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Critical thinking and patient assessments

Nurse Leader Weekly, August 2, 2007

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An important component of the assessment process is reassessment. After any intervention, it is paramount that a reassessment be performed. This formula of assessment-intervention-reassessment is a primary component of critical thinking.

The following examples demonstrate application of the concepts and approaches of critical thinking as it relates to patient assessment. Strategies and attributes of critical thinking during patient assessments include the following abilities:

Thinker:

• Identifies and initiates appropriate standing orders.

Evaluates evidence and facts:

• A patient states he did not receive any pain medication from the previous nurse. However, all records indicate that medication was delivered appropriately.

Evaluates policy:

• The nurse recognizes that although the physician has written an order that it is OK to use a new subclavian central catheter, no chest x-ray was done after catheter insertion. The physician is contacted to request a chest x-ray and have it read before the new catheter is utilized.

Confident in decisions:

• A physician challenges the nurse about a life-saving medication that was given while the patient was on transport for a procedure. The nurse refers the provider to the written protocols that were followed to come to the decision of administering these medications.

Effective communication:

• Communicates to other members of the healthcare team using a concise, organized process of verbalizing the situation, background, assessment, recommendations, and requests for further actions.
• Understands that no assumptions should be made.

Displays critical analysis:

• At the end of the shift, reviews patient outcomes and determines if delivered therapies or decisions were appropriate.

Editor's Note: This excerpt was adapted from the book Critical Thinking in the Intensive Care Unit, published by HCPro and written by Shelley Cohen, RN, BSN. For more information on this book (and others!), click here and be connected to HCPro's new online resource, www.StrategiesForNurseManagers.com.

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