Lesson 1, Topic 1
In Progress

Critical Thinking

May 1, 2021

“Thinking with a purpose” describes the term critical thinking. Critical thinkers question information, conclusions, and points of view and look beneath the surface. They are logical and fair in their thinking. The skills related to critical thinking are applied to reading, listening, and writing across all subjects. Critical thinking is a complex process, and no single simple definition explains all aspects of critical thinking. Each author who writes about critical thinking has his or her own definition. The National League for Nursing (2000) defines critical thinking for nursing as “a discipline-specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns.”

Critical thinking is essential to providing quality nursing care for patients in various situations. One of the first skills a nursing student learns is to take a temperature. The student nurse must choose between obtaining tympanic (ear), oral, rectal, skin, temporal, or axillary measurements. Critical thinking enables the nurse to use the nursing process in choosing the appropriate method. One consideration is the need for accuracy in the results. Also, certain medical or surgical problems may interfere with the accuracy of the reading. If a patient has an ear infection, the results of a tympanic reading may not be accurate. The nurse avoids a rectal thermometer when the patient is recovering from hemorrhoid surgery. If the patient is likely to have a seizure, an oral thermometer is contraindicated because the patient may bite down on the device. The condition of the site to be used should also be taken into consideration. Heavy perspiration often interferes with axillary temperature readings; oral temperature is affected by ingestion of hot or cold beverages. All of these variables are taken into consideration by the student nurse who uses critical thinking skills in the decision-making process.

It is crucial for nurses to not only be able to perform skills (the “doing” of nursing) but also to think about what they are doing. Nurses use a knowledge base to make decisions, generate new ideas, and solve problems. Nursing students add to their knowledge base by studying facts, principles, evidence-based practice guidelines, and theories. Knowledge of psychology, anatomy, physiology, pharmacology, and other related course work helps the student to gain the scientific knowledge base to think critically.

Nurses also must reflect on situations or care given to determine what was effective and what was not effective. Critical thinkers are able to analyze this information and adjust care accordingly, if necessary. Critical thinkers are also able to explore the relationships between concepts and ideas and apply these concepts to unique patient care situations.

To help determine the difference between thinking and critical thinking, consider the following nonclinical situations:

•Situation 1: On the day before classes begin, the student is anxious about getting started and is unsure of her chances of success. She is thinking, “I hope I don’t get lost. I hope the teachers are nice. I wonder if I will be able to pass the tests. Will I succeed?” On the day classes begin, she drives to school, finds a parking space, and enters the building to locate her classroom.
•Situation 2: On the day before classes begin, the student is anxious about getting started and is unsure of her chances of success. She is thinking, “I will drive to the school so I can judge how much time to allow for travel. I want to go early and locate my classroom today so I will have an easier time tomorrow. Maybe I can get some course materials early so I can organize my notebook.”

Both of these situations describe individuals who are thinking. The student in situation 1 is experiencing a mental activity, but it is aimless and without purpose. The student in situation 2 has recognized the need to gain control and get organized. This student is beginning to think critically and with a purpose, which is to decrease the anxiety associated with her first day of class.

The following clinical situations provide examples of some aspects of critical thinking at the bedside.

•Situation 1: The nurse was caring for a patient with chronic obstructive pulmonary disease and peripheral vascular disease. During the assessment, the nurse used a pulse oximeter on the patient’s finger to measure the patient’s oxygen saturation level. The measurement yielded an oxygen saturation of 87%. The assessment revealed clear lung sounds, no difficulty with respirations or reports of shortness of breath, capillary refill <2 seconds, and extremities cool to the touch. The nurse demonstrates critical thinking skills by realizing that the assessment does not match the oxygen saturation measurement and decides to recheck the oxygen saturation level with the earlobe probe because the patient’s hands were cool to the touch. The oxygen saturation level with the earlobe probe was 93%, which matched the assessment findings. With use of critical thinking skills, the nurse was able to make comparisons between the assessment findings and the oxygen saturation level and problem solve by determining how to address the situation.
•Situation 2: A patient with diabetes was admitted to the hospital for a bladder infection. At the change of shift, the oncoming nurse entered the room to perform an assessment. The nurse noted that the patient was unresponsive. The nurse demonstrates critical thinking skills by realizing the patient is most likely experiencing one of two problems: hypoglycemia or hyperglycemia. The nurse first performed a quick “ABC” assessment and determined that the patient’s airway was open, the patient was breathing, and the patient’s heart was circulating blood. Then, because the patient was admitted with an infection, the nurse suspected that the patient was experiencing a rise in blood glucose levels, or hyperglycemia. He obtained a finger stick blood sugar reading of 346. The nurse also noted that the patient’s skin was warm, dry, and flushed. The patient’s respirations were deep, and her breath smelled “fruity.” The nurse quickly called the physician to report these findings and anticipated receiving orders to give the patient more insulin. Critical thinking skills enabled the nurse to deal with this patient situation appropriately.

Anticipating questions, asking an expert, and asking why are all examples of other strategies to improve critical thinking. It often takes a while to become comfortable with these ideas, but doing so helps the student or nurse gain insight into one’s thinking. Hearing others think aloud may also help the student learn how other people reason. The student should take advantage of every learning opportunity and realize that every experience, mistake, and encounter is a potential learning opportunity.