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How to Strengthen & Develop the Critical Thinking Students Require for Practice

By June 28, 2018June 8th, 2023No Comments

Did you know that though critical thinking is the desired outcome of nursing education it cannot be taught directly?

So how does an educator teach critical thinking?

I shared in last week’s blog that it is imperative that students UNDERSTAND pathophysiology to lay the foundation of critical thinking that is required to make correct clinical judgments.

But there is a problem. Most students struggle with this challenging content. This obstacle can be overcome.

To strengthen student understanding and usage of this essential content, like everything else that is taught in nursing education it must be contextualized to the bedside of clinical practice.

Here’s how you can make this needed connection.

Six Questions to Develop Critical Thinking

I have created six sequential questions that a clinical educator can use to contextualize pathophysiology to the patient that is being cared for and help develop the critical thinking that students require to be safe and better prepared for professional practice!

1. Define and describe in your OWN WORDS, the pathophysiology of the primary problem of your patient.

Just because a student has memorized content and can “parrot” the right answer, this does not equate to understanding and being able to apply this knowledge to the bedside.

For example, most students can quickly state that atenolol is a beta blocker, but most have no idea what a beta blocker is blocking! In the same way, when it comes to the pathophysiology of the primary problem, students must synthesize and state in their own words what the problem is to strengthen their understanding of the patient’s primary problem.

2. How would you explain and teach your patient about the pathophysiology of this medical problem using non-medical terminology?

Just as every nurse educator knows unless the content is deeply understood you are unable to effectively teach it.

In the same way, when students can answer question number one and understand the pathophysiology of the primary problem, they will be able to simplify difficult content to the level of understanding of the patient and the family.

This is the foundation of effective patient education that educators must insist on.

3. What body system(s) are directly impacted by this disease and how are those systems affected?

Identifying the body system of the primary problem is simple. But then take it to the next level and have students identify specifically how these body systems are impacted by the primary problem.

For example, heart failure impacts perfusion and the cardiac system. But how does impaired perfusion specifically affect the kidneys and cause acute/chronic renal failure?

4. PRIORITY nursing assessments with this disease? (refer to body system that is most affected). What assessment findings may be abnormal as a result of this illness?

Get specific with nursing assessments that are required for the primary problem.

Students should be able to recognize that the cardiac, respiratory, and renal systems are directly impacted by heart failure, and these systems need to be thoroughly assessed. But what are the specific assessments that comprise each of these body systems that the nurse must be intentional to complete?

Never assume! I have had advanced students who had no idea where the valvular landmarks were to assess heart sounds. Therefore insist that your students be specific and then follow through and have them describe or better yet directly observe their assessment to ensure that they can translate this knowledge to the bedside.

5. What lab tests are altered by this problem? How are those lab tests affected? Does the altered lab test affect any physical assessment findings?

When the primary problem in the body systems impacted are truly understood, the specific lab tests that are most relevant become apparent to the student. With heart failure, the BNP is a clinical marker for heart failure, and the importance of trending the creatinine as the gold standard for renal function and perfusion becomes obvious and apparent.

6. What medications are most commonly used to manage this problem? What is the mechanism of action of this drug(s) in your OWN words?

Understanding the pathophysiology of the primary problem will help students understand WHY certain drugs are used to manage the disease process, and the mechanism of action must be stated in the student’s own words.

For example, in acute heart failure a loop diuretic such as furosemide is used to manage and promote excretion of excess fluid. A distal tubule diuretic such as thiazide is not nearly as potent and used for maintenance instead.

When students understand the physiology of the renal system and the differences in the concentration of sodium in the loop versus distal loop the rationale becomes evident and understanding that translates to safe clinical practice is present.

Pattern Recognition

To make sense of the vast amount of clinical data that students will experience in the clinical setting, they need to see how it is related and has a fit with other data they collect.

This series of six questions that I developed through my lens of current clinical practice can guide students into recognizing the patterns that are present with clinical data when pathophysiology is deeply understood.

As adult learners, your students are looking for relevance in all that is taught. When the importance of pathophysiology and its relationship to critical thinking is seen by your students, they will recognize this relevance and apply themselves to understand this essential content if they are motivated to be the best and pursue excellence as a student nurse.

In Closing

By incorporating these questions into your clinical paperwork or as clinical questions to put in your repertoire to ask students in the clinical setting, critical thinking can be strengthened and developed.

Don’t make clinical education and the teaching of critical thinking so difficult. Keep it simple by drilling deep and emphasizing pathophysiology and contextualizing it to the patient.

Contextualizing content is the hook that students require to transfer learning from the classroom to the bedside and transform nursing education! (Benner, Sutphen, Leonard, & Day, 2010)

Do this, and your students will have the critical thinking that is required to not only pass the NCLEX® but graduate practice ready and be well prepared for professional practice!

Related Blog Posts


  • Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.

Comment question:
What strategies have you found effective to integrate pathophysiology in the class and clinical settinmgs?
Comment below and let the conversation begin!

Keith Rischer – Ph.D., RN, CCRN, CEN

As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…

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