[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.

[Alhasan]

In my nursing role, critical thinking was essential in a complex case involving one of my residents who was hospitalized with an altered level of consciousness and unresponsiveness, even to sternal rubs. Despite extensive diagnostic imaging and tests, no source of infection was found. After about a month, the physicians were considering discharging the resident in this condition.

Throughout this period, I advocated for drug monitoring, given that the resident was on multiple anti-epileptics. Initially, no one believed the medications were related to the resident’s condition. However, I conducted thorough research on a new anti-epileptic medication recently introduced in Canada, which the resident had started taking. My investigation revealed potential drug interactions. Notably, we had correctly removed Phenytoin from the regimen due to its interaction that increases concentration.

Further research indicated that although rare, some individuals experienced increased Clobazam levels. Symptoms of Clobazam toxicity closely matched the resident’s presentation. I compiled this information and presented it to the neurologist, advocating for therapeutic drug monitoring (TDM) for Clobazam levels. The results confirmed the resident had double the therapeutic level of Clobazam, indicating toxicity. We promptly discontinued Clobazam, and within a few months, the resident returned to their baseline condition.

This situation exemplifies critical thinking as it required analyzing and synthesizing complex information, identifying potential underlying causes not initially considered by the medical team, and advocating for an evidence-based intervention that ultimately resolved the resident’s condition. Unlike mere decision-making or problem-solving, critical thinking in this context involved a deeper level of inquiry, systematic evaluation, and proactive advocacy to ensure the resident’s well-being.

[Claire]

As nurse we do use our critical thinking skills everyday! I can think back on even the night shift I just finished how many times I had to use my critical thinking skills!

The example I will used is how last evening one of my colleagues resident’s pig tail drain was leaking and had been for multiple days. Staff had been dressing it with what had been the products previously, yet still flushing the tubing and draining it as it was still patent and in place to connect to fluid. It obviously though had been displaced slightly and leaking at the insertion site. We do not remove drains at our facility nor do residents be transferred for procedures such as this due to this individual goals of care and PPS %.

We needed to think throughly and investigate what was occurring, possible causes, effect on the resident regarding skin integrity and comfort, what we were able to do in a hospice setting and what products we had in house that could be utilized. We needed an objective. It wasn’t a simple problem solving scenario of a problem solving as there were assumptions to consider. We needed to make a decision, but it was one that needed to be thought through regarding what we knew about drains, what was the point of the drain and the feelings the resident had regarding the situation and what we could actually do to “solve” the situation. One of the ideas we had was to use an ostomy flange and bag around the insertion site with the tubing inside and locked, which would contain the leakage as well as the tubing which could also be unlocked and drained. We all felt this was using our critical thinking skills! Yet we made an assumption that this resident would want to try this intervention, as it seemed sound. Yet she had had a friend with an ileostomy that traumatized her which this resident remembered well, and did not want any ostomy supplies used due to this memory and upset. We honoured this. She was agreement with regular dressing changes with different products and skin protective cream instead of the solution we had devised. This wasn’t just straight forward decision making and problem solving as it was more holistic in nature. We needed to understand the context and meaning to the individual and decide on an intervention that was effective, yet offered an alternative.

[Carmen]

Your post shows the importance of critical thinking in nursing. The way you and your team approached the pig tail drain issue considering both the clinical and personal factors shows a compassionate approach to patient care. I admired how you respected the resident’s feelings and found an alternative solution that honored her wishes.

[Carmen]

I encountered a patient presenting with side effects from their prescribed medication. To address the situation, I used critical thinking by thoroughly assessing the patient’s presentation and all possible facts such as medical history and other medications being taken. After collaborating with the prescribing MD, closely monitored the patient’s response and provided supportive care. This approach involved more than solving the problem, but it required analyzing complex information, evaluating the risks and benefits of different interventions and making information decisions based on evidence.

[Melissa]

Hi Carmen,
I enjoyed reading your experience of critical thinking in the nursing role. I also experienced a situation involving medications and agree with you that the example you provided did in fact utilize critical thinking as you identified a problem-completed an assessment, gathered all necessary pertain information and implemented an effective method to resolve the issue. While doing this you were able to evaluate the risks vs benefits of interventions and making decisions based on clinical evidence without bringing further harm to your patient.

[Melissa]

Nurses do use critical thinking skills on a daily basis while working with patients. I can think of many times myself or my colleagues have had to use critical thinking skills in our practice. One example I can think of that required critical thinking skills was when a resident of mine was on a medication for their blood pressure routinely and was monitored each morning prior to administration. The one morning their blood pressure was noted to be on the lower end of the parameters. I completed an assessment on the resident and gathered their medical history and medication details. I then notified the attending MD of my findings and a new order was received to hold this blood pressure medication, as well as a new order for the future to hold the medication if this particular residents blood pressure is below specific parameters. This resident’s blood pressure was then monitored for the next 2 shifts (Evening, nights) to ensure it did not suddenly increase due to them not having their medication. If it was to suddenly increase the MD would then be contacted for further orders. I believe this situation utilized critical thinking and not just decision making or problem solving as I analyzed and evaluated the situation in front of me. I did not just go ahead and administer the blood pressure medication just because there was an order for it. Without critical thinking skills being utilized in this situation the patient could have been put at risk by allowing their blood pressure to continue plummeting causing a medical emergency if the medication had of been administered.

[Janet]

I read your posting and thought about a retirement home that I worked in where not all the nurses would complete assessments some just giving medication as it was in the med cart. Which could lead to detrimental med errors and adverse situations. I used to complete assessments and get grief from residents, I used to tell them that I would be doing all required assessments before administering their medications as I wasn’t going to allow for being “fired” during my shift. They used to get frustrated however I had relationships with most of them that allowed for some humor and they eventually got to understand the importance. M colleagues well that was up to the DOC to address there behavior and there practices. I hope that they learned that you must complete the assessments that were required for med administration without having any errors or adverse effects.

[Marilyn]

@Melissa, please email me moliver@werpn.com… thx

[Marilyn]

@Janet , please email me moliver@werpn.com… thx

[Janet]

Critical thinking is a crucial skill for nurses as it allows them to make sound clinical judgments and decisions that ultimately impact patient outcomes. I truly believe critical thinking is learned through experience and is not something that can be taught. The knowledge to make the decision is from a textbook however the judgement and problem solving come from experiences and instincts.

I worked as a foot care nurse for some time and after leaving a patients home, I noticed a man laying on the grass with a few individuals around. I thought nothing of it at first and as I approached my vehicle my gut told me something was wrong. I walked over to the driveway and asked is everything okay the couple stated NO! they had said the man collapsed while they stopped at the stopped sign, The wife stood there frozen and said please help. I explained I was a nurse and offered to assist. When I rolled the man over he was clearly not breathing, I tried asking the wife questions however she was unable to answer, when I started assessing the man, which lead to CPR. As I completed CPR on the spouse I was watching the wife go weak and asked the bystanders to get her sitting down. I continued CPR and when EMS took over I quickly addressed the wife who was not well herself and at this time family had arrived. All in all quick thinking and being able to look at a situation and respond quickly and critically saved a mans life [ driving by at a future time he was outside watering the lawn] and assist a spouse witnessing a traumatic experience from being injured as well.

[Ruth]

As I am working in a retirement home evening shift, one evening I had a situation where a resident on palliative care had a fall in the hallway. I ran to the resident ASAP. Following my arrival in the hallway, I recognized the person whose family requested the retirement home to ask their permission to send him to a hospital. The resident had minor bleeding on his forehead and arms; he was screaming in pain and couldn’t move his leg. He was also hypertensive. I need to use my critical thinking skills. So, I decided to call EMS. Before that, I tried to call the family and let them know. Despite multiple attempts to contact the family, no response was received. I left a voicemail and waited for 20 minutes. Still no answer. So, I decided to call EMS for an assessment and safe lifting. The EMS arrived, and I explained the situation. The EMS people stated, “He is screaming in pain. We can’t leave him here,” and then the resident was taken to a hospital. The family called back after the resident was taken to a hospital, and they were very upset. and stated that, ”Why don’t you respect our decision? We will report you to your boss; we don’t want to spend 4-5 hours at the ER.” We have a party at home. It is our anniversary day.” When I tried to explain the situation, they didn’t want to listen. The evening was very stressful. My shift ends. When I came back to my next shift, the DOC called me into the office. Stated that “Mr. A’s family was very upset about that evening, but as a nurse, you made the right decision.”.

[Sherri]

Thinking of a time when I used critical thinking was in the past year, when an elderly Resident of mine was dependent on the narcotic hydromorphone. However ,she was at the end of her life. This resident was not eating much. Her pulse was low, respiratory rate high,B.P low, with a low grade fever.She was listless and sweaty. I wasn’t sure what her condition was, if it was an overdose,or heart attack. After I gathered the facts I quickly collaborated with the RN. We sent her to hospital. It turned out that she had Pneumonia! I thought I was critical in my observations; subjectively and objectively.

[Rebecca]

Hi Sherri,
Thank you for sharing that experience with us and how you used your critical thinking skills and using your resources. I appreciate that you also mentioned you collaborated with the RN. I can appreciate that you ruled out the possible options and determined the best outcome would be to send client to the hospital. Making those decisions on your own can sometimes seem blurry, you know the answer but confirming and collaborating really supports in finalizing that decision. I also appreciate you shared an example that critical thinking is not only for one person but can be shared for the best possible outcome.
Thank you.

[Sherri]

Ruth,
I was very touched by your compassion. I can empathize with you, it takes special people like us, to make the world a better place.

[Rebecca]

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.

Thinking of a time I used critical thinking in my nursing role when I complete my home visits to clients home for community care, I find I am always using my critical thinking. I assess my client’s environment, physical capabilities, recourses, and supports system. For example, during many of my visits I educate clients/family on importance of proper safety devices and having the necessary equipment in place for falls risks, thus decreasing clients risks and promoting independence, reminding clients to use them. Explaining the importance of not just having the appropriate equipment in place but ensuring the use of these supports critical thinking skills. Educating my clients and family based on knowledge, understanding and then communicating to my team to remind clients they must use their walkers/canes/scooters and so on will support rolling out our conversation and when I request updates from my team, I will be able to understand if this plan of action was successful and or if we need to review and request for OT/PT for more supports. Using the nursing process of assessing, implementing and evaluating is more than just problem-solving or making a decision, there is much more and more success.

[Kristina]

Hello,

My example that I will use for my critical thinking skills will be in regards to my role at my place of work; as the BSO Lead.

It had been noted a few times in BSO referrals that one particular resident at my work would finish her lunch and then instantly get up from the table and try and elope. It was incredibly hard to redirect her and due to the heavy construction at my work, most doors are open due to electrical wiring being completed. The resident was continuously doing this, every day after her lunch was finished, she was up from the table and heading for the front door. Redirection and GPA techniques were very hard to utilize with this resident as she is still quite independant in her ADL’s and would constantly yell and threaten staff that she would “beat them up” if they tried anything with her.

As part of my critical thinking on how to support the resident and the staff, I implemented a “Nursing Measure” on our nursing treatment plan for the resident. I executed a plan and started a trial for the resident, by administering her PRN Trazodone medication for 1 week with her noon medications, to see if this would help with her behaviours. After 1 week of this trial, Nursing staff found it extremely helpful. The resident’s behaviours had subsided quite a bit, and she did not exit seek after her lunch meal was completed. Her moods had actually improved as well, making her less agitated through out the day and she began participating in more activities within the home with the program staff.

[Author]

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