Critical Thinking Help

ImThatGuy, BSN, RN · Mar 19, 2011

Ummm....you actually need help with thinking?

solneeshka, BSN, RN · Mar 20, 2011

Ignore the poster above. (People ought to be able to post here asking for help without getting snotty comments. She didn't say she needs help with thinking, she said she needs help with *critical* thinking, which is a specific skill that has a specific application in a nursing setting, and which she obviously needs help with or she wouldn't be asking for it.)

Next, when different issues come up in the clinical environment, try deciding which of the things you are dealing with might kill the patient, and deal with that first. So if the patient wants more ice and needs to have a diaper change and has medications due, which of these things might kill the patient? The answer depends on the specific situation. There are different situations where any one of these three might be the most important priority. If the patient has severe dehydration and is asking for water, that's great and you want to encourage that, so the water is most important. If the patient has a grade 4 pressure coccyx pressure ulcer and has a brief soiled with feces, you really need to get that taken care of in order to prevent infection in the wound that could easily lead to sepsis. If the patient already has infection going and one of the schedule meds is an antibiotic, that becomes the most important.

Focusing on "which of these options could kill the patient?" is an old and effective NCLEX technique, and it can also be useful in the real world. Give it a try and good luck!

ImThatGuy, BSN, RN · Mar 20, 2011

No, no, no, no. Critical thinking is not a specific skill. It's just something you do. Snotty or not I could care less. You've succumbed to the indoctrination. You're free to think critically without learning it in nursing school. I'm so sick of that catchphrase. I think it's very damaging to the reputation of nursing education.

Jingles39 · Mar 20, 2011

Totally agreed, ImThatGuy. I haven't started nursing school yet, so perhaps there's something I'm missing here, but it all just seems like good, old fashioned THINKING to me.

VickyRN, MSN, DNP, RN · Mar 20, 2011

Critical thinking is the ability to prioritize, to know the correct action(s) to take, especially when under stress or duress (such as on a busy medical-surgical floor when all the call bell lights are going off at once). Critical thinking is knowing the "whys" behind the nursing interventions you undertake and not just doing things by rote or being task-oriented. Critical thinking is integrating the knowledge you have learned in the classroom skillfully, safely, effectively, and appropriately into the clinical setting. A deficit in critical thinking can seriously jeopardize patient safety. Critcal thinking, in short, is "doing the right thing for the right reason" and is at the heart of nursing practice. For instance, your client is in renal failure with a creatinine of 4 and has a serum potassium of 5.5. He also is receiving D51/2NS with 20 mEq KCl continuous IV fluids. What should you, the astute nursing student, do? Another example - your client has a documented anaphylactic reaction to penicillin, yet is scheduled to receive Cefaclor IV for pneumonia. What should you do?

Case studies and reflective practice are two powerful ways in which you can improve your critical thinking skills. Have you requested a face-to-face conference with your clinical instructor for her feedback on specific instances in which your critical thinking skills were lacking on the clinical floor? You can then think back on these occurrences (reflect) and think about ways you could have performed better. Also, case studies involving typical patient care scenarios on your clinical unit can be very helpful. Do you receive information about your assigned client ahead of time? If so, be very thorough in the way you prepare for clinical. Thoroughly research the patient's medical diagnoses, the pathophysiological processes that are taking place, his or her allergies and medications, lab values, and what high priority nursing interventions you should perform to help the client achieve optimal health during your shift.

VickyRN, MSN, DNP, RN · Mar 20, 2011

@ ImThatGuy, this is the Nursing Student Assistance Forum. This is not the place for a personal soapbox on the merits of critical thinking or hijacking the thread. The OP needs our support and helpful advice if he/she is to succeed in nursing school. If you do not have anything useful or beneficial to post here, please do not post at all. And, if you wish to opine or obfuscate about the topic of critical thinking, please start a separate thread in the General Student Nursing Forum. Thank you :twocents:

Despareux · Mar 20, 2011

Critical thinking is just a name for putting it all together, which does require education and proper training. Do you know what exactly you are having trouble with--assessment, prioritizing, communication...?

ImThatGuy, BSN, RN · Mar 20, 2011

@ ImThatGuy, this is the Nursing Student Assistance Forum. This is not the place for a personal soapbox on the merits of critical thinking or hijacking the thread. The OP needs our support and helpful advice if he/she is to succeed in nursing school. If you do not have anything useful or beneficial to post here, please do not post at all. And, if you wish to opine or obfuscate about the topic of critical thinking, please start a separate thread in the General Student Nursing Forum. Thank you

Obfuscate. Good word.

For what it's worth I think my remarks were helpful. Critical thinking is merely taking a thoughful approach to something.

Nurse Kyles, BSN, RN · Mar 20, 2011

I apologize, but I haven't read all of the above posters.

Do you do clinical prep the night or morning before clinical? In my second semester clinical my instructor had us do a prep sheet that REALLY helped all of us with our 'critical thinking skills'.

We would list all of these things in two columns:

-Medications & Fluids..................-Medical Diagnoses

-Focused Assessments................-Related Tests/Labs (Hi, Lo, WNL)

-Complications (S/s)....................- Applicable Nursing Diagnoses (3)

-Therapies /Treatments............... - Patient teaching/Nursing Interventions

Anyway we would list all of the things we would do under each category & then draw lines to everything it relates to. The sheet looks crazy with all sorts of lines going everywhere. (usually I try to color code everything by system) But really it helps you VISUALIZE all of the connections that your instructor expects you to be making in your head. That way when your instructor asks you why something is being done you can say because of X, Y & Z with confidence.

If you would like an example of what I am talking about I would be happy to scan an example sheet & send it to you. Good Luck!

solneeshka, BSN, RN · Mar 20, 2011

I apologize, but I haven't read all of the above posters.
Do you do clinical prep the night or morning before clinical? In my second semester clinical my instructor had us do a prep sheet that REALLY helped all of us with our 'critical thinking skills'.
We would list all of these things in two columns:
-Medications & Fluids..................-Medical Diagnoses
-Focused Assessments................-Related Tests/Labs (Hi, Lo, WNL)
-Complications (S/s)....................- Applicable Nursing Diagnoses (3)
-Therapies /Treatments............... - Patient teaching/Nursing Interventions
Anyway we would list all of the things we would do under each category & then draw lines to everything it relates to. The sheet looks crazy with all sorts of lines going everywhere. (usually I try to color code everything by system) But really it helps you VISUALIZE all of the connections that your instructor expects you to be making in your head. That way when your instructor asks you why something is being done you can say because of X, Y & Z with confidence.
If you would like an example of what I am talking about I would be happy to scan an example sheet & send it to you. Good Luck!

Now *that* is a useful reply!

missyu · Oct 6, 2017

Hi Nurse Kyles!

I just came upon this feed and this awesome post! I was wondering would you still have an example available? :)