Critical Thinking and Decision-Making Ability of Nurses Working in Critical Care Units Regarding Pain Management

Abstract

Effective pain management in critical care settings requires nurses to employ strong critical thinking and decision-making abilities. These competencies enable timely, evidence-based interventions for patients with complex, dynamic pain conditions. Despite their importance, few studies have examined this relationship in the Pakistani context, where nurses often face high workloads, limited training, and systemic constraints. Objective: To assess the critical-thinking and decision-making abilities of nurses working in critical care units and to determine the relationship between these two variables in the context of pain management. Methods: This descriptive cross-sectional study was conducted in the critical care units of General Hospital Lahore between January and June 2024. A total of 60 registered nurses with at least one year of ICU experience were enrolled through non-probability purposive sampling. Data were collected using a structured questionnaire comprising demographic data, the Critical Thinking Disposition Inventory (CTDI), and a validated Decision-Making Questionnaire for Pain Management. Descriptive statistics summarized demographic variables, while Pearson correlation and ANOVA tests assessed relationships between variables. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 29.4 ± 5.8 years, with a predominance of females (78.3%). The overall mean critical-thinking score was 69.7 ± 8.2, indicating a moderate to high level of critical-thinking ability, with the highest domain score in Interpretation (12.3 ± 2.4). The mean decision-making score was 74.2 ± 9.6, reflecting satisfactory decision-making competence. More than half (51.7%) demonstrated moderate decision-making ability, while 30% demonstrated good decision-making ability. A strong positive correlation (r = 0.68, p < 0.001) was observed between critical thinking and decision-making abilities. Educational qualifications were significantly associated with decision-making performance (p = 0.03), with higher levels of education associated with higher scores. Conclusion: Critical-thinking ability strongly influences decision-making in pain management among critical care nurses. Enhanced educational attainment correlates with improved clinical reasoning and decision-making competence. Strengthening continuous professional education and integrating critical-thinking modules into nursing curricula can significantly improve pain management practices and patient outcomes in critical care settings.