Critical Thinking and Decision-Making in Nursing: How to Write This Discussion Post in APA 7
A section-by-section guide for nursing students on how to respond to the prompt asking you to discuss the history and theoretical framework of critical thinking and decision-making — from the Socratic method through to contemporary clinical reasoning models — formatted correctly in APA 7.
This discussion prompt contains a factual error that your response must address — and failing to address it is one of the most common reasons nursing students lose marks on this specific post. The prompt states that “critical thinking is new to nursing,” but this claim is incorrect. Critical thinking has an established intellectual history spanning more than two millennia, and its formal integration into nursing education and practice spans several decades. Your discussion post is not simply asking you to agree with the prompt’s framing — it is asking you to engage with the actual history and theoretical frameworks, which means your response must correct this error, trace the lineage from Socratic inquiry through twentieth-century philosophy to contemporary nursing theory, and connect those frameworks to how nurses make clinical decisions. This guide tells you exactly what to cover, how to structure it, and how to apply APA 7 format throughout.
What This Guide Covers
What the Prompt Is Actually Asking
The prompt has two explicit discussion requirements and one implied requirement that students consistently miss. Understanding all three before writing determines whether your post earns full marks.
Addressing the Factual Error in the Prompt
The prompt’s framing — “while the concept of critical thinking is new to nursing” — is the first thing your post should address. This is not a matter of opinion; it is a matter of documented history. Critical thinking has been embedded in nursing education frameworks since at least the 1980s, and the National League for Nursing (NLN) included critical thinking as a curriculum outcome in its accreditation standards during that decade. The American Association of Colleges of Nursing (AACN) Essentials documents, which have shaped baccalaureate nursing education since 1986, have consistently positioned critical thinking as a core competency.
A discussion post that begins “Critical thinking is indeed new to nursing, but it has been around since Socrates…” has accepted an inaccurate framing and built its argument on it. The prompt contains a concession structure — “while X is true, Y is also true” — but the X claim is not actually true. Your post should not replicate a factual error. Instead, open with a brief, evidence-based correction: nursing has formally integrated critical thinking since the 1980s, and the concept’s intellectual history is far older — which is precisely why examining that history matters for nursing practice. Then proceed with the historical and theoretical discussion.
History of Critical Thinking: From Socrates to Nursing Education
The history of critical thinking as an intellectual tradition does not begin with Socrates — it is traceable to him as its most widely cited ancient figure. Understanding what Socrates actually contributed, and then how that contribution was developed through subsequent intellectual history, gives your post the historical depth the prompt is asking for.
5th Century BC — The Socratic Method
Socrates (approximately 470–399 BC) did not write anything himself — his method is known through Plato’s dialogues. The Socratic method involves systematic questioning to expose contradictions, test assumptions, and arrive at more defensible conclusions. For Socrates, unexamined beliefs were not reliable guides to action — knowledge required subjecting claims to rigorous interrogation. The pedagogical implication for nursing education is direct: Socratic questioning trains practitioners to challenge assumptions, identify what they do not know, and reason through uncertainty rather than accepting surface-level conclusions. This is the intellectual ancestor of clinical questioning frameworks used in nursing education today. When your post discusses Socrates, the claim to make is not that he invented critical thinking for nurses — it is that his method of disciplined, systematic questioning is the philosophical foundation of what later became formalized as critical thinking.
17th–18th Century — Empiricism and the Scientific Method
Francis Bacon (1561–1626) and René Descartes (1596–1650) extended the Socratic tradition into what became the scientific method — the systematic observation, hypothesis testing, and evidence evaluation that underlies both modern science and evidence-based practice. Bacon argued that knowledge should be derived from careful observation rather than inherited authority. Descartes argued for methodological doubt — subjecting every belief to skeptical scrutiny before accepting it. Both contributed to a tradition of disciplined reasoning that nursing, as a practice discipline grounded in evidence, directly inherits. The connection between this tradition and nursing’s contemporary emphasis on evidence-based practice is explicit and worth naming in your post.
20th Century — John Dewey and Reflective Thinking
John Dewey (1859–1952) is the figure most directly responsible for translating the philosophical tradition of critical inquiry into an educational framework. In How We Think (1910, revised 1933), Dewey argued that reflective thinking — deliberate, active, persistent examination of beliefs in light of evidence — is the cornerstone of sound education and professional practice. Dewey’s concept of reflective thinking is the direct precursor to what nursing educators later formalized as critical thinking. His insistence that thinking is not a passive process but an active engagement with problems, evidence, and consequences maps directly onto the nursing process and clinical reasoning. Any nursing discussion post on the history of critical thinking that does not mention Dewey is missing a foundational connection.
1941 — Edward Glaser and the First Formal Definition
Edward Glaser provided one of the first formal definitions of critical thinking in 1941, describing it as the ability to think carefully about problems and issues, knowledge of methods of logical inquiry and reasoning, and skill in applying those methods. Glaser, working with his advisor Watson, also developed the Watson-Glaser Critical Thinking Appraisal — the first standardized instrument for measuring critical thinking ability — which became widely used in educational research, including later research in nursing education. Watson and Glaser’s framework identified five dimensions of critical thinking: inference, recognition of assumptions, deduction, interpretation, and evaluation of arguments. These five dimensions remain relevant to nursing clinical reasoning today.
1962–1987 — Bloom’s Taxonomy and Educational Integration
Benjamin Bloom’s taxonomy of educational objectives (1956) created a hierarchy of cognitive skills — from basic knowledge and comprehension through analysis, synthesis, and evaluation — that became the standard framework for curriculum design in higher education, including nursing. The higher-order cognitive skills in Bloom’s taxonomy (analysis, synthesis, evaluation) are precisely what nursing educators mean when they refer to critical thinking in clinical practice. The taxonomy was revised by Anderson and Krathwohl in 2001, with the highest level renamed to “creating” — but the core structure continues to shape how nursing competencies are defined and assessed. When you trace the history of critical thinking in nursing education, Bloom’s taxonomy is the pedagogical bridge between philosophical tradition and clinical application.
1980s — Formal Integration into Nursing Education
The formal integration of critical thinking into nursing education occurred during the 1980s, when both the National League for Nursing and the American Association of Colleges of Nursing began requiring critical thinking as a demonstrable curriculum outcome. Scheffer and Rubenfeld’s (2000) Delphi study — one of the most cited nursing-specific research efforts on the topic — identified a consensus definition of critical thinking in nursing, describing it as purposeful, informed, outcome-focused thinking applied to phenomena such as nursing judgments, clinical diagnoses, and care plans. The study identified both cognitive skills (analysis, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge) and habits of mind (confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection) as components of nursing critical thinking.
1990s–Present — Paul and Elder’s Framework
Richard Paul and Linda Elder’s critical thinking framework, developed through the Foundation for Critical Thinking beginning in the 1990s, provided the most widely adopted contemporary definition and framework in nursing education. Paul and Elder describe critical thinking as the art of analyzing and evaluating thinking with a view to improving it, structured around intellectual standards (clarity, accuracy, precision, relevance, depth, breadth, logic, significance, and fairness) and intellectual traits (humility, courage, empathy, integrity, perseverance, confidence in reason, and autonomy). Their framework is cited extensively in nursing education literature and is the foundation of many nursing programs’ critical thinking curricula. Your post should name Paul and Elder explicitly when discussing the contemporary theoretical framework.
Theoretical Frameworks for Critical Thinking in Nursing
The prompt asks for the “theoretical framework” — singular — but the field has produced several distinct frameworks, and a strong discussion post engages with more than one. Each framework emphasizes different aspects of the critical thinking process and has different implications for nursing education and clinical practice.
Elements of Thought and Intellectual Standards
Paul and Elder’s framework organizes critical thinking around eight elements of thought (purpose, question at issue, information, interpretation and inference, concepts, assumptions, implications and consequences, and point of view) and nine intellectual standards that thinking must meet (clarity, accuracy, precision, relevance, depth, breadth, logic, significance, and fairness). In nursing, this framework is applied to clinical reasoning by requiring nurses to identify the purpose of their assessment, the clinical question they are addressing, the information they have gathered, the assumptions they are making about the patient’s situation, and the implications of their clinical decisions. The framework is explicit enough to be taught, assessed, and applied in clinical practice — which accounts for its widespread adoption in nursing curricula. When your post describes a theoretical framework, Paul and Elder’s is the one most likely to be recognized and valued by a nursing instructor.
Cognitive Skills and Dispositions
Peter Facione led a landmark Delphi study in 1990, commissioned by the American Philosophical Association, that produced a consensus definition of critical thinking for educational purposes. The study identified six core cognitive skills — interpretation, analysis, evaluation, inference, explanation, and self-regulation — and a set of affective dispositions that support critical thinking, including truth-seeking, open-mindedness, analyticity, systematicity, confidence in reasoning, inquisitiveness, and cognitive maturity. Facione’s framework was subsequently adapted for nursing by Scheffer and Rubenfeld (2000), who added nursing-specific language and context. The nursing adaptation added habits of mind (attitudinal components) alongside the cognitive skills, recognizing that critical thinking in clinical practice requires not only the ability to reason but the disposition to do so consistently, even under time pressure and with incomplete information.
Critical Thinking in Nursing Practice
The Scheffer and Rubenfeld (2000) Delphi study is the most directly nursing-specific critical thinking framework and the one most likely to be required reading in nursing programs that assign this discussion post. The study engaged nursing experts across specialties and education levels to reach consensus on what critical thinking means specifically in nursing practice. The resulting framework identifies ten cognitive skills (analysis, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge) and ten habits of mind (confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection). This framework explicitly ties critical thinking to nursing’s unique demands — particularly the need to reason under uncertainty, with incomplete information, in high-stakes situations where errors have clinical consequences. Your post should engage with this framework by name because it directly responds to what it means for critical thinking to be used “in nursing” specifically.
Theoretical Frameworks for Decision-Making
Decision-making theory is a distinct body of literature from critical thinking theory, though the two are closely related in clinical practice. Critical thinking provides the reasoning process; decision-making theory describes how that reasoning culminates in a specific choice. Your post needs to address both, and connect them explicitly. There are three major theoretical perspectives on decision-making that appear in nursing and healthcare literature.
Normative Decision Theory
Normative (or rational) decision theory describes how decisions should be made under conditions of certainty or calculable risk — selecting the option that maximizes expected utility based on available information. This model underpins clinical guidelines and protocols, which represent institutionalized rational decision-making. In nursing, normative decision theory is reflected in evidence-based practice protocols, clinical pathways, and standardized care plans — situations where the best decision is calculable from available evidence and established guidelines. The limitation for clinical nursing is that many clinical situations involve uncertainty, incomplete information, and value judgments that rational calculation alone cannot resolve.
Descriptive Decision Theory
Descriptive decision theory, associated with Kahneman and Tversky’s work on cognitive biases (beginning in the 1970s), describes how decisions are actually made by humans — which is systematically different from the rational model. Their research identified heuristics (mental shortcuts) and cognitive biases — availability bias, anchoring, confirmation bias, and representativeness bias — that shape clinical judgment in ways that can produce errors. In nursing, this framework is essential because it explains why experienced practitioners sometimes make reasoning errors that simpler analysis would prevent. Teaching nurses to recognize cognitive biases is a direct application of descriptive decision theory to clinical safety.
Naturalistic Decision-Making (NDM)
Naturalistic decision-making, developed by Gary Klein (1989) through his Recognition-Primed Decision model, describes how experienced practitioners make decisions in real-world conditions — time pressure, ambiguous information, high stakes, and dynamic situations. Klein found that experienced decision-makers rarely evaluate multiple options systematically. Instead, they recognize patterns, generate a single option that seems workable, and mentally simulate its implementation. This model is highly relevant to experienced nursing practice, where the pattern recognition of clinical expertise produces rapid, effective decisions that novice nurses cannot replicate through rational analysis alone. NDM theory explains the role of intuition in experienced clinical nursing — not as guesswork, but as pattern recognition built from extensive clinical experience.
Your discussion post should address all three frameworks briefly, rather than covering one in depth and ignoring the others. The contrast between them is analytically valuable — normative theory explains protocol-based practice, descriptive theory explains why clinical errors occur despite good intentions, and naturalistic theory explains how expert nurses make fast, accurate decisions in complex situations. Together, the three frameworks provide a complete picture of decision-making in nursing contexts.
When and How Nursing Formally Adopted Critical Thinking
The formal integration of critical thinking into nursing is traceable to specific organizational decisions and published standards. Knowing these dates and sources gives your post the historical specificity that distinguishes a strong response from a vague one.
Clinical Reasoning Models Specific to Nursing Practice
Beyond the general critical thinking frameworks, nursing has developed practice-specific models for clinical reasoning and decision-making. Your post should mention at least one or two of these because they demonstrate how theoretical frameworks translate into the specific cognitive work nurses perform at the bedside.
Assessment, Diagnosis, Planning, Implementation, Evaluation
The nursing process — Assessment, Diagnosis, Planning, Implementation, Evaluation — is the most widely taught clinical reasoning structure in nursing education. It represents the institutionalization of systematic, evidence-based decision-making in nursing practice. Each step of the nursing process requires critical thinking: assessment requires discriminating relevant from irrelevant data; diagnosis requires analysis and inference; planning requires synthesis and prioritization; implementation requires applying standards and predicting outcomes; evaluation requires comparing outcomes against expected results and adjusting the plan accordingly. The nursing process is the practical manifestation of critical thinking frameworks in daily clinical work. When your post discusses how critical thinking operates in nursing practice, the nursing process is the most direct and recognizable example to use.
Noticing, Interpreting, Responding, Reflecting
Christine Tanner’s (2006) clinical judgment model, published in the Journal of Nursing Education, is one of the most influential nursing-specific frameworks for understanding how nurses reason clinically. The model identifies four aspects of clinical judgment: noticing (perceiving the clinical situation and what is relevant), interpreting (making sense of the situation using available information), responding (deciding on a course of action), and reflecting (evaluating the response and what it reveals about the patient’s condition and one’s own reasoning). Tanner’s model is distinctive because it incorporates both cognitive and experiential dimensions — it acknowledges that clinical judgment is shaped by the nurse’s background, the context of the clinical setting, and the relationship with the patient and family, not only by analytical reasoning. The model also explicitly addresses the development of clinical intuition as a product of pattern recognition built through clinical experience, connecting to Klein’s naturalistic decision-making framework.
The Current Regulatory Standard for Nursing Competence
The National Council of State Boards of Nursing (NCSBN) developed the Clinical Judgment Measurement Model as the theoretical framework for the Next Generation NCLEX (NGN), introduced in 2023. The CJMM identifies six cognitive processes in clinical judgment: recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes. This model is directly relevant to nursing students because it represents how their clinical reasoning will be assessed for licensure. The CJMM also serves as evidence that nursing’s regulatory body has formally recognized clinical judgment — grounded in critical thinking — as the core competency of safe nursing practice. Citing the NCSBN’s CJMM in your post demonstrates awareness of how the field’s theoretical frameworks connect to contemporary licensing standards. According to the NCSBN (2023), the NGN’s clinical judgment measurement model reflects decades of research establishing that safe nursing practice requires not just knowledge, but the ability to reason clinically under conditions of complexity and uncertainty.
How to Structure the Discussion Post
This post requires more than a single paragraph. A response that covers the history of critical thinking from Socrates through contemporary nursing frameworks, addresses the decision-making theoretical frameworks, and applies APA 7 correctly cannot do so in fewer than 300–500 words if it engages substantively with the required content. The following structure produces a complete, organized response.
-
Opening: Correct the Prompt and Frame the Discussion (50–80 words)
Address the prompt’s factual error directly and briefly, citing evidence that critical thinking has been formally integrated into nursing for decades. Then reframe: exactly because critical thinking has a long intellectual history, tracing that history is important for understanding how it applies to nursing practice. This opening move demonstrates intellectual engagement with the prompt rather than passive acceptance of its framing — and it gives your post a clear argument to organize around rather than simply reciting history.
-
Historical Development: Socrates to Nursing Education (120–180 words)
Trace the intellectual lineage from Socratic questioning through Dewey’s reflective thinking, Bloom’s taxonomy, the Watson-Glaser framework, and the formal integration into nursing via NLN and AACN requirements. You do not need equal depth on every figure — identify the major turning points and explain what each contributed. Every historical claim that names a theorist or cites a publication requires an APA 7 in-text citation. End this section with the Scheffer and Rubenfeld (2000) nursing-specific definition, which represents the synthesis of the historical development in a nursing context.
-
Critical Thinking Frameworks: Paul & Elder and Facione (80–120 words)
Describe the major theoretical frameworks for critical thinking, naming Paul and Elder’s elements and standards and Facione’s cognitive skills and dispositions. Explain what each framework adds to the understanding of critical thinking specifically in nursing. Connect to the Scheffer and Rubenfeld nursing adaptation. Cite each framework’s originating source in APA 7 format.
-
Decision-Making Frameworks: Normative, Descriptive, Naturalistic (100–150 words)
Address the three major decision-making frameworks: normative (rational) theory, descriptive theory with cognitive biases (Kahneman and Tversky), and naturalistic decision-making (Klein). Explain what each contributes to understanding how nurses make clinical decisions. Connect to nursing-specific models — the nursing process, Tanner’s clinical judgment model, or the NCSBN CJMM. At least one of these frameworks should be cited to a peer-reviewed source.
-
Synthesis: Why This History Matters for Nursing Practice (50–80 words)
Close with a sentence or two connecting the historical and theoretical content to the practical implications for clinical nursing today. Why does it matter that nurses understand this history? What does knowing the theoretical frameworks change about how a nurse approaches clinical reasoning? This closing synthesis demonstrates that you engaged with the content analytically, not just descriptively.
-
References in APA 7 Format
List every source cited in the post in APA 7 format. The reference list begins on a new line after the post content, labeled “References” (centered, bold in a formal paper — check your course’s discussion post formatting requirements for whether the bold heading is required in the forum). Each reference is formatted according to APA 7 rules for its source type — book, journal article, website, or government/organizational document.
APA 7 Rules That Apply Directly to This Post
APA 7 introduced several changes from APA 6 that affect how nursing students format their citations and references. The following rules are the ones most directly relevant to this specific discussion post.
| APA 7 Rule | How It Applies to This Post | Common Mistake to Avoid |
|---|---|---|
| Author-date in-text citation | Every claim from a source: (Paul & Elder, 2019); (Tanner, 2006); (Scheffer & Rubenfeld, 2000) | Naming a theorist in the sentence without the date in parentheses: “Paul and Elder argue…” needs “(2019)” after “Elder” |
| Up to 20 authors in reference list | APA 7 eliminated the “et al. after 6 authors” rule in the reference list — list all authors up to 20 | Using APA 6 rules (truncating after 6 authors with et al. in the reference list) |
| DOI as hyperlink | Journal article references include the DOI formatted as a live hyperlink: https://doi.org/xxxxx | Writing “doi: xxxxx” instead of the full URL format that APA 7 requires |
| No publisher location for books | APA 7 eliminated the requirement to list city and state/country for book publishers | Including “New York, NY:” before the publisher name — this was APA 6, not APA 7 |
| Website references include retrieval date only if content changes | For stable organizational documents (AACN Essentials, NCSBN publications), no retrieval date is needed | Adding “Retrieved [date] from” to every website reference — only required for content that changes over time |
| Singular “they” for unknown gender | When referring to a hypothetical nurse or patient, use “they/their” rather than “he/she” or “s/he” | Using “he/she” constructions — APA 7 explicitly endorses singular “they” for gender-neutral reference |
| Journal article format | Author, A. A., & Author, B. B. (Year). Title of article. Title of Journal, volume(issue), page–page. https://doi.org/xxxxx | Italicizing the article title (only the journal title and volume are italicized in APA 7) |
Which Sources to Use and Cite
The sources that strengthen a nursing discussion post on this topic are specific. Using the right sources signals academic competence; using weak sources undermines even a well-organized post.
Strong Sources for This Post
- Scheffer & Rubenfeld (2000): “A consensus statement on critical thinking in nursing.” Journal of Nursing Education, 39(8), 352–359. The most-cited nursing-specific critical thinking study.
- Tanner (2006): “Thinking like a nurse: A research-based model of clinical judgment in nursing.” Journal of Nursing Education, 45(6), 204–211. Standard reference for clinical judgment models.
- Paul & Elder (2019): The Miniature Guide to Critical Thinking Concepts and Tools. Foundation for Critical Thinking Press. The most widely used framework in nursing curricula.
- AACN Essentials (2021): The current competency framework for baccalaureate nursing education — authoritative organizational source.
- NCSBN (2023): Next Generation NCLEX documentation — establishes the current regulatory standard for clinical judgment.
- Kahneman (2011): Thinking, Fast and Slow. Farrar, Straus and Giroux. The most accessible reference for System 1/System 2 decision-making and cognitive biases.
Weak Sources That Undermine This Post
- Nursing textbook chapters without specific authors listed — cite the specific chapter authors in APA 7 format, not the textbook title alone
- General nursing websites (.com sites with no identifiable author or publication date) — not academically citable
- Wikipedia entries on Socrates or critical thinking — use primary or peer-reviewed sources instead
- Outdated sources (pre-2000) on nursing-specific critical thinking — except for foundational works (Dewey, Watson-Glaser), use literature from the past 10–15 years for nursing application claims
- Sources that confuse critical thinking with problem-solving generally — the literature distinguishes these constructs and your post should too
- AI-generated summaries — not citable in APA 7 as academic sources; if you used AI tools as a starting point, you must verify all claims against primary sources and cite the primary sources, not the AI tool
Where Posts Lose Marks on This Specific Prompt
Accepting the Prompt’s False Claim
“Critical thinking is indeed new to nursing, but it has origins in Socratic philosophy…” This validates an inaccuracy and builds the argument on a false premise. The post will be factually wrong from its first sentence, which undermines every subsequent claim.
Instead
“While critical thinking may appear to be a recent addition to nursing discourse, it has been formally embedded in nursing education standards since the 1980s (AACN, 2021; NLN, as cited in Scheffer & Rubenfeld, 2000) and its intellectual history extends across more than two millennia. Tracing that history reveals why critical thinking is not peripheral to nursing practice but foundational to it.”
Only Mentioning Socrates
“Critical thinking has been around since Socrates, who used questioning to find truth. This method is still used in nursing today.” Two sentences on Socrates with no connection to Dewey, Bloom, Paul and Elder, Facione, Scheffer and Rubenfeld, or any nursing-specific framework. The post has named the starting point without tracing the development.
Instead
Trace the lineage: Socratic questioning → Dewey’s reflective thinking → Bloom’s cognitive taxonomy → Watson-Glaser’s formal measurement → Paul and Elder’s contemporary framework → Scheffer and Rubenfeld’s nursing-specific definition. Each step should explain what it contributed that the previous step did not. This is a historical argument, not a list of names.
Treating Critical Thinking and Decision-Making as the Same Thing
“Critical thinking is how nurses make decisions.” This collapses two distinct constructs into one sentence and prevents any substantive engagement with decision-making theory as a separate body of literature. The prompt asks for both, separately.
Instead
Distinguish the two: critical thinking is the reasoning process (analyzing evidence, identifying assumptions, evaluating inferences); decision-making is the culminating action step (selecting a course of action from available options). Then name decision-making frameworks separately — normative, descriptive, and naturalistic — and connect each to how nurses make clinical decisions in specific types of situations.
APA 7 Errors
“According to Paul and Elder critical thinking involves eight elements of thought.” No date. No parenthetical citation. No page number for a direct concept. This is not APA format at all, and in a post that explicitly requires APA 7, it signals that the student did not engage with the format requirement.
Instead
“Paul and Elder (2019) identify eight elements of thought that structure critical reasoning: purpose, question at issue, information, interpretation and inference, concepts, assumptions, implications and consequences, and point of view.” Author-date in parentheses, directly after the named theorists. Reference list entry at the end formatted in APA 7 style with DOI as hyperlink.
- Opening sentence addresses and corrects the prompt’s claim that critical thinking is “new to nursing” — with a citation
- Historical lineage traced from Socrates through at least Dewey, Bloom, and Paul & Elder to nursing-specific frameworks
- Scheffer & Rubenfeld (2000) cited as the nursing-specific critical thinking framework
- At least two named decision-making frameworks discussed separately from critical thinking frameworks
- At least one nursing-specific clinical reasoning model named (nursing process, Tanner’s model, or NCSBN CJMM)
- Every claim from a source has an APA 7 in-text citation with author and year
- Reference list at the end formatted in APA 7 — no publisher location, DOI as hyperlink, journal title and volume italicized
- No APA 6 formatting errors (publisher city, “doi:” prefix, truncating author list after 6)
- Critical thinking and decision-making treated as related but distinct constructs
- Florence Nightingale or another nursing-specific historical example used to ground the history in the profession
Before-and-After Writing Examples
Critical thinking is a concept that has been around for a long time, even though it is new to nursing. Socrates used critical thinking to question people and find the truth. This is similar to what nurses do when they assess patients.
Critical thinking in nursing means thinking carefully about patient care and making good decisions. Nurses need to think critically every day. Decision-making is important in nursing because nurses have to make decisions about patient care all the time. Good decision-making leads to better patient outcomes.
Critical thinking has been part of nursing education for many years and will continue to be important in the future.
Problems: Validates the false premise. No named theorists beyond Socrates. No theoretical frameworks for either critical thinking or decision-making. No APA citations. No reference list. Circular reasoning (“good decision-making leads to better outcomes”). Under 150 words and still fails to address the prompt’s two explicit requirements.
Contrary to the suggestion that critical thinking is new to nursing, the concept has been formally embedded in nursing education standards since the 1980s, when the National League for Nursing and the American Association of Colleges of Nursing began requiring it as a demonstrable curriculum outcome (Scheffer & Rubenfeld, 2000). Its intellectual roots extend considerably further. Socrates (470–399 BC), whose method of systematic questioning is documented through Plato’s dialogues, established the foundational principle that unexamined beliefs are unreliable — that knowledge requires subjecting claims to disciplined interrogation. This principle is the philosophical ancestor of clinical questioning in nursing practice.
The translation of Socratic inquiry into an educational framework was primarily the work of John Dewey, whose concept of reflective thinking — deliberate, active, evidence-based examination of beliefs — directly preceded what nursing educators later formalized as critical thinking (Dewey, 1933). Benjamin Bloom’s taxonomy of cognitive skills (Bloom, 1956), later revised by Anderson and Krathwohl (2001), provided the pedagogical bridge, with its higher-order categories of analysis, synthesis, and evaluation mapping directly onto what nursing programs mean by critical thinking. Paul and Elder (2019) subsequently produced the most widely adopted contemporary framework, organizing critical thinking around eight elements of thought and nine intellectual standards that clinical reasoning must meet. Scheffer and Rubenfeld’s (2000) Delphi study translated these frameworks into nursing-specific language, identifying ten cognitive skills and ten habits of mind that characterize critical thinking in nursing practice.
Decision-making theory is a distinct but related body of literature. Normative decision theory — the rational model — underpins clinical protocols and evidence-based guidelines, where the best option is calculable from available evidence. Descriptive theory, associated with Kahneman and Tversky’s research on cognitive biases (Kahneman, 2011), explains why clinical reasoning errors occur despite practitioners’ good intentions: availability bias, anchoring, and confirmation bias systematically distort judgment. Klein’s (1989) naturalistic decision-making model describes how experienced nurses actually reason in real clinical conditions — through pattern recognition and rapid mental simulation rather than systematic option evaluation — which accounts for the role of clinical intuition in expert nursing practice. Tanner’s (2006) clinical judgment model integrates these frameworks into nursing-specific terms: noticing, interpreting, responding, and reflecting. Together, these frameworks explain not only how nurses should reason but how they actually do, and where their reasoning is most vulnerable to error.
References:
Anderson, L. W., & Krathwohl, D. R. (Eds.). (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s educational objectives. Longman.
Bloom, B. S. (Ed.). (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. David McKay.
Dewey, J. (1933). How we think: A restatement of the relation of reflective thinking to the educative process. D.C. Heath.
Kahneman, D. (2011). Thinking, fast and slow. Farrar, Straus and Giroux.
Klein, G. A. (1989). Recognition-primed decisions. In W. B. Rouse (Ed.), Advances in man-machine systems research (Vol. 5, pp. 47–92). JAI Press.
Paul, R., & Elder, L. (2019). The miniature guide to critical thinking concepts and tools (8th ed.). Foundation for Critical Thinking Press.
Scheffer, B. K., & Rubenfeld, M. G. (2000). A consensus statement on critical thinking in nursing. Journal of Nursing Education, 39(8), 352–359. https://doi.org/10.3928/0148-4834-20001101-06
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211. https://doi.org/10.3928/01484834-20060601-04
Frequently Asked Questions
Why This Prompt Appears in Nursing Programs and What It Is Testing
Nursing programs assign this discussion post because understanding where critical thinking came from — and what theoretical frameworks have been developed to describe it — is foundational to using it deliberately rather than unconsciously. Nurses who know only that they are supposed to “think critically” but do not know what that means theoretically cannot assess their own reasoning, identify where it is failing, or improve it systematically. The theoretical frameworks are the vocabulary that makes self-examination of clinical reasoning possible.
The decision-making component is equally important for clinical safety. Research on medical and nursing errors consistently identifies cognitive biases and reasoning failures — rather than knowledge gaps — as leading contributors to clinical adverse events. Understanding descriptive decision theory (Kahneman, 2011) gives nurses a framework for recognizing when they are most vulnerable to reasoning errors: under time pressure, fatigue, or high cognitive load, System 1 thinking (fast, intuitive, pattern-based) dominates over System 2 thinking (slow, deliberate, analytical), and the cognitive biases that System 1 is prone to go unchecked. Nurses who understand this dynamic can build in deliberate checks — pausing, verifying, seeking a second perspective — at precisely the moments when their reasoning is most likely to be compromised.
According to the NCSBN (2023), the Next Generation NCLEX’s clinical judgment measurement model explicitly addresses this concern by testing whether candidates can recognize cues, analyze them accurately, generate appropriate solutions, and evaluate outcomes — not merely recall factual knowledge. The regulatory body’s shift toward clinical judgment as the primary measure of nursing competency is direct evidence that the theoretical frameworks your post discusses are not academic abstractions but the operational foundation of safe nursing practice.
Continue with: nursing assignment help · discussion post writing service · APA 7 citation guide · critical thinking assignment help · nursing case study writing service.