[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.

[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!

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[Author]

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