Critical Thinking

[Manofstone]

One of my classes is online and we've been dealing with "Critical Thinking". We were presented with a scenario in which Patient A has chest pains, Patient B needs a bath, Patient C needs to be transported to the another department for testing and a doctor has requested the most recent vitals on Patient D. In this scenario you are a LVN/LPN over another LVN/LPN and a CNA.

My solution was to head over to Patient A's room as I direct the other LVN to wash Patient B and I tell the CNA to trasport Patient C for testing. I figure when I'm done I'll get the vitals for Patient D or I'll direct the other LVN or CNA to do it if they find me still in Patient A's room dealing with his chest pain.

My other class mates are telling me that I should rushed over to Patient's A's room (ignoring my LVN/CNA and other patients) and deal with his chest pain until I'm certain that he/she is not having a heart attack.

Why can't I tell my other team memebers what to do as I'm heading towards a possible emergency? It seems to me that I'm wasting resources if I rush off to Patient A's room and leave my team members standing around.

[CountryMomma, ASN, RN]

I would have chose your same answer, except, depending on the acuity of client D, I might have Nurse B obtain those, *then* focus on the other two clients, as I attend and assess Client A.

Also, the condition of the client due fortransport would need to be considered, in whether a nurse or CNA transports him/her, wouldn't it?

Nurse B should be self-sufficient and self-directed, though. And theoretically, LPNs should be able to direct and delegate to a CNA.

[Manofstone]

Ya, I kinda figured that the other LPN should be fine on her/his own...but it was written into the scenario. I agree about the condition of the client for transport...but there were no details about any possible issues in moving that client. But it's good to hear that I was on the right path. The other students are on my case for not running into Patient A's room while ignoring everything else.

[vintagemother, BSN, CNA, LVN, RN]

In my Lvn school we were presented with many scenarios like that. I think that the teacher, nclex, and the text book would say to look at the problem as cut and dry. Which would mean patient A gets attention first due to a problem with ABCs.

In real life, we do have to manage several problems at once without ignoring anyone and by delegating.

Nursing school thinking....in my opinion, it's different than critical thinking. It's critical thinking according to the way "they" want us to think, lol!

[Philly_LPN_Girl, LPN]

I would have chosen the pt with chest pains because of a possible heart attack I always do ABC's then Maslows the cna could have washed the pt up and did vital signs

[vintagemother, BSN, CNA, LVN, RN]

...I always do ABC's then Maslows/

What ^^ diva la juice said

[pookyp, LPN]

Patient A!

[CountryMomma, ASN, RN]

I don't think anyone is disagreeing that Client A is the priority. Any basic nursing student would apply Maslows. I think the focus was on delegation and priority setting. I don't understand why delegating on the way to Client A's room would be inappropriate.

Also, with certain vitals, or priority vitals, we were taught nurses should gather them.

[vintagemother, BSN, CNA, LVN, RN]

. I don't understand why delegating on the way to Client A's room would be inappropriate.

Personally and in real life? Delegating is what i would do on the way to client A.

I'm just saying that in MY nursing school, we have gotten those kind if questions wrong when we delegate or say we'd do this or that on our way to do the most important task.

I'm not saying my schools way of teaching is right, either. No sir-eee! I'm just trying to help the OP get in her head the "nursing way of thinking" it took me a whole first term to "get it" and I have all As so far in school.

Maybe other schools teach it differently, but I've had to learn the nursing school way of thinking. (Which I disagree with sometimes, but isn't the point)

[Manofstone]

vintagemother, I think you nailed it. I have a business background myself and everything is multi-tasked no matter how important. Yes, the chest pain patient needs to be seen stat, but I can walk and talk at the same time. How hard is it to say, "Bob, take patient in room 326 down to radiology for testing and Susan take and bathe the patient in 325?", as I'm walking? I'm guessing that happens every day without harm to the chest pain patient.

[MedChica]

My other class mates are telling me that I should rushed over to Patient's A's room (ignoring my LVN/CNA and other patients) and deal with his chest pain until I'm certain that he/she is not having a heart attack.

I don't agree with letting everything fall by the wayside until you're certain that Patient A's not having a heart attack. Time management is key. Get a system or you'll drown.

I don't see an issue with your thought process.

So, anyway,

1. I'd go to Patient 'A'.

2. I'd get some fresh vitals from Patient D from the LVN.

3. I'd ask the aide to drop Patient 'C' off at the dept in question and throw Patient 'B' in the shower when they get back.

Rationale?

- Evaluating those chest pains are most important.

- The shower is the lowest priority.

- The LVN doing the shower is being underutilized. Also, the aide is preferable (to me) because they're simply going to be faster at everything. The whole appointment situation is nothing to sweat over, anyway. Even if it's an add-on ASAP/STAT, an individual was tasked with taking the pt to their appt at the start of the shift. It's not a new development.

- A request for fresh vitals can't wait. You have to phone up the provider, too. They might have questions, TO's to be taken, etc...

Putting it off or giving this duty to someone who can't complete the task will create more work in the end. Also, if you call the vitals in late, the provider's going to wonder (ALOUD) about 'what took you so long' and blah, blah, blah.

I don't want to hear it. LOL

- Taking vitals is the quickest task. The longest part involves waiting for the provider's call-back. But - so long as the vitals were performed, called in and you've charted this? You've done your part. The point is, the LVN will be done wayyyy before me and able to assist with the chest pain issue.

If there's a status change for Patient 'A'? They've got to be within 'hollaring distance'. LOL I can't have them holed up in a shower, 'somewhere in the dept'. I can't leave the pt with chest pains to go looking for them. The nurse can't leave the pt in the shower to come assisting me.

- In the end, I'll go check on the aide. Help them finish up.

[morte, LPN, LVN]

what is the name of this class? have you been thru med surg? have you been discussing delegation?

I think you may be seeing here, what some persons refer to as the "task oriented" nature of LPN courses and the instructor is trying to expand the students thought process....just a thought.