2 Critical Thinking and Evidence-Based Practice 27
Judgments of quality should be continually approached in relative terms. The
EBP team assigns a quality grade for each piece of evidence reviewed. The judg-
ment that underlies this determination is in relation to the body of past and
present evidence that each member has reviewed. As the group and its individual
members gain experience reading and appraising research, their abilities and
judgments will likely improve.
Critical Thinking and Translation
The challenge for a nurse participating in an EBP project is translating the con-
tributions of each type of evidence to patient-care decisions. The team must not
only grade the level and quality of evidence but also determine the compatibility
of recommendations with the patient’s values and preferences and the clinician’s
expertise (Melnyk & Fineout-Overholt, 2006).
Two goals of critical thinking are to assess credibility of information and to work
through problems to make the best decisions (Halpern, 1996). This requires flex-
ibility, persistence, and self-awareness. It challenges nurses to consider alterna-
tive ways of thinking and acting. Maudsley and Strivens (2000) postulated that
a competent practitioner must use critical thinking skills to appraise evidence,
tempering realistic notions of scientific evidence with a healthy dose of reflective
skepticism. This certainly holds true for nurses as they execute the translation
phase of EBP.
Recommendations for Nurse Leaders
Though some key elements of critical thinking are not discussed within the con-
text of the nursing process, some components of critical thinking are clearly vital
to the work of nursing. Therefore, nursing accreditation bodies recognize critical
thinking as “a significant outcome for graduates at the baccalaureate and mas-
ter’s levels” (Ali, Bantz, & Siktberg, 2005). Furthermore, critical thinking skills
such as questioning, analyzing, synthesizing, and drawing conclusions from avail-
able information are definite assets to nurses in reaching meaningful evidence-
based practice decisions.
