Define critical thinking.

[eriksoln]

OK, another post got me thinking about critical thinking (I sound like a late night talk show host now). Anyway, how do you define it? Have any good examples of things you've done that displays it?

Its such a buzz word nurses use and I cant wrap my mind around it. Every time someone tries to explain it, I just cant help but think........"Thats just doing your job, its not some special form of thinking."

Good example.......someone posted about a new nurse who gave a BP med to someone with an already low BP. The new nurse didnt check the pt's BP before giving it. Then finished the post with something to the effect of "This is task oriented nursing at it worst" or something of that nature.

Now, I look at that, and.......considering myself a task oriented person (why is that considered bad?, isnt the point to get the work done?)......think......."No way, a task oriented person would not skip the task of checking the BP, that was a case of laziness."

Anyone have a description of critical thinking that works. I know a lot of people simply call it common sense. Is that all it really is?

[eriksoln, BSN, RN]

I believe that critical thinking is problem solving. I can remember when I was a student in RN training and I had a pt. that did not have a chair that was needed on the floor. I ran up to the rehab floor and grabbed one. My instructor told me that was critical thinking. But, I must admit prior to that I told him that there were no chairs on the floor. He told me that I must get one and to use my critical thinking skills. ? Anyways, I was harrassed by this certain instructor for not using critical thinking skills. However, by the end of the course, he told me that I improved.

I can follow that.

[leslie :-D]

i shudder at the idea of we nurses being only task-oriented.

if that were the case, then many others could do our job...

serious...

if that's what merely doing "tasks" entails, less any thinking.

we need to be fully aware of why we're doing what we're doing:

and any risks, adverse outcomes r/t our actions.

that is a whole lot more than just being task-oriented.

leslie

[ghillbert, MSN, NP]

Critical thinking is not "going beyond your job" - it IS your job as an RN. It is not common sense (although god knows that is not as common as you'd think!).

To me, critical thinking is being able to:

1) Join the dots and

2) Anticipate the next dot

Or as a great surgeon once told me, "I look at the patient, and try to figure out what will kill them immediately, what will kill them in the short term, and what will kill them in the long term".

If you have a postop aortic valve patient, you need to be able to consider "what is the worst that can happen?" In this case, it may be bleeding, arrythmias (esp bradys/blocks), it may be hypotension or hypertension. You need to be able to look at the patient's history, and what we have done to them, and consider what can go wrong. And THEN do something about it. Agree with the example about following up a high INR. Another is: a postop patient is showing signs of hypoxia. As well as looking at their lungs, breathing, oxygen therapy, you need to be checking: are they bleeding? is their H&H low? are they fluid overloaded? do they have a PE? In other arenas, it's called "situational awareness". A lot of it is your base knowledge, much of it is a function of your experience with that type of patient and knowing what has gone wrong in the past and how to avoid it happening.

[GomerPyle]

it would seem to me that "critical thinking" truly comes with time in service? am i wrong in this reasoning? a noobie nurse with a fresh license has not acquired enough experience to build a personal database from which to draw on. that being said, i know enough to not give a anti-hypertensive med to a pt. with bps in the 80's, but is this necessarily "critical thinking"? i too struggle with that term....just my .

[ghillbert, MSN, NP]

In your example, I'd think critical thinking was: holding the BP med, rechecking the BP, then considering why the BP is that low. Is it new? Is it normal for the patient? Orthostatic? Related to bradycardia? Due to other meds? Fluid deficit? Bleeding?

Just holding the med and not doing anything else would not define critical thinking for me.

[SharonH, RN]

i shudder at the idea of we nurses being only task-oriented.

if that were the case, then many others could do our job...

serious...

if that's what merely doing "tasks" entails, less any thinking.

we need to be fully aware of why we're doing what we're doing:

and any risks, adverse outcomes r/t our actions.

that is a whole lot more than just being task-oriented.

leslie

Thank you so much Leslie! I have a real problem with nurses who are task-oriented. I thought nursing had evolved beyond that?

The problem is that critical thinking is not buzz word. It is the ability to problem solve, work outside of the box, anticipate problems and formulate different plans of action for dealing with problems. This is a skill all nurses should have and unfortunately there are too many who are "task-oriented".

I work with a LPN who is task oriented. If you give her an assignment, tell her how to do it and give her definite parameters to work with and she will knock it out of the park. Anything that requires her how to figure it out on her own and she is lost. I have to support her a lot and I resent it. We as nurses are supposed to be better than that.

Task-oriented is what causes nurses to focus on completing the physician orders only and never think to assess the patient's teaching and other needs. Task oriented is what leads to preventable complications because the nurse didn't think to teach the patient how to use the IS, cough and deep breathe, ambulate ASAP after surgery and on and on because if the doctor didn't write it, they're not going to do it. Can you tell this is a pet peeve of mine?

[leslie :-D]

In your example, I'd think critical thinking was: holding the BP med, rechecking the BP, then considering why the BP is that low. Is it new? Is it normal for the patient? Orthostatic? Related to bradycardia? Due to other meds? Fluid deficit? Bleeding?

Just holding the med and not doing anything else would not define critical thinking for me.

one bp reading and subsequent hold on med, is too early to start questioning.

if the next bp is still low, then i'd start the detective work.:)

but of course, i'd still be monitoring pt inbetween scheduled med times.

leslie

[leslie :-D]

sharon, i am totally w/you.

i detest the notion of "task-oriented".

i visualize mindless acts of assigned function.

if that were the case...

nevermind.

those thoughts scare the life out of me.

leslie

[Scrubby]

This is just my humble opinion here but I agree with all comments about task orientated.

Do you ever think though that the reason some nurses become way too TO is because we are always going on about time management? Seriously, I think TM is important but way overrated compared to being able to think critically about what is going on.

[rngolfer53]

I guess I would describe it as being aware of the entire process of your Pt's condition: Apply your knowledge base and the nursing process to ask "What is going on here, e.g. why is my Pt's BP dropping?" and "What will happen if I do (or don't do) X?"

[ghillbert, MSN, NP]

one bp reading and subsequent hold on med, is too early to start questioning.

if the next bp is still low, then i'd start the detective work.:)

but of course, i'd still be monitoring pt inbetween scheduled med times.

leslie

Yes, me too. That's why I said "recheck the BP", and also to see what the patient's norm is. If it's usually 150/, then a SBP of 80/ is severely abnormal. I don't think it's too early to wonder why it's that low in a patient that is obviously on antihypertensives because they are usually hypertensive.

[GomerPyle]

i guess i'm in awe and truly humbled by the critical thinking skills exhibited in this thread. again, i feel that these critical thinking skills come with time. i can't compare my critical thinking skills with another rn of 10-15 yrs experience. i believe that experience plays a big part in one's ability to critically think through whatever experience presented. wow...this former aircraft mechanic has much to learn i'm so glad i found this website...what a valuable resource..........