Zainal Nur Hidayah, Islam Md Asiful, Rasudin Nur Syahmina, Mamat Zakira, Hanis Tengku Muhammad, Rodzlan Hasani Wan Shakira, Musa Kamarul Imran
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Department of Biomedical Science and Physiology, School of Pharmacy and Life Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK.
Nurs Rep. 2025 May 20;15(5):175. doi: 10.3390/nursrep15050175.
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. : 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. : 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. : 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.
批判性思维对于注册护士在做出临床决策时至关重要，而这些决策会影响患者的治疗结果。本综述旨在识别关于临床实践中护士批判性思维和临床决策的研究，并根据地区、观察结果和预测因素对其研究结果进行综合分析，同时评估所使用的测量工具。：按照PRISMA指南，对截至2024年12月的PubMed、科学网、CINAHL和SCOPUS数据库进行了全面检索。使用纽卡斯尔-渥太华量表评估纳入研究的质量。将具有相似主题成分的研究分组进行叙述性综合分析。进行了随机效应模型计算的荟萃分析。：本综述纳入了来自世界卫生组织各区域的40项研究（24项关于批判性思维，12项关于临床决策，4项两者都涉及），揭示了关于观察到的技能的不同结果。确定了10种批判性思维和4种临床决策测量工具。许多研究还探讨了这些技能的个体和群体层面的预测因素。对四种常用工具（加利福尼亚批判性思维倾向问卷、护理专业学生批判性思维能力量表、临床决策制定护士量表和护理决策制定指标）的荟萃分析显示存在显著异质性，但合并平均得分具有统计学意义。：综合分析突出了全球对护士批判性思维和临床决策的研究，包括对各种预测因素的探索。然而，常用测量工具的荟萃分析结果存在显著异质性，这凸显了需要更标准化的测量和分析方法，如多水平建模，以更好地考虑潜在预测因素（个体和群体层面）的层次性质，从而在该领域进行更可靠的比较并得出更有力的结论。
