Critical thinking and the student nurse

Nursing schools love to talk about “teaching critical thinking.” Entire books have been written about the subject. How do we teach our future nurse to think critically about their patients and what’s going on with them?

The problem is that most of these academics have no idea what they're talking about.

I work with nursing students practically every day and I see what they’re being taught by their classroom instructors. I also remember what I was taught in school. We teach students to complete head-to-toe physical assessments on all of their patients, yet we don’t teach them what to do with all that information they collect. I understand the need to learn the art of doing a head-to-toe; that’s important. However, where’s the piece where we teach nurses to first look at the patient and then think about what information they REALLY need to collect.

Example: You have a 22 year old male in following surgery on his knee. He has no medical history to speak of and is in perfect health, save the knee injury that put him in the hospital to begin with. Now why would it be important to listen to his bowel tones in all four quadrants? Couldn’t we illicit the needed information simply by asking the patient, “have you passed any gas since surgery?”

A few months ago, I was watching a nursing student completing an assessment. They palpated pedal pulses, listened to bowel tones, and auscultated heart sounds on a women in her 40’s with hand cellulitis. When we left the room I asked, “now what are you planning on doing with all that information you just collected?”

The student paused for a moment, deep in thought.

“Chart it, I guess.”

Sadly, that is what many nursing school graduates think is important about their assessments: collect the data and chart it.

If that student had first thought about what information really needed to be collected prior to going into the room, their assessment would have yielded much more useful information in a much easier fashion. Is the cellulitis improving? What does the hand look like? How’s their pain? Their receiving a bit of narcotics for that pain, so how is their bowel functioning? When was their last bowel movement? All of this information is gathered without ever having to palpate a pedal pulse or listen to a bowel tone.

In order to create successful nurses, schools need to begin teaching their students TRUE critical thinking skills. Don’t just talk about it, really teach it. Teach students to think about the information they gather and why it’s important. If data isn’t important in a particular situation, then don’t gather it. Believe it or not, you don’t have to listen to everyone’s heart and lung sounds!

Teaching students to be information gathering robots isn’t good for nursing and doesn’t create successful nurses. And after all, isn’t that what we want to do?