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Critical thinking on tests vs clinical setting

Nurses   (2,024 Views | 15 Replies)
by sm2013_SN sm2013_SN (New) New

233 Profile Views; 4 Posts

I just completed my first year as a nursing student, and right now I am working as a med tech at an assisted living community, where I am able to pass meds and chart on my residents, as well as send them to the hospital if needed. I have always been really book smart, and do extremely well on all my nursing exams. I am able to critical think very effectively for an exam. However, I feel like it is difficult for me to translate this type of critical thinking into my real life practice. Things that I know I could have thought of do not go through my mind during a real assessment. For example, the other day when a patient has blood in his urine, I didn't think to check the catheter insertion site to realize that my patient's catheter had been pulled out a little. It took the tech after me to realize that. I feel like that is something that should have crossed my mind.. any advice on how to become a better critical thinker in a clinical setting, where ultimately it is going to matter the most when I am done with nursing school? I keep doubting myself and wondering if I am meant to be a nurse. I also keep comparing myself to other students who are able to critically think better than I am..

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brownbook has 35 years experience.

1 Follower; 3,413 Posts; 46,648 Profile Views

Obviously you have good critical thinking skills since you came to Allnurses for advice 😃.

It would be helpful if you told us what you did or thought when you saw blood in your patients urine?

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4 Posts; 233 Profile Views

I asked him when he got his catheter changed and I asked my other coworkers with me that day who told me it's a normal occurance for him, so I just assumed that's what it was. But from my own nursing knowledge I know that hematuria isn't normal. So I guess I need to trust my own intuition instead of what others are telling me??

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brownbook has 35 years experience.

1 Follower; 3,413 Posts; 46,648 Profile Views

I wouldn't be to hard on myself. You knew it wasn't normal, you asked co-workers about it. They gave you their ideas/advice. I assume you are newish on your job so it makes sense you acquiesced to their knowledge and experience.

You shouldn't start labeling yourself....."I have poor critical thinking skills." Instead just put it down as a good learning experience and very little if any harm was done to the patient.

Many people, myself included, inspite of my superior critical thinking skills, (my insert smiley face is still acting up!) would have easily gone with what co-workers who had worked their longer said.

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RNperdiem has 14 years experience as a RN.

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These skills are learned with experience.

One of the biggest changes for me in moving from a CNA to RN role was my overall mindset.

As a CNA I was focused on getting tasks done. First came vital signs, breakfast trays, turn and check bedbound patients etc. Work was a checklist.

As an RN, I still have all the tasks, but there is a focus on what goals I want to accomplish for each patient. How can I move them forward in their recovery and prevent complications. If a patient is on oxygen, I now think: Can I wean them off the oxygen. If the foley is bleeding it is time for some troubleshooting. Don't worry, critical thinking comes with practice.

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14 Followers; 4,216 Posts; 32,782 Profile Views

Your studies provide the facts, and one is able to group these facts. Facts about CHF, facts about COPD, facts about alterations in health, etc. But what the book side really can't accomplish is giving you a mental picture of what these groups of facts look like in person. I'll never forget one of the days I was brand new and witnessed flash pulmonary edema. "A-ha!!!" Prior to that day I had a collection of "facts" about it, but when I would see a patient with difficulty breathing - I wasn't at that place where I could narrow that down much at all...I just knew somebody was having a hard time breathing, "as evidenced by..."

There are benefits of Sim labs, but they, too, don't come close to conveying the real-life manifestations of the facts you're learning.

It will come together. It's so cool when it does.

I agree with the above posters, especially on the point of not over-critiquing and labeling yourself at this early stage.

Best wishes ~

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hppygr8ful has 18 years experience as a ASN, RN, EMT-I and specializes in Psych, Addictions, Elder Care, L&D.

8 Followers; 3 Articles; 3,091 Posts; 34,567 Profile Views

Critical thinking is a skill that some people have and or that they learn. If you look at it from a practical standpoint people, yourself included, engage in critical thinking daily without even knowing it. When to get up, what to eat, what route to drive to work, school, dates etc...all require a certain amount of critical thought. Since you are new in the clinical setting understand that it will take you some time to develop these skills and thinking patterns. It's always ok to ask questions - just find someone who doesn't mind having their ear bent once in a while and come to them with a statement of what the problem is and what you have tried. Sometimes you do need a second set of eyes to troubleshoot a problem and believe it or not (In spite of all talk about bullying) some of us are quite willing to help and want you to succeed.

Peace and Namaste

Hppy

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quiltynurse56 has 3 years experience as a LPN, LVN and specializes in LTC and Pediatrics.

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You are new to the job and with what I guess is a lack of experience, you are not sure what is normal for patient and what is something to be concerned about. Now that you have been reminded about checking catheter placement as one of the first things to check. Each experience like this will improve your ability to care for patients.

As has been said, much of the critical thinking is learned. When each one of us started out or started a new job, we need to learn procedures and protocols. I also check previous charting to see if this is something that has occurred before and what was done about it. This helps to develop your critical thinking.

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mmc51264 has 8 years experience as a ADN, BSN, MSN, RN and specializes in orthopedic; Informatics, diabetes.

2,854 Posts; 39,711 Profile Views

recognizing that you missed something is the beginning of critical thinking. You'll get there :)

This is why I do not understand nurse who, after 6 months to a year, think they "got it" I have been a nurse for 5+ years and still learn every day-mostly about the things I don't know I don't know.

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4 Posts; 233 Profile Views

Thank you all so much. I realized I am being way too hard on myself. There are plenty of things I do right, but of course I never pay attention to those. I will now try to look at situations like this not as a "I should have known that. I must be terrible" but rather "this is a good learning experience and I have gained knowledge that will help me with future clinical decisions." I am new to this forum but it is amazing! I feel so much support.

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1,763 Posts; 20,669 Profile Views

As a new nurse, I feel like my critical thinking skills are lacking sometimes too. I find that I have to stop and seriously think about things that other nurses on my unit know immediately. From what I understand, it comes with time. I personally follow mental checklists. For instance, next time you see blood in someone's urine, think about the body systems that are immediate players (genitourinary). This means you could look at the outside genitalia (where you would immediately see the catheter had pulled a bit); if there isn't a problem with the catheter, you could ask your patient if they're experiencing flank pain, abdominal pain, dysuria (could be signs of kidney/bladder infection or kidney stones); then you might think of outside factors such as medications that the patient is taking that could result in bleeding. In short, just do a focused assessment for the system that's affected. It's ok if you don't know what the problem is right off the bat: use your assessment skills and use your resources.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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I asked him when he got his catheter changed and I asked my other coworkers with me that day who told me it's a normal occurance for him, so I just assumed that's what it was. But from my own nursing knowledge I know that hematuria isn't normal. So I guess I need to trust my own intuition instead of what others are telling me??

Trust but verify.

Your intuition told you that hematuria wasn't normal, so you should have checked the insertion site, the labs (were his liver enzymes high? had he been on warfarin?, kidney issues? etc.) before you asked your coworkers. If, as they say, it was a normal occurrence, had that been documented? If it hadn't been, then it was a new finding and needed to be explored as such.

If you have the critical thinking down for textbook exams, you are in the process of developing the critical thinking you need for clinical situations. The good news is that you have more school time to develop those skills even further AND you get to practice on the job. You'll get there.

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