[Sharon]

Nurses use critical thinking skills every day. Think of a time you used critical thinking in your nursing role; now share your example online explaining why you feel it was critical thinking and not just decision making or problem-solving.

[Katherine]

In my role as a Community Mental Health Nurse, I used critical thinking when one of my clients with schizoaffective disorder started showing more paranoia and isolating from others. At first, it seemed like he wasn’t taking his meds, but instead of jumping to conclusions, I took a step back and looked at the bigger picture — side effects, sleep issues, family stress, and substance use.

By gathering information from the client, his family, and our team, I realized it wasn’t just about adherence but a mix of factors affecting his stability. For me, this was critical thinking because it meant analyzing, questioning, and connecting different pieces before making a decision. It reminded me how important it is to stay curious and open-minded in community mental health, where every situation is layered and unique.

[Stephanie]

Hi Katherine! i do agree that having the knowledge and skill set can really benefit our critical thinking in nursing! Its great you were able to identify other concerns/red flags that may be going on with your patient before just assuming they were not taking medications as prescribed.

[Stephanie]

A time where I used critical thinking skills within my nursing role was whenever I was given any patient assignment i would usually assess as to who in my assignment required the initial assessment. It was assumed that all patients will be assessed however it can be important to triage who required assistance first if a non high risk patient was assessed first it could potentially lead to error. I would start by considering the Background of each patient whether it be they were pre/post operative, ALC, Medical, or high risk for falls, isolation precautions etc… based on my report from previous shift and Diagnosis or reason for admission. I took the data i collected from the information provided and assess who required nursing attention first. For example if my one patient was a postoperative patient and I went and assessed a patient who was ALC and stable I may miss an important direction for postop orders. Such as assess the incision or dressing, monitoring O2 saturations ect..
I feel in my nursing role this is critical thinking and not just a decision making or problem solving because it did require the knowledge and skill set to identify the difference and prioritize each patient to provide safe and adequate care.

[Tina]

Hi Stephanie
I like your example of prioritizing who may need to be assessed first at the start of your shift. It is important to see who is at a greater need or risk. I know from my years in a hospital environment that getting to the early risers who were a falls risk was important.

[Anastasia]

I agree with this. As a supervisor when a nurse calls in sick we ask other nurses to triage their clients. A lot don’t like to do this because they have already planned their day. By not doing this they could be causing harm to a client who really needs a visit but did not get it because the nurse did not triage.

[Jessica]

As an infection control professional (ICP) critical thinking is a skill that I use daily. Part of my role is to assess Patients who arrive to the hospital and are flagged with an isolation. During triage, the Patient answers a set of questions to trigger isolation requirements and when admitted, the Doctors complete additional documentation for acute respiratory infection (ARI) concerns.
As an ICP we assess Patients, ensure appropriate specimen are collected, and reassess the Patients once results are available. As an Infection Control Nurse, I use my skills and knowledge to determine if a Patient needs to remain in isolation/whether or not there is a risk for transmission.

As noted in the module, this is a “complex process that entails an orderly investigation of ideas, assumptions, principles and conclusions”. Every Patient is unique and I have to take into consideration health history, diagnosis, symptoms and other differentials. Critical thinking guides my process of final decision making (isolation status) and may incorporate problem solving if Patients test positive for something infectious and require separation.

[Katherine]

I really appreciate how clearly you described the role of critical thinking in your daily work as an ICP. It’s impressive how many factors you have to consider — patient history, symptoms, test results — and how you use critical thinking to make safe, evidence-based decisions. I like how you highlighted that every patient is unique and that your decisions aren’t just following a checklist, but require analysis and judgment. Your example really shows how critical thinking is essential in infection control and patient safety.

[Tina]

As a LTC nurse I am critical thinking everyday. From when a resident has a fall, as one such time, a resident fell backwards. Due to the nature of the fall the resident hit her head hard, causing a head injury. The important critical thinking required, that she was not to be moved, as she had bleeding from the head, she could have internal bleeding as well. I then stayed with the resident well having a team member call the charge nurse and the nurse practitioner. This was critical thinking and not problem solving or decision making because of the nature of how critical the situation was. Another time is daily when I critically think about who may be more expressive during morning care and may require to have their medications first. If I just looked at how I hand out my residents medications as a problem to solve or a decision, I might over look how care for a resident may make them feel uncomfortable. By going to the more vulnerable resident gives them a better sense of safety before being given morning care.

[Amit Kaur]

Hi Tina
Thank you for sharing.I also work in the LTC and agree that everyday we use critical thinking and have to make our decision considering the situation like resident’s health status,behaviours,staff,sources available to support,overdue and new assignments.

[Amit Kaur]

About 4 years ago ,One of my resident (94 y with full code CPR) got sick. The day shift nurse called Dr and got an order for A/B and blood work. A/B arrived,dose administered,blood work completed on special order, POA made aware.By the end of next day her condition deteriorated. Dr ordered, contact POA if agree send her to hospital or EOL comfort measures, code status change to DNR.
At my night shift I got a report that her POA had declined to send the resident to hospital but she decided to keep status CPR.
I contacted POA and explained the condition (PPS score 30% )and all the measures taken for resident with no improvement. I also contacted my on call supervisor who did not clear directions by saying continue monitoring and respect POA decisions. I was in an ethical dilemma. 94 y ,PPS 30% and CPR?

I contacted again POA and requested her to come and decide based on the situation. I also called 911
who arrived before POA. Explained everything to the paramedic and requested to communicate with POA before making a decision. Paramedic staff communicated with POA then POA decided to keep her mother
comfortable with EOL measures,I immediately got her sign on code status change and initiated EOL comfort measures.

I think this situation was not decision making or problem solving as POA had declined everything. Critical thinking was calling 911 and involving paramedic staff .

[Mauei Caela]

Hi Amit,

You were right to involve paramedics and the client’s Power of Attorney (POA) regarding their condition. Your critical thinking in utilizing support and applying your judgment helped ensure the client was comfortable in their final moments. Unfortunately, experiences like yours highlight challenges in healthcare, such as unclear care directives and unrealistic patient or family expectations. I hope that clearer communication and setting realistic expectations can help reduce such situations in our work, supporting both families and clients more effectively.

[Viatcheslav]

I think the good example of when I used critical thinking in my nursing role was when I questioned newly written wound care doctor’s order.
Upon receiving the patient and going through the new wound care order sets, I noticed that what was written did not match what I was seeing. Based on my previous experience I was certain that products and sequence prescribed for the dressing were not only not the best choice but, frankly, wouldn’t work on the wound to the desired effect and if anything would cause more harm.
I feel that it was a critical thinking on my part as instead of just following the order and trying to make it work, I questioned it after analyzing the situation and came to the conclusion that it is probably written in error, even though it was written by specialist and then approved by another doctor. I requested ASAP order clarification through the PSN on the unit, stating that I cannot proceed with the dressing as the order just doesn’t make sense. She came back within 20 minutes with a new order, saying that I was absolutely correct in questioning the order. That the wound doctor made a mistake while filling the order set, as she was thinking about another case; second doctor who approved it just assumed that the first one has done everything right as it was their specialty.

[Kayla]

Hi Viatcheslav,
I think that is a great example of critical thinking, and a tough situation forsure! It can definintely be intimidating to question a dr but its so important to advocate for the best interest of the patients, your critical thinking definitely had the best outcome for your patient in mind!

[Anastasia]

While caring for an elderly client with pneumonia, I noticed that although her oxygen saturation was still within normal limits, she appeared slightly more lethargic and her respiratory rate had subtly increased. Instead of assuming she was just tired, I rechecked her vitals, reviewed her medication chart, and compared my findings to the previous shift’s notes. I then called the nurse practitioner to reassess, and early intervention prevented a respiratory crisis.
Why this was critical thinking: This went beyond following routine assessments. I analyzed subtle cues, connected data from different sources, anticipated potential complications, and acted proactively. Critical thinking involves interpreting and integrating information to make a judgment — not just solving a problem that’s already apparent.

[Stephanie]

Hi Anatasia,
Your critical thinking was top notch in this situation. You observed subtle cues from the patient and prevented a crisis. I think as nurses we need to go above normal assessments, especially when we think something is wrong and be proactive for people who cannot advocate for themselves.

[Mauei Caela]

As a nurse in the Long-term Ventilator Unit, I recall a critical situation where a part-time colleague was caring for a BIPAP vent patient who desaturated and turned blue. Responding to the emergency call bell, I assessed the situation and decided to delegate fetching the Respiratory Therapist (RT) to another colleague in the hallway, allowing me to support the nurse and patient immediately.

I initiated manual bagging with the ambubag connected to oxygen, kept the emergency bell on for awareness, and guided my colleague to set up the IN/EX machine for suctioning a potential mucus plug while I was still bagging the patient. We worked together efficiently – I used the IN/EX machine, then she bagged the patient for oxygen support. We did this alternately. We successfully removed the mucus plug, stabilizing the patient until the RT arrived. The RT told us that she had just finished helping another patient in the other wing, who also had the same situation, explaining why she arrived late. She told us that we did great, as that’s what she would have done in that situation as well.

I think this is critical thinking because I was able to demonstrate rapid assessment (I quickly evaluated the situation and prioritized actions. I could’ve grabbed the RT myself, but I am closer to the patient so I intervene instead), Effective Delegation (Asking another nurse to fetch the RT allowed me to intervene immediately), Collaboration (I supported my colleague, leveraging our teamwork for optimal patient care), Adaptation (We adjusted our approach considering the BIPAP vent and patient’s needs.)

[Stephanie]

My critical thinking experience was when a resident was stating “ow” or “don’t touch me” during care, repositioning or you could hear the resident down the hallway moaning in pain at random times. I took the time to gather information from family, examined the e-MAR and PRN medications vs. scheduled medications, read previous entry notes. Tried pain medication before care with no success. I noticed that one medication was abnormally low for a hospice setting and spoke with MRP about increasing dose of a medication for nerve pain. Tried the increase medication, it worked. Resident has little to no pain during care or repositioning. It became tolerable.
It is a critical thinking example with decision making and problem-solving intertwined with it. Critical thinking is taking the whole perspective of what is happening and considering all aspects of a person. Making the decision to call MRP after taking problem-solving steps led to an unknown pain to be solved and resident not suffering.

[Trudy]

As a mental health community nurse, I have clients that I see regularly. This one client’s mental health was declining rapidly. He was not answering my calls or the door for visits. I became increasingly worried. This client was connected with subsidized housing, where another care team would visit this client and had access to his apartment unit for inspections. The care team also did not hear from the client in a while, so they posted the request for entry. Arrangements were made for the care team and myself to enter this client’s unit. As I entered, I immediately saw the client lying on the sofa, eyes closed. Given this client’s history of aggression and selective mutism, I had to be cautious as well as use my critical thinking to see if this person needed medical attention. The client was non-responsive as I shouted his name. I approached closely to see if the client was breathing, he was, I kept talking and I approached closer to touch the client on his shoulder. As I alerted the client with my every move, the client then sat up abruptly and started yelling at me not to touch him. Even though I was startled, I was also relieved that the client was ok and I used steps to figure out if this client needed medical attention or other supports.

[Loubna]

Thank you Trudy for sharing this experience. You demonstrated strong critical thinking skills in a challenging situation. You remained calm, assessed the safety of the client and considered his behavioral history before acting.

[Loubna]

An example of when I used my critical thinking skill in long-term care was with a resident with advanced dementia. She had been increasingly agitated for two days, yelling, pacing and resisting care. During this time, she had a fall while trying to get out of her wheelchair. At first, it could have been seen as a dementia behavior, but I suspected there might be an underlying cause. I assessed her for post fall injuries. She was not seriously hurt and checked her vital signs. I remembered that in the past, she had shown similar agitation when she had a urinary tract infection. I reported my observations to the charge nurse and suggested to get a doctor order for a urine test. The results confirmed she had a UTI. After the antibiotic started, her agitation decreased, and returned to her usual behavior. I consider this critical thinking because I didn’t just respond to her agitation or fall. I analyzed the situation, considered her history and took the right steps to ensure her well-being and safety.

[Donna]

As a nurse, I use critical everyday, but one particular situations stands out. During a night shift in a long-term care facility, I noticed a resident who was usually alert and social and suddenly became unusually quiet and disoriented. While it could have been easy to assume fatigue or dementia progression, I decided to assess further. I checked her vital signs, reviewed her medication record, and noted that her blood pressure was lower than usual. After reviewing her history and fluid intake, I suspected dehydration and potential medication side effects. I contacted the on-call Nurse Practitioner, who later adjusted her medication and ordered lab work confirming mild dehydration.

I believe this was critical thinking not just decision making because it involved analyzing multiple factors, questioning initial assumptions and using evidence based reasoning before taking actions. It reminded me that critical thinking in nursing means connecting patterns, anticipating complications and advocating for timely intervention.

[Donna]

I use critical everyday, but one particular situations stands out. During a night shift in a long-term care facility, I noticed a resident who was usually alert and social and suddenly became unusually quiet and disoriented. While it could have been easy to assume fatigue or dementia progression, I decided to assess further. I checked her vital signs, reviewed her medication record, and noted that her blood pressure was lower than usual. After reviewing her history and fluid intake, I suspected dehydration and potential medication side effects. I contacted the on-call Nurse Practitioner, who later adjusted her medication and ordered lab work confirming mild dehydration.
I believe this was critical thinking not just decision making because it involved analyzing multiple factors, questioning initial assumptions and using evidence based reasoning before taking actions. It reminded me that critical thinking in nursing means connecting patterns, anticipating complications and advocating for timely intervention.

[Kayla]

One incident that I can think of in particular would be when I was in a clients home (community mental health setting), and was visiting with a client, and during the visit it was apparent that the client was decompensating from there baseline and quite aggressive, I had to use critical thinking on the bestway to end the visit in a safe way, I stayed by the door, ensured client had no plans to harm themselves or others, and ended the visit, I then reached out to the psychiatrist and advocated form client to be formed and brought back into hospital for reassessment as they were non medication compliant and rapidly declining from their baseline.

[Author]

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