need help in developing critical thinking

jam2007 · Mar 3, 2009

I've got same concern with you. The mosty terrifying part is that your nurse supervisor or the doctors that making rounds will ask question and we dont have the answer at that moment. I've observed from my co-workers that they just know how to joggle the words than providing the infos that are needed. Even if you know what to do and you dont look confident of what you are doing they will judge you as dumb. I think confidence matters most than knowledge. Its good to have both though....

Interesting observation. I have to agree..during rounds I have heard some of the nurses spouting verbatim what they were told in hand-off like it was their original thought. I am not the most confident..even when I know I am right; I know I need to work on my self-confidence and have that as a goal of mine. There is so much more to this profession than I anticipated:banghead:

RedhairedNurse, BSN, RN · Mar 3, 2009

I am a new RN on a busy medical/tele floor where I see many different diagnosis. It is a high acuity floor and not alot of "walkie-talkies" I am trying to fit the pieces together...for example, if someone has Afib..I need to make sure they are on an anticoag, hooked up to tele, monitor VS, etc. I guess I'm having difficulty pulling the whole picture together with the disease process, meds, etc. and am attributing that to the ability to critically think. Hope that makes sense.

Sounds like to me you are doing well. I had an experienced nurse with probably over 10yrs exp the other day wonder why an Afib patient was on coumadin; luckily, I could answer her question since being fresh out of nursing school. Sounds like you are getting it, just always use your mind and think think think before you give meds or anything else.

I was about to give a pt her BP meds but checked her pressure first and it was low. She was also getting lasix and other diuretics which of course I held due to the low BP. If I would have been in a hurry, I may have given it, but I took the time to think about these meds first. I'm grateful for learning experiences such as these and will never forget to critically think before giving a med or doing a procedure. I also think about what the pt has wrong with them, critically think of something that could go wrong, even though the pt is stable. Just always have your mind tuned in to your surroundings.

I'm like you and still have a lot of learning to do, but this is what I have found so far. Wishing you well.

shinneh · Mar 5, 2009

i also don't know how to enhance my critical skills. i want to do good in my exams.

Daytonite, BSN, RN · Mar 5, 2009

books that i know of are:

critical thinking in nursing: a cognitive skills workbook by saundra k. lipe and sharon beasley. runs about $36.
strategies, techniques, and approaches to thinking: critical thinking cases in nursing by sandra luz martine de castillo. runs about $35.
winningham and preusser's critical thinking in medical-surgical settings: a case study approach by barbara a. preusser. runs about $34.

you can find nursing case scenarios on the internet by simply doing a search of "nursing case studies" or "nursing case scenarios". i actually found a site one time that had short viseo vignettes for nursing students to watch and then they were to write a care plan. unfortunately, there were no answers. i did not take the websites down because on allnurses the students are interested in samples to look at and not exercises to do in addition to their coursework.

i was a nurse who originally got an aa in nursing and went back for a bsn 20 years ago. as a manager some years later i found myself very busy helping to orient new grads. i had also been writing care plans for nursing homes for many years to supplement my income. it took me a while, but i began to realize what was going on with critical thinking and the nursing process although we were not taught this when i was first in nursing school. at least, i don't remember it. and, care planning as it is done today, was emphasized in my bsn program but i wasn't really getting the hang of nursing diagnosis then. i know enough now, however, to confidently tell you that almost all critical thinking in nursing can start and end by the application of the steps of the nursing process. there is information about science, medicine, nursing and other disciplines that we can pull into our problem solving when using the nursing process, but if the sequence of the steps of the nursing process are followed the outcome is always going to be the best rational response. of course, it assumes you input good information. for the past few years as i have been helping students with their care plans i have been expanding on what needs to be done in the 5 steps of the nursing process. for care planning the first 3 steps have become very developed. but, those steps can be just as easily applied to any situation because as i keep telling students: the nursing process is a formula for solving problems. it was extrapolated from the science community. and, i give this analogy as a demonstration of how it works in another area beside nursing:

you are driving along and suddenly you hear a bang, you start having trouble controlling your car's direction and it's hard to keep your hands on the steering wheel. you pull over to the side of the road. "what's wrong?" you're thinking. you look over the dashboard and none of the warning lights are blinking. you decide to get out of the car and take a look at the outside of the vehicle. you start walking around it. then, you see it. a huge nail is sticking out of one of the rear tires and the tire is noticeably deflated. what you have just done is step #1 of the nursing process--performed an assessment. you determine that you have a flat tire. you have just done step #2 of the nursing process--made a diagnosis. the little squirrel starts running like crazy in the wheel up in your brain. "what do i do?" you are thinking. you could call aaa. no, you can save the money and do it yourself. you can replace the tire by changing out the flat one with the spare in the trunk. good thing you took that class in how to do simple maintenance and repairs on a car! you have just done step #3 of the nursing process--planning (developed a goal and intervention). you get the jack and spare tire out of the trunk, roll up your sleeves and get to work. you have just done step #4 of the nursing process--implementation of the plan. after the new tire is installed you put the flat one in the trunk along with the jack, dust yourself off, take a long drink of that bottle of water you had with you and prepare to drive off. you begin slowly to test the feel as you drive. good. everything seems fine. the spare tire seems to be ok and off you go and on your way. you have just done step #5 of the nursing process--evaluation (determined if your goal was met).

other professions that use the scientific process to think critically and come up with rational problem solving include research and development, medicine, police detective work, and any of the trades that fix and repair stuff that breaks down.

shinneh · Mar 5, 2009

for the nth time, miss Daytonite, thank you. you really are a big help.

"outcome is always going to be the best rational response." - i'll keep that in mind. but when answering an exam, and you are undecided between two choices.. what is the best thing to do?

Daytonite, BSN, RN · Mar 5, 2009

. . .when answering an exam, and you are undecided between two choices.. what is the best thing to do?

read the stem of the question again, very carefully, to be clear as to what it is asking. know the steps of the nursing process and what goes on in each of them. after that it depends on your knowledge of nursing and the various disciplines that you had to learn. see the information on https://allnurses.com/general-nursing-student/looking-test-taking-224581.html - looking for test taking strategies