Critical Thinking in Contemporary Nursing Practice

Patient Case Care Study

Today’s nursing environment is in a constant state of change as Canada’s healthcare environments continue to become increasingly complex (Brunt, 2005). This increased complexity can be attributed in part to new technology becoming increasingly integrated into healthcare, the growing Canadian older adult population, and the financial limitations currently being experienced by healthcare system (Brunt, 2005). In order for nurses to continue to provide quality care to Canada’s diverse and aging population there must be an increased emphasis on the development and use of critical thinking skills in the nursing profession (Brunt, 2005). Critical thinking is the “ability to examine and reflect on an issue in an organized

Post-operatively she presented nauseated with stable vital signs and was placed on nothing by mouth status for remainder of the day which would be switched to thin fluids as tolerated after twelve hours. It was expected that Patient X would be discharged home after a few short days of observation to where she lives with her sister and is visited by a personal support worker every few days. However, Patient X began experiencing nausea and vomiting, producing around 50-100ml of black coffee grind emesis every two to three hours with acute episodes of shortness of breath. Initially this was attributed to blood that was left behind from the surgery but this continued five days post op, to the day where she became one of the patients under the writers care. On report it was communicated Patient X had 2/3 and 1/3 running at 100ml/hr, she was on two liters nasal prongs, and had not had a bowel movement in six days. The medications she had ordered daily were, sucralfate before each meal, beclomethasone q12h, ipratropium BID, metoclopramide QID, Nifedipine at bedtime, ondansetron TID, pantoprazole BID, risedronate weekly, Advair BID, sucralfate before meals and at bedtime, levodopa/carbidopa BID, and fesoterodine fumarate, which was on hold because she was unable to keep it down as a it is a by mouth medication. The as per needed medications she had ordered at shift

When caring for Patient X the first way I demonstrated critical thinking while providing her care was in response to her elevated respiration rate and her shortness of breath. During my assessment I demonstrate critical thinking by understanding that an elevated respiratory rate and increased shortness of breath put Patient X at risk for respiratory arrest and acid base imbalances (Lewis, Heitkemper, Dirksen, O’Brien, 2014). In response to this finding I stopped my assessment and questioned how can I decrease her respiratory rate? Based on my knowledge of the medications she had ordered I provided Patient X with one puff of her PRN salbutamol and two puffs of her am ipratropium and then re-evaluated her breathing before continuing on with my assessment. Situations like this which require judgment about timing and selection of the most appropriate medications indicate explicitly the ability of a nurse to demonstrate critical thinking and clinical judgement in direct relation to patient health status (Eisenhaur, Hurley & Dolan, 2007). I came to this decision based on my empirical knowledge concerning the pharmacology of both Atrovent and Ventolin as well as my knowledge of the respiratory system. I chose to give her both these medications in response to her respiratory distress.