Critical thinking . . . schmritical thinking
The term gets tossed around so much in nursing education now that it has really lost all value. In fact, I think that rather than teaching students HOW to critically think . . . many schools are just using the word because they HAVE to.
This episode discusses what critical thinking is, what the cognitive levels of NCLEX questions are, and how to combine that knowledge to answer the questions AND be an amazing nurse.
Cognitive Levels of NCLEX Questions
The NCSBN who write the NCLEX exam uses Blooms Taxonomy to develop questions. Essentially Blooms Taxonomy is:
A continuum of increasing cognitive complexity—from remember to create.
As you can see from the image, it is made up of 6 cognitive levels that increase in complexity as you move “up” the pyramid.
In other words, it is much easier to remember a fact than it is too create a concept . . . from a cognitive standpoint.
If you learn that the normal lab value range for sodium is 135-145 . . . all you have to do is remember that fact to get a remember question right.
Pretty simple . . . however, if you are given a question about a patient with a deteriorating neuro status and are ask what the best action would be for this patient . . . would you be able to analyze the situation and determine that a sodium level needs to be checked?
The second question takes you to a much deeper level of understanding and requires you to actually APPLY the knowledge and ANALYZE previous knowledge to best care for the patient.
This is where you need to be hanging out. . . forget simply remembering facts . . . you need to be critically thinking about patient care in order to best care for patients.
In reality, I don’t give a damn if you can tell me a sodium level is low AFTER THE FACT . . . its a bit late by then. Can you recognize the signs of SIADH and prompt the physician to run a Na level before the patient starts declining neurologically due to hyponatremia . . . see where I went there . . . ? Can you see the difference in the two situations?
What is Critical Thinking?
So let’s talk about critical thinking and how it applies to everything we are talking about here.
The NCSBN website states the following:
Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.
Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.
Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!
There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.
4 Steps to Critical Thinking in Nursing
Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.
- Suspend ALL Judgement
- Collect ALL Information
- Balance ALL Information
- Make a Complete and Holistic Decision
You have to start by suspending all judgement. In other words, if you walk into a patients room and see them tachycardic and armature decision would be to run and grab the metoprolol to try to drop the heart rate.
An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .
Now you must collect ALL information. This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.
Now, balance all information. This means take all the data that you have and start weighing it to find out what is pertenant and what you can ignore. If the temp is 98.9 . . . it’s probably not the cause. If the BP is 74/56 are we looking at a volume issue?
Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.
Critical Thinking in Nursing and on the NCLEX®
Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .
Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!
A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?
42% of the students that have taken this question have selected this answer:
Administer IV fluid boluses to increase urinary output
The problem with that answer is that it is thinking at a REMEMBERING level when this question requires ANALYSIS level comprehension.
Test takers see urine output as low . . . and want to correct that quickly with fluids.
However, this is a CHFer . . . you can’t (shouldn’t) bolus your CHF patient especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.
So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.
And I promise you this helps in “REAL” life too . . . not just in nursing.
How to Develop Critical Thinking Skills
Here are two articles and websites that talk about the development of critical thinking that will help you get to the analysis level and feel more confident with NCLEX style questions and remain calm on the nursing floor.
And as always . . . check out our NursingPracticeQuestions.com site to take a few practice NCLEX questions.
Ok . . . enough from me. I want to hear your thoughts. What are you doing to improve your critical thinking skills?
Date Published - Jan 15, 2016
Date Modified - Jun 25, 2018