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Critical Thinking

1.5 Contact Hours
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Athletic Trainer (AT/AL), Certified Nurse Practitioner, Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Respiratory Care Practitioner, Respiratory Therapist (RT)
This course will be updated or discontinued on or before Sunday, November 9, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

CEUFast, Inc. (BOC AP#: P10067) is approved by the Board of Certification, Inc. to provide education to Athletic Trainers (ATs).

FPTA Approval: CE24-753328. Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.

≥92% of participants will understand critical thinking and how to implement this skill into practice.


After completing this course, the healthcare professional will be able to:

  1. Explain the importance of critical thinking in healthcare.
  2. List examples of personal factors influencing our perception and practice of critical thinking.
  3. Identify the person ultimately responsible for proficiency in critical thinking.
  4. Summarize how increased experience can affect a healthcare professional's critical thinking skills.
  5. Identify two knowledge elements pertaining to critical thinking in healthcare.
  6. Identify three prerequisites for critical thinking.
  7. Describe ways in which empirical referents are measured.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Critical Thinking
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Heather Rhodes (APRN-BC)


The role of critical thinking in healthcare disciplines cannot be overemphasized. The ability to synthesize complex information and triage action based on critical analysis is a core skill to providing high-quality patient care. Papp et al. (2014) defined critical thinking as the ability to apply higher-order cognitive skills (such as conceptualization, analysis, and evaluation) and the disposition to be deliberate in that process, leading to an appropriate and logical action.

Case Study #1: Greg

Greg K. is a 45-year-old male who presented with a constellation of symptoms, including fatigue, joint pain, skin rashes, and occasional fevers. Initially, the primary care physician suspected a viral infection, but when the symptoms persisted and worsened over several weeks, Greg was referred to a specialist for further evaluation.

Critical Thinking vs. Creative Thinking

Critical thinking is the cognitive search for one answer to a problem through logical thinking. It is a fundamental principle that underlies healthcare disciplines. Creative thinking begins with one problem but instead entertains multiple solutions.Healthcare professionals must be agile and innovative in recognizing and addressing clinical issues. A healthcare professional’s ability to practice critical thinking will significantly enhance or hinder their ability to make decisions in the healthcare setting. Critical thinking in healthcare is essential to professional accountability in providing quality patient care.

Implementing Critical Thinking

Repeated exposure to realistic and risk-free scenarios amplifies objective analysis skills, proficiency, critical thinking, and self-confidence (Al Gharibi et al., 2020). Healthcare educational programs integrate simulation exercises into the curriculum to develop critical thinking using real-world scenarios (Guerrero et al., 2022). Simple and complex scenarios are utilized to create situations where the students must make rapid decisions that directly impact patient outcomes. Self-reflection as part of the simulation exercise allows the student to understand better the ‘why’ behind the decision and consider alternatives that might improve outcomes in the future.

Cultural differences can affect how critical thinking is understood and applied. For example, in the United States, decision-making is considered an active component of critical thinking, whereas, in Thailand, there was a strong association between happiness and critical thinking.

Personal factors can also influence the way critical thinking is perceived and practiced. For example, decreased medical knowledge and lack of perceived time can negatively impact the ability to exercise critical thinking. Poor metacognitive skills, a fixed mindset, heuristics, and biases all affect the ability to think critically (Persky et al., 2019).

The Defining Attributes of Critical Thinking

Attributes of a concept are defining factors that must be present for critical thinking to be present and effective. According to The Foundation for Critical Thinking (2023), attributes defining critical thinking include knowledge acquisition, knowledge application, information analysis, decision-making, and reflection.

Knowledge Acquisition and Knowledge Application

The foundation of any healthcare education is knowledge, skills, and attitudes (Jiménez-Gómez et al., 2019). Developing and expanding proficiency in critical thinking requires healthcare professionals to first exhibit competence in the expected knowledge base, including disease processes, treatment options, adverse medication reactions, and side effects. A fundamental knowledge base is acquired during initial program training, and continued growth in this knowledge base is expected as part of the ongoing healthcare profession. Critical thinking skills are enhanced as individuals accumulate new knowledge and apply it to intricate patient cases and complex healthcare scenarios. The foundational basis for critical thinking resides in acquiring and utilizing new information. Healthcare educational programs work “intensely to reduce dichotomies that are present in nursing programs, namely between theory-practice and training and reality” (Jiménez-Gómez et al., 2019)Each individual is responsible for developing their proficiency in critical thinking and growing in their profession to the point where “reflection, self-criticism, and professional responsibility are developed” (Jiménez-Gómez et al., 2019).

Analysis of Information

Healthcare professionals are expected to analyze and prioritize clinical information when providing patient care. Examples include but are not limited to interpreting lab values, reviewing test results, accurately identifying patients whose clinical status is changing, and understanding the expected course of a medical process. The application and improvement of this skill with increasing professional experience positively contribute to the development of critical thinking skills and self-confidence (Al Gharibi et al., 2020; Guerrero et al., 2022; Jiménez-Gómez et al., 2019; Papp et al., 2014; Persky et al., 2019).

Case Study #1 Continued

The nurse practitioner meets with Greg K. and takes a detailed medical history, including past illnesses, travel history, and family medical history. Greg reports a family history of autoimmune disorders and a recent trip to a region known for tick-borne diseases. The nurse practitioner noticed that Greg’s symptoms were vague and could be associated with various conditions. However, the presence of joint pain and skin rashes raises suspicions of an autoimmune disorder.

Informed Decision Making

Informed decision-making is a skill that must be taught to all students in healthcare professions before they enter the workforce. The practice and execution of informed decision-making can positively and negatively affect patient outcomes. Students within a healthcare profession can become inundated with clinical data daily, which can be irrelevant, relevant but not urgent, relevant and urgent, or critical. Healthcare professionals are expected to promptly analyze information and make quick decisions based on the available information. Note that a solid knowledge base and educational foundation will accurately impact the healthcare professional’s ability to practice informed decision-making (Al Gharibi et al., 2020; Foundation for Critical Thinking, 2023; Guerrero et al., 2022; Jiménez-Gómez et al., 2019; Papp, et a.l, 2014; Persky et al., 2019).

Case Study #1 Continued

Several hypotheses are considered, including lupus, rheumatoid arthritis, or tick-borne illness like Lyme disease. The nurse practitioner reviews laboratory results, including complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibody (ANA), and specific tests for Lyme disease. The results showed elevated ANA and positive Lyme disease antibodies. Based on the evidence, Lyme disease is suspected with possible autoimmune complications. The nurse knows from taking the medical history that there is a family history of autoimmune disorders. The nurse considers the evidence and knows that there is still uncertainty about whether the symptoms were solely due to Lyme disease or if an underlying autoimmune condition was contributing. The nurse practitioner consults with her colleagues in infectious disease and rheumatology to gain insights into the complex presentation. They collectively reviewed the evidence, including clinical findings and test results.


Reflection focuses on reviewing the thinking process to identify ways in which improvement can occur. The process of reflection resembles debriefing following an event or a critical clinical situation. The process can be performed as an individual or as a team. It allows for improvement in future scenarios since it allows team members to review each action to determine if it is appropriate and timely. It can also enable the team to examine the role of team members or adjust systems and processes that are applied in the critical thinking process. It permits the individual or group to identify gaps in knowledge that need to be remediated and allows for cognitive growth (Foundation for Critical Thinking, 2023; Guerrero et al., 2022; Jiménez-Gómez et al., 2019; Papp et al., 2014; Persky et al., 2019).

Case Study #1 Continued

Greg K. was started on antibiotics for Lyme disease, and a watchful waiting approach was taken for the autoimmune component. Follow-up appointments were scheduled to monitor Greg’s process and adapt the treatment plan as necessary.

Antecedent for Critical Thinking

Open-mindedness, autonomy, and knowledge are prerequisites for critical thinking that affect the student’s or professional’s capacity to engage in critical thinking. A vital requirement for critical thinking is the learner’s willingness to remain open-minded. Open-mindedness prepares the learner to consider alternative solutions or courses of action for improved outcomes. In the case study above, the nurse remained open-minded to the possibility that Greg’s symptoms may not all be attributed to Lyme disease. Being open-minded in this situation allowed the identification of an underlying factor beyond the immediate illness.

Autonomy has also been identified positively as a prerequisite for critical thinking. Independent thinking is paramount for clinicians who want to become critical thinkers. The process needs to become internalized and automated within the individual. In the case study presented, the nurse practitioner consulted with colleagues on the case, but ultimately, the decision on how to proceed with treatment remained with the nurse practitioner.

Critical thinking increases competence in clinical practice, which in turn improves patient outcomes. Clinical competence among graduates from healthcare educational programs is not homogenous and highly depends on the curriculum's focus on developing critical thinking skills. Employers are keen to recruit professionals with a solid educational foundation and have refined their critical thinking skills to a competent or expert level.

Knowledge is not enough to ensure a healthcare professional's competence. The ability to apply the acquired knowledge to positively affect the patient’s health outcomes is the fundamental skill that critical thinking exercises can assess for and improve. Remaining open-minded, retaining autonomy while exploring other options with colleagues, and having a solid knowledge base are all foundational to implementing critical thinking.

Empirical Referents

The final part of concept analysis in critical thinking is identifying empirical referents. An empirical referent in critical thinking within healthcare professions is the clinical competence of the professional. The professional is duty-bound to maintain clinical competence in their area of practice. One method of evaluating the empirical referent of clinical competence is to measure patient quality care outcomes.

Healthcare professionals must adjust to swiftly evolving clinical circumstances and utilize minimal resources to care for patients with complex medical conditions. These clinical practitioners must navigate medical situations that are often ambiguous, multifaceted, and stressful, where each decision can trigger a series of events that may ultimately determine the fate of the patients under their care.

In cases where traditional interventions are not effective, clinicians must use creative thinking combined with critical thinking to come up with patient-specific solutions that are quickly implemented and flexible so that they may be adaptable to other patients.

Cognitive Skills

There are six basic cognitive skills required for critical thinking. These include interpretation of information, critical analysis, evaluation through establishing the validity and reliability of information sources, explanation, and self-regulation (Pesky et al., 2019).

Critical Analysis

Critical analysis is applied to a clinical scenario to separate clinically relevant information from unnecessary information. To that end, the Socratic method can be used where the clinician asks questions and seeks answers to distinguish between factual information versus what one believes. It is used to examine data and consider the consequences of any actions. This method can apply anywhere within a task, such as history taking or when finalizing the treatment care plan. The technique can also be applied at the end of a shift or the end of a procedure (Shirazi & Heidari, 2019).

Assessment of the reliability of the information a clinician processes is necessary for critical thinking. A clinician incapable of making significant decisions independently and quickly in critical situations becomes part of the problem instead of part of the solution. Analyzing essential data and distinguishing between problems that require urgent intervention and those that are not life-threatening is material to positive patient outcomes (Shirazi & Heidari, 2019).

Independence of thought is necessary for maturity in critical thinking. The critical thinker must remain impartial in their decision-making process. Developing both inductive and deductive reasoning skills is crucial.

While providing routine care, clinical professionals typically make decisions using minimal critical thinking skills, primarily relying on habit. Critical thinking skills become essential when an unusual or abnormal event occurs, compelling clinicians to employ advanced critical thinking abilities.

The Process

In most healthcare professions, the process is an essential method of systemic and rational planning in providing specialized care in a patient-centric manner. The process has five parts: assessment, diagnosis, planning, implementation, and evaluation (ADPIE).

“Intuition is the perception and understanding of concepts without the use of conscious reasoning”(Papathanasiou et al., 2014). It is typically not considered an appropriate technique for clinical decision-making. Some clinicians view it as a type of educated guessing, whereas others regard it as an integral component of clinical knowledge and skill acquisition. Some maintain that clinical instincts can be cultivated and refined through experience, rendering experienced clinicians invaluable. Note, however, that intuition is highly dependent upon clinical experience. The reliance on intuition should be discouraged with new graduates.

Case Study #2: Anna

You are a nurse working in a post-surgical unit. Anna K is a 70-year-old Asian female who recently underwent abdominal surgery for a benign tumor. She was admitted to your unit within the last 24 hours. Her past medical history includes hypertension, type 2 diabetes, and depression. The surgery was uneventful, and Anna was stable during her post-operative recovery.

On the morning of postoperative day two, Anna’s vital signs were within normal range, but she had become restless and agitated by lunchtime. She rated her abdominal pain at a level 6 on a scale of 0 to 10 and described a “sharp stabbing” pain around the incision. Her dressing initially appeared dry and intact but has not been rechecked since the beginning of the shift. Her urine output is lower than expected, and she has not had a bowel movement since the surgery.

Clinical Discussion of Anna

The nurse must have a fundamental knowledge base about surgical procedures to fully understand Anna's risks. Although her vital signs were initially stable, her status has changed with the increase in pain and clinical presentation. This situation requires the nurse to complete a new assessment, including vital signs. During the assessment, the nurse must use critical thinking skills, pulling from her knowledge about surgery and infection, to problem-solve the underlying issues that may be contributing to her increasing pain, restlessness, and agitation.

The nurse’s priority is to assess Anna’s pain further. It is critical to determine the nature, location, and intensity of the pain and inquire about any other associated symptoms that might be present, including nausea or vomiting, which could indicate paralytic ileus.

The surgical site should also be inspected again, along with auscultation of her bowel sounds to assess for borborygmus, signs of infection, hematoma, or dehiscence, which could cause increased pain and might require immediate intervention. Given Anna’s low urine output, the nurse should also consider dehydration as inadequate fluid intake could contribute to restlessness, abdominal discomfort, and constipation. Fluid replacement should be considered in collaboration with the medical provider to avoid fluid overload in patients with hypertension.

A medication review, including any analgesic or opioids administered for pain, should also be completed. If Anna did not receive any pain medication as scheduled, this could be contributing to her increasing pain at this time. Pain medication can also contribute to constipation.

If not already addressed, patient education regarding the importance of deep breathing exercises, coughing, and early ambulation to prevent post-surgical complications should also be considered and done. Helping Anna understand the expected course of recovery and what symptoms to report to staff allows her to have some control over her recovery process. It helps with early intervention if problems develop, especially after discharge.

As the nurse, you completed a full nursing assessment with vital signs and medication review. You found that the patient had a low-grade fever with redness and drainage around the incision site. A call was made to the surgeon, reporting the new findings. The surgeon came to the unit and completed a wound culture before ordering a new antibiotic with dressing changes every four hours. Anna’s pain was managed with her new treatment plan, and the crisis was averted with early intervention. Knowledge base is vital to critical thinking and is foundational for positive patient outcomes.

Case Study #3: Mark

You are an outpatient Doctor of Physical Therapy who receives a referral for Mark, a 36-year-old man with a diagnosis of low back pain with sciatica. He has a history of episodic low back pain, for which physical therapy and NSAIDs have helped in the past. He is presently on Naproxen sodium 500mg, twice daily, as an anti-inflammatory and pain reliever, as well as Flexeril for muscle spasms at night. He was initially seen by his primary care physician, who performed an X-ray, which was unremarkable. Based on Mark's request and reports of past success with physical therapy, the primary care physician proceeds to refer him to physical therapy with a recommendation of joint mobilization, lumbar traction, and core stabilization exercises.

The patient is a well-developed, pleasant, healthy male of average weight and height. His gait is antalgic and guarded, and he demonstrates a severe unwillingness to move during his transitional movements from sitting to standing and while walking to the examination room and the plinth.  Upon patient interview, you are informed that he was lifting an iron support beam as part of his home construction project and immediately had severe pain in his lower back and down his right lower leg to his toes. He does not volunteer information about bowel or bladder control, but once asked; he does admit that he lost bladder control yesterday. He simply could not feel that he had to go. He attributed this to being distracted by his severe pain. He noted that “something weird” was happening when he used the restroom, and both legs went numb whenever he tried to urinate or have a bowel movement. He reports that he has not been sexually active since his injury. Upon examination, he demonstrates immediate pain reproduction with slight forward flexion and extension.  Special testing revealed a positive straight leg raise test at 15 degrees on the right lower extremity and 20 degrees on the left lower extremity. He has decreased bilateral reflexes in the L4, L5, and S1 reflexes and a non-dermatomal decreased sensation to light touch in his bilateral feet and lower legs right>left. He has bilateral weakness with manual muscle testing in his quadriceps, anterior tibialis, fibularis, and ankle plantar flexors. When tested in sitting, he had more than three beats of clonus in his plantar flexors on the right foot.

Clinical Discussion of Mark

In Mark’s case, you must use your critical thinking skills to determine if Mark is appropriate for outpatient physical therapy. Once you have completed your evaluation, you need to decide if you will treat Mark, and if so, is Mark appropriate for manual therapy, traction, and exercises as recommended by his primary care physician, or does Mark require further diagnostic imaging or referral to a different specialist? Clinically, you need to decide if you will treat Mark, treat and then refer him to another specialist, or refer him without physical therapy treatment.

Given the severity of Mark's pain, a positive straight leg raise in the affected and contralateral lower extremity, weakness, and reflex alterations in multiple nerve roots, there is concern for a severe rupture of one of his lumbar discs. Often, severe discs can be treated with exercise and traction in combination with the medications that Mark has already been prescribed. It is essential that you, as the Doctor of Physical Therapy, recognize the more severe and concerning symptoms of bladder incontinence and Mark's report of his legs “going numb” when he tries to urinate or attempts a bowel movement. These symptoms are red flag symptoms and could be indicative of cauda equina syndrome, and while rare, are an actual emergency. Mark needs to be referred to the Emergency Department immediately for further testing. Mark’s wife took him immediately to the nearest emergency department, where they performed an MRI and determined Mark did have a massive disc herniation, creating cord and nerve root compression. It was recommended that he have immediate, emergent surgery for decompression.


In the case studies above, critical thinking was pivotal in the patient outcomes. The critical thinking process involved gathering comprehensive information, identifying patterns, generating hypotheses, evaluating evidence, consulting with colleagues, and refining the diagnosis and treatment plan. All healthcare professionals must prioritize critical thinking as an essential skill. Critical thinking commands respect and is highly sought-after in 21st-century professional practice. With healthcare systems growing in complexity, practitioners are tasked with seamlessly blending healthcare expertise with ever-evolving technological advancements. Proficiency in critical thinking is ultimately the responsibility of each clinician.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


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  • The Foundation of Critical Thinking. (n.d.). Defining Critical Thinking. Visit Source.
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  • Jiménez-Gómez, M. A., Cárdenas-Becerril, L., Velásquez-Oyola, M. B., Carrillo-Pineda, M., & Barón-Díaz, L. Y. (2019). Reflective and critical thinking in nursing curriculum. Revista latino-americana de enfermagem, 27, e3173. Visit Source.
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  • Persky, A. M., Medina, M. S., & Castleberry, A. N. (2019). Developing Critical Thinking Skills in Pharmacy Students. American journal of pharmaceutical education, 83(2), 7033. Visit Source.
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