Post 1 DW
“Critical thinking is purposeful thinking involving reflective reasoning before deriving a conclusion, which leads to a clinical decision” (Lee et al. 2017, p. 1). Critical thinking is like being a detective. It is deciphering what is relevant and essential in each situation and making a decision that promotes the best possible outcome for the patient. Critical thinking is the act of analyzing facts to understand a problem or topic thoroughly. Critical thinking typically includes collecting information and data, asking thoughtful questions, and exploring possible solutions. A nurse not only needs to be able to understand and digest events and information, but they also need the skills to communicate that to patients, families, and individuals involved in the patient’s care (Walton, 2017).
Knowledge work is one strategy I use to employ my critical thinking in clinical practice and in my practicum experience. During my practicum, I reviewed patients’ charts and researched information regarding their diagnoses and prognoses. One example from my practicum is the patient I’m using for my threaded patient assignment. I have been reviewing information about pancreatic cancer and the long-term prognosis of the patient’s diagnosis late in the disease process. I checked the patient’s labs and diagnostic images to understand better how pancreatic cancer can affect the patient and the symptoms that a patient may experience before diagnosis. This strategy is extremely important to use so that I continue to learn and grow in the nursing profession and keep abreast of new research.
Another critical thinking strategy I employ in my clinical practice and practicum experience is self-talk. I use self-talk to review my past experiences in certain situations and use them to guide my practice. An example from my practice is when I had a patient who had a stroke. This patient was talking to me on my first neurological check, and the next hour when I went back to assess the patient, the patient was difficult to arouse and had expressive aphasia. I had experienced this before, and knowing that the prior patient’s stroke had evolved, I called a neuro response. I took the patient for a stat cat scan of the head; the stroke had evolved into a large stroke. In about 30 minutes, the patient was flown to another hospital for intervention. As nurses, we use past experiences to drive our practice. We can use that information to deliver the best possible care to our patients.
Reference:
Lee, D. S., Abdullah, K. L., Subramanian, P., Bachmann, R. T., & Ong, S. L. (2017). An
integrated review of the correlation between critical thinking ability and clinical decision-making in nursing. Journal of Clinical Nursing, 26(23-24), 4065–4079. https://doi.org/10.1111/jocn.13901
Walton, B. (2017). Are you in congestive nursing failure? Legal issues, critical thinking
and the impact on practice. Ohio Nurse’s Review, 92(4), 16-23.
Post 2 CP
Technically, all strategies are being utilized during clinical practice. The two strategies I use the most in my critical thinking thought process are self-talk and if-then thinking. Self-talk is basically talking to yourself over expressing how to complete a task, completing a complicated problem, considering what tasks need to be completed for the day, and other topics related to everyday scenarios in the clinic setting (Walton, 2017). If-then thinking is where the person can consider the consequences of their actions; like if I obtain consent for a procedure, then the cath lab staff has one less thing to complete (Walton, 2017).
The practicum experience requires high levels of critical thinking as it is vital for the quality of care provided to the patient by utilizing evidence-based practice (Zuriguel-Perez et al., 2017). Self-talk is one way to use critical thinking. For example, a patient was readmitted over the weekend for low blood pressure and unresponsiveness. The House supervisor and cardiothoracic were aware and provided the necessary care in the emergency department but insisted that the patient be admitted to the cardiac unit. The assigned nurse was upset and wanted to know why the patient was not admitted to ICU. I spent a few minutes self-talking out loud, even though it sounded more like venting, on the patient’s condition before being discharged the evening before. The patient insisted they could discharge home instead of skilled nursing. They had help and were medically stable from a cardiothoracic standpoint. The patient returned to the ER twelve hours later with low blood pressure and unresponsiveness. CT of the head was negative, a bolus of one liter of fluids was given, and labs were unchanged from the previous day; besides the admission diagnosis and presenting condition patient was floor stable. I also thought about other topics, talked with the family, and concluded that monitoring the patient more frequently and reassessing alertness in a couple of hours.
The strategy is successful in many areas because thinking inside your mind is one thing but hearing yourself think out loud is another. I catch more errors listening to myself because as I go through a problem my brain instantly thinks it does not sound right. Then researching the topic on the computer or paper copy will verify my suspensions of what sounds incorrect.
The second strategy, if-then thinking, is the second most used technique in clinical practice. The sustainability and implementation of inconsistency problems can occur when evidence-based practice, procedures, and policies are not followed, creating patient care gaps (Canada, 2016). Knowing inconsistencies occur, utilizing the if-then thinking can help identify some of these issues. For example, giving patients Lasix to help pull off fluid can make them breathe more manageable. Hold it and wait until after the procedure to avoid incontinence causing embarrassment. The inconsistencies come from staff nurses who give all morning medications without thinking about the patient’s daily schedule. A policy states to hold diabetes, diuretics, and anticoagulants before a procedure. Sometimes, the if-then thinking is talked about to another staff member, not just yourself.
The strategy is successful in many areas because thinking about if-then problems can help prevent patient health issues. Whether using the if-then strategy for yourself or talking with another staff nurse can help identify the problems at hand so they can be fixed. The conclusion can cause someone to research the topic on a computer or paper copy to verify the incorrect problem.
References
Canada, A. N. (2016). Probing the relationship between evidence-based practice implementation models and critical thinking in applied nursing practice. Journal of Continuing Education in Nursing, 47(4), 161-168. https://doi.org/10.3928/00220124-20160322-05
Walton, B. (2017). Are you in congestive nursing failure? Legal issues, critical thinking, and the impact on practice. Ohio Nurse’s Review, 92(4), 16-23. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=ac23c688-edbb-483b-8f42-f1b58adf60cdredis
Zuriguel-Perez, E., Falco-Pegueroles, A., Roldan-Merino, J., Agustino-Rodriguez, S., del Carmen Gomez-Martin, M., & Teresa Lluch-Canut, M. (2017). Development and psychometric properties of the nursing critical thinking in clinical practice questionnaire. Worldviews on Evidence-Based Nursing, 14(4), 257-264. https://doi.org/10.1111/wvn.12220