critical thinking in nursingAlmost any person can be taught how to complete most of the tasks of being a nurse: assessing blood pressure, inserting a Foley catheter, starting an IV, etc. However, being a competent nurse requires more than just mastering tasks. It requires the ability to think critically.

Acquiring excellent critical thinking skills is considered the “Holy Grail” of nursing. It takes into consideration nurses’ assessments, ability to recognize problems, interpret data, and anticipate appropriate interventions. Critical thinking involves the ability to connect the dots and respond appropriately to improve patient outcomes.

Can critical thinking skills be taught?

I’ve been a clinical instructor for many years and would often focus my teaching strategies on enhancing my students’ critical thinking skills. One method I found effective was to play the “What if” game. I developed this game after an experience I had when I started working on a neurosurgical step-down unit after 10 years of experience as a cardiac nurse.

During my shift, I rounded with the neurosurgeons and would always ask specific questions about each patient’s diagnosis and surgical procedure.  For example, if I were taking care of a patient with a pituitary tumor resection, I asked, “What is the most common complication for a patient having a pituitary tumor resected?” The surgeon replied, “Hemorrhage.”

I then asked, “How would I know if a patient was hemorrhaging?” The surgeon said that the patient would lose his/her visual fields. I then asked him what if that happened. He told me to page the attending immediately and get the patient to radiology for a stat head CT.

How did I use this information?

Nurses performed complex neuro assessments every two hours that took 15–20 minutes.  In the ideal world, we would have the time to do this. But in the real world, sometimes we would only have two minutes to do a quick down and dirty neuro exam.

If pressed for time, I would check visual fields first on my pit tumor patients, then come back later for the rest of the assessment. Why? Because I wanted to make sure that I assessed the patient for the most common complication after this type of surgery. I then started to apply that game to other diagnoses, surgeries, and medications.

Consider caring for a patient s/p knee replacement. Find out what the most common complications are (DVT, infection). Then ask what assessments would tell you that the patient might be having those complications (track temps, WBC count, calf swelling/tenderness, etc.). Ask yourself “what if” your patient started having these problems. What would you do?

Repeat this game with your patient population and encourage your colleagues to do the same.

Developing excellent critical thinking skills for nurses takes time, patience and a commitment to view our role beyond the tasks of being a nurse. The quintessential gifts nurses bring to the delivery of health care are the ability to assess, anticipate risk, and intervene appropriately. As Dag Hammarskjold said so eloquently, “Constant attention by a good nurse may be just as important as a major operation by a surgeon.”

How can you apply the 'What If" game to the benefit of your patients in your current practice?