Interview - Thinking Critically

[ukbsktbll]

So I have an interview in about two weeks at a major hospital. They do a residency program for new grads which is supposed to be top notch. Well I am very interested in getting in the critical care field. One of the key factors they focus on is critical thinking. Now throughout school there has always been the talk of how important that is. I do it all the time but I just can't think of things off the top of my head with such a broad topic. So I was seeking some advice.

[diane227, LPN, RN]

Critical thinking is necessary in all areas of nursing and I define it as the ability to assess a situation and to be able to make a determination as to what may happen or what you will need to do in the future. How what you will do now will affect the patient later on. Being able to put two and two together. Being able to walk through the steps before you need to.

For example. I have a nurse on my floor right now who has no critical thinking skills at all. She will come to me with all types of questions, but when I talk to her she has not read the progress note, orders or the MAR. Basically she has no idea what is going on with her patient or why the doctor is doing certain things to this patient. What the care objective is for this patient. She came up to me the other day and said she needed to call the doctor because the patient needed an order for a breathing treatment. I told her to look at the chart. He had already written one.

In addition, critical thinking skills are necessary so that you can catch an error before it occurs. For most of us this is in the form of giving the wrong medication or being unable to read physician handwriting or having the doctor write an order for something that is not consistent with the plan of care for this patient. This is why it is so important to read the progress notes and know the labs on your patients. You have to know the whole picture in order to make an informed decision.

And for me, I like to look at a patient, expecting the best but knowing that the worse might happen. For example, when I worked in the ED if I had a 65 year old male come into the ED with abdominal or chest pain radiating to the back with a history of hypertension, he was automatically assumed to have an aortic aneurysm. He may not and that would be good, but he is at risk and it can kill him if he sits in the waiting room. Second example. 23 year old female comes to triage c/o lower abdominal pain, spotting, pain worse on the left, LMP 5 weeks ago. She just brought herself a bed in the back ASAP because you have to make the assumption that she has an ectopic pregnancy.

And listen to the patient. They can usually tell you what is wrong if you just listen.