Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis
<b>Background:</b> Critical thinking is fundamental for registered nurses (RNs) when making clinical decisions, which impact patient outcomes. This review aimed to identify studies on critical thinking and clinical decision making among nurses in clinical practice and synthesize their fi...
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| Format: | Article |
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MDPI AG
2025-05-01
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| Series: | Nursing Reports |
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| author | Nur Hidayah Zainal Md Asiful Islam Nur Syahmina Rasudin Zakira Mamat Tengku Muhammad Hanis Wan Shakira Rodzlan Hasani Kamarul Imran Musa |
| author_facet | Nur Hidayah Zainal Md Asiful Islam Nur Syahmina Rasudin Zakira Mamat Tengku Muhammad Hanis Wan Shakira Rodzlan Hasani Kamarul Imran Musa |
| author_sort | Nur Hidayah Zainal |
| collection | DOAJ |
| description | <b>Background:</b> Critical thinking is fundamental for registered nurses (RNs) when making clinical decisions, which impact patient outcomes. This review aimed to identify studies on critical thinking and clinical decision making among nurses in clinical practice and synthesize their findings based on the regional area, observed findings, and predictive factors, and to assess the measurement tools used. <b>Methods</b>: A comprehensive search of the PubMed, Web of Science, CINAHL, and SCOPUS databases up to December 2024 was conducted in accordance with the PRISMA guidelines. The Newcastle–Ottawa Scale was used to assess the quality of included studies. Studies with similarly themed components were grouped for narrative synthesis. A meta-analysis of random-effects model calculations was performed. <b>Results</b>: This review included forty studies (twenty-four on CT, twelve on CDM, four on both) from various WHO regions, revealing diverse findings on observed skills. Ten CT and four CDM measurement tools were identified. Many studies also explored individual and group-level predictive factors for these skills. Meta-analyses of four common tools (CCTDI, NCT4P, CDMNS, and NDMI) showed significant heterogeneity, with statistically significant pooled mean scores. <b>Conclusions</b>: The synthesis highlights the global research on nurses’ critical thinking and clinical decision making, including the exploration of various predictive factors. However, the significant heterogeneity in the findings from meta-analyses of commonly used measurement tools underscores a need for more standardized measurement and analytical approaches, such as multilevel modeling, to better account for the hierarchical nature of potential predictive factors (individual and group levels), which would allow for more reliable comparisons and stronger conclusions in this field. |
| format | Article |
| id | doaj-art-7efda276f5a6486abae22a2bd6ff751d |
| institution | DOAJ |
| issn | 2039-439X 2039-4403 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nursing Reports |
| spelling | doaj-art-7efda276f5a6486abae22a2bd6ff751d2025-08-20T03:14:46ZengMDPI AGNursing Reports2039-439X2039-44032025-05-0115517510.3390/nursrep15050175Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-AnalysisNur Hidayah Zainal0Md Asiful Islam1Nur Syahmina Rasudin2Zakira Mamat3Tengku Muhammad Hanis4Wan Shakira Rodzlan Hasani5Kamarul Imran Musa6Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, MalaysiaDepartment of Biomedical Science and Physiology, School of Pharmacy and Life Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UKBiomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, MalaysiaNursing Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, MalaysiaDepartment of Community Medicine, Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Jalan Sultan Mahmud, Kuala Terengganu 20400, Terengganu, MalaysiaNursing Research Unit, Nursing Division, Ministry of Health Malaysia, Level 3, Block E7, Parcel E, Persint 1, Federal Government Administrative Centre, Putrajaya 62590, MalaysiaDepartment of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia<b>Background:</b> Critical thinking is fundamental for registered nurses (RNs) when making clinical decisions, which impact patient outcomes. This review aimed to identify studies on critical thinking and clinical decision making among nurses in clinical practice and synthesize their findings based on the regional area, observed findings, and predictive factors, and to assess the measurement tools used. <b>Methods</b>: A comprehensive search of the PubMed, Web of Science, CINAHL, and SCOPUS databases up to December 2024 was conducted in accordance with the PRISMA guidelines. The Newcastle–Ottawa Scale was used to assess the quality of included studies. Studies with similarly themed components were grouped for narrative synthesis. A meta-analysis of random-effects model calculations was performed. <b>Results</b>: This review included forty studies (twenty-four on CT, twelve on CDM, four on both) from various WHO regions, revealing diverse findings on observed skills. Ten CT and four CDM measurement tools were identified. Many studies also explored individual and group-level predictive factors for these skills. Meta-analyses of four common tools (CCTDI, NCT4P, CDMNS, and NDMI) showed significant heterogeneity, with statistically significant pooled mean scores. <b>Conclusions</b>: The synthesis highlights the global research on nurses’ critical thinking and clinical decision making, including the exploration of various predictive factors. However, the significant heterogeneity in the findings from meta-analyses of commonly used measurement tools underscores a need for more standardized measurement and analytical approaches, such as multilevel modeling, to better account for the hierarchical nature of potential predictive factors (individual and group levels), which would allow for more reliable comparisons and stronger conclusions in this field.https://www.mdpi.com/2039-4403/15/5/175critical thinkingclinical decision makingnursesnursingclinical practicesystematic review |
| spellingShingle | Nur Hidayah Zainal Md Asiful Islam Nur Syahmina Rasudin Zakira Mamat Tengku Muhammad Hanis Wan Shakira Rodzlan Hasani Kamarul Imran Musa Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis Nursing Reports critical thinking clinical decision making nurses nursing clinical practice systematic review |
| title | Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis |
| title_full | Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis |
| title_fullStr | Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis |
| title_short | Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis |
| title_sort | critical thinking and clinical decision making among registered nurses in clinical practice a systematic review and meta analysis |
| topic | critical thinking clinical decision making nurses nursing clinical practice systematic review |
| url | https://www.mdpi.com/2039-4403/15/5/175 |
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