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.
We’ve written a MASSIVE post on careplans and critical thinking:Read More on Critical ThinkingHow to develop critical thinking as a nurse.
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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.
- A person trying to interpret an angry friend’s needs, expressed through a rush of emotion and snide comments, to give that friend some help and support.
- A manager trying to be as objective as possible when settling a dispute by summarizing the alternatives, with fairness to all sides to a disagreement.
- A team of scientists working with great precision through a complex experiment in an effort to gather and analyze data.
- A creative writer organizing ideas for the plot of a story and attending to the complex motivations and personalities of the fictional characters.
- A person running a small business trying to anticipate the possible economic and human consequences of various ways to increase sales or reduce costs.
- A master sergeant and a captain working out the tactical plans for a dangerous military mission.
- A soccer coach working during halftime on new tactics for attacking the weaknesses of the other team when the match resumes.
- A student confidently and correctly explaining exactly to his or her peers the methodology used to reach a particular conclusion, or why and how a certain methodology or standard of proof was applied.
- An educator using clever questioning to guide a student to new insights.
- Police detectives, crime scene analysts, lawyers, judges, and juries systematically investigating, interrogating, examining, and evaluating the evidence as they seek justice.
- A policy analyst reviewing alternative drafts of product safety legislation while determining how to frame the law to benefit the most people at the least cost.
- An applicant preparing for a job interview thinking about how to explain his or her particular skills and experiences in a way that will be relevant and of value to the prospective employer.
- Parents anticipating the costs of sending their young child to college, analyzing the family’s projected income, and budgeting projected household expenses in an effort to put aside some money for that child’s future education.
- A financial planner anticipating the impact of new income tax legislation on a client’s future tax liabilities.
- A first responder coming upon the scene of an accident and quickly analyzing the situation, evaluating priorities, and inferring what actions to take in what order.
Examples from Facione, P. & Gittens C. Think Critically, Pearson Education
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