04.05 Advanced Critical Thinking

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  1. What is critical thinking?
    1. It’s a process!
      1. Analyzing and evaluating situations
      2. Making judgments about the situation
      3. Which leads to decisions that ensure best clinical outcomes
    2. 4 Steps to Critical Thinking
      1. Suspend all judgment
        1. Look beyond the obvious
        2. ALWAYS listen to a patient complaint
      2. Collect all the information
        1. Ask questions
        2. Get a second opinion
        3. Assess your patient
        4. Treat the patient, not the monitor
      3. Balance all the information
        1. Think about priorities
        2. Think through decisions to outcomes
          1. “If I do this, this will probably happen, then this will happen”
        3. Decide what is most important
      4. Make a holistic decision
        1. Think big picture. Look at the whole patient.
        2. Always prioritize ABC and patient safety.
  2. Critical thinking in your first year…
    1. Avoid being too task oriented.
    2. Learn to recognize critical situations.
    3. Think ahead and anticipate problems
      1. Start your day thinking about why your patient is admitted and what problems are common for this diagnosis- thinking “worst case scenario”
        1. What would the patient look like in these situations?
        2. What would you do if these “worst case” scenarios happened?
        3. What equipment and medications would you need?
        4. Is there anything you can do to prevent them from happening?
    4. Use learned structures to provide guidance in moments of stress.
      1. ABCDE assessments
    5. Know your resources and USE them
      1. Charge nurse
      2. Rapid Response Team
    6. Always ask “why”.
    7. Reflect on your experiences.


Today we’re going to be talking about advanced critical thinking. 


So what is critical thinking?  Well it’s actually kind of a complex thing to try and put into words.  Two things to keep in mind though is that it is a process and skill. The process involves analyzing, evaluating, making judgments and then making decisions. The main thing to note here is that it’s not something that happens in the blink of an eye it’s something that unfolds as you gather information and gain experience.   Thinking of critical thinking as a skill is helpful because it acknowledges that this is something that improves over time- the more you do it the better you’ll be and the more confident you’ll feel.


Here at NURSING.com, we’ve come up with 4 easy steps that will help you with your critical thinking.  I’m just going to cover them quickly, check out the lesson titled critical thinking that’s in the fundamentals course. 

Okay so the 4 steps!  

First, suspend all judgement.  This means you approach the situation with an open mind. Look at everything, not just the obvious.

Second, collect all the information.  Consider all the options and then gather all the relevant data. Listen to and look at your patients.

Third, balance all the information.  Start to think about what is most important.  Play out options in your mind- what happens if you do one thing or the other?

Fourth, make a holistic decision.  Think about the WHOLE patient, not just isolated events or single symptoms. Remember interventions should prioritize ABC- airway, breathing, circulation and patient safety. 

We’ve got a few tips for you to help get you started on the right foot! 


Probably the first thing to keep in mind is that you’ll likely have a tendency to be really task oriented.  Be careful, because this can prevent you from seeing the big picture!


Second, you really want to keep building your mental pictures of what sick patients look like.  You want to be able to recognize these critical situations when they are happening. 

Third, try to think ahead and lan for the worst case scenario. Then make sure you that you have the equipment and interventions available to manage that. This has saved me so many times. Once I admitted an adolescent who was diagnosed with epilepsy and I didn’t have a prn order for managing seizures.  I got the order and no kidding the patient had a seizure that night that I had to treat.


Fourth, use established structures, like ABCDE assessment to help stressful situations.  These are designed to help you do things in the right order even when things are crazy.


Fifth, know your resources.  Who can you call for help? Do you have a rapid response team?  Can respiratory therapy help? This is part of planning ahead. 


Sixth, with each critical event, reflect and ask why.  This will make sure that you are growing and learning with each event. 


Okay, let’s go over the key points! 

Critical thinking is a process and skill that you will develop over the first year of nursing.  

There are 4 steps to keep in mind that will help you think critically in any situation.  They are 1) suspend all judgment 2) collect all information 3) balance all information and 4) make a holistic decision

In your first year make sure you keep building your confidence in recognizing critical situations. Also make sure you are thinking, planning and reflecting.

We love you guys! Go out and be your best self today! And as always, Happy Nursing!