Why is Critical Thinking Important?

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Answer

We can't talk about teamwork and patient care without discussing critical thinking. That is a big focus of respiratory and nursing schools everywhere. Critical thinking is using prevention and health promotion to avoid any problems. We look at the best way based on current evidence.

Thinking is a skill. Learning how to think critically requires knowledge, insight, experience, practice, and feedback. Not all of us are at the same skill level with critical thinking. Some of us are not as experienced and some of us don't have all of the knowledge yet. However, we are responsible to be knowledgeable of extremely sophisticated equipment and technology. We have to adapt to a constantly changing body of knowledge. It can't rest on one particular person for all of this knowledge so we're going to use our team and colleagues to help us in these types of situations. The AARC standards state that the patient-centered care process serves as a critical thinking model that promotes a competent level of care. Schools work very hard to help create this competence in their students.

With critical thinking, whether you're working with one colleague or multiple colleagues, make sure you have clear and precise questions that you want to be answered. Identify if you're assuming things that are not based on any type of objective data. Make sure that you have credible sources and resources. Hold your focus on what the situation at hand is. Deal with the complexities of the situation. For example, you could have multi-faceted deterioration of a patient, not just a respiratory issue that we have to deal with. When there are more than two people on your team, it is considered to be a multidisciplinary team. Withhold judgment against individuals as you are assessing. Together, we must analyze and come up with a conclusion and a next step forward.

Critical thinking is a mental activity. We're going to evaluate individual’s arguments, propositions, and judgments of the situation. That is going to guide beliefs and our decision-making. Critical thinking requires the ability to:

• Prioritize
• Anticipate
• Troubleshoot
• Communicate
• Negotiate
• Make decisions
• Reflect

Let's take a closer look at all of these facets of critical thinking.

Prioritize

To prioritize means to look at what is expected of you in one particular day and what could be unexpected. For example, think about your workload and patients and reflect on whether all of your patients need therapy. Can any of them have changes in frequency or modalities? You also want to prioritize any change in condition that they may have and any emergencies that come up. Think about new patients that may be in the queue.

Anticipate

We also want to be able to anticipate, which is thinking ahead to possible problems. For example, when we change the care plan, how is that patient going to respond? Are they going to respond in an expected way, or will they respond in an unexpected way? We need to be able to see the big picture. When we have new patients, we are going to need their history. We need to know what their current status is and what kind of tech we're going to need available. We'll want to develop questions for the provider on what we need to know about the patient.

Troubleshoot

Troubleshooting is usually related to equipment. We first need to detect and locate the problem. When we find that problem, what resources do we have available? Are there manuals we need to access? Is there something easy, such as online resources that we can access? Sometimes equipment has troubleshooting menus and responses embedded within them. We need to look at the error messages and we may need to even consult another RT or colleague who is more experienced with that particular piece of equipment.

Get those resources and be able to deal with the situation. It is also important to remain calm in front of the patient’s family and colleagues. Have a systematic approach to the malfunction and be prepared to do whatever it takes to keep that patient safe in that situation.

Communicate

We all need to communicate in ways that are the most comfortable for us, but be clear and convincing. Sometimes it's more challenging to be clear and convincing in chaotic situations. We may need to speak more loudly than usual. Try to use the name of the person to get their attention in a chaotic situation, have eye contact, and be sure that we communicate with them what our question is or if we're assigning them a particular role. We want them to acknowledge that they heard the question or that they are going to complete that role.

Share information and be able to explain what's happening clinically, from our perspective to the nurses and doctor. There could be patient data that's conflicting or some insufficient data, which could make it difficult to analyze and evaluate a patient properly. Communicate with the patient when it is appropriate and keep them up to date on their situation.

Negotiate

We negotiate when we don't have the sole power or authority to do what we believe is right and best for the patient. Discuss the situation with others and try to influence them. We might use a question to phrase a suggestion. For example, do you think it would be a good idea to do switch to high-flow oxygen? We also want to be sure that we listen to each other when negotiating.

Decision-Making

Decision-making is when we determine what judgment or course of action is next. You may be doing that as an individual or with a group, such as a multidisciplinary team. This is where you think about what is happening and what you are going to do.  If you are working with a multidisciplinary team, it’s important to ask questions of the team in decision-making.

Shared decision-making is a concept that includes the patient and the clinician who work together to decide what's best for the patient. That result would depend on what's needed, such as tests, treatments, and care plans. We want to balance the risks that the patient might undergo and any unexpected outcomes that might occur with any of these tests or treatments with patient preferences and values. Sometimes there are cultural differences to be thought about. For example, some individuals really trust the provider and want the provider to make all the decisions. Sometimes they don't want to participate, which is something to consider.

Reflect

Reflecting is when we look at ourselves inwardly and assess our opinions, assumptions, and any biases and decisions that we previously made. Think inwardly and learn from your problems and mistakes. Your ability to reflect is going to change over time and throughout your career. The best way that we can learn from our problems and our mistakes is to review the event with our team and debrief after it.

Next, utilize available resources. Gather intel from wherever we can get it. This includes staff members who consistently care for the patient, such as the primary nurse, RTs, other nurses, therapists, and nursing assistants. You can also gather information from physicians, nurse practitioners, PAs, and the entire response team.  Evidence-based practices are another important resource that is constantly evolving. The National Guideline Clearinghouse has listed over 2,700 clinical practice guidelines. Each year, the results of more than 25,000 new clinical trials are published. There is no single practitioner that can handle, absorb and use all of this information. The need for specific knowledge in certain areas of care by different team members has become a necessity.

This Ask the Expert is an edited excerpt from the course, link to course here - The Registered Nurse and Respiratory Therapist Alliance: Identifying and Assessing Acutely and Subtly Declining Patients, presented by Nancy Nathenson, RRT.