Nursing Notes

July 30, 2010

Facilitating Critical Thinking in New Nurses

Filed under: Nursing — Shirley @ 5:44 am
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Here is another informative article from HealthLeadersMedia.com.  This article is about helping new nurses develop critical thinking skills, something every nurse must rely on to navigate the healthcare systems safely–both for the patient as well as for the nurse.

Read this article and let me know what you think about it, won’t you?

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Excerpted from Briefings on Evidence-Based Staff Development, an HCPro publication, July 27, 2010

This article was adapted from one that originally appeared in the August 2010 issue of Briefings on Evidence-Based Staff Development, an HCPro publication.

Critical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes (Foundation for Critical Thinking, 2010). It is a skill that evolves over time and with experience.

Nurses beginning their first jobs after graduation need help developing critical thinking skills. Pamela Schubert Bob, MHA, RN, CPN, NE-BC, nurse manager at Children’s Hospital Boston, wanted to help facilitate critical thinking in new, or as she refers to them, “novice” nurses.

“I overheard one of my nurses tell a doctor, ‘I don’t know anything about that because I wasn’t here yesterday,’ ” said Schubert Bob. “I cringed because this was an unacceptable response. I felt that younger, newer staff weren’t seeing the big picture. They were looking at taking care of patients for a shift, instead of taking care of a patient as a whole.”

“I wanted to create an environment in which it was okay for the staff to ask and answer critical thinking questions,” she says. “So I started to create this environment quite informally.”

Creating a critical thinking program

Schubert Bob began by approaching a newly hired nurse whose patient had a history of seizures. “I asked her what she would do if her patient had a seizure. She wasn’t sure how to respond. We worked through things like what equipment should be at the bedside, what actions to take during a seizure, etc. At the end of those five minutes she felt much more confident.”

Schubert Bob continued these informal critical thinking exercises. After each report, she would interact with new nurses, asking critical thinking questions and sometimes using worst-case scenarios as a starting point.

The impact on nurses’ critical thinking skills was almost immediate. To help with mentoring, she developed a critical thinking program that relied on the expertise of available senior nursing staff. These experienced nurses were trained to interact on a one-to-one basis with new nurses in five-minute sessions.

Training nurses to stimulate others’ critical thinking skills

Schubert Bob points out that “not every experienced nurse can mentor and teach others. You really have to want to do it.” Most staff nurses “jumped at the chance,” she says. Schubert Bob provided the initial training, which consisted of a didactic component that included an explanation of critical thinking and its importance to nursing practice, the kinds of questions to ask new nurses for the purpose of improving critical thinking, and how to formulate and ask open-ended questions such as the following:

  • What is the worst-case scenario for your patient?
  • What are your plans for patient education?
  • How will your documentation help your peers to maintain continuity of care? (Schubert Bob, 2009)

These critical thinking sessions were designed to take about five minutes. After training, each senior nurse listened to a critical thinking session between a new nurse and Schubert Bob or another trained facilitator.

“Regular sessions for questions, direction, and support were offered until the senior nurses were comfortable facilitating critical thinking sessions,” says Schubert Bob.

The program in action

Once the program started, either senior or new nurses could initiate sessions. A list of trained critical thinking mentors was posted so new nurses could easily approach trained facilitators.

Both new and experienced nurses felt that this program improved critical thinking skills. In fact, additional tools were developed to facilitate critical thinking among all levels of staff. These included:

  • Bulletin boards. Case study scenarios were presented that offered opportunities for feedback and identification of best possible solutions to patient problems.
  • Independent study folders. Three-page folders were created that explained the critical thinking project, discussed what critical thinking is, and how all staff could be part of the critical thinking process.

Schubert Bob and her staff were able to initiate a critical thinking program that takes only five minutes to implement. Their efforts serve as a good example of education that is cost-effective and efficient.

References

Foundation for Critical Thinking (2010). “Defining Critical Thinking.” Accessed June 25, 2010, here. Schubert Bob, P. (2009). “Critical-Thinking Program for the Novice Nurse.” Journal for Nurses in Staff Development 25 (6): 292?298.

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