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 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.
