Critical Thinking

nursinghealth · Sep 12, 2016

A few examples:

Your patient is admitted for a hip replacement. He is on narcotics for pain relief, which can cause constipation, so it's not surprising that he has not had a bowel movement in 3 days. However, you read in his medical history that he has an Abdominal Aortic Aneurysm. Critical thinking will tell you that producing a bowel movement is now a priority because the increased pressure in his abdomen places him at risk of rupturing his aneurysm.

You are removing a patient's IV. You checked the patient's lab work in the beginning of the shift and noted that their platelets were low. You know that decreased platelets place patients at risk for bleeding. Critical thinking tells you that when you remove the IV you should apply pressure to the site for longer than you normally would because you know it will take longer for the bleeding to stop.

You check your patient's MAR before your shift. You notice that your patient is scheduled to receive Fragmin at 0900 and Enoxaparin at 2100 on the same day. Critical thinking causes you to question this because they are both anticoagulants, and you know that they will increase the risk for bleeding. You call the MD to double check the order before administering it.

You are caring for a patient post-op day 1 after abdominal surgery. You check their lab work in the start of your shift and you notice that their potassium level is a little high. You see your patient for the first time and find a bag of NS with 40mEq KCL (potassium) infusing in the patient's IV line. The patient is not on a diuretic, which would cause them to lose potassium. Critical thinking tells you that you should confirm the order with the MD as the patient is at risk for cardiac issues if their potassium becomes too high.

These are just a few examples. I'm a new nurse so I often feel like I have no idea what I'm doing. I'm learning every day, and so will you. Just keep asking questions!

Kooky Korky, BSN, RN · Sep 13, 2016

Talk about generational gap! Those old nurses don't think critically, huh?
Critical thinking was emphasized when I went to school in the 70s, although we did not have that handy dandy buzzword with which to describe it.
I remember being taught that it was our responsibility to know what drug/treatment/test we were giving/doing, the reasons for doing it, the proper way to give it or do it, the right dose and how it related to the patient's condition. We were also taught to monitor for side or toxic effect, know when to hold, delay or question the order. and to know the rationale for using this drug/treatment or requesting that test. Anyone who didn't understand why Lasix was given to someone in CHF or why we would monitor the patient's electrolytes while giving it could write a paper explaining the rationale and turn it in the next day.
Critical thinking is difficult to describe and difficult to teach. But the absence of critical thinking is very noticeable!

Exactly!!

Kooky Korky, BSN, RN · Sep 13, 2016

No, she knows. But you coming in asking for a definition without providing what you THINK it is is kind of a hallmark "do my homework for me" ploy.
Also, google is a thing.

Nah, it's just that some people have suspicious minds or fear someone will take advantage of them.

Just like there is one person here whose reaction is very quickly that someone is a "Troll". no thinking it over or evidence/reasoning apparent, just a quick labeling.

And I thought this board was a place where people discuss things.

I wish I had just googled. But thanks to those who participated helpfully.

Kooky Korky, BSN, RN · Sep 13, 2016

Good point. What you call "work with blinders" I call "Playing the dumb card".
Playing the dumb card has become a very common coping mechanism, for all career paths. It seems to me, some just never learn to deal with the stresses of a workday. So they willfully underachieve and hope expectations for them will lower.
I saw this more so in the restaurant business than anywhere else. I could give a thousand examples. One waitress hated folding silverware, so she never quite picked up the skill (if you call it that) and often left her part undone. But she was too smart to just not do it. She just made sure she always looked in over her head with other duties and didn't get to it. Meanwhile, when friends came in for a meal or she felt someone was a big tipper.............wow, she all of a sudden came out of the fog and did her job like a pro.
Nursing has many who are like her. They can't cope with the workday, find certain tasks too much to handle and........play the dumb card. It floors me when these types then turn around and get defensive about being considered task oriented.
The problem with playing the dumb card is, people eventually stop taking it as an act and just assume you are dumb.
I often wonder, when this debate about critical thinking comes up, how often are the people we say don't get it are..........just playing the dumb card.

How do you fold silverware?

Kooky Korky, BSN, RN · Sep 13, 2016

Good point. What you call "work with blinders" I call "Playing the dumb card".
Playing the dumb card has become a very common coping mechanism, for all career paths. It seems to me, some just never learn to deal with the stresses of a workday. So they willfully underachieve and hope expectations for them will lower.
I saw this more so in the restaurant business than anywhere else. I could give a thousand examples. One waitress hated folding silverware, so she never quite picked up the skill (if you call it that) and often left her part undone. But she was too smart to just not do it. She just made sure she always looked in over her head with other duties and didn't get to it. Meanwhile, when friends came in for a meal or she felt someone was a big tipper.............wow, she all of a sudden came out of the fog and did her job like a pro.
Nursing has many who are like her. They can't cope with the workday, find certain tasks too much to handle and........play the dumb card. It floors me when these types then turn around and get defensive about being considered task oriented.
The problem with playing the dumb card is, people eventually stop taking it as an act and just assume you are dumb.
I often wonder, when this debate about critical thinking comes up, how often are the people we say don't get it are..........just playing the dumb card.

I didn't mean for it to be a debate. I just stupidly asked a question, thinking I could get a reply here. Had no idea it was a hot potato topic.

Kooky Korky, BSN, RN · Sep 13, 2016

Well now I know.
The OP states she is retired,so I assuming she was critically thinking all along without the buzzwords.

Nearly retired. And yes, that's what I've been doing. I stated that a few posts back, also.

Kooky Korky, BSN, RN · Sep 13, 2016

I chose not to fluff my answer up with a paragraph long of a$$patting in order to "nicely" convey that this site is not a Google search and answers are not generally just given. If this person is not actually a student then great. The question seems like a homework question. Students don't learn from just getting answers and not having to try for themself. Hence the "we don't do your homework for you." My apologies for not being "constructive" enough.

If that's a sincere apology, I accept. Thank you.

Next time you start to assume something based on your impression, you can simply ask for clarification or just be nicer in your reply. A little a$$patting goes a long way. :roflmao:

Kooky Korky, BSN, RN · Sep 13, 2016

From what I understand(I may be wrong though) is that critical thinking was only emphasized in the past 20 years,so nurses who were educated in the 60's and 70's were more task oriented.
I also think this is where the generational gap in nursing comes in.
On a thread asking about a saline or Hep lock,many nurses said they never got a chance to start Iv's while in school.
Some nurses seemed upset that many of us were not taught that in school,but really,it was not a big deal.
It is just that it is a task that could be taught to anyone because there is no critical thinking involved.
I know Cna's that start Iv's legally.

Doing tasks requires not just doing the task but knowing how to do it, what items you need to do it, and probably other things that I'm not thinking of just now because my pets are going a little wild.

You can't just stick somebody. School must have told you it was no big deal to start IV's, but there really is actually a good deal that goes into it, especially if you don't really like and might not be good at needles, veins, asepsis, having all of the items you need without making 20 trips to the supply closet or med cart, or what if your pt is combative, etc.

Where are you where CNA's start IV's legally? Are they certified?

LPN's don't even do this in some states without certification.

You can't teach any or every skill to everybody or just anybody.

Kooky Korky, BSN, RN · Sep 13, 2016

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).

Or that SHE couldn't teach me.

smartnurse1982 · Sep 13, 2016

Doing tasks requires not just doing the task but knowing how to do it, what items you need to do it, and probably other things that I'm not thinking of just now because my pets are going a little wild.
You can't just stick somebody. School must have told you it was no big deal to start IV's, but there really is actually a good deal that goes into it, especially if you don't really like and might not be good at needles, veins, asepsis, having all of the items you need without making 20 trips to the supply closet or med cart, or what if your pt is combative, etc.
Where are you where CNA's start IV's legally? Are they certified?
LPN's don't even do this in some states without certification.
You can't teach any or every skill to everybody or just anybody.

In NC the hospitals can teach a Cna level 2 to work with Iv's.

In Peds home care we do teach parents to manage central lines,vents,trachs,feeding tubes,Iv ABT's.

LOVEGREEN · Sep 13, 2016

How do you fold silverware?

. This is also called rolling silverware and it entails assembling the silverware into napkins . This is done at most casual dining restaurants. I used to enjoy it, a moment of zen at the end of my shift.

AutumnApple · Sep 13, 2016

How do you fold silverware?

Put it in a napkin (butter knife, then fork then spoon) then roll it all up tightly. Then the hostess can grab as many napkins as she needs while seating people.

Sounds simple but some can't make the roll tight enough and it all ends up spilling out.

The whole process is called "folding" or rolling the silverware. It is the bane of many a waitress career. Busy, time consuming and never completely done.