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Topics About 'Critical Thinking'.

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  1. In fact, critical thinking is fundamental in helping you pass the NCLEX and becoming a safe and effective nurse! To emphasize how fundamental critical thinking is to being a proficient nurse, let's take a quick review at the basic systematic foundation in which nurses organize their thoughts and use critical thinking: The Nursing Process is a five-part systematic decision-making method focusing on identifying and treating responses of individuals or groups to actual or potential alterations in health. The five steps in the Nursing Process are as follows: Assessment/Analysis Collecting and analyzing objective patient data through a variety of methods such as interviewing, physical examination, patient response, measurements, and lab specimen collection. During this phase of The Nursing Process, you are challenged to determine if you have collected and analyzed enough data before moving onto the next step. Whether you are sitting for an exam, or taking care of a patient, you must be certain that you have all of the necessary data to safely move onto creating Nursing Diagnoses. Nursing Diagnosis Identifying actual or potential health risks, and defining the severity of health alterations based on the individual needs of the patient. Not only does creating a nursing diagnosis require you to rely on your body of nursing knowledge, but it also challenges you to anticipate your patient's needs on a holistic level. Using Maslow's Hierarchy of Needs is a great tool you can use when developing your nursing diagnoses. Remember that actual alterations in health take priority, but nurses use critical thinking to also plan for potential risks. Planning Creating an individualized nursing care plan to prevent, reverse, slow, or relieve the symptoms and/or progression of illness based on the patient's needs. When you are in the planning phase, it's important to establish objective and measurable goals for your patients. Identifying interventions, establishing anticipated outcomes, and considering appropriateness and utilization of supportive personnel are all examples of nursing considerations that require critical thinking skills. Implementation Strategic delivery of patient care plan and nursing intervention(s) based on the patient's individual needs. Now we get into the fun part - direct patient care and coordination! During the implementation phase of The Nursing Process, the number one priority is always safety. Not only considering the safety of the patient, but also the safety of you and your colleagues. Being safe when providing direct patient care and coordination requires high level critical thinking skills. From medication administration to teaching patients and family members discharge instructions, you must utilize all the strategies that you've learned during nursing school to ensure safe and effective care. During the implementation phase it is vital that you question everything and assume nothing! Evaluation Analyzing the effectiveness of nursing intervention in meeting the patient's individual needs, and meeting anticipated patient outcomes. Evaluating whether or not our interventions were successful in meeting the patient's needs is one of the most important steps of The Nursing Process. This requires high level analysis critical thinking skills to determine what's next in the patient's care plan. Have we met all of their physical needs? Have we met all of their psychosocial needs? Have they met the goals that were created in the planning phase? Has their status improved, stayed the same, or declined? If the patient has met the anticipated outcomes, then the interventions that were implemented are working, and no changes to the care plan are required. However, if we find that the interventions are not meeting the anticipated outcomes for the patient, then we must go back to assessing the patient for more objective data that will help us in updating the patient's plan of care. Believe it or not, utilizing The Nursing Process when answering NCLEX questions, or when providing direct patient care is a natural progression of critical thinking, and it will help you in making safe and effective clinical decisions. By following the five steps of The Nursing Process, while utilizing additional strategies that you've learned in nursing school, you will be on your way to mastering critical thinking and making sound nursing judgments. One final word of advice: don't get caught up in the obscurity of certain concepts or buzzwords such as "critical thinking". Instead you should master the systematic tools and strategies that are provided to you. With regular practice and mastery of critical thinking skills, you'll soon find yourself as a valuable addition to the nursing profession! LEARN how to pass the NCLEX... Download NCLEX Study Guide! Have you struggled with the concept of critical thinking? Do you have any critical thinking strategies you'd like to share? Do you think that critical thinking is effectively taught in nursing school? Please share your thoughts in the comments section below!
  2. MBar1

    A Shift in Perspective

    Have you ever tried to change the ingredients in your mother’s chicken pot pie recipe and lived to hear the repercussions of such a malevolent crime? The answer is probably yes. But following what appears to be an act of treason from the perspective of your mother, you simply take it to the chin and pray that you never have the audacity to change any of your mother’s cooking again. You will proceed to eat the same pot pie that you have been accustomed since the age of 7 and your life will go on relatively unchanged for better or for worse. This, however, can not be spoken of in the same context of your nursing practice, and especially so when it comes to the concept of change. Nursing Practice and Change To attempt to change your mother's special pot pie recipe and fail miserably is the equivalent to a slap on the wrist. But to take the same approach to your practice is not only a tragedy, but an act of negligence that has the potential to do more harm than good. You see, almost every action that you perform as a nurse, and every thought you have towards an inquiry along the continuum of your critical thinking has been answered or proven in some way. Whether it be the type of fluid solution, antiseptic, medication to treat blood pressure, or the type of dressing to use for a wound, somewhere, somehow, it has been proven to either be effective or ineffective, shown to perform a certain mechanism that was previously unknown, and/or claimed to be the “gold standard” with 95% certainty. There are only two certainties with respect to the ways of knowing in nursing and in science, that is, objective truth and subjective truth. We simply do not play “pin the tail on the donkey” when it comes to answering a research question. The scientific method is employed, a hypothesis is created, an experiment is performed, and results are tabulated. This idea of “method” can be traced back to the Platonic era, in which truth was established using geometry and deductive reasoning [4]. Florence Nightingale and Change Skipping ahead to the 19th century, we see the emergence of what is referred to today as “evidence-based medicine” and the beginning of a new era and approach to the practice of medicine and nursing. To speak about the concept of evidence-based medicine without first paying homage to the individual who began the conversation would be inappropriate [1]. Florence Nightingale, the face of nursing, and her contributions to the Crimean War in the mid-1800s, precipitated a change in perspective that we see today in the practice of nursing. If it wasn’t for Nightingale's astute eye, and perhaps outlook on her role in the grander scheme, it could be concluded that the number of casualties caused by the war would be far greater and topics such as asepsis and infection prevention would not be where they are today [1]. Fast forward to present day, and we literally have information at our fingertips. From RNAO Best Practice Guidelines to medical periodicals, peer-reviewed journals, etc. It would be ungrateful for us as a collective to do “what has always been done” and simply ignore a proven truth. While there are barriers that exist with respect to the implementation of evidence base(s) into practice, which include, but are not limited to nursing characteristics, organizational culture, and clinical context, there are ways to promote change [2]. Evidence-based practice is the new kid on the block. Underneath lies improved patient outcomes, a stepping stone for future research, improved cost savings, and equally as important, provides accountability and transparency within the decision making process [3]. Change is Constant And with that said, the only constant here is change. Change in the way things are done. Just because something is ALWAYS done a certain way, it does not mean that it’s the right way to go about it. Owe it to yourself, and most importantly, your patient, to be up to date on the happenings around you. You will be better for it and so will the practice of nursing. We owe it to Nightingale.
  3. Julie Reyes

    Critical Thinking

    I wish someone would have explained exactly what it meant to "think critically" when I first started nursing school - it sure would have saved me a lot of time trying to figure out how to answer my assignment questions and create better care plans! My hope is this article will help you delve deeper into your patient care by looking holistically at your patient - from the cause of injury/illness to the pathophysiology to the interventions and WHY you are using the interventions you chose. Let's start with you as a student nurse tech in an emergency room. Level 1 You are a new student nurse and you have just learned how to take a blood pressure. Your job is to take vitals on patients who come into the Emergency Room and record them. This is the first level of the pyramid. Level 2 You understand the numbers - diastolic and systolic - and what a normal range is. Level 3 You understand that you need to report the "abnormal" range numbers to someone because something is not right with the patient. Level 4 You are now a nurse working in the Emergency Room. You understand your patient, who just came in the ER because of an auto accident and has no external bleeding, has a lower than normal BP that could be due to some sort of internal bleeding that you cannot see. You call for help (Rapid Response/Code, depending on the situation) because this patient may turn into a code. You draw labs and a type & cross for blood matching, radiology in to do x-rays, and respiratory in for oxygen support. Level 5 You understand that your patient (in the ER) needs you to provide fluids through an IV so that he/she will not "bottom out" and die. You remember your ER has a protocol for this situation and you begin to follow that protocol: You take steps to help the patient, including starting an IV, elevating the feet, keeping the head flat. You set the monitor to record BP every 5 minutes (or 2, depending on your situation). You understand you will need to monitor the urine output for this patient so a foley is needed. Level 6 You begin to classify your patient's hemorrhage level from a class I - class IV Level 7 You understand that a low BP due to hypovolemia (low fluids in the body) can cause the heart rate and respiration rate to increase and perfusion failure/tissue hypoxia. You know you need to begin to administer IV fluids - but you know that you cannot use ISOTONIC fluids, instead, you will need a crystalloid. You anticipate the need for blood and (you can then discern if your patient needs whole blood versus packed red blood cells). You also know the amount of fluids you can give in a certain time frame so that you don't turn the patient's remaining blood into "kool-aid" with a fluid overload and thinning it out too much. Level 8 You understand if your patient continues down the present road, the next step will be organ dysfunction and possibly multi-system organ failure and death, so you need to perfuse those organs and prevent shock. Level 9 You understand your patient needs to go to the operating room to find the source of bleeding. You prepare to administer medications to prevent shock - specifically inotropes like dopamine - because you know it has a positive chronotropic and inotropic effect and if a higher dose is used will have a vasoconstrictive effect that can help your patient's perfusion, can help with cardiac output, and can help your patient live! As your knowledge base increases, you will be able to anticipate what is needed for your patient and why. You will be able to intervene before the next problem arises and help fight off the Grim Reaper in some cases. Critical thinking is thinking deeper than the surface level - it means understanding what is happening and why, what will happen to the patient if interventions are not done, and what is needed to make the issue normal - or as normal as possible - again.