Critical Thinking: How To Inspire It? - page 4
Hi AllNurses.com Friends, Much is said and written about the importance of critical thinking and how it affects the quality of patient care. Everyone has an opinion: The National Patient... Read More
Sep 7, '03A great deal of the 'culture problem' is down to the management of the unit. Without an effective leader, it's difficult to change things, and new staff members often join in with the lowest common denominator.
Sep 7, '03I tend to agree with those who said heavy patient loads cause a lot of errors, because when we're faced with 6-8 or more acutely ill patients, we end up operating on autopilot---do this, check that, give this med, change that IV......we all know the drill. Lately my hospital has been making an effort to staff better, and when we have only 3-4 patients apiece plus a PRN to help with admissions, patient care is MUCH improved. Just last week, I was the PRN admitting an elderly patient for the fifth time in as many months for increased confusion, dehydration, and UTI. She was in the early stages of Alzheimer's, but still lived at home alone, with a son close by who visited daily but did not pick up on the subtle changes she was experiencing until she became acutely ill. Well, I had enough time to delve into the old charts and research her previous hospitalizations.....and guess what, her weight had dropped by over 20# since May! No one had made a note of it, or even noticed it, in all that time. The poor woman wasn't eating, wasn't drinking enough fluids...no wonder she wasn't doing well. After informing the MD (who was very glad I'd caught this) of my findings, I made referrals to the discharge planner and the dietician, and the last I heard, she was going to be discharged to an assisted living facility. I felt bad for her because she had to give up her home, but she was clearly incapable of taking proper care of herself, and her son simply had neither the time or the energy to look after her 24/7. The ALF would at least make sure she had three meals a day and monitor her for changes in condition.
This is exactly the kind of thing that gets missed all the time when nurses have too many patients to look after. We simply don't have TIME to go that extra mile, to think critically about what makes a patient tick and how to improve the peripheral areas in his or her life that contribute to illness. Most of us have those skills, but they grow rusty from disuse because we have to be so task-oriented in order to get everything done on time. It is only when health care returns to its roots and stops being only about the almighty dollar that staffing levels will reflect patient needs. And in the current political climate, I doubt that day will come in my lifetime, sorry to say.
Sep 17, '07I'm reading your discussion on this board with great interest. I'm an instructional design professional working on a critical care nursing skills program for a hospital system (I have to keep all this on the QT for professional reasons).
I have to admit, right up front, I'm a total naif when it comes to critical care nursing. Yeah, I've been to an ER and watched those nurses work (as a patient, not in my current assignment), and I'm very conscious of what the RNs do when I visit my GP or my allergist, but, like I said, when it gets right down to it, I'm pretty ignorant of the scope of what RNs do.
Having said that, I'm also trying to figure out how to best present a model of critical thinking that nurses can use to quickly and accurately assess what's going on with a patient and select and execute the correct remedial action. I'm very aware of the limitations of the task-based approach described early on in this forum, and have always believed that teaching how to perform the tasks is a lower level of thinking and performing (but it's much easier to do).
Where most training programs fall short is in failing to teach a diagnostic, critical thinking regimen that gets you from the conditions the patient presents through the critical thinking process to the point where you've decided on a course of action to follow (at this point, I believe, the task-based focus takes over). It's the higher levels of thinking, though, that I want to impart to my training audience.
I guess if I were to sum it up, I'd like to put together a program that accelerates a nurse's progression through the five levels of critical thinking that wishingmary described.
Would love to hear your thoughts and ideas on this.
Thanks.Last edit by cwall99 on Sep 17, '07 : Reason: wanted to edit out some typoes and clarify a point.