[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.

[Jaswinder]

At my workplace as a nurse I applied critical thinking when caring to a patient who suddenly complaints of dyspnea. I checked the vital signs, patient oxygen saturation had dropped as compared to previous readings. I assessed the patient again and listen the lung sounds , checked the patient history and current medications. After getting more information reported to the healthcare team and the patient was assessed by the RN and doctors. After evaluation the healthcare team informed that the patient was experiencing respiratory complications that require urgent medical care.
I believe I used critical thinking instead of simple decision making because I didn’t depend on only one symptom. Before reaching any decision, gathered more information and did comparison with normal condition and considered potential causes.

[Shea]

Hello,
I agree with your example, it really shows how important critical thinking is with one symptom present. You completed your assessment in a timely manner , compared it to the patient’s baseline and considered possible causes before involving the healthcare team. Critical thinking allowed you to care for your patient in a timely manner so they could receive the care they required.

[Cheryl]

I had a client who was becoming quite aggressive in his home during a respite home visit where my staff was on their own. She tried de-escalating and reorientating client along with offering distractions etc. Every single thing tried (in calm demeanor) was only escalating things. This client had dementia and was looking for his wife as she had left during the respite visit. The staff called me in a panic. She was advised to leave the visit and I called wife to return home. The staff remained on the phone with me until wife came home and monitored the client for elopement etc. Had the client tried to elope, then 911 would have been called for police. Staff’s safety is of the utmost importance and her being removed from the risk of harm was important, however having her stay onsight and monitor his behavior from afar ensured his safety as well. In the end, no one was harmed and wife came home with no incident.

[Emmaline]

Hi Cheryl, in this situation good nursing judgment was use along with critical thinking ensuring that the resident and staff Remained safe.

[Jovelisa]

That was a good decision to stay with your staff for support during the time of difficult situation. Even though you were not present in the situation but your voice alone was such a comfort. Your guidance, the staff’s calm demeanor and the wife coming home, prevented any further critical incidence such as elopement. This is a team work.

[Shea]

One time I used critical thinking in my nursing role was when a resident in long-term care suddenly became more confused and weak than usual during my shift. At first it could have been easy to assume it was from increased behavior due to their diagnosis. Instead, I assessed the resident more closely, checked their vital signs, reviewed their documentation, and spoke with the personal support workers about any changes they noticed. I also considered possible causes such as infection or dehydration and reported my findings to the NP, a urine was obtained and the resident was assessed by the NP and treated for a urinary tract infection. I believe this was critical thinking because I did not just assume the resident was having behaviors and continue to monitor. I used critical thinking to investigate further, looked at the whole situation, considered different possibilities, and used my clinical judgment to decide the next steps to keep the resident safe which was to send a referral to the NP for follow up based off my assessment.

[Thea]

Hi Shea,
Your example clearly shows how important critical thinking is in nursing. Instead of just assuming the resident’s confusion and weakness were due to their existing diagnosis, you took extra steps to look into the situation. You checked vital signs, reviewed documentation, and spoke with PSWs, which helped you understand what was really going on. By considering other possible causes, such as infection or dehydration, you demonstrated strong clinical reasoning. Getting the NP involved based on your findings led to the discovery and treatment of the urinary tract infection. This is a great example of how critical thinking keeps residents safe and leads to better outcomes in long-term care.

[Jaswinder]

It is a good example of critical thinking in nursing practice. You didn’t assume anything, you took time to carefully assess the resident and getting information from others. By considering all the possible causes and share the findings with other staff, ensured that patient receive the right care without any potential error. Your actions indicate that how important it is to collect the information and thinks critical before taking any further action to keep residents safe and encourage their well being.

[Alexis]

Hi Shea,
this is a great example of critical thinking. It explains in the text a key point of critical thinking is to take in all possible view points. your story greatly reflects the importance of that by speaking with the PSW about changes they noticed, someone who is with them frequently to obtain more insight on their actions. you also identified possible assumptions (ie their diagnosis) which the text identifies as part of the critical thinking process. You considered the context by analyzing the documentation, obtaining vitals and possible causes surrounding the patients behaviour. All of these things combined shows you examined all possible reasons for this patients behaviour and the results shows you came to a reasonable and justified conclusion which is what critical thinking is defined as in the text. i really enjoyed reading your discussion and connecting it all to the text!

[Margaret]

Great example Shea! I like how you didn’t jump to the assumption that the resident’s restlessness was purely behavioral. By assessing and obtaining a urine sample, you identified the underlying UTI and ensured appropriate treatment. This really highlights how critical thinking in nursing means looking beyond the obvious and considering all possible causes before acting.

[Thea]

Nurses use critical thinking every day to assess situations, analyze information, and make decisions that affect patient care. When I worked in long-term care, I noticed one evening that a resident seemed more confused and agitated than usual. It could have been easy to assume this was just sundowning, which is common with dementia. Instead, I chose to take a closer look at what was happening.

I checked the resident’s vital signs, observed their behaviour, and reviewed their recent charting and medications. When I talked with the resident, I noticed they looked uncomfortable. After investigating further, I suspected the resident might have a urinary tract infection, which can cause confusion in older adults. I told the charge nurse what I found and contacted the physician. Tests later confirmed the infection.

This situation shows that critical thinking is more than just making decisions or solving problems. I gathered information, questioned my initial thoughts, and considered other possible causes for the change. Critical thinking means looking at the evidence, thinking about different reasons, and using your judgment to decide what to do. By doing this, I identified the real problem and ensured the resident received the right care.

This experience reminded me of the importance of critical thinking in nursing. It helps prevent missed diagnoses and ensures residents receive safe, effective care.

[Chantelle]

I really like your example, it’s a good reminder not to jump to conclusions, especially in long-term care. It would’ve been easy to assume sundowning, but you took the time to look deeper. Catching something like a UTI early to make a big difference. It really shows how important it is to trust your instincts and assess properly.

[Erin]

Great example, Thea. I feel like if you don’t know the residents baseline to there level of confusion a UTI could easily be missed. Being patient and taking the time to use our critical thinking skills is so important with our dementia residents.

That was a really good example. Quite often, urinary tract infections are delayed in being diagnosed for exactly that reason…. sundowning, behavior, etc. As much as it is obvious, it’s frequently overlooked.

[Linda]

Great example, and also a very common experience with that demographic of patient. It can be so easy to overlook triggers or sources of irritation with those that cat speak for themselves or have an altered LOC. A good nurse needs to use critical thinking skills to correct the situation and care the patient appropriately since they have limited input on what is bothering them.

[Stephanie]

Your experience is a great reminder that we can’t just rely on “autopilot.” It would have been easy to chart that agitation as typical sundowning and move on, but your catch shows exactly why critical thinking is so vital.
You didn’t just react to the behaviour; you questioned your first assumption and looked for the “why.” By connecting their physical discomfort to the knowledge that infections present differently in seniors, you caught the issue before it became a crisis. It’s a perfect example of how looking past the obvious ensures our residents stay safe.

[Marion Catherine]

Common to all health care facilities, the overburdened PSW population is being further stretched to the point where the work environment is unsafe. Increasing behaviours resulting from the progression of the residents’ diagnoses create an unstable environment on the unit. The residents become suspicious and paranoid about their neighbours and often this creates episodes of verbal and or physical aggression. I work on a locked unit caring for residents with increasing behaviours due to the progression of their diseases.
During the last hour of the shift, at the nurses’ station, the two units’ PSWs and one of the 2 RPNs were gathered and engaged in a discussion of how to address the unmanageable workload the PSWs were expected to complete during the shift. The other RPN mentioned to the PSWs that when she addressed the issue to their supervisor earlier in the week, a very unsavory response was provided. I was not an active participant in this conversation as I was documenting and charting an intervention for a resident who was experiencing a symptom of sundowning, but I was listening. A deafening silence broke out when the question, ‘’what we can do now if the supervisor is unwilling to discuss the matter’’ was asked.
In the split seconds of that silence, I considered who was at the nurses station, that my unit was unsupervised, and sundowning behaviours were emerging. I simply and clearly stated to go to the Union. It was a quick remedy, and the Union has the time to invest in resolving this concern. This suggestion was not accepted and the discussion carried on about their next steps. As the conversation resumed, I left the station to get back on the unit to ensure the residents were safe and supervised.
I consider this to be a decision showing critical thinking because the other RPN who is a full-time nurse on the unit was managing the situation with the PSWs and had been leading this conversation all week.
I offered my opinion to go to the Union as this matter was ongoing and increasingly worrisome, and that timeliness was of the essence. In assessing the situations at hand, I responded to the area that also needed immediate support – the residents safety and wellbeing – while the rest of the staff took the time needed to devise a plan of action to ensure safer work expectations. Standing by the PSWs and supporting a group decision on how to resolve their concerns is an important task in leadership. However, given the immediate concerns for the well-being of the residents under my care, and that the other RPN was already very engaged with the PSW situation, I chose to get back on the unit to ensure the safety and wellbeing of the residents and address an issue that was brought to my attention regarding an escalating aggressive behaviour.

[Cheryl]

This clearly shows good awareness of balancing staff concerns with resident safety. When sundowning behaviors were starting, ensuring supervision and safety were made showing a great clinical decision. Your reflection demonstrates strong situational and prioritization of resident care while also realizing the need to support your staff concerns as well.

[Tammy]

hi all
one time at my work, there was a resident whom became almost unresponsive at the breakfast table after recieving medication. she was a diabetic and it could have been assumed that her BG was low or even that she was more tired from a poor night sleep r/t new pain. her intial bg check was within range, it then checked again after some sugar was administered and found to be lower. she was sent to the ER and admitted to hospital where they evaluated her medication and also explored the new pain and was sent home with more supports. if she was not sent and more attempts to raise her BGs were only explored, she wouldnt have had more diagnostics done or had more supports in place.

[Angusami]

Hello,
Thank you for sharing you experience. You took initiative, followed the nursing process and took appropriate action, based on your critical thinking that benefitted the resident.

[Sharon]

Critical thinking contributes immensely to patient safety. In this case recognizing that treating the initial low is not enough; and re-evaluating the client to ensure resolution was very critical. Also been able to recognizing the need for further medical investigation was crucial in this case. Well done.

[Angusami]

Hello,
Critical thinking in nursing is vital and we tend to use every shift. It also based on your nursing process – diagnosis, assessment and appropriate intervention. I used critical thinking on a specific shift, when our staff member reported that resident has an acute confusion- imagining things. I completed the initial assessment on the resident, vitals, pain assessment, x no days with confusion, previous episodes of same complaints and any other associated symptoms ( i.e cloudy urine). Based on the assessment findings, I informed the RN supervisor for further direction. NP was contacted/ordered collection urine sample and resident was started on antibiotic treatment appropriately.

[Vanessa]

Great example of critical thinking. You utilized your nursing skills and your example is evident that you are a good listener as took the staff members report seriously. You further identified that that the RN needed to be informed, escalating further treatment for the resident.

[Vanessa]

When I worked as a restorative care nurse, I relied on my critical thinking skills to develop individualized care plans that truly reflected each residents goals, abilities, and potential for for improvement, Creating these plans meant looking beyond standardized interventions and carefully assessing what each resident needed to succeed. I regularly analyzed progress and success rates adjusting interventions when outcomes weren’t meeting expectations or when a residents condition changed. This constant cycle of assessment, planning and evaluation helped ensure that every care plan remained meaningful, achievable nd centered on the resident’s personal goals.

[Jamie]

This is a great example of critical thinking. When you have so many residents you must think critically about the best way to complete care plans. Will it benefit more to create completely personalized plans or follow more of a standard? I think thinking critically in this situation would show that person-centered care is the bet course of action. Meaning we take the full person into consideration as the basis of what we build our care plans off of rather than trying to make everyone fit perfectly into a standard.

[Sharon]

Critical thinking contributes immensely to patient safety. I rely on my critical thinking skills to administer medication by utilizing the rights of medication administration. Administering medication is a routine for some nurses but it is a critical task. Medication errors can lead to severe consequences sometimes even death. Critical thinking allows nurses to double-check , some times triple- check medication orders and ensure the correct dosage is administered. I remember overseeing a new nurse as she prep her meds for medication administration for a client ; while she was gathering the meds I asked that we double check the meds together. It was at this time that we caught that she had mistakenly poured 2 tabs of Clobazam as opposed to pouring 1 tab as per MAR. Critical thinking in nursing enhances the overall quality of care.

[Freda]

Hi Sharon, you are so right in your points of critical thinking and medication administration. Medication is such a large part of nursing practice and there are so many moving parts with administering that can go wrong if not managed correctly. More than ever with the complexity of residents and patients there is increased risk. We definitely have to be alert and have our critical thinking hat on at all times.

[Shannon]

I agree with you on your statement of critical thinking. Some nurses become complacent in their practice of medication administration. Even though I have been in nursing for almost 20 years,I still double check and triple check. Then check my med cart throughout the shift to ensure I have not made any errors. Safety first. As well as protecting this nursing listen we have all worked so hard for.

[Brittany]

In my daily practice, I consistently apply critical thinking, not only in routine care but also in high-pressure situations. A recent example occurred while working in a clinic when a patient experienced an anaphylactic reaction following an allergy shot. This was one of his final maintenance doses after years of treatment. Our clinic policy states that patients must remain for a 30-minute observation period post-injection. However, this patient left the waiting area after only five minutes and went to his car, where he began experiencing symptoms of anaphylaxis. Fortunately, he was able to return to the clinic, alerting staff. Recognizing the urgency of the situation, I immediately went to retrieve an epinephrine auto-injector. Upon arrival at the emergency kit, I discovered that the EpiPen had expired by over one year. Quickly reassessing, I identified that there was a pharmacy within the building and ran there to obtain a new, unexpired EpiPen while our registered staff waited with the patient. After administering the medication, I remained with the patient, closely monitoring vital signs until EMS arrived.
This experience reinforced the importance of rapid decision-making, adaptability, and situational awareness. Since this incident, I have become more vigilant in ensuring patients adhere strictly to the 30-minute observation period and take extra steps to monitor them closely, including checking on them every 10 minutes when clinic time allows. It also highlighted the importance of regularly checking emergency equipment to ensure readiness. Had a pharmacy not been immediately accessible, the outcome could have been significantly different.

[Evan]

good observation skills, knowledge of your surroundings, and quick thinking may have saved that patients life. this is a great example of critical thinking, to not only respond appropriately to the emergency but also how to handle the situation when dealing with expired medication in a crisis.

[Marilyn]

As we enter week 4, the conversation has been very rich; filled with critical thinking and implementation. So far, this discussion really highlights how essential critical thinking is in nursing practice.

Reading the responses about your experiences reinforced that critical thinking is used in many situations, whether identifying infections behind confusion, managing challenging behaviors, preventing medication errors, or responding to emergencies.

The biggest takeaway from the conversation so far is the importance of gathering complete information, considering different possible causes, and acting promptly.

Great conversation so far and I’m looking forward to further contributions.

[Lisa]

I believe critical thinking is second nature to nurses. In my most recent practice I had a resident that was lethargic and not responding as per usual. PSWs informed me that resident had been spilling her drinks and they wondered if a nosey cup with handle would be more appropriate. Upon assessment I noticed resident had a runny nose, fatigue and borderline low-grade fever. Resident receives routine tylenol. With this information I relayed to my team that resident appeared to be having a common cold and we should let her rest and recover for a few days. The next time I worked resident was alert and responsive again. Critical thinking was used in this scenario; instead of assuming resident was deteriorating and sending a RD referral I assessed the resident and implemented a different plan of care to best serve my resident.

[Alexis]

A time I used critical thinking in my nursing role was when I was redeployed to the surgical floor from my normal telemetry unit due to nursing shortage. I received a patient from the previous shift and was getting bedside report from one of the nurses. The patient looked very fluid overloaded. I could see patient was still receiving fluids and they were never stopped post surgery. I expressed my concerns to the nurse to take into account her view point. she expressed she mentioned it to the family and they said “she gets like this after a long day” . At this time, I used divergent thinking as the text describes as a skill of critical thinking. I analyzed a variety of other options in my head and didn’t just go with what the previous nurse assumed and what the family said without visually seeing the patient. I reviewed her chart to gather more information about this patient. I used my basic support from my background of telemetry nursing to analyze the current situation and considered the context which was patient was elderly, had underlying heart disease, had surgery and had been on IV fluids for an extended period. The text goes on the state that critical thinking is viewed from 3 perspectives and reflecting on this story I believe I did perform these three perspectives making it critical thinking opposed to decision making or problem solving. Number one being thinking ahead- I thought ahead to what the next few hours could look like for this patient if she continued to receive IV fluids including respiratory distress, affects on her cardiovascular system and the overall negative effect it could have on her. Thinking in action- completing my head-to-toe assessment finding edema, fine crackles to the lower lobes and looking at the patient Infront of me displaying many signs of fluid overload and given the current iv fluids she was running. I then thought back, how her previous treatment plan ie having surgery, being on fluids for an extended period of time and her preexisting medical history could all contribute to her risk of developing fluid volume overload. critically thinking allowed me to act quickly to allow for the best outcome of this patient by contacting the MD who put into place the correct plan of care for how this patient was presenting.

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[Susan]

I use critical thinking on a day to day basis in my nursing career. An example of my critical thinking is when we assess patients prior to their cancer treatment days. Our nurses do each patient’s vital signs and discuss any symptoms they may be having.
I had a lung cancer patient come in after walking a block so she didn’t have to pay for hospital parking, Pt was quite short of breath on arrival, seemed uncomfortable and her heart rate was elevated to 130’s, the patients oxygen saturations were 91% which was within her normal since her diagnosis. When I finished doing her vital signs, I palpated her radial pulse, she was slightly clammy and her pulse was irregular. I assessed the pattern from the sat monitor which also was quite irregular. The patient herself kept saying that it was just because she had walked too far and she would feel better soon, she told me this has happened alot to her over the last few weeks since her last chemo.
As we are an outpatient clinic, I immediately took her to the emergency department via wheelchair instead of waiting for our clinic oncologist to assess, as I suspected that she may have an uncontrolled arrythmia .
Pt was becoming decompensated and was taken in to the ER immediately and was in an uncontrolled atrial fibrilation and was admitted to the ICU requiring a full cardiac work up and medication control.
While the patient did have lung cancer and could have been short of breath because of that, and these patients heart rates can become elevated with the exertion required, further assessment told me that there was more going on and the outpatient clinic was not the appropriate place for that to happen, taking her to the ER put her in an environment where she could be safely monitored and took precedence over her oncology appointment at that time.

[Samantha]

One notable instance where I applied critical thinking was during my time in Long term Care. I observed a resident whose behavior, level of consciousness, and overall cognition were fluctuating throughout the day. Although the shift from her baseline was subtle, both the PSWs and I recognized that something was off. We initially obtained an order for a urinalysis, but when the results came back negative, the medical team was inclined to “wait and see.” Restless with that approach, I spoke with the resident’s daughter to gather a more detailed medical history. Based on those insights and the specific nature of the resident’s confusion, I advocated for a blood panel. The results confirmed she was hypercalcemic, allowing us to treat the underlying issue rather than dismissing it as a minor behavioral change. I think as nurses its important to not ignore even subtle clues that our patients are showing. I also learned that its okay to push back and advocate for your clients to get answers. I remember feeling very proud that I didn’t just ‘sweep it under the rug’ and that I used critical thinking even when the first test for UTI was negative.

[Nathalia]

Hi Samantha,

I’m glad you went ahead and looked for more information when you knew something was off. As nurses our critical thinking allows us to look past the immediate problem and look for alternatives for cause and treatment. Your quick response enabled the appropriate treatment to be delivered which supports our guideline to cause no harm and help patients. Although sometimes we may feel like we’re overstepping, i feel that as long as we do it with respect and with the intention of helping we don’t need to over worry. All healthcare workers and clients appreciate our input as we look to provide holistic care and notice the details when others don’t. I appreciate that you looked at was present and most obvious, but went to the family who knows the client most to inquire further before making a decision while involving the family in the care.

[Leah]

An incident that happened earlier in my nursing career in LTC, when a student PSW was feeding a resident who was on a very thicken drink protocol, I reminded this student that this resident needs 3 scoops of thickener and they understood. I walked away from the dining room for a few minutes, I then heard shouting and staff calling for me, the student had given the resident normal water, not thickened and started choking, all staff started panicking. I ran right to the suction nearby and proceeded to use it on the resident. Luckily the charge nurse heard the panicking and came to assist. The resident was okay and it was a teaching moment for the student. I was still fairly new to this unit and never had used the suction machine before, I was praised for my critical thinking that morning.

[Freda]

An example of using critical thinking process in my practice was finding myself working a nightshift and experiencing a medication for treating or preventing osteoporosis that was scheduled for administration at 0600 once a week. The medication also came with administration instructions that it was to be administered first thing in the morning with 6 to 8 ounces of water and the resident was to sit up for 30 minutes following administration for the medication to be effective. So as it would seem once a week there were several residents requiring this administration and myself being the only nurse I realized the challenges and risks. Firstly the resident being awaken at this hour, being informed to take the medication, drink 6 to 8 ounces of water and then to sit up straight for 30 minutes. Secondly trying to manage this with 4 or more residents on the same morning. My first assumption was there must be a rational for this and I might be lacking the experience to follow through. So I started asking questions, first to other nurses around their experience, then to the DOC and next the pharmacy. After a few weeks and information gathering I realized I was not alone with this challenge. What I did find out with my information gathering was pharmacy could offer an alternative medication that could be injected once every 6 months should the resident chose to pay. The other alternative would be to alternate the days so that there would only be one or two residents maximum on any particular day. I took the information to the DOC in the home and together we implemented the changes. Through the implementation pharmacy was also able to access funding so the injectable medication would be covered. In the end this was a win for all. As per the reading I used the critical thinking process to provide better care and safer practice.

[Samantha]

Hi Freda, I really appreciated your response to this question. It was impressive to see how you identified a critical issue and its potential risks rather than simply “suffering through” a flawed process. By conducting thorough research and collaborating with interdisciplinary teams—such as the the DOC and pharmacy you effectively challenged the “normal routine” to find a better solution. This not only improved the workflow for the nursing staff but also enhanced the quality of care for all residents, demonstrating your strong advocacy skills and commitment to excellence.

[Sarena]

I like your example of critical thinking in a very sudden change of events. Quick critical thinking in a stressful situation with getting the suction. The student will be checking diet textures carefully after that. Lessons learned.

[Emmaline]

One time I demonstrated strong critical thinking skills was while working in home care within the community. I had a client who had recently returned home from the hospital just a few days after surgery. During my visit, I noticed right away that he didn’t seem like himself. He was in significant pain, appeared weak and lethargic, and had a very poor appetite.

I began a full assessment and took his vital signs. His blood pressure was elevated, and he had a high temperature. I administered medication to help manage his pain and fever, but I continued to investigate further. When I assessed the surgical site, I realized the area appeared infected.

Recognizing the seriousness of the situation, I immediately informed my supervisor, called 911, and ensured he was transported to the hospital. After further evaluation at the hospital, he was diagnosed with sepsis.

This situation required me to use critical thinking by looking at the whole picture, considering all possible causes, and using my clinical judgment to determine the safest and most appropriate next steps for the client.

[Aysha]

Hi Emmaline,

This is crucial to assess our client whenever we feel they are not in their baseline or if we observe any change. We shouldn’t be judgmental or hesitate to assess our client. To notice the significant change in the client we need to know the baseline of the client which reflects our accountability towards our work. I really appreciate your nursing judgment and critical thinking which made you to take an effective decision to send the client to hospital.

[Chantelle]

During a shift while working as a nurse, I used critical thinking when a resident suddenly started complaining of not feeling well. Their vitals weren’t extremely abnormal at first, but something didn’t sit right with me, especially because the resident seemed different. Instead of brushing it off, I reassessed them, looked at their medical history, and kept a closer eye on any changes. Later the patient’s condition started to decline, and because I was paying attention early, we were able to act quickly. I feel this was critical thinking because it wasn’t just about following a routine or solving a problem it was about noticing several changes, using my judgment, and thinking.

[Jamie]

As a nurse, often need to apply critical thinking when trying to accommodate my clients. Working in an HIV clinic means that I need my clients to be able to have their blood work done and get their medications in a timely manner as this not only effects the clients but could be a public health concern if things are not followed up on and monitored regularly. My client population is quite different, I see immigrants, refugees, Canadian-born, drug users, unhoused individuals etc..
Every client has their own potential barriers to care, so critical thinking is required on a daily basis to figure out the best way to make sure each client is receiving their care in a timely manner. I need to think critically about the best way to communicate with a particular client in order to make their needs clear and ensure their understanding. I need to address their barriers to ensure that these do not stand in their way of receiving information, receiving treatment, or being brought in for follow ups.
This would be critical thinking as opposed to just decision making because it involves reviewing the full person and identifying all their barriers and addressing them in a way that allows that person to engage in their health care better.

[Sarena]

An example of critical thinking for me was with a diabetic resident who was scheduled to receive Insulin, but before giving it, I noticed that they were shaky, sweaty, and not eating. I checked their blood sugar to find it low, indicating Hypoglycemia.
Using critical thinking, I hold the insulin, treated the low blood sugar as per LTC home policy, and notified the nurse in charge.
I assessed the resident first, recognized a risk, and adjusted care to prevent harm instead of just following the medication routine.

I have really enjoyed reading all of your experiences in this forum. Mine is a little different in that i am going to retell a situation in a LTC Home with staffing. There was a situation that involved 2 PSWs openingly arguing with each other. Because of this, care wasn’t being provided causing a domino effect with other departments ie breakfast was delayed. Because I had seen a bit of what was going on, I pulled each PSW separately into a safe space and asked what was going on. At the root of the problem was that they were feeling overloaded with work stress and not personal dislike. Bringing them together, I helped them have a solution focused conversation and reminded them that we are a team and that we are here for the residents. I checked in with both of them near the end of the shift and found them working well together. The situation was resolved and there was no further reasons to escalate the situation to management.

[Marion Catherine]

Dear Member, thank you for sharing this experience. It shows how asking questions and keeping an open mind can go a long way to resolving conflict. Recognizing and understanding that we are all under an extra-ordinary amount of stress and very high expectations does create an almost impossible environment to succeed. However, by demonstrating confidentiality, respect and a quest for the truth as well as meeting facility policies, you have inspired courage to ask questions.

[Katrina]

A critical thinking situation occurred when a nurse came to call me for help during the start of the shift, as it was reported an old wound was reopened and needed to be redressed. That wasn’t the case, a deep laceration was present, causing severe active bleeding. Right away I took precautionary measures, such as properly dressing the wound, notified manager, skin wound protocol in place as per policy and made sure the resident’s vitals were stable and pain under control. I also informed ET nurse that stitches may be required, which it did. I was with the resident through entire process, that this occurrence consumed my entire shift. I felt it was very necessary for me to not only make sure the wound was properly taken care of, but to also be there for emotional support.

[Leah]

Katrina you did an excellent job prioritizing your patients health and making sure they got the proper treatment on this wound. Even though it was time consuming I’m sure your team and the patient appreciated your critical thinking before the wound led to bigger issues.

[Jovelisa]

This experience is ongoing. Early in the morning, I noted the res. was chewing something, I put gloves on, asked her to open her mouth, she refused, tried to bite my fingers,. with extra gentle persuasion approach, res. opened her mouth and it was a chewed up meat, which appeared to be chicken from her dinner. I used my critical thinking, to offer the res. pureed food for breakfast and monitor if res. is going to pocket the pureed texture. Everything went well, I was so sure to follow my critical thinking even though I would have to explain the situation to her family later. I also had the support of my team.

[Aysha]

As a BSO nurse I have to utilize my nursing judgement on each shift. An example of critical thinking for me was with a resident exhibiting responsive behaviors and was difficult to redirect.
I was called to offer support to the resident. I went to the unit and staff reported that PRN medication was administered but not effective. Resident continued to be restless and behavioral. He may benefit with injectable medication to calm down. I attended the resident and assessed his behaviors. I made sure the behaviors were not for any unmet needs. I checked if there was any worsening confusion. I took his vitals and assessed pain. I offered 1:1 support and repositioned him. At last, I checked his bowel history and found he was on day-4.
I assessed his abdomen and realized he was restless because of the discomfort and was unable to explain due to his low cognition.
I assisted staff with to administer the suppository and resident had a BM. Within half an hour resident was totally calm and comfortable. No behavior was exhibited after. Resident settled and slept after the BM.
I feel it was critical thinking and not just decision making or problem-solving. Because I didn’t depend on the report of the staff or took quick decision to call the MD or RN to get the order for injectable medication. I utilized my nursing judgement, I assessed the resident and decided to go with the initial findings, and I was successful with the implementation of my skills and resident was comfortable.

[Deirdre]

Aysha,
Great skills there and that you looked at the whole patient. There are so many different triggers that can set dementia patients off and that you were able to determine what it was after using those skills is so important. I hope other nurses will take this experience and use it to help them next time instead of using pharmacologic interventions.

[Stephanie]

A time that comes to mind that I used critical thinking recently in my nursing role was a patient admitted with cellulitis of their lower leg. The patient was feeling generally unwell throughout the morning but remained alert and talking to me. They were already prescribed IV antibiotics. Their lower leg was red (maintained within the boundaries we were monitoring), warm to touch, and tender. Throughout the day and into the afternoon the patient was not as talkative, rousing to verbal stimuli, low grade fever, and increased redness to the lower leg. The IV antibiotics, I believe was vanco had been increased to a more therapeutic dose but was not due until that evening as they had already had their morning dose. I had informed my charge nurse and MD that I was concerned with my clinical findings and how the patient was feelings after had been receiving at least some IV abx prior. The MD believed the increase in ABX would be effective. Fast forward to the next morning the patient continues to be drowsier and just feeling generally unwell, after receiving two doses of the increased abx. Remaining with the low-grade fever. Their WBC was climbing. I again approached the charge nurse and MD about my clinical findings and feelings that the patient was not improving. The MD ended up coming back to reassess the patient and to order a stronger abx with a wider coverage and I believe some IV hydration if I remember correctly. I felt that using critical thinking and my assessment skills I was able to continue to advocate for my patient that wasn’t feeling well and was slowly declining. I feel this goes beyond decision making because I was considering many different factors, vitals, assessment, bloodwork, and just general well-being of my patient.

[Erin]

It was Christmas time and I was working an evening shift on a dementia ward. I was making my final rounds checking in on the residents when I came to a resident who was sitting at her keyboard. Her face was very flushed and she sat there rubbing her throat but was quite calm. I started by getting her vitals, as she was unable to answer my questions appropriately due to her dementia. Her vitals were mostly stable except her pulse was slightly elevated and she had decreased air entry. She then started trying to take something off of her tongue. It appeared like fine bristles. I immediately started looking around her and found a stocking that was supplied from the community for the residents, all filled with different items. My resident was eating the makeup brush. And I had no idea how much she could have stuck in her throat.
I sent her out immediately to the hospital and when she eventually returned she had also swallowed a small hair clip that was removed.

By using my critical thinking skills and assuming the problem, I was able to make the decision to send her out to be further assessed as it was beyond what I could do for her.

[Kellie]

That was definitely a situation that could have ended much worse for the resident. Good on you to use that critical thinking and realize there was more happening than appeared. Resident can transgress to putting objects in their mouth. I once observed a resident raking her tongue with a fork to the point of bleeding.

[Shannon]

I believe I used critical thinking when I completed my RAI MDS assessments. I loved how I could fully assess a person by looking through all the look back periods. Going through their progress notes, talking to the resident, getting feed back from staff and then absorbing it all into an assessment. Critically thinking what could be done or what could this resident benefit from. Sometimes it would be as little as sending a dietary referral for constipation requesting prune juice or referring to the doctor for laxatives. Also critical thinking by going through their medications, reviewing it and making suggestions to reduce their poly pharmacy. Putting through changes and communicating them to resident, staff and family. Then I would use my critical thinking to audit and edit assessments prior to submitting them to CiHi.

[Adeline]

Hello Shannon, I agree with you. Getting different perspectives from healthcare team members is really important for critical thinking. Also, looking at the progress notes helps give a clear picture of what’s been going on with the patient, which makes it easier to think critically and provide safe care.

[Terrinah]

You did an excellent job by using all your skills to assess the patient and making sure you gave the proper care.

[Adeline]

Critical thinking is an essential component of patient care. During a typical workday as a nurse, I begin my shift by reviewing the 24-hour report. This step represents the initial stage of critical thinking, as it involves analyzing information collected from various healthcare professionals over the previous 24-hour period. This process is highly beneficial in guiding my daily responsibilities, as it enables me to effectively prioritize patient care. Specifically, it helps me determine which patients to attend to first and identify residents with the most urgent needs. Overall, each of these steps requires the application of critical thinking skills to ensure safe and effective patient care.

[Margaret]

During one of my shifts, I was providing care for a patient who suddenly became verbally unresponsive and catatonic, which was a significant change from their baseline. Instead of immediately assuming the patient was simply resting or sleepy, I carefully assessed their vital signs, checked for any immediate medical concerns, and monitored for subtle signs of distress. I also reviewed their recent medications and consulted with the team before implementing any interventions. I consider this an example of critical thinking rather than just decision-making because I had to analyze multiple pieces of information, weigh potential risks, and anticipate possible complications before taking action. It wasn’t a straightforward problem with a single solution; it required careful evaluation, professional judgment, and ongoing monitoring to ensure patient safety.

[Evan]

While I’m sure there are many examples, at the moment the only example I can think of is when dealing with resident responsive behaviours. I work on the secure dementia unit at my facility. when managing behaviours, we always try to use non-pharmacological interventions first, if those don’t help then we attempt/consider PRN medication. The reason I say this is critical thinking and not just problem solving is because we have to constantly weigh the pros and cons of the medication and the residents current condition (ex. the medication will help the behaviour, but the residents usual unsteady gait is more unsteady then normal and therefore increased falls risk) Are the benefits of the medication worth the potential risks? Are other residents at risk if the medication isn’t given?

[Terrinah]

During my shift in a nursing home, I had a resident who was battling anxiety and depression and she started showing signs of depression and started being aggressive with other resident. I checked the resident’s vital signs, observed their behaviour, and reviewed their recent charting and medications. When I talked with the resident, I noticed they looked uncomfortable, I acted fast by calming them down and giving them medication.

When I was a student doing my last consolidation, my preceptor asked me to do a full head to toe assessment on a recent surgical patient. She accompanied me to the room. I explained to the patient what I was doing and why and then did as I was told. Everything was going well but then I noticed and documented the significant edema from her waist down, pitting in her lower legs and feet. After we left the room, she asked me to describe my assessment. The edema had caught my attention an I suggested I felt there was probably a kidney function issue. My preceptor hadn’t even considered that. We spoke to the surgeon and the patient was taken back into surgery that same afternoon. Both the preceptor and the surgeon commended me for picking up on a detail that had gone unnoticed.

[Linda]

We, as nurses, use critical thinking every day in the emergency department from the minute a patient walks in the door. Some examples of this are when a person rates their pain. Often times if the patient states an 8/10 pain, you can see physically that they are hurting. But not everyone presents the same. Each time you need to use your critical thinking skills to ensure that you are providing the most appropriate care. Is there a cultural factor with their representation of pain? Are they drug seeking? Are they scared and not outwardly showing pain is helping with their fear? Is it an age related stigma that they shouldn’t show their pain?
Another example is any SOB patients that come in…instead of simply delivering oxygen and waiting for the doctor to assess you need to question why they are SOB. Is there any recent travel or history of embolisms? Is there increased swelling or recent weight gain? Is this a known cardiac patient? Are they a known asthmatic? There are so many complexities to investigate to find the root cause that come before decisions are made.

[Olaronke]

The use of critical thinking skills is done almost always as a nurse. I remember when I was a floor nurse years ago, one of my assigned patients seemed more tired and slightly confused than usual. Her vitals were normal, when taken – which could’ve been overlooked – but knowing her baseline it still seemed a bit off. I decided to assess deeper, by reviewing her file, assessing her cognition, behaviors and addressing my concerns to a colleague. We discovered that the patient was developing an infection. I see this as critical thinking, not just decision making because I didn’t react to what had been presented to me. I noted the changes, analyzed them and brought them to the attention of another and prevented things from getting worse.

[Deirdre]

Great job looking at things from all angles.

[Teresa]

That was an amazing job! Thank you for sharing your stories

[Nathalia]

As Nurses we utilize critical thinking in every day decisions to ensure the safety and health of our patients. An example of an event where i had to use critical thinking was when i was completing an initial visit for a client in the community. The visit was scheduled and service had already started with PSW support. Upon my arrival i found the client laying on the floor completely soiled. The recliner he was sitting on was soiled as well as the carpet, the couch and mattress and the bathroom walls. Client was laying on the floor comfortably as he stated since he was waiting for support. Client was intoxicated with alcohol as a large empty bottle of alcohol was laying beside him. As i walked in and witnessed the situation, my first thought was the client has not been receiving support as there was no evidence of cleanliness and the state of both client and the environment was deplorable. Before i made any assumptions, i assessed the area and the client to ensure he was safe and stable to be able to transfer with assistance. I called the office to report my findings and requested extra support immediately in order to get the client back to a safe position. Then, i began collect data to be able to investigate as to why the client was in this state, does the client have any family or external support, have the staff been complying with scheduling and support of the client and where was the gap for assistance. I was able to receive assistance from a PSW that picked up the one time shift to assist and we were able to clean the client and environment as much as possible. I was able to contact family which unfortunately were not supportive and estranged from client due to his state and decisions as he was not accepting help and was making wrong decisions for his health. I then contacted our funder to follow up regarding the current service frequency and advocate for client not to be alone in the home as he was not able to look after himself, staff were attending and completing the appropriate tasks, but client would make a mess himself in the hours he was alone. After gathering further information and details i went ahead and advocated for the client to be sent to hospital and placed on the crisis list for a LTC as client could no longer stay in his home due to the increased safety and health concerns. I had to activate all the resources available including OT, Social work and Psychologist as clients health was declining and we needed a complete evaluation in order to keep client in hospital instead of having him return home. Although client had full capabilities i had to use my critical thinking skills to weight the options at available and the need to maintain a safe environment and a healthy/stable patient, which was impossible with the current state of the client. I was able to advocate for the clients wellbeing and discussed all options and consequences with the client, which was hard to accept for the client, but in the end client received the support necessary and was kept safe.

[Kellie]

An experience that comes to mind is an admission that we had in LTC. He was fairly young with an active addiction DX. His POA had decided that he was there to “dry up”, and refused to bring any alcohol or cigarettes. It was a Friday and I knew that contacting management or the MD over the weekend would be difficult. I also knew that the side effects he would experience would be awful for him. I sought out management and the NP to ensure that staff knew exactly how to care for him and that we had what we needed to keep him comfortable and avoid withdrawal.

[Stephanie]

I noticed a resident who was unusually quiet and hadn’t touched their meal. While their vitals were stable and they weren’t in any obvious distress, my intuition told me something was shifting. A problem-solving response would have been reactive – simply offering a supplement or encouraging a nap. Instead, I used critical thinking by looking at the “gray area” and connecting their history of heart failure to a slight increase in their pedal edema that morning.

[Deirdre]

Critical thinking in nursing can look like so many different things and these have all been great examples.
My most recent example was assessing a resident in LTC post fall, who had a head injury and after 1 full day staff were trying to say that they were just not themselves, changes in behaviour, mood, mobility was a little slower but still stable, but staff felt he needed to go to the ED for assessment. With my 25 years of being a RN I was able to use the critical thinking process and that part 1) it is a process that entails identifying assumptions and that we were maybe assuming he had a serious head injury which was causing his changes, and part 2) of the process states consider the context and meaning of issues, so this is a 90 something old man with a history of dementia and recently did just get over a respiratory infection, so he is going to have some changes that we are going to notice more closely d/t the close head injury routine. and part 3 of the process states to gather data to allow for consideration of alternatives and prediction of multiple possible outcomes. So after reviewing the objective clinical findings, I did not think his changes were because of a head injury, but resident may have an underlying infection that may have contributed to the fall, so I have requested that we send urine for testing and to have NP see patient the next day as this was the weekend. Sometimes sending a resident of LTC to the ED can but a lot of stress on the resident and the family and unless it is clear that this is an emergency it is better for all to treat the resident in their LTC home.
After getting a urine sent, MD did start an antibiotic and resident did get better, not totally to their baseline, because I feel like after every infection an older dementia resident gets it can set them back permanently a little bit.

[Adella]

In my current role as an infection control professional during uncontrolled or lengthy outbreaks we would collect as much information about the outbreak as possible prior to entering a home and then walk through with an IPAC lead or environmental staff member to look at what the home has in place and what could be lacking to bring an outbreak under control. It is problem solving it is thinking in the moment to see what could be contributing to spread.
I can think of on instance where Group A strep was spreading within a home and no one could figure out how it was being transmitted, after a thorough walkthrough and assessment to talk about shared items it was found that the bathtub was the potential cause. The tub was very old and had many factors that could be a risk of transmission. The home put a thorough cleaning and disinfection process in place until the tub could be replaced and the spread stopped.

[Teresa]

45 year old patient, female from home alone, presented to ED with falls, upon learning of hx, patient had numerous falls within the past 48 hrs. Bloodwork taken. Lab imaging ordered. Referrals to proper channels initiated. This being done, is to rule out possibilities of metastatic diseases. But while in ED, patient is having loose stools and upon further examining and questioning, patient stated that high doses of laxatives was taken 2x everyday and for almost a week ergo, the loose stools and the frequency and urgency to go to the washroom hence the falls, due to electrolytes imbalance. And to add to that, patient stated that she needs to remove all the “toxins inside her body”. At the end, patient was admitted for further testing and monitoring and received IV to hydrate and a referral to OT/PT, SW and psychiatrist was done to help with her mental health, and among other things.

In this scenario, I used my critical thinking, Why did she had a falls x3 and having loose stools? Further questioning the patient is very critical and important to get to the bottom of her presenting herself to ED and get her diagnosed correctly and properly without further jeopardizing her health status.

[Adella]

I think that I often have to look at critical thinking as a larger scale, not just an individual. When looking at outbreak response and management we collect all of the information and then formulate a plan to move forward, ensuring that we take resident wellbeing and ethics in to consideration. Then deciding what measures to put in place to help to control an outbreak and limit the spread of illness. Example: you have multiple group a strep cases and you need to put measures in place to stop the spread, you identify that it could be a common space such as a tub room contributing to this. What can you put in place that will not have implications for daily cares of residents. So you address concerns around cleaning and disinfection, look at processes in place and have a home implement these, along with education to other staff on IGAS signs symptoms and procedures to clean the tub room.

[Cheryl]

During my early days in nursing, I had a resident that use to be in wheelchair most of the day and the night. I advocated for this resident to be placed into bed with safety measures in place. PSW staff did not want to transfer this resident due to the falls risk and climbing out of bed. Utilizing my clinical thinking I took a look at the full picture of the resident, falls risk, skin integrity, mobility and overall health of the resident. Instead of just trying to place the resident into bed, I looked at the situation in full and prioritized the residents overall well being. We trialed giving resident snack, and fluids, transferring resident into bed providing care with a warm blanket and initiated 15 minute checks. By creating this routine this resident was able to be in bed and sleep all through the night.

In the end, my decision was guided by providing an individualized care routine while maintaining safely. This reinforced the clinical thinking aspect of nursing by looking at the residents needs and what would work best.

[Author]

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