The excluded articles were mainly from other disciplines other than nursing and used a less rigorous study design than RCT.

The three longest interventions were developed in Asia [ 26 , 28 , 29 ]. The longest was 300 h in duration, through one year [ 30 ]. These interventions were based on learning programs, case-based learning, person-centred care (PCC), and reflective training programs. However, it is important to take into account that Asian nursing curriculum programmes are different from European or United States curriculum because their internship is carried out only during the last academic degree year, while in Europe, following the European directive 2005/36/CE, 2013/55/UE nursing education requirements of 4600 h (2300 h of clinical practice) is carried out along the 3–4 years of the academic degree [ 33 ]. On the other hand, the intervention with the biggest sample was 419 nursing students [ 30 ], 210 in the experimental group, and 209 in the control group, and the one with the lowest sample was 51, with 24 students in the control group and 27 in the intervention group [ 32 ]. Therefore, all the included studies had a good sample size.

This systematic review has detected different methodologies to help nursing students improve their reasoning and decision-making skills. Virtual simulation was the most frequently used teaching method, both as a mobile application and as a serious game. In terms of its effectiveness in a study carried out in Taiwan, the use of a mobile application resulted in significantly higher knowledge scores, better skill performance, and higher satisfaction in students than traditional paper materials [ 21 ]. Virtual simulation [ 11 , 14 , 21 ] has also proven to be an effective tool for enhancing knowledge and confidence in recognising and responding to rapidly deteriorating patients, but studies that combined two educational strategies were more effective [ 29 ], like clinical simulation combined with another teaching strategy such as lectures or videos [ 12 ].

An interactive learner-centred nursing education mobile application with systematic contents effectively allowed students to experience positive practical nursing skills [ 11 ]. However, in a study comparing serious game simulation versus traditional teaching methods, no significant difference was found immediately or in the month following the training [ 22 ], but serious games can improve nursing students’ cognitive skills to detect patient deterioration and to make safe decisions about patient care [ 14 ]. Although the innovative teaching method was well received by the students, who expressed higher levels of satisfaction and motivation [ 22 ]. We can affirm that the development of a mobile application and its application can be effectively used by nursing students at all levels [ 11 ]. However, the performance of all these studies was measured on its short-term outcomes, only 40 min [ 21 ], 2 h [ 22 ], and 1 week [ 11 , 14 ] of intervention, and was performed with a mean sample size of 97 nursing students.

The data obtained in a study developed in Brazil [ 12 ] confirm that clinical simulation is effective for the development of nursing students’ clinical reasoning in wound evaluation and treatment and that clinical simulation in conjunction with other educational methods promotes the acquisition of knowledge by facilitating the transition from what the student knows to rational action. Moreover, the high-fidelity simulation strategy increases the perception of stressors related to a lack of competence and interpersonal relationships with patients, multidisciplinary teams, and colleagues compared with the conventional practice class in the skill laboratory. This increase was related to the students’ capacity for self-evaluation and critical reflection, concerning their learning responsibility and the need to acquire the required skills for patient care [ 23 ]. However, in the case of the effect of multiple simulations on students, there are no differences found between the double-versus single-scenario simulations [ 24 ]. The intervention time in these three studies was 30 min [ 23 ], 3.5 h [ 12 ], and 4 days [ 24 ]; then the time used to implement the intervention can determine the results obtained.

The different learning methods have an impact on various learning outcomes and students’ variables. Team-based learning [ 25 ], reflective training [ 26 ], the person-centred education programme [ 27 ], web-based concept mapping [ 30 ], and teaching cognitive-behavioural approaches [ 31 ] have proven to be effective in enhancing problem-solving abilities, knowledge, and reasoning processes and consequently improving the quality of nursing practical education. Team-based learning increased problem-solving ability scores significantly, while those in the control group decreased [ 25 ]. Reflective training, developed in China based on the new mentoring approach, was effective in encouraging nursing students to explore, think about, and solve problems actively during an internship, consequently improving their disposition for critical thinking [ 26 ]. A person-centred education programme using design thinking can effectively improve how nursing students perceive individualised care. Using design thinking allowed the students to apply their theoretical knowledge of the programme to plan innovative solutions that may effectively resolve real health problems [ 27 ]. These programmes were developed in 5 or 6 days [ 27 , 31 ], 1 week or 3 weeks [ 25 , 30 ], and 1 year [ 26 ].

The education programme focused on improving ethical decision-making had statistically significant improvements in nursing students’ self-efficacy in communication confidence, complex ethical decision-making skills, and decreased communication difficulty [ 28 ]. Case-based learning was more effective with lectures than without them in developing students’ critical thinking abilities [ 29 ]. This study was one of the longest developed with 300 h during one school year. This long-term learning intervention could have a positive impact on this study sample. Therefore, the time of the learning intervention could be a limitation in the studied RCTs. The one-time self-instruction guide was ineffective in impacting students’ diagnostic accuracy in solving case studies [ 32 ], and it is possible that only one day of intervention is not enough.

Studies have shown that problem- and team-based learning [ 25 , 31 ] are more beneficial than traditional teaching [ 29 ], as they enhance nursing skills and improve problem-solving abilities, clinical performance, communication competencies, critical thinking, and self-leadership.

Researchers generally agree that clinical reasoning is an important ability and one of the most important competencies for good nursing practise to ensure optimal patient outcomes [ 29 ] and to recognise and address patient deterioration effectively. However, effective communication is crucial in clinical reasoning. It is required to establish a rapport with patients, conduct health evaluations, make collaborative decisions, and discuss clinical cases with colleagues and supervisors. Developing clinical reasoning skills during training is essential to improving nursing professionals’ practice. To enhance clinical reasoning abilities, nursing schools should integrate simulations at every level of education to ultimately improve patient care. Improving nursing students’ preparation will impact the quality of patient care. In addition, new innovative teaching methodologies based on the use of technology could be a motivational driver in nursing clinical reasoning [ 22 ].

5. Limitations

This systematic review did not perform a search on CINAHL. Although most of the journals included in this database are included in MEDLINE, this should be addressed in the future because of the relevance of the database to nursing research. The results of the included studies could have also been influenced by the different times of the interventions and the different contexts. In addition, the reviewers have identified other studies published in languages other than those required by the inclusion criteria. It seems that many articles are published by Asian researchers, but some of them are not in English, so they cannot be analysed.

6. Conclusions

As society progresses, the new generation of nursing students poses a challenge; new technologies are ingrained in their daily lives with access to increasingly advanced technologies like artificial intelligence, and we must adapt training to capture their interest and increase their learning skills. The utilisation of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students’ reasoning skills. As a result, it is crucial to incorporate these tools into the learning process to maintain students’ interest, motivation, and satisfaction in education. Clinical simulation is particularly important in the training of students in terms of clinical performance. Still, it is necessary to add another teaching method to increase the efficacy of clinical simulations. Therefore, nursing schools should evaluate their current teaching methods and consider integrating or modifying new technologies and methodologies that can help enhance students’ learning, improve their clinical reasoning and cognitive skills, and potentially improve nursing students’ ability to affect patient care positively. By doing so, students will be better equipped to provide high-quality patient care in the future.

Funding Statement

This research received external funding from the European programme Eramus +2021-1-BE02-KA220-HED-000023194.

Author Contributions

Conceptualisation, A.P.-P. and A.Z.; methodology, A.P.-P. and A.Z.; formal analysis, A.P.-P.; writing—original draft preparation, A.P.-P.; writing—review and editing, A.Z.; visualisation, A.Z.; supervision, A.Z. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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How to Pass Pathophysiology in Nursing School | What is Pathophysiology?

Nursing students will take a nursing class in college called Pathophysiology to help them understand how to restore the body after it suffers from a number of possible abnormalities that lead to diseases. Many nursing students find pathophysiology difficult and that is takes good study habits to successfully pass the class.

Nurses ensure that patients remain healthy. When patients enter hospitals and clinics, nurses must identify their medical conditions and treat them accordingly. Some diseases can be prevented and those that cannot are managed by nursing professionals so that patients can be restored back to good health.

What is Pathophysiology?

The area of pathophysiology refers to the scientific study of disease or abnormal processes. Any ailment of the body that disturbs its normal physiological processes is the study of pathophysiology. The process involves looking for specific malfunctions that cause or come from disease. Nurses use pathophysiology every time they come in contact with a patient. Nurses must have an exceptional level of skill in this area since what is considered a healthy function or structure in one patient may not necessarily be considered healthy in another patient.

Nursing students take a pathophysiology course in college to prepare them to identify these abnormalities. Courses are available from accredited colleges or universities, and students can take this course completely online or on campus. The course consists of cases studies, visual aids, assessment scales, simulations, tests, and other tools.

The main objectives of pathophysiology courses are as follows:

• Use critical thinking to understand the pathophysiologic principles for nursing
• Analyze and explain the effects of diseases processes at the systemic and cellular levels
• Discuss the various variables that affect the healing of the organ and tissue systems
• Analyze the environmental risks of the progression and development of certain diseases
• Explain how compensatory mechanisms respond to physiologic alterations
• Compare and contrast the effects of culture, ethics, and genetics have on disease progression, treatment, health promotion, and disease prevention.
• Critique diagnostic testing and determine its relationship to signs and symptoms

How Nurses Use Pathophysiology on the Job

Nurses use pathophysiology to understand the progression of disease in order to identify the disease and implement treatment options for their patients. Nurses use the information that they find to identify the next course of the disease so that they can provide their patient’s with the appropriate care they need. The medical procedures and medications that nurses administer to patients depend greatly on the nature of the disease.

Nurses also use pathophysiology to care for their terminally ill patients. Caring for patients as their lives near the end is just as important as caring for patients who are not terminally ill. Nurses have to be able to identify the signs that their patients display in their final days. Nurses have the responsibility to provide care that helps patients experience the upmost comfort as they reach their final days of life.

It is very important that nurses gain a significant amount of exposure to a diverse number of patients because diseases tend to manifest differently in every person. What is normal for one patient may not be normal for the next patient. Lack of exposure to diverse medical diseases may lead to erroneous or missed diagnosis.

How to Pass Pathophysiology–Great Study Guide

As stated at the beginning of this article, Pathophysiology is one of the courses nursing students have trouble passing. This is due to the fact there is so much material to cover in such a short time as a single semester. Buying a good study guide is essential for passing Pathophysiology.

A study guide can help break down what material you need to study and what is likely to be asked on a test. A great study guide recommended by many nursing schools is by Mary Ann Hogan called “ Prentice Hall Reviews & Rationales: Pathophysiology “. Here is what it looks like:

Tips on How to Study for Pathophysiology in Nursing School

Pathophysiology is one of the hardest courses that nursing students will take in nursing school. Here are a few suggestions that can help nursing students meet success in this course.

• Read and reread the material as much as possible. The best way to memorize the information for this course is to go over it repeatedly. Also, read the chapter summaries and introductions to help to get a better understanding of the content.
• Utilize professors as needed. Use the professor as an expert resource to help clarify any information that is not clear. Ask questions immediately to prevent a halt in studying. Students should pay close attention during the lectures because the professor may provide extra information to help with the test.
• Make flashcards. Nursing students can write information pertaining to drugs and their side effects, interactions, and uses on flashcards.
• Pay close attention to wording on the test. Words like never, always, none, all, and should may help students identify the correct answers on the test. Read each question and answer carefully before making a selection.

Nurses have a wealth of information that they must know in order to help their patients. It is important to understand how a disease affects a specific individual before a specific treatment can be administered to help the patients prolong their lives. Exposure to an abundance of people and diseases is what makes the skills learned in the pathophysiology course so valuable.

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