By Karen Siroky, RN, MSN, contributor, and Bette Case, Ph.D., RN, contributor
For most new RNs, the first few months are crucial. At this time, many new nurses experience a confidence-building professional “Ah-ha!” as you begin to use critical thinking skills in caring for your patients.
In Writing Nursing Diagnoses: A Critical Thinking Approach, Idolia Cox Collier, et al., wrote that critical thinking is both a skill and an attitude or a habit of mind. Critical thinking involves recognizing pertinent, significant data; verifying and validating data; using an organized assessment format to obtain the necessary data; and generating multiple diagnostic hypotheses.
You practiced critical thinking in nursing school. But during these crucial first months on the job, all your new responsibilities may have overwhelmed you.
According to an article by Judy Boychuk Duchscher, MN, RN, published in the Journal of Nursing Education, your critical thinking skills may awaken and begin to grow when you encounter an unfamiliar situation and think, “What do I do now?” and answer, “Ask my preceptor.” You must take it further and ask “What will my preceptor do?” and “Why can’t I do that?”
Cultivate and actively practice critical thinking skills and strategies, just as you build other nursing skills. Take a proactive, problem-solving approach. When faced with a problematic situation, quickly begin to analyze the situation, look at the situation from many different perspectives and generate a number of possible ways to improve the situation or solve the problem.
For most successful nurses critical thinking strategies become the way of practicing nursing. Critical thinking comes alive when they exercise nursing judgment in patient care. Nurses use critical thinking strategies to generate ideas, consider alternative explanations, draw conclusions and make appropriate judgments about the patient’s needs--always purposeful and goal-directed.
Test your critical-thinking skills
Where will critical thinking take you in this situation? Your patient’s urine output has averaged 100 mL per hour. But over the last two hours, his urine output was 25 mL. The physician has ordered: “Notify the M.D. if urine output < 30 mL x 3 hours.” What do you do? Wait an hour and follow the order? Or, act on the significant change?
Evaluate ALL of the information you have:
- Is your patient dehydrated? What other assessments could validate or disprove this assumption?
- Are your patient’s kidneys failing? What other information could lend credence to this possibility?
- Is there something wrong with the patient’s catheter? How would you determine if this is the case?
Questions like these show that you have awakened your critical thinking and are beginning to develop nursing judgment. You’re not simply following orders; you are using your nursing judgment to make a difference for your patients.
Congratulate yourself when you make this step. It’s a big one, and will serve you well as you continue in your nursing career.
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