Critical thinking skills...

missmollie, ADN, BSN, RN · Feb 17, 2015

I think of critical thinking in nursing as equivalent to being a journalist. You need to ask who, what, when, where, and why questions. Pull from what you know and possible outcomes when something presents itself.

Example:

Person has been vomiting for the last 24 hours.

Questions to ask:

-Who does this affect? -> The person. If it's infectious then it might affect others. If it is from something they ate at home, expect the family to start showing the same s/s. If it's from something they ate at a restaurant, expect more people to start showing up with the same s/s.

-What does this do to the body? -> Patient is losing stomach acid which could result in alkalosis. Patient is losing liquid and unable to effectively rehydrate, what body systems will this involve.

-What assessments will the nurse make? Think about the head to toe assessments and what dehydration and alkalosis can do to the body. Find out what you would expect to see. Talk it through with your instructor, they'll lead you the rest of the way.

In learning critical thinking skills, you have to start at the beginning and work your way through it. The more you practice, the better it will get, and don't be frustrated if you miss something. Once you realize you missed an important step, you'll learn never to miss that again.

I'm sorry that it's been a rough semester for you! Hope this is helpful.

AJJKRN · Feb 17, 2015

Getting a job as a CNA may help you out more than you think in terms of reading information and learning how to apply those skills. Even though you'd be working as a tech, you can essentially treat every shift as a clinical and pick up on the why's and how's of what the nurses you are helping are doing. This should also be a less stressful environment for you to learn and grow which may give you more confidence when in upcoming clinicals, not to mention some exposure to time management skills which are crucial for your development as a nurse during your first year or so. No worries, we all struggled and sometimes still struggle with our time management depending on the shift. Best of luck, let us know how you're making out from time to time.

HouTx, BSN, MSN, EdD · Feb 17, 2015

Have you had any experience with concept mapping? In order to Critically Think 'on the fly' you need to be able to draw upon accurate mental models... complex arrangements of interrelated factors. Highly expert people have very complex mental models that may be triggered by things too subtle for the rest of us to even notice. Many nurses tend to call that 'gut feeling' because they can't express it easily.

You already have some mental models that have developed over time. For instance, if you were driving along and suddenly felt that your vehicle was hard to steer, you'd begin running through a few things in your mind - ruling them out or keeping them as a 'possible' cause based on your understanding of auto mechanics. If you had a very low understanding, you'd probably stop with "flat tire". But if you had advanced knowledge, you may begin to think about alignment issues, power steering components, etc.

If you have a good clinical mentor/coach, they can help you a lot by talking through the analysis process. Classically, this is called Socratic method - the coach asks you a series of questions that steer you in the right direction. "What could be causing a rapid heart rate?" "Which of these things is your patient currently experiencing?" "If that is the case, what should you do?" "How will you know if your intervention is working?" "If that doesn't work, what else could you do?"

Next time you're put on the spot by an instructor, rather than maintaining stunned silence, I would suggest that you begin "thinking out loud" - sharing your reasoning process as you work through the issue. If nothing else, your instructor will realize that you do know how to engage in the critical thinking process even if you don't have a ready answer.

nurseprnRN, BSN, RN · Feb 17, 2015

Next time you're put on the spot by an instructor, rather than maintaining stunned silence, I would suggest that you begin "thinking out loud" - sharing your reasoning process as you work through the issue. If nothing else, your instructor will realize that you do know how to engage in the critical thinking process even if you don't have a ready answer.

Perfect answer. I would always have time for a student who at least gave it a stab, and hearing the thought process gave me an idea of how I could tweak it to help him/her understand the big picture. Critical thinking is all about having an awareness of that big picture and how its parts work together.

Cruz.Cookie, BSN, RN · Feb 19, 2015

Thanks all for the advice . I just recently secured a job as a student nurse in the cardiac Icu so I'm excited !! I can't wait to have that experience and see what it entails in the future :) hopefully , this can help me with the critical thinking process.