Books for Thinking Critically

books i know of are:

• critical thinking in nursing: a cognitive skills workbook by saundra k. lipe and sharon beasley. runs about $36.
  
• strategies, techniques, and approaches to thinking: critical thinking cases in nursing by sandra luz martine de castillo. runs about $35.
  
• winningham and preusser's critical thinking in medical-surgical settings: a case study approach by barbara a. preusser. runs about #34.

most students use some sort of nclex review book to help them out because they usually contain the strategies for answering application type questions which is what you are after. saunders and kaplan are the two most popular books.

i would advise that answering these nursing application questions involves knowing the underlying pathophysiology of the medical disease in question, knowing the medical and nursing treatments that are normally applied and in the order of priority and understanding where the situation of the question has placed you in the timeline of the nursing process so you know what your next logical move according to the nursing process should be. the nursing process part of the question which is often something you have to critically think to put into the mix, is what very often trips students up. you have to know the steps of the nursing process and what goes on in each step.

• http://go.dbcc.edu/hhps/nursing/study_skills.html - study skills for the nursing student from daytona beach community college nursing department with some good advice.
  
• http://go.dbcc.edu/hhps/nursing/test_taking_skills.html - test taking skills also from daytona beach community college nursing department. a couple of sample questions and how to choose the correct answer for these application type questions.
  
• http://www.efn.org/~nurses/ - this is a website maintained by the nursing students at lane community college in eugene, oregon. for study and learning tips specific to nursing students click on "tips for learning" at the left side of this home page.
  
• http://www.learningext.com/students/qofweek.asp - question of the week. every monday a question from the online nclex-rn examination course from ncsbn and it's answer is posted here on this page.
  
• http://www3.us.elsevierhealth.com/cgi-bin/mosby/cdonline/saxton/question - mosby's question of the week from mosby's comprehensive review of nursing. also has archived questions that you can access.

wave. . .i know what critical thinking is because i've been a nurse for so very long. to be honest, i really didn't start to get the hang of it all until after i had graduated. we never had to do care plans when i was in nursing school back in the 1970's, at least not that i could remember, not writing up care plans and turning them in to our instructors. i found out after graduating how putting together a care plan helped to understand all the thinking that went into the decision making processes involved around the treatments that got done for the patient, both medical and nursing. this is really all critical thinking is--rationalization of what is being done and why. after a while you go through this thinking process for each patient's situation so quickly that you barely realize you are doing it.

the thing about being in school is that you are being asked to pick apart the process painful step by painful step which slows it down to a snails pace. and, we don't work that way in real life. so, that is one of the frustrations of it. i have broken this process down in a sheet of paper i created called the critical thinking flow sheet for nursing students. you will see the link for it at the bottom of all my posts. if you open up the file, you can print out the form. (if you can't open the file, send me a pm or e-mail with your e-mail address and i'll e-mail the file to you.) i set it up by medical disease because that is what everyone is most comfortable with. all care begins by knowing the signs and symptoms of a person's disease (the pathophysiology). this is because all care, whether medical, nursing, dietary, or other discipline is aimed at treating or correcting the symptoms the patient is having. and, the patient's symptoms are always manifestations (a show) of what has gone wrong with the normal functioning of their body or body organ. the difference between medicine and nursing is how we assess the patient. all treatment starts with doing an initial assessment (remember the steps of the nursing process and step #1 is assessment). where a medical assessment is looking to determine how the anatomy and physiology has gone haywire, a nursing assessment is looking to determine more of how the patient has reacted to how the anatomy and physiology has gone haywire. nursing schools still teach students how to do a physical assessment of the patient similar to how a doctor does it. but, part of our assessment is supposed to include an assessment of the patient's ability to perform their adls. every care plan book i've written has emphasized this concept of how the patient reacts to their situation. and, if you take the time to read the definitions of the various nursing diagnoses (which you're supposed to do when you begin using them anyway) you'll see that this is exactly what they refer to. so, understanding that difference between how doctors think and how nurses think is a big step toward understanding what nurses do as compared to what doctors do. because we have to learn how doctors diagnose and treat i think it's only natural that students get confused and want to veer in that direction, but that is not what nursing is at all. we do things just a tad differently. if you begin to start to get that, i think the critical thinking will start to fall in place. because the critical thinking is how you problem solve. you have to know something about these problems, but also how to assess for them as well. once you've nailed down what the problem is, the next step is to bring in strategies to treat them. this is the nursing process, or care plan process, that school is trying to teach you.

i don't know if i'm making myself real clear here or not. i do feel that when an instructor says, "you need to work on your critical thinking", that they need to supply you with an example of what you're doing wrong and how you need to correct yourself.

i have not actually seen any of the books i've listed above although i have meant to purchase one of them, just never was at the top of my list of priorities. i do have a copy of saunders comprehensive review for the nclex-rn examination, 3rd edition, by linda anne silvestri. i think it is a very good book to use to study for your school tests. it lists the signs and symptoms of medical conditions in increasing order of seriousness. that is important to know since that can help to determine which interventions are going to need to be done before others, depending on the symptoms a patient is displaying. the book also includes the nursing interventions specific to the particular medical condition being discussed. and, they are all listed in nice concise lists. if you can't find a particular subject, use the index in the back and try alternative terms because this book has extensive information. the cd that comes with it has over 4,000 nclex style questions on it. i have found that some of the answers to the questions are incorrect. i think this was clerical error because in the "study" mode, you can get explanations for the answers, and these explanations are spot on. they will also give you some insight into the critical thinking involved in getting to the right answer.

Wave. . .one itty bitty problem with a patient or two doesn't make you a failure at nursing care. Patients are patients. Keep in mind that sometimes people are grumpy when they are hospitalized and not feeling well. You don't want to get too aggressive. Some people just don't take a bath every day--it's their life long habit and nothing you try to do is likely to convince them otherwise. Much of taking care of difficult patient's involves some creativity. I worked on a stepdown unit where we had a lot of post-op thoracotomy patients who had chest tubes. Some of these people wouldn't cough even with our coaching and it was important so they wouldn't get pneumonia and it helped to push the drainage and air out through their chest tubes. Mind you, I had already been an RN for 10 years. It happened one day that I was saying sometime to the patient in another bed that got them laughing (I love to joke around and laugh) and the chest tube patient also started to laugh and the most wonderful thing happened. He started to cough and hockered up a wad of phlegm. I can't tell you of any textbook that says that if a patient starts to laugh, they'll also start to cough if they need to. But, I learned it that day. From then on, any chest tube patient that wouldn't cough got hit with a barrage of jokes designed specifically to get them to laugh and cough. They didn't know that, but I knew exactly what I was doing. I'm not a real good joke teller either. I have to work at them and memorize every line of the joke so I get it right. So, much of helping patients with simple ADLs is like this--never seen in a textbook and discovered through practical application.

Uh, oh. You want to bring up nursing diagnosis. Well, I think you are probably right about nursing diagnosis making us nurses look important. I was actually reading the preface of my copy of NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008 and noticed something about "nursing terminology". We all know that there is medical terminology. When you look more in depth at the nursing diagnoses and the differences between them (something I'm sure most of you would never think of doing!) you will find that there are very subtle differences between some of them. For this reason it can be easy to have to choose between two possible ones and choose wrong. It's because of the terminology used in each of them. I wish NANDA would define this terminology and explain it a little more blatantly to those of us who are too dumb to see it in front of us (I'm referring to myself in this). I'm hoping to attend their next convention where I can talk to some of these people who put this stuff together to get some perspective on this. I really want to know the thinking process that goes into it. It does involve the use of language, but that's as far as I understand it. To this point, I look more closely now at my little book I mentioned above at each diagnoses' definition, related factors and defining characteristics to help me understand what they are trying to get at and classify with each nursing diagnosis. This is how I've been finding the subtleties.

You say your instructors don't want you to write a care plan using that known info. I don't understand what you are saying. Are you talking about the NANDA information or the patient information? A care plan should always address the known information about a patient. However, the determination of how you take that information and present it in a care plan can be done by any method and NANDA rules are just one way. There are other authors that have come up with other similar things, but your instructors need to give you the rules you need to follow to do it. My BSN program did this. They basically told us what a nursing diagnosis was to be, how to put together a nursing diagnostic statement, gave us a short list of one or two books to use as references in doing this and said, "now go and write care plans for us". Needless to say, the books they recommended are no longer even in publication, nor the author even heard of anymore. But, it was all about following the steps of the process they gave us. It's kind of like playing a game. If you can understand the rules and play "Monopoly", you can also understand the rules and play "Scrabble", "Sorry", "Life", etc. In a sense, that's all some of this is: follows the rules to get the desired result. Took me years of college to get that bit of wisdom, and even then, had to have a professor explain it to me. DOOH!

Here is a website that is not particular to nursing -- but seems to have a great deal of information (and resources) for students and faculty alike.

http://www.criticalthinking.org