Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.
The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!
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Critical Thinking in Nursing: Example 1
I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs to the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90’s on oxygen.
I stopped. And thought. What the heck is going on?
I looked at his history. Congestive heart failure.
I looked at his intake and output. He was positive 1.5 liters.
I thought about how he’s got extra fluid in general, and because of his CHF he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..
His lungs were clear earlier. I heard crackles throughout both lungs.
OK, so he’s got extra fluid that he can’t get out of his body.. What do I know that will get rid of extra fluid and make him pee? Maybe some lasix?
I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said.. “Give him 20 mg IV lasix one time.. I’ll put the order in.” CLICK.
I gave the lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.
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Critical Thinking in Nursing: Example 2
My patient just had her right leg amputated above her knee. She was on a dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. The told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with a goal of weaning off PCA.
“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?
I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.
I thought about nerve pain. I thought about other patients that report similar pain.. Diabetics with neuropathy would talk about similar pain… “What did they do for it?” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.
“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.
I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain, after I described my patient’s type of pain and thought process.
“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner.”
She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort was significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.
And that we did!
She was able to work with therapy more because her pain was tolerable and was finally able to get rest.
Critical thinking is something you’ll do every day as a nurse and honestly you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution and trying it out. Critical thinking in nursing is just that, but in a clinical setting.
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Date Published - Sep 30, 2016
Date Modified - Jun 12, 2017
Written by Jon Haws RN
Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.
Clinical skills in nursing are obviously important, but critical thinking is at the core of being a good nurse.
Critical thinking skills are very important in the nursing field because they are what you use to prioritize and make key decisions that can save lives. Nurses give critical care 24/7, so the critical thinking skills of nurses can really mean the difference between someone living or dying. These types of skills are important not just for clinical care, but for making important policy decisions.
Critical Thinking for Nurses
For you to become a successful nurse, you will need to learn how a nurse thinks on the job. In nursing school, you will learn how to do an IV, dress a wound and to save lives, but there is more to being a nurse than just having good clinical skills. Standard protocols in nursing will work 99% of the time, but what about that 100th time when they don’t work? That’s when your critical thinking skills can either save or cost a life.
What is different about the thinking of a nurse from an engineer or dentist? Mainly it is how the nurse views the patient and the sorts of problems nurses have to deal with in their work. Thinking like a nurse requires you to think about the entire world and content of nursing, including ideas, theories, and concepts in nursing. It also is important that we better develop our intellects and our skills so that we become highly proficient critical thinkers in nursing.
In nursing, critical thinkers need to be:
All of these attributes must be true, whether the nurse is talking, speaking or acting. You also need to do these things when you are reading, writing and talking. Always keep these critical thinking attributes in mind in nursing!
Nurses have to get rid of inconsistent, irrelevant and illogical thinking as they think about patient care. Nurses need to use language that will clearly communicate a lot of information that is key to good nursing care. It is important to note that nurses are never focused in irrelevant or trivial information.
Key Critical Thinking Skills
Some skills are more important than others when it comes to critical thinking. Some of these skills are applied in patient care, via the framework known as the Nursing Process. The skills that are most important are:
Interpreting – Understanding and explaining the meaning of information, or a particular event.
Analyzing – Investigating a course of action, that is based upon data that is objective and subjective.
Evaluating – This is how you assess the value of the information that you got. Is the information relevant, reliable and credible? This skill is also needed to determine if outcomes have been fully reached.
Based upon those three skills, the nurse can then use clinical reasoning to determine what the problem is. These decisions have to be based upon sound reasoning:
Explaining – Clearly and concisely explaining your conclusions. The nurse needs to be able to give a sound rationale for her answers.
Self regulating – You have to monitor your own thinking processes. This means that you must reflect on the process that lead to the conclusion. You should self correct in this process as needed. Be on alert for bias and improper assumptions.
Critical Thinking Pitfalls
Errors that occur in critical thinking in nursing can cause incorrect conclusions. This is particularly dangerous in nursing, because an incorrect conclusion can lead to incorrect clinical actions.
Critical thinking can fail when logic is improperly used. One common fallacy is when one uses a circular argument. A nurse could write a nursing diagnosis that reads ‘Coping is ineffective, as can be seen by the inability to cope.’ This just makes the problem into a circle and does not solve it.
Another common illogical thought process is known as ‘appeal to tradition.’ This is what people are doing when they say ‘it’s always been done like this.’ Creative, new approaches are not tried because of tradition.
Logic errors also can happen when a thinking makes generalizations and does not think about the evidence.
All people have biases. Critical thinkers are able to look at their biases and do not let them compromise their thinking processes.
Biases can complicate patient care. If you think that someone who is alcoholic is a manipulator, you might ignore their complaint that they are anxious or in pain, and miss the signs of delirium tremens.
Being closed-minded in nursing is dangerous because it ignores other points of view. Also ignored is essential input from other experts, as well as patients and families. This means that fewer clinical options are explored and fewer innovative ideas are used.
So, no matter if you are a public health nurse or a nurse practitioner, you should always keep in mind the importance of critical thinking in the nursing field.