Critical Thinking And Reflection In Nursing

Not so long ago, nurses were task-workers who simply carried out doctors’ orders and followed a fixed set of rules. Today, they are skilled and capable professionals whose expertise is essential to patient care and public health initiatives. It’s been a long road. And it’s clear that developing critical thinking skills has helped to bring about this transformation within the profession during the last half century.

So what exactly is critical thinking? There are a multitude of definitions – some of them very complex – so the Foundation for Critical Thinking (2010) has assembled some of them on its website. This one is our favorite:

Critical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes.

 

It’s not hard to apply this definition to nursing, is it? Nurses do all those things every day! It can be made even more specific to nursing by saying that critical thinking is a systematic approach to the nursing process that employs all the steps above to bring about excellent clinical outcomes while enhancing patient safety and patient satisfaction.

Critical thinking is definitely a skill that develops over time and as you gain more experience. But that doesn’t mean it’s absent in young or less experienced nurses. In fact, critical thinking skills are what make young nurses effective while they are gaining on-the-job experience. A less experienced nurse with keen critical thinking skills will be able to strategize and manage all sorts of new situations, while dealing effectively with everyone involved – the patient, family members, physicians, and other care team members.

When do you need critical thinking?

If you consider critical thinking to be multi-dimensional thinking, it becomes clearer when it’s most effectively employed. Multi-dimensional thinking means approaching a situation from more than one point of view. In contrast, one-dimensional thinking tackles the task at hand from a single frame of reference. It definitely has its place in nursing – one-dimensional thinking is used when nurses chart vital signs or administer a medication.

Critical thinking skills are needed when performing a nursing assessment or intervention, or acting as a patient advocate. As a patient’s status changes, you have to recognize, interpret, and integrate new information in order to plan a course of action. For example, what would the course of action be if an elderly patient became confused from his medications, was unable to understand instructions, and put himself at risk for falls? There may be no single “right” answer – you have to weigh all of the variables, prioritize goals, and temper next steps with empathy and compassion.

Critical thinking also involves viewing the patient as a whole person – and this means considering his own culture and goals, not just the goals of the healthcare organization. How would you handle a teenage girl who comes into your clinic asking for information about STDs? What about a seriously hypertensive patient who admits he can afford his medication, but doesn’t believe it is important that he take it every day without fail?

Critical thinking forms the foundation of certain nursing specialties, like case management and infection control. These areas require strategizing, collaborative relationships, and a multi-dimensional approach to tackling a problem (like preventing unnecessary hospital readmissions or discovering the source of an infection outbreak, for example). And of course, nurse managers use critical thinking skills every day as they keep their units running smoothly.

So what’s the next step?

To develop your critical thinking skills, you can:

  • Suspend judgment; demonstrate open-mindedness and a tolerance for other cultures and other views.
  • Seek out the truth by actively investigating a problem or situation.
  • Ask questions and never be afraid to admit to a lack of knowledge.
  • Reflect on your own thinking process and the ways you reach a conclusion.
  • Indulge your own intellectual curiosity; be a lifelong learner.
  • View your patients with empathy and from a whole-person perspective.
  • Look for a mentor with more experience than you have; join professional organizations.
  • Advance your nursing education.

The best way to develop your critical thinking skills and empower yourself with knowledge is through an online RN to BSN or RN to BSN/MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in nursing education, nursing informatics, and executive leadership.

Written by Bruce Petrie, Ph.D., VP, Research and Institutional Effectiveness
Revised July 2017
Tagged as nursing skills

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!

via GIPHY

 

RELATED ARTICLE:Ep211: Critical Thinking and Nursing Care Plans Go Together Like Chicken and Waffles

 

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.

 

Baddabing.. Badaboom.

 

RELATED ARTICLE:How to Use the Nursing Process to ACE Nursing School Exams

 

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.

 

Conclusion

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.

 

We’ve written a MASSIVE post on careplans and critical thinking:

Read More on Critical ThinkingHow to develop critical thinking as a nurse.

 

Trouble with Nursing Care Plans? You're not alone. Download our FREE template.
Grab the Template

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.

Categories: 1

0 Replies to “Critical Thinking And Reflection In Nursing”

Leave a comment

L'indirizzo email non verrà pubblicato. I campi obbligatori sono contrassegnati *