Critical Thinking

carolinapooh, BSN, RN · Sep 9, 2016

I have read on here it is the difference between performing a nursing task and performing a nursing skill.
Anyone can perform a nursing task,even a monkey if you teach them.
example: Changing a trach tube or inserting a peripheral IV.
A nursing skill requires critical thinking.
Example: Figuring out what a trach/vent pt is turning blue
Sorry if that did not help,but all i know the difference between the two is still blurry to me.

Yes - and that is the difference in the taxonomy. Performing a task is exhibiting the lowest level on the scale - Knowledge. This would be tantamount to saying "the United States declared her independence in 1776". This is the use of facts. Taking vital signs would be our analogy. You know how to take vitals.

Synthesis, Analysis, and Evaluation - the three highest levels of Bloom's (he was an educator, BTW) - would be knowing what's happening to the vented patient and what to do about it. Or knowing to hold a BP med and why - and what would happen if you gave it. (Some of that is Knowledge, too, but knowing what to DO about it isn't.)

It's not magic. :) And you're 100% correct.

Graduatenurse14 · Sep 9, 2016

Thank you carolinapooh and smartnurse1982 for speaking rationally about critical thinking!! I can't take it when nurses talk like it's a superpower that only nurses have.

Horseshoe, BSN, RN · Sep 9, 2016

I have never heard anyone say that nurses are the only ones who employ critical thinking in their practice, nor that nurses invented it.

However, I have witnessed nurses who practice on autopilot, "following orders" blindly without using their higher levels of thinking. These are the nurses who are constantly reacting to events, rather than using their critical thinking skills to anticipate and prevent complications before they can happen.

AutumnApple · Sep 9, 2016

It's the highest levels of Bloom's taxonomy: synthesis and analysis. I forgot evaluation. :)
It's actually a buzz word that gets on my nerves. It's not unique to nursing, it's not anything fantastic: it's just higher level thinking. Engineers do it, teachers do it, everyone does it. All it is is synthesis and analysis, followed by evaluation. Look at a situation from all angles, consider possible outcomes from one's actions, make a decision based on all available information. Higher level thinking, plain and simple. You don't need a nursing license to do it.

It is a buzz word, yes. I so agree with you there. But it didn't have to be. Our profession ruined it. Yes, everyone else did too, but we were the forerunners in turning it into a buzz word with many wild uses and definitions.

I place it right up there with "Holistic Care". That is another buzz word that didn't have to be one.

Tasks: Procedures that can be taught in a classroom setting. They involve a list of steps that for the most part remain stagnant and are the same in every situation. For the most part, tasks and critical thinking are independent of one another.

A common misconception is that doing tasks efficiently involves critical thinking. For instance, if you were to use a cart to stack the water on instead of doing them one at a time. While this is good, and you are "working smart instead of hard", it is not critical thinking. I'd consider that common sense actually. This misconception is what leads many task oriented thinkers to believe they are utilizing critical thinking.

Skills: Like tasks, they have steps. The steps are not always the same though, and they tend to change from one situation (or patient) to another. Skills require critical thinking.

Filling the water containers is a task: Get the containers, fill them, don't give to NPO patients, gown up if the room is an isolation room.

Admitting a patient is a skill even though it involves many tasks. Let us say you are admitting someone to the unit who presented to the ER with abdominal pain: Critical thinking would tell you they are likely to have tests done that require NPO status, hence you would not fill their water container despite them not technically being NPO (yet).

Critical thinking is nothing more than the ability to take many tasks and manage them, along with the variables that require a decision on your part (like not giving water). The "decision" part is the critical thinking.

That is why people who can not make such decisions are called "task oriented". They can do the tasks, but can't make the decisions.

elkpark · Sep 9, 2016

It's what I thought. A ticked off boss once told me she couldn't teach it to me, making it seem like you either were born with it or knew it intuitively, but it couldn't be taught. What a load of crap she fed me.
Thanks to all of you.

Of course it can be taught. Nursing school faculty spend a significant amount of time figuring out how to incorporate teaching critical thinking into their curricula. Perhaps your "ticked off boss" meant that she had come to the conclusion that she couldn't teach it to you (i.e., you couldn't or wouldn't learn it).

AutumnApple · Sep 9, 2016

For me, the "Can critical thinking be taught?" question is just another variation of the old sociological riddle of "Are we born or made?".

We can compare teaching critical thinking in nursing to players in sports being taught how to play well. In sports, players have "talent" or they don't. In nursing, we have an aptitude for critical thinking, or we don't.

Yet, having that aptitude isn't enough it seems. Sports professionals all the time are labeled as someone who has "talent" yet many of them don't make it. They might even say, once said player is labeled a bust, that he/she "couldn't be taught, had a bad attitude." Then there are the ones who everyone says is short on talent, but they play well. They often are considered "teachable" and have a "good attitude, are great team players."

Nursing is much the same. There is that underlying, innate level of aptitude for critical thinking. But it's not enough. Nor is lacking in being a natural "critical thinker" a red flag that you'll never be a good nurse. You have to be teachable.

Unfortunately, our efforts to teach it are slowed down by the way the term itself has become a buzz word. Too many wild uses of the term being tossed around with no intention other than to "join the crowd" and use the lingo.

If we can't define it, we can't teach it.

People kill me using the term so loosely. They'll pat themselves on the back for spotting a misspelling and proclaim themselves critical thinkers. (face palms herself into unconsciousness).

llg, PhD, RN · Sep 9, 2016

For me, the "Can critical thinking be taught?" question is just another variation of the old sociological riddle of "Are we born or made?".
We can compare teaching critical thinking in nursing to players in sports being taught how to play well. In sports, players have "talent" or they don't. In nursing, we have an aptitude for critical thinking, or we don't.

I too get frustrated at how people throw the term around lightly and often don't truly understand it. As an educator, I also use the sports metaphor when I think about critical thinking.

It's is very hard to change a person's way of thinking. First of all, they have to want to change -- and be willing to approach their inner thought process in a different way. Not everyone is willing and able to do that. Also, a certain amount of brain power is necessary and not everyone has that. Not all people can grasp complex things -- and some people are overwhelmed by complexity and ambiguity to the point that they can't work within it.

For example: I have been working with a non-nurse recently to help her learn some new content for her job. I explain, I demonstrate, we do a few examples together, she does a few examples on her own and demonstrates that she can do it herself -- and then a couple weeks later, she says she doesn't understand it and can't do it. We sit down again and go through the whole thing again -- and the same thing happens. I really think that with her ... she has reached the point at which there is little more that I can do. She actually knows the material, she just won't use it in her work. When faced with the need to use that knowledge, she just shuts down and won't try. She says she "can't" without even trying. I think it is a combination of struggling to understand material that is a little more complex than she is used to, fear, and reluctance to change the way she approaches her job. I can lead her down the path of progress, but she needs to take some steps herself to actually succeed in the job.

Just like in sports ... a person my want to be a super-star -- and the best they can do even with a lot of practice is to be a not-very-good recreational player. We are not all going to make the Olympic team no matter how hard we try. But I like to think we can all get better if we are receptive to coaching, willing to change, and willing to practice, practice, practice.

DeeAngel · Sep 9, 2016

Meow. Cat, I am nearly retired, not a student. Maybe you just don't know the answer.

If you're nearly retired and don't know what critical thinking means god help us all.

carolinapooh, BSN, RN · Sep 9, 2016

I have never heard anyone say that nurses are the only ones who employ critical thinking in their practice, nor that nurses invented it.
However, I have witnessed nurses who practice on autopilot, "following orders" blindly without using their higher levels of thinking. These are the nurses who are constantly reacting to events, rather than using their critical thinking skills to anticipate and prevent complications before they can happen.

I have witnessed people from ALL professions walking around that exact same way.

From what I've seen, read, and been told, the nursing profession indeed acts as though critical thinking is some sort of secret skill that no one uses unless they've been to nursing school - and it's not the case.

carolinapooh, BSN, RN · Sep 9, 2016

If you're nearly retired and don't know what critical thinking means god help us all.

"Do your own homework" was hardly a constructive answer, which is what prompted Kooky Korky to respond that way. Can't really say I blame him/her.

Kooky Korky, BSN, RN · Sep 10, 2016

For me, the "Can critical thinking be taught?" question is just another variation of the old sociological riddle of "Are we born or made?".
We can compare teaching critical thinking in nursing to players in sports being taught how to play well. In sports, players have "talent" or they don't. In nursing, we have an aptitude for critical thinking, or we don't.
Yet, having that aptitude isn't enough it seems. Sports professionals all the time are labeled as someone who has "talent" yet many of them don't make it. They might even say, once said player is labeled a bust, that he/she "couldn't be taught, had a bad attitude." Then there are the ones who everyone says is short on talent, but they play well. They often are considered "teachable" and have a "good attitude, are great team players."
Nursing is much the same. There is that underlying, innate level of aptitude for critical thinking. But it's not enough. Nor is lacking in being a natural "critical thinker" a red flag that you'll never be a good nurse. You have to be teachable.
Unfortunately, our efforts to teach it are slowed down by the way the term itself has become a buzz word. Too many wild uses of the term being tossed around with no intention other than to "join the crowd" and use the lingo.
If we can't define it, we can't teach it.
People kill me using the term so loosely. They'll pat themselves on the back for spotting a misspelling and proclaim themselves critical thinkers. (face palms herself into unconsciousness).

I think I disagree that some have talent and some don't or that some are teachable and some aren't. I think people have different gifts, different dominant talents/inclinations.

So often, a different teacher/coach or method allows for success.

I think undiagnosed or misdiagnosed illness, insufficient sleep, environmental illness, allergy, nutrient deficiencies, problems in one's personal life, a basic personality clash with the coach, boss, or teacher, a bad attitude on the part of anyone involved, or many other things might account for problems in the classroom or on the job.

And some people learn visually, some by doing, some by other dominant means. If the teacher or coach is one who doesn't teach that way, there can be a problem.

Nature vs. Nurture Some of each, I think.

Kooky Korky, BSN, RN · Sep 10, 2016

If you're nearly retired and don't know what critical thinking means god help us all.

If you didn't want to help, you should have just cruised on by. It was not necessary to make a rude remark, based upon an incorrect assumption.

And your prayers are answered - as it turns out, based upon the helpful answers of others here, I have been thinking critically without knowing it was called that.

Be venomous elsewhere.

Meow again, cat.