Nursing students begin to hear about critical thinking skills early in nursing school. But what is critical thinking and why does it matter? How does it play out in real life?
Critical thinking has generally been defined as reasoned, reflective thinking which can evaluate the given evidence and its significance to the patient’s situation (Cody, 2002). McGrath (2005) also describes how critical thinking involves reflection and occasionally, suspension of one’s immediate judgment to adequately evaluate and appraise a situation, including questioning whether the current practice is evidence-based. Facione (2011) states that critical thinking is a part of what we mean by “good thinking” and involves cognitive skills such as interpretation, analysis, evaluation, inference, explanation, and self-regulation. A lack of critical thinking may manifest as a failure to anticipate the consequences of one’s actions (Facione, 2007).
In Cody’s article (2002), he describes how critical thinking has become a “buzzword” in nursing and educational literature, void of any real substance. He gives an example of a medical-surgical nursing textbook in which “Critical thinking in nursing practice” is in the title, but the textbook is void of any real content on critical thinking, other than traditional nursing practice. Cody (2002) proposes that the teaching of nursing theory (instead of generic nursing diagnoses and interventions) are a better way to enhance critical thinking for nurses, since nursing theory is unique to the nursing discipline. Cody (2002) also proposes that critical thinking be viewed more as a creative/constructive and relational process, rather than a lone individual who must find answers to complex problems through their own analytical reasoning. Certainly a new nurse learns how to think and process data by consulting others more experienced on the health care team which supports the idea of critical thinking as a relational process. However, there is an individual cognitive process of clinical reasoning and analytical skills that must be develop in nursing students early on. Perhaps critical thinking has become just a buzzword in nursing, but the reality of the concept remains vital to excellent patient care, as in the following real life example.
One example of where I had to use critical thinking in my nursing career occurred when I was working 3-11. During report I was told I would be taking over care for a 22 year old new admission that had just arrived on the floor a few hours ago from ER. In report, the day shift nurse expressed extremely frustration with the ER and the physician who was responsible for caring for this young patient. Apparently the patient was extremely sick. She had a resting heart rate in the 170′s and very low hemoglobin and no interventions had been done for her so far. The day shift nurse had still received no orders for her from the physician several hours after her admission to the floor. In fact the physician had still not seen the patient despite multiple calls from the day shift RN. Out of report, I immediately assessed this patient. She was pale, lethargic, and had an increased respiratory effort. Her blood pressure was abnormally low and her heart rate remained in the 170′s. I immediately called a “rapid response” code in order to quickly get the physician and respiratory therapist into the room to see this patient. Anticipating a needed blood transfusion and more IV fluids, I initiated a second IV line. A new nurse who I was orienting was assisting me that day. I was able to explain my rationales and thinking to her so she could process what was happening and what needed to be done.
The physician eventually ordered blood transfusions, ABG’s, and we transferred the patient to the ICU. As I pondered what might be happening to this patient, it dawned on me that at her age, she might be taking oral contraceptives placing her at greater risk for a PE, which might explain her rapid heart rate and respiratory rate. I checked with her mother and sure enough, she was taking daily oral contraceptives. I called the physician again to see if he would like to order a CT scan, which he did. We decided to take her to CT scan first before moving her to ICU in order that she could get a faster diagnosis due to her rapidly deteriorating condition. The nurse I was orienting went with me to take the patient to CT scan with the heart monitor and her oxygen. We then took her to the ICU and gave report to the ICU nurse. For this patient, it was critical that she had the CT scan as quickly as possible to get the proper diagnosis to guide treatment. In this situation, the use of critical thinking to evaluate the evidence for what was going on with this patient was essential. I had to question what we were currently doing for her and what else needed to be done in order to provide the best care. Regardless of the seemingly overuse of nursing’s buzzword, the concept remains essential for nurses to develop this skill: not only to have knowledge but to be able to apply knowledge in anticipation of patients’ needs using evidence-based care guidelines.
Cody, W.K. (2002). Critical thinking and nursing science: judgment, or vision? Nursing Science Quarterly, 15(3), 184-189.
Facione, P. (2011). Critical thinking: What it is and why it counts. Insight Assessment, ISBN 13: 978-1-891557-07-1.
McGrath, J. (2005). Critical thinking and evidence- based practice. Journal of Professional Nursing, 21(6), 364-371.