Nurses General Nursing Article

Critical Thinking

Critical thinking is an intellectual process which uses one's clinical skills to guide one's patient care. Clinical decisons that need to be based on a logical thinking process. How can one learn critical thinking and put that into practice?

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Critical Thinking

Critical thinkers want to be clear. They want to be logical. Nurses want to be accurate and precise in their practice. It is safe practice and in a patient's best interest.

So how does one become a critical thinker? A nurse needs to learn how to be fair and actively listening to their patients. Newer nurses would benefit from a mentor. Someone who's practice they admire, and who they can observe and learn from. Nurses benefit from leading with their heads, and not their hearts.

For every action, there's a reaction. So to critically think, a nurse must be systematic in the practice of assessment. A good assessment starts with getting as much information that you can and in a perfect world, from the patient. Sometimes, that is just not feasible. And depending on the unit on which you work, not possible. So a good head to toe is paramount to good critical thinking skills.

Always, always follow your facility policy. And always be sure that first and foremost, your patient's heart is beating and they are breathing. Otherwise, here's a good run down on an assessment, which can only enhance critical thinking.

So literally, start at the head. Are they alert, oriented, do they have any bruising or head lacs? Can they speak, swallow? What's going on with the neck? JVD? Can they shrug their shoulders? Raise their arms? What is their grips like? Skin color, condition, temperature? Do they have good cap refill? What is their blood pressure? Are they breathing well? RR? Labored? Equal chest rise and fall? Listen to their heart. Are they at a regular rate and rythym? While you are there take an apical pulse. Are you hearing and feeling the same thing?

Listen to each lobe of the lung, both sides. What do the lungs sound like? Look at the skin conditon of the back.

Is the patient urinating and having BM's? Regularly? What kind of sounds do you hear in the abdomen, each quad? Is their any tenderness? Where? Look at the sacral area of the back. What is the skin condition?

Does the patient have any swelling of the legs or feet? Do they have any discoloration? What is the cap refill like in the toes? Do they have good sensation? Do they move, walk, walk with an appliance? Frequent falls?

Finally, what is their home life like? Do they live alone? Are they scared? Are they being hurt? Do they have any services in place? Do they need any services in place? Do they need an alternate level of care? Do they, or the family that lives with them, need any specialized teaching to maintain function?

In order to critically think well, all of the information that a nurse needs to make an informed report to the MD and/or other disciplines needs to start with a through and good assessment. You need to be aware of what the goal of the patient is to make reasoned thought a reality for the end goal of the highest level of function for your patient.

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jadelpn

About jadelpn, LPN, EMT-B

jadelpn, LPN, EMT-B

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classicdame

classicdame, MSN, EdD

2 Articles; 7,255 Posts

Specializes in Hospital Education Coordinator.

an important part of critical thinking is allowing your own ego to be put aside and LISTEN to what others are saying. The opportunity to learn exists in every human interaction.

nurseprnRN

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

For a more comprehensive description of critical thinking in nursing, see:

Critical Thinking and Nursing

An excerpt:

"Critical thinking is the disciplined, intellectual process of applying skilful reasoning as a guide to belief or action (Paul, Ennis & Norris).

" In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip).

" Critical thinking when developed in the practitioner includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgments and safe decision-making."

Another reference:

"So what exactly is critical thinking? There are a multitude of definitions - some of them head-scratching-ly complex - so the Foundation for Critical Thinking has assembled some of them on its website. This one is our favorite:

C
ritical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes."

Vespertinas

Vespertinas

652 Posts

NEVER ASSUME. You'll be proven wrong again and again.

TrissRN726

TrissRN726

34 Posts

This was great! For someone like me who is making the transition from a doctors office to the hospital this was like a refresher for thorough assessment, although I do assessments at my current job it is quite different in an acute care setting. Thank you

meanmaryjean

meanmaryjean, DNP, RN

7,899 Posts

Specializes in NICU, ICU, PICU, Academia. Has 46 years experience.

Outstanding!!!

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Guests

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Finally, what is their home life like? Do they live alone? Are they scared? Are they being hurt? Do they have any services in place? Do they need any services in place? Do they need an alternate level of care? Do they, or the family that lives with them, need any specialized teaching to maintain function?
And don't forget: What can they afford? Far more of my patients need services than are able to pay for them.
BrandonLPN

BrandonLPN, LPN

3,358 Posts

Has 5 years experience.
For a more comprehensive description of critical thinking in nursing, see:

Critical Thinking and Nursing

An excerpt:

"Critical thinking is the disciplined, intellectual process of applying skilful reasoning as a guide to belief or action (Paul, Ennis & Norris).

" In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip).

" Critical thinking when developed in the practitioner includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and

abilities for sound clinical judgments and safe decision-making."

Another reference:

"So what exactly is critical thinking? There are a multitude of definitions - some of them head-scratching-ly complex - so the Foundation for Critical Thinking has assembled some of them on its website. This one is our favorite:

C
ritical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes."

See, now my problem with the excerpts you quoted here is they're just so..... dry. Unrelateable and jargon-filled to the point of being impenetrable. That third quote, for example, is rendered almost meaningless by it's own inaccessible language. The content is all true and of value, but that's useless if the reader is coma-inducing bored three words in.

Here's an excerpt from the New York Times on the "dead language" of academic jargon:

In fact, the more abstract your subject matter, the more your readers will appreciate stories, anecdotes, examples and other handholds to help them stay on track.

In her book "Darwin's Plots," the literary historian Gillian Beer supplements abstract nouns like evidence, relationships and beliefs with vivid verbs (rebuff, overturn, exhilarate) and concrete nouns that appeal to sensory experience (earth, sun, eyes). Note her language in this passage:

Most major scientific theories rebuff common sense. They call on evidence beyond the reach of our senses and overturn the observable world. They disturb assumed relationships and shift what has been substantial into metaphor. The earth now only seems immovable. Such major theories tax, affront, and exhilarate those who first encounter them, although in fifty years or so they will be taken for granted, part of the apparently common-sense set

of beliefs which instructs us that the earth revolves around the sun whatever our eyes may suggest.

Her subject matter - scientific theories - could hardly be more cerebral, yet her language remains firmly anchored in the physical world.

Contrast Beer's vigorous prose with the following passage from a social sciences book:

The partial participation of newcomers is by no means "disconnected" from the practice of interest. Furthermore, it is also a dynamic concept. In this sense, peripherality, when it is enabled, suggests an opening, a way of gaining access to sources for understanding through growing involvement. The ambiguity inherent in peripheral participation must then be connected to issues of legitimacy, of the social organization of and control over resources, if it is to gain its full analytical potential.

Why does reading this paragraph feel like trudging through deep mud? The secret lies at its grammatical core: Participation is. . . . It is. . . . Peripherality suggests. . . . Ambiguity must be connected. Every single sentence has a zombie noun or a pronoun as its subject, coupled with an uninspiring verb. Who are the people? Where is the action? What story is being told?

Alnitak7

Alnitak7

559 Posts

Specializes in retired from healthcare. Has 25 years experience.

When I was a new girl on the wing, I was always told, "hurry up," "We don't have time to do that," and "Speed up your act." What?? I don't have time to wash someone's face when they're hot? Oh, and five to ten minutes is not always enough time to give good patient care.

There were times when I found out the real reason we had to hurry up was just so we can sit down at the nurses station and do nothing.

My struggle was with knowing the right people to listen to and when to respect myself first.

amygarside

amygarside

1,026 Posts

This is a great article. It is very informative.

cardiacrocks

cardiacrocks, BSN, RN

144 Posts

Specializes in Cardiac. Has 2 years experience.

Critical thinking is also thinking through things like, If I give this drug what will it do? Also, why did the doctor order a drug? Also, I have seen potassium still ordered and lasix stopped and the K+ being 4.5 or near 5 and the MD forgot to d/c the K+ along with the lasix. There is SO much to critical thinking, I've seen nurses who need to work on this skill and nurses who it just seems to naturally happen for them. Good article.

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