In this post I wanted to reflect on a time when my critical thinking and reasoning on a patient’s condition and the outcome did not go quiet as I planned. The patient was in the ICU for respiratory distress and pneumonia and the care we were giving was mainly about treating her pneumonia with antibiotics and having her on a bipap to help her lungs. The first signs that I noticed something was changing was when I took a look at her EKG monitor and noticed suddenly that the heart rhythm wasn’t in sinus rhythm anymore. That was my first clue. The second was her skin was becoming flushed and her orientation was changing. At this point, all I kept thinking was this is not good and if her heart rhythm keeps changing I will soon be coding this patient. I remember feeling a rush of adrenaline, talking with my orienter about my thoughts and having her give me her second opinion on my thought process. We were able to get the doctors to come see her and were able to shock her heart rhythm back to sinus. I thought that the situation could be going for the worst, I did not expect this to happen when her condition did not indicate she would be having heart issues as well. The assessment skills that I used were looking at her EKG, monitoring her blood pressure every 5 minutes and making sure someone was keeping an eye on the patient the whole time. The biggest assessment skill I used was being able to know the difference from a normal heart rhythm and one that could be leading to a fatal condition. The biggest thing that I learned from this experience was that you always need to think ahead, and that those basic skills we learned about assessing a patient and being able to identify when something is wrong is so important in being able to detect a problem before it hits the fan. This experience has helped me to be on my toes for signs others than what the patient’s condition is.
Lastly, I wanted to reflect on a assignment that I had to use my critical thinking and assessment skills as well as seeing what my other classmates also had to say. The assignment helped me see that there is more than just the obvious. I did not think about the mental health aspect of the patient in the case study and so reading what my other classmate had to say about the mental health of the patient. That is something that I need to work on with my patients and making sure that I assess the patient’s mental health and to make sure I know what resources are available in the hospital I work at.
What does critical thinking mean to me? Through my education and my experiences I think that critical thinking is when you apply that education and experiences and not just think in the present but also think about past events and what could happen because of these actions. I think reasoning and thinking about all aspects of a situation are keys to critical thinking. I also believe that critical thinking is not exactly something someone can teach you about and suddenly you are an expert at it. I believe it takes practice and having a mentor help guide your thinking.
An example of my own person experience with critical thinking is actually today at work. I am currently orientation on an ICU unit and we came on shift being told to hurry to our patients because one of them was on the verge of crashing. When we got to the patients, I realized the one that was declining was a patient who was completely coherent and was alert, non-sedated and was suctioning himself just the day before. We received report and as we watched our monitors to see what happened next, I asked myself what will I do if in the next 30 seconds this patient crashed. What do I need to do to be ready for the worst and what can I do to help decrease the patient from getting to that point. Long story short, we called the physicians and got an order for a specialty bed to help the patient breath better but during this time I had to turn up the patients sedation because coughing needed to be a minimum. Propofol can decrease a persons blood pressure so in preparation for that I consulted with the physician about getting a vasopressor on board to help keep his blood pressure up while we try and keep the patient sedated enough to prevent coughing. This I think is an example of critical thinking, I had to think ahead in the situation and know what propofol can do to blood pressure which could’ve led to my patient crashing if I did not get something else on board.
While I think about critical thinking in nursing practice, I realize that the best nurses are the ones that critically think. We are in a profession that the condition of our patients can change from one moment to another because of our actions. If we are not vigilant and always thinking about what can happen, what we are doing, and what we will do if something goes wrong we can easily hurt a person. I think what interests me the most is that by each experience and by talking with others and asking what others think is most important with this patient we can help build our critically thinking skills. I love that I am in a profession where I have to think about so much and a profession that is evolving all the time.
Hello Everyone! My name is Daniela, I recently graduated from nursing school and am beginning a job as a nurse. I am the youngest of three, I have two older brothers. I went into nursing to help people through some of their hardest times in life and I am looking forward to going through this new journey. I am beginning my bachelors program and that is why I have this blog. I am going to use this blog to post reflective journals and be able to think through and process my thoughts regarding certain topics for you to read. The purpose of this reflective post is to give you an introduction of who I am and why I am posting these reflective journals.