Critical Thinking: Is It Not Common Sense?

Critical thinking is developed when your foundational knowledge and experience start to blossom into clinical judgement.

Have you ever heard the saying, “Common sense isn’t that common”? Sometimes in life, we do experience or witness truth to this saying. But when it comes to critical thinking in nursing, is it just common sense? Well, yes and no.

This week, I had a wonderful conversation with a student about ways to develop critical thinking. He told me, “Dr. Gaines, we are always told to think like a nurse, but I am not a nurse yet!” To his point, this is true. No, you are not a nurse yet, but that doesn’t mean that you do not have access to the tools to do so.

The Nursing Process Develops Critical Thinking

I know, I know... I hear your eyes rolling and sighing through the computer. Yes, the nursing process is where it is! This foundational method ensures that nurses assess the situation comprehensively by looking at the patient as a whole. Here’s an example of how to use ADPIE and critical thinking together with a COPD patient:

Assessment: Gather comprehensive data about the patient's health status through observation, interviews, and physical examinations.

1. Subjective: “My breathing has worsened over the last three days. I am coughing more; it is harder to catch my breath with the slightest movement. I’ve been sitting in my recliner mostly all day and sleeping in it at night. Now I’m starting to cough up thick white junk.”

2. Objective: Visually, the patient’s color looks dusky. The patient’s words are hard to distinguish between breaths. Now the patient is in a tripod position with mild retractions. Lung sounds are course, with rhonchi in the right middle lobe and crackles in the bilateral lower lobe bases.

Diagnosis: Analyze the assessment data to identify the patient's problems and health needs.

1. Ineffective breathing pattern

2. Impaired gas exchange

3. Ineffective airway clearance

4. Activity intolerance

5. At risk for infection

Planning: Develop a care plan with specific goals and outcomes tailored to the patient's needs.

1. Improve oxygenation

2. Make sure I get the appropriate labs

3. Medications I need to help improve breathing

Implementation: Execute the care plan by performing interventions and treatments.

1. Place bed in semi-Flowers to help with breathing (Ineffective breathing pattern).

2. Place the patient on a continuous oxygen saturation monitor. Place a nasal cannula and connect the patient at 2 liters (ineffective breathing pattern).

3. Order a PureWick© or place a urinal at the beside or a bedside commode (activity intolerance).

4. Teach patient huff coughing techniques to help clear airway of mucus and have respiratory use a flutter valve in between breathing treatments (Ineffective airway clearance).

5. Orders for CBC and ABGs to be drawn from the provider (at risk for infection and ineffective breathing pattern).

Evaluation: Review and assess the outcomes of the interventions to determine their effectiveness and make necessary adjustments.

1. Patient is less labored in semi-Fowlers. No tripoding noted at this time.

2. Oxygen saturation is maintained at 94% with 2 liters of oxygen.

3. Patient agreed to use Purwick to avoid dropping oxygen levels with trips to the bathroom.

4. Patient used huff cough and flutter valve to expel thick, copious sputum.

5. White count is within range at this time.

Critical thinking = Good Clinical Judgement

By following the nursing process, you can refine your critical thinking abilities. You recognize the clues that are gathered in the assessment. You understand how the disease process can impact the patient's course in a clinical setting. Not only that, but you know the RIGHT measures to put in place to prevent or slow the progression. After the interventions were put into place, did they work? Did it not work? If it didn’t work, you ask yourself, what did I miss in my assessment? Reassess the patient.

Yes, it always looks easy on paper. But doesn’t this example mirror a testing format? Can you identify the interventions that were performed that you can perform within your scope (initial step or first action)? What was a priority for the patient (ABCs)? Which intervention directly correlated with patient safety (falls prevention, reducing oxygen demand)?

Using the nursing process will naturally help you think like a nurse and become a critical thinker.

Good clinical reasoning is a direct result of assessing the patient’s big picture and choosing the right action!