Critical Thinking in Acute Care

[Nurse SMS, MSN, RN]

I am noticing a real disconnect between the evidenced-based practice requirements that need to be documented and the critical thinking that should go along with these practices. I come into PD from a critical care environment, so I am unsure if the med-surg environment is just that different or if I have a real opportunity here to improve both best practices as well as documentation awareness.

What do you do to help increase critical thinking in your hospital?

[Lunah, MSN, RN]

Do you have any kind of simulation equipment? We recently did a neuro trauma class that included a capstone with our sim man, and it was really helpful to see all the vital signs and symptoms brought to "life."

[Nurse SMS, MSN, RN]

We have one high fidelity manikin. Not sure what it is capable of to be honest. We don't use her/him much. Not a bad idea! I will check it out.

[Nurse Beth, MSN]

I have a new grad who didn't respond to change in pt's condition with any urgency (per her preceptor) and I had her start a reflective journal. After each shift, she writes what happened, what went well, what did not go well, what she would have done differently, etc.

I also told her to tell her preceptor what she planned to do, with rationale, and ask "Do you agree with my assessment?" rather than ask what to do next.

In our preceptor training, we emphasize questioning the residents rather than providing all the answers.

[Nurse SMS, MSN, RN]

That is GREAT info to have Nurse Beth. Thank you. I like that - "Do you agree with my assessment" is a great way to open the door to a conversation about errors in thought or variables that were missed or dismissed.

[dumbnurse, ASN, BSN, MSN, LPN]

Here's what I think and it may be a little harsh...students need to be challenged early and frequently on how to give report and present a patient to others. They need to be asked specific questions about patho, the nursing process and what has to happen for this patient to go home or transferred. And they must document their assessment findings even if it is on paper, connecting risk management with the routine. I just heard that the NCLEX is going to a case study style of questioning and if this is true, we must return to that tried and true way of learning and place the student into those situations daily.

[dumbnurse, ASN, BSN, MSN, LPN]

When my students are unable to chart on the computer (most quarters), they document their routine assessments and then are required to take those abnormals and narratively document how they would use the nursing process. They are also required to review all protocols that the floor has as they relate to their patients (vap, cauti, heparin, clebsi's, etc.) and tell me how all that fits in. Nursing school is still very top heavy on content which some students still focus on too much and forget the "what now"!