Its January, its cold (not as cold as it could be) and class has started for the traditional setting and the online environment. This semester I continue as clinical instructor for the pediatric module at Holy Family doing our clinicals at a busy inner city pediatric hospital. I think as a faculty we well and truly overwhelmed these poor students the first two weeks of orientation, I know I had a headache by the end of it. Finally last Thursday at 6.30am sharp (I had been there a while by then.....yawn!) we were all on the floor, ready for assignments, implementing the nursing process, using evaluation and critical thinking skills like it was second nature, and oh yes....mastering the dreaded paperwork! It went well, again a lovely bunch of students, I already know I am going to enjoy them once they stop being so terrified and realize they know more than they think they do. But its good to be cautious in a new situation like this. We will work on and build skills as we go.
Comparing that with the online class I am teaching there is a world of difference and similarities with the two learning environments. I am in week 4 of teaching a community health class called Vulnerable Populations, the syllabus is excellent (thank goodness I did not have to write it), the readings are wonderful, engaging and up to date, the online environment is a nightmare to navigate. The first week I struggled to do such simple tasks as post my welcome letter, get to email, and grading papers gave me hives.....too many buttons to push. Everything has to be done within the online world, it has been a sharp learning curve but now we are in week 4 I feel I am just beginning to get the hang of it. I have already signed on to teach another class in February on Older Populations....it cant be that different from pediatrics ...right? That being said, a student is a student, these students have an electronic relationship with me but I still think given a little effort you can build a sense of community. I have tried to get involved with the discussion boards, answer questions and emails promptly and even put in that extra human-Angie touch. These students struggle like every other student with balancing work, family, school...been there...done that. Its hard, you give up a great deal, tv, a social life, food beyond frozen pizza. However, online education means you can plan and write papers, participate in group discussion at any time of the day or night. For example I graded papers this morning in my pajamas in bed while watching the Today Show.......that's a pretty good gig.
It is expensive with time though, I am online seven days a week, I am working as a community health nurse sometimes seven days a week. But thank goodness I have a job that I love and my sweet dog just lies by my feet and keeps me company!! Next week I am praying for snow (with no power cuts) so I don't have to go anywhere.
Monday, February 6, 2012
Wednesday, January 18, 2012
Dealing With The Difficult Patient
Amazing as it may sound not everyone is thrilled to see me when I knock on the door with my sunshine and promises of supernatural healing powers!! Some people are grumpy, angry, weepy, unresponsive, talk too much, talk too little. Some people have an agenda to get me in the middle of their family squabbles and of course pass judgement in their favor. Some people expect me to stay for dinner, walk the dog, do the laundry and clean the bathroom. Yep, I have been asked to do it all and seen so much dysfunction in the family group I almost think my family is normal (steady on, I said "almost).
I was once asked in an interview for a job how I dealt with difficult people and after I thought about it for a moment, I answered something like this.
I do not consider that I have difficult patients. I have patients that have baggage like most of us, maybe their baggage is more focused because of an acute illness or the exacerbation of a chronic one. People exhibit stress in so many different ways. The way a person manifests stressed maybe directed at me, the nurse, because I am supposed to be there to fix the problem and don't I have a resource list the size of a telephone book! I have learned to take a deep breath before answering and realize the negativity in the room is not about me and I should not take it personally. This person has a problem that needs solving, and we can brainstorm together. When I turn it around and show concern for a patients anxiety they usually calm down and we can discuss/identify the real problem at hand, be that financial, emotional, a pain response, a lack of acceptance of the health issue. But sometimes a person does not calm down, then its time for a time out and I try and leave to protect everyone.
When I am in a patients house, carrying out care I tend to be chatty, some may say overly chatty! I like to ask a lot of questions, why? because fact finding is a safety tool to find out more of a persons health status. But I also ask lots of questions because I think peoples stories are just so interesting. In the medicare population I serve I have met a survivor from Auschwitz, a lady (now 90) who immigrated on her own from Italy when she was 16, WW2 veterans and more recently veterans from Iraq and Afghanistan wars. These boys are just a little older than my oldest son so the maternal feelings kick in very strongly. One young man I a seeing right now, several times a week for wound care needs can be pleasant and sociable and then the next day can be as dark as a black hole, PTSD is a terrible thing.
Unfortunately, not everyone wants chatty Kathy in their ear when I am doing wound care or checking a BP, I have learned to be quiet when I need to. Quietness can be an important therapeutic tool when dealing with "difficult patients". It gives a person control of what to say and when. Its hard as heck for me to shut up sometimes but it is valuable to hear what comes back.
Now, if I could just learn to do that at home!!!!!
I was once asked in an interview for a job how I dealt with difficult people and after I thought about it for a moment, I answered something like this.
I do not consider that I have difficult patients. I have patients that have baggage like most of us, maybe their baggage is more focused because of an acute illness or the exacerbation of a chronic one. People exhibit stress in so many different ways. The way a person manifests stressed maybe directed at me, the nurse, because I am supposed to be there to fix the problem and don't I have a resource list the size of a telephone book! I have learned to take a deep breath before answering and realize the negativity in the room is not about me and I should not take it personally. This person has a problem that needs solving, and we can brainstorm together. When I turn it around and show concern for a patients anxiety they usually calm down and we can discuss/identify the real problem at hand, be that financial, emotional, a pain response, a lack of acceptance of the health issue. But sometimes a person does not calm down, then its time for a time out and I try and leave to protect everyone.
When I am in a patients house, carrying out care I tend to be chatty, some may say overly chatty! I like to ask a lot of questions, why? because fact finding is a safety tool to find out more of a persons health status. But I also ask lots of questions because I think peoples stories are just so interesting. In the medicare population I serve I have met a survivor from Auschwitz, a lady (now 90) who immigrated on her own from Italy when she was 16, WW2 veterans and more recently veterans from Iraq and Afghanistan wars. These boys are just a little older than my oldest son so the maternal feelings kick in very strongly. One young man I a seeing right now, several times a week for wound care needs can be pleasant and sociable and then the next day can be as dark as a black hole, PTSD is a terrible thing.
Unfortunately, not everyone wants chatty Kathy in their ear when I am doing wound care or checking a BP, I have learned to be quiet when I need to. Quietness can be an important therapeutic tool when dealing with "difficult patients". It gives a person control of what to say and when. Its hard as heck for me to shut up sometimes but it is valuable to hear what comes back.
Now, if I could just learn to do that at home!!!!!
Wednesday, December 28, 2011
The Need For Boundaries
So after stating how passionate I am about community nursing I have had a particularly challenging couple of weeks where I had to modify my personal code for nursing. This code includes all people regardless of age, socio economic status or sexual orientation not only deserve health care they deserve easy access to excellent health care. This has led me into situations of great poverty, some questionable safe environments that I would never tell my family about (my husband would never sleep again) but I am reassured by the fact that whatever the situation that person needed nursing in that moment.
So, the week before Christmas I was asked to admit a patient whose only insurance was from the Veterans Affairs Dept, lived in poverty, had limited family support but needed nursing services and possibly physical therapy. Well the place was filthy and the patient was elderly but no bugs (I hate bugs!). Mild dementia was apparent and during the course of my interview, due to the patients past work experience in security I felt led to ask the question "Any firearms in the house?" To which the patient replied, "Oh yes, plenty and they are all loaded and ready". Aahh, dilemma, elderly gentleman, not completely orientated on a good day with the ability to blow my brains out. This was a no brainer, I quickly said my good byes and backed out of the house keeping my eyes on his hands. But I was conflicted, not being able to put myself and other members of the team in his household was/is a deficit to this mans well being. Long chat with the family later, explained if the firearms are removed I would surely return....still waiting to hear A man and his gun are not easily parted.
Second scenario, a patient who I have had on my caseload for over a year, a non-compliant chain smoking COPD patient on O2 (always a good combination). Basically lonely and due to his, lets say, less than pleasant disposition has alienated most of his family. No problem for me, he's not my father, brother, uncle and so have always been able to separate myself from his caustic tongue and tried to give him a bit more company and conversation when I had the opportunity. However, over the last several months, maybe due to early dementia or hypoxia or both his conversation has become very sexually inappropriate not only to me but to other members of the team. I tried subtle hints of acceptable behavior which led to a full blown come-to-Jesus conversation of what he was and was not allowed to talk about. All of this did no good, but my attachment to him and my need to come through for him kept me there. But our therapeutic relationship continued to deteriorate. The past couple of weeks he has been incredibly well, chest clear, down to smoking one cigarette a day and almost normal pulse ox readings. I leapt at the chance and discharged him! Aah dilemma, I am no longer providing services to an individual with a chronic illness where I have had the ability to identify problems early enough to avoid several hospital admissions and there were no bugs so surely, how bad could it be!!!
Third scenario, another veteran (getting a lot of those, love them). Recently discharged after a lengthy stay in the VA for severe abscess that still would require long term wound care. I arrived at the house to perform the admission and the first thing I noticed was cockroaches and not just a few, I have never seen an infestation this bad, they were almost swarming in the house, crawling all over me and over every surface (did I mention I hate bugs!). Sterile, clean procedure.....forget it, just do the best you can. Family seemed oblivious to the infestation and accompanying hoarding (really ever played Marco Polo in someones house to find them!!). Of course I reported to the VA Social Work department and every other agency I could think of, may take them a while to respond. In the meantime, this guy, who I quite liked and had empathy for still needed wound care 3 times a week. So at the next visit I explained I could not come in the house but still wanted to help him (really had nightmares for nights of cockroaches crawling all over me!). So we came to an arrangement, he would come out on the porch and I would do his wound care without coming in the house. Its December....its freezing, so I wrap him up in blankets, expose the appropriate body part, do the care as quickly/safely as I can. I spend the time apologizing why I am making him sit outside in the cold, he spends the time apologizing for the state of his house, its mutual purgatory. Dilemma, I feel terrible making this poor man who has multiple chronic medical issues, including PTSD but I do not want to bring any friends along for the ride to another patient or to my own house.
So, even though I have this personal creed that all peoples deserve the best care at anytime, I have to constantly amend my own code of ethics to do the greatest good for the greatest number of people. Yep, I love community nursing, but I also love wearing clothes you can boil and the right/need to walk away when I absolutely feel I have to.
So, the week before Christmas I was asked to admit a patient whose only insurance was from the Veterans Affairs Dept, lived in poverty, had limited family support but needed nursing services and possibly physical therapy. Well the place was filthy and the patient was elderly but no bugs (I hate bugs!). Mild dementia was apparent and during the course of my interview, due to the patients past work experience in security I felt led to ask the question "Any firearms in the house?" To which the patient replied, "Oh yes, plenty and they are all loaded and ready". Aahh, dilemma, elderly gentleman, not completely orientated on a good day with the ability to blow my brains out. This was a no brainer, I quickly said my good byes and backed out of the house keeping my eyes on his hands. But I was conflicted, not being able to put myself and other members of the team in his household was/is a deficit to this mans well being. Long chat with the family later, explained if the firearms are removed I would surely return....still waiting to hear A man and his gun are not easily parted.
Second scenario, a patient who I have had on my caseload for over a year, a non-compliant chain smoking COPD patient on O2 (always a good combination). Basically lonely and due to his, lets say, less than pleasant disposition has alienated most of his family. No problem for me, he's not my father, brother, uncle and so have always been able to separate myself from his caustic tongue and tried to give him a bit more company and conversation when I had the opportunity. However, over the last several months, maybe due to early dementia or hypoxia or both his conversation has become very sexually inappropriate not only to me but to other members of the team. I tried subtle hints of acceptable behavior which led to a full blown come-to-Jesus conversation of what he was and was not allowed to talk about. All of this did no good, but my attachment to him and my need to come through for him kept me there. But our therapeutic relationship continued to deteriorate. The past couple of weeks he has been incredibly well, chest clear, down to smoking one cigarette a day and almost normal pulse ox readings. I leapt at the chance and discharged him! Aah dilemma, I am no longer providing services to an individual with a chronic illness where I have had the ability to identify problems early enough to avoid several hospital admissions and there were no bugs so surely, how bad could it be!!!
Third scenario, another veteran (getting a lot of those, love them). Recently discharged after a lengthy stay in the VA for severe abscess that still would require long term wound care. I arrived at the house to perform the admission and the first thing I noticed was cockroaches and not just a few, I have never seen an infestation this bad, they were almost swarming in the house, crawling all over me and over every surface (did I mention I hate bugs!). Sterile, clean procedure.....forget it, just do the best you can. Family seemed oblivious to the infestation and accompanying hoarding (really ever played Marco Polo in someones house to find them!!). Of course I reported to the VA Social Work department and every other agency I could think of, may take them a while to respond. In the meantime, this guy, who I quite liked and had empathy for still needed wound care 3 times a week. So at the next visit I explained I could not come in the house but still wanted to help him (really had nightmares for nights of cockroaches crawling all over me!). So we came to an arrangement, he would come out on the porch and I would do his wound care without coming in the house. Its December....its freezing, so I wrap him up in blankets, expose the appropriate body part, do the care as quickly/safely as I can. I spend the time apologizing why I am making him sit outside in the cold, he spends the time apologizing for the state of his house, its mutual purgatory. Dilemma, I feel terrible making this poor man who has multiple chronic medical issues, including PTSD but I do not want to bring any friends along for the ride to another patient or to my own house.
So, even though I have this personal creed that all peoples deserve the best care at anytime, I have to constantly amend my own code of ethics to do the greatest good for the greatest number of people. Yep, I love community nursing, but I also love wearing clothes you can boil and the right/need to walk away when I absolutely feel I have to.
Thursday, December 15, 2011
The Nurse as an Entrepeneur
So, final exams and evaluations are done, wrapped up with a final faculty meeting where we discussed what worked well and what was a struggle, it was a great semester. Somehow, I was blessed with a great bunch of students who I truly enjoyed, I am grateful. Quick 6 week turn around until the spring semester starts, what will I do with myself for all that time, you may ask. Throw myself into my other job!!
I work for myself as an independent contractor as a community nurse. I have worked in the community for over 12 years, been a slave to someone elses schedule, been owned by companies that wanted to send me where ever they chose. After a stint of stepping away from community nursing and taking a management job in hospital I realized it was not for me, I thrive on patient contact and yearned to get back into the community but wanted to do it in a different way.
With the help of my husband I set up my own company. We have 3 children we are supporting through college so the name of the company was a no-brainer, TFT, or "Tuition for Three " because that is ultimately the main reason why I am working sooo hard at this point in my life. I committed to give it 6 months to be successful and then I would go and look for a "real job". Well within 7 days my schedule was full and has not slowed down since, apparently there are a lot of sick people out there and they need services. The advantages of channeling my pay through my own company is the tax benefits, even so much as a soda or a ball point pen can be claimed, and especially that all expensive mileage! I have control of my schedule, but I am usually so worried about a pipeline of work I often work 7 days a week. But I do get to take time off and my boss (me!) usually gives it to me, as an example this year I have accompanied my husband on his business trips to San Diego, Salzburg and Orlando, a welcome break in the chaos of life. The downside of running your own business, doing the monthly spreadsheets. keeping track of all those pesky receipts, no vacation or sick pay. But without doubt I am happier and more fulfilled being my own boss than I ever have been in my nursing career.
And, I love love love community nursing, it has become a passion and a ministry. Nursing one person at a time is a luxury many hospital clinicians do not experience on a daily basis. When I am in a persons home I am there for them and their family without distraction for as long as it takes. I have an abundance of varied cases at differing acuity levels and no two days are the same. Serving a mainly medicare population one day I may have several catheterizations, wound care and BP checks, another day it may be diabetic education, palliative care support and pain control. As an independent contractor in the community it can be very isolating so communication is even more essential, with the primary care provider, other members of the team (Physical/Occupational Therapy, Social Work etc) to ensure effective and safe case management.
It has been a very busy week, kind of nice not to have a split personality of community nurse and clinical instructor but as I look forward to Christmas and the children coming home from University I am sooo grateful I am doing something that I love so much and have some measure of control over my daily destiny.
I work for myself as an independent contractor as a community nurse. I have worked in the community for over 12 years, been a slave to someone elses schedule, been owned by companies that wanted to send me where ever they chose. After a stint of stepping away from community nursing and taking a management job in hospital I realized it was not for me, I thrive on patient contact and yearned to get back into the community but wanted to do it in a different way.
With the help of my husband I set up my own company. We have 3 children we are supporting through college so the name of the company was a no-brainer, TFT, or "Tuition for Three " because that is ultimately the main reason why I am working sooo hard at this point in my life. I committed to give it 6 months to be successful and then I would go and look for a "real job". Well within 7 days my schedule was full and has not slowed down since, apparently there are a lot of sick people out there and they need services. The advantages of channeling my pay through my own company is the tax benefits, even so much as a soda or a ball point pen can be claimed, and especially that all expensive mileage! I have control of my schedule, but I am usually so worried about a pipeline of work I often work 7 days a week. But I do get to take time off and my boss (me!) usually gives it to me, as an example this year I have accompanied my husband on his business trips to San Diego, Salzburg and Orlando, a welcome break in the chaos of life. The downside of running your own business, doing the monthly spreadsheets. keeping track of all those pesky receipts, no vacation or sick pay. But without doubt I am happier and more fulfilled being my own boss than I ever have been in my nursing career.
And, I love love love community nursing, it has become a passion and a ministry. Nursing one person at a time is a luxury many hospital clinicians do not experience on a daily basis. When I am in a persons home I am there for them and their family without distraction for as long as it takes. I have an abundance of varied cases at differing acuity levels and no two days are the same. Serving a mainly medicare population one day I may have several catheterizations, wound care and BP checks, another day it may be diabetic education, palliative care support and pain control. As an independent contractor in the community it can be very isolating so communication is even more essential, with the primary care provider, other members of the team (Physical/Occupational Therapy, Social Work etc) to ensure effective and safe case management.
It has been a very busy week, kind of nice not to have a split personality of community nurse and clinical instructor but as I look forward to Christmas and the children coming home from University I am sooo grateful I am doing something that I love so much and have some measure of control over my daily destiny.
Friday, December 2, 2011
The Other Side of The Bed
So this was the week where I became the patient and not the clinician. Started off with a virus (which I ignored, nurses are good at this) which developed into a UTI (sucks to be a woman sometimes) which developed into Pylonephritis, yikes how did that happen. Well as soon as I realized I had UTI called my primary who put me on Cipro, me thinks "Cipro never works for me but too sick to argue with him" Guess what, 48 hours later I am worse so go to my doc again who throws his hands up and says, you are too sick, go to the ER..........I hate the ER!! I hate the waiting, I hate going over the story again just give me some Bactrim, let me crawl back to bed and I will be fine.
Predictably the ER was horrifically busy, I knew it was not going to get any better when the Helicopter landed bringing in a patient in life threatening condition. An hour into my wait the triage nurse called me in. Despite being very sick I tried very hard to engage her with my incredible humor and huge personality.......no eye contact, not one iota of warmth from her cold detached manner. Maybe she was having a bad day, maybe she was really tired but does any of that matter to the one patient (not necessarily me) sitting in front of her. Two hours and a pee pot (full of you know what) later I left with my script for Bactrim. Two days later still feeling like death, when the hospital called me saying the urine culture had come back with a particular nasty resistant bug and would I like to start another antibiotic before we resort to IV medication because I now had pylonephritis!!! Well now Friday, I do finally feel better but a bit of a washed out, over cooked wet noodle. Good for nothing. But of course have been musing the experience all week as all I could do was lie in bed and play on my Ipad and watch way too much daytime TV. Here are my thoughts.
- Its OK for us to speak up for ourselves and our patients when we are not sure the right treatment is being prescribed, not sure I would have got better on Bactrim as the front line drug but I kick myself that I settled because I did not feel great. We must learn to put advocate in our vocabulary.
- Therapeutic touch and communication are as important as taking an accurate set of vitals. Eye contact is a must, listening is essential. If we do not develop these skills in ourselves and future nurses it shuts down communication which means we as nurses may not get essential information which could be a huge safety issue.
- I am sooooo grateful my husband was in town (he should have been in Chicago but trip got cancelled) and he unexpectedly showed up in the ER even though I told him not to with a cup of tea and a smile in hand!!!!!
Thursday, November 24, 2011
Guest Blogger Day - Allow Natural Death?
Let me introduce to you a dear friend, Karen Brombley, Kal to those who know her well. We met many years ago when she moved into my neighborhood and it has been one of those precious and sustaining friendships. We had our first babies together, now those babies are 22 and have 19 year old siblings. Kal works as Nurse Consultant for Children and Young People's Palliative Care,
currently working on Masters in Clinical Leadership in Palliative Care. She has been a children's Nurse for 25 years, the last 14 of which have
been in the community. Her piece is part of a very topical and important debate, end of life issues. I often think there are worse things than dying when I see my patient caseload. Thanks so much Kal, for joining the conversation.
Allow Natural Death?
I work in Paediatric Palliative Care and,
as you can imagine, one of the most debated issue is that of DNR/DNAR/DNAPCR
(there seems to be no limit to the permutations of the initials that can be
used). Basically, to resuscitate or not?
Part of my job, as well supporting children
and their families through this process, is to support the teams that are
looking after them. Many struggle with this decision, and I try and help them.
How? I believe it’s about understanding the
disease progression that the child is suffering from. Understanding that the
medical consensus is that the child has reached the point in their life when
their death is fast approaching, and nothing will prevent this. Because
resuscitating a child at this point is futile, and at worst results in them
being intubated on intensive care, having to have treatment withdrawn. This is
not a good way to die.
Obviously the most significant
conversations are with the child and their parents. I believe that it is our
job to work with them, enable them to somehow come to terms with what is
happening. They are the only people who will live with these decisions for the
rest of their lives. We, the professionals, will remember them occasionally;
some children will impact us more than others. But for those parents it’s every
day. And we need to enable them to walk the tightrope of choices about care,
ensuring that what is right for the child is not lost in the sea of their parents’
grief.
So once such a decision is made it is vital
that everyone supports it. Which brings me to lots and lots of teaching
sessions, workshops, meetings, working through the issues.
Which is where ‘allow natural death’ comes
in. It’s an alternative phrase, rarely used outside of hospices. It’s a very
powerful phrase, it changes the perspective from something negative, that
implies a denial of something the child is entitled to, to something positive,
something natural. It can transform a person’s view, I’ve literally seen that
light bulb moment in people when they see that this time can be seen another
way. That death is part of a natural process, and sometimes it is right and
proper that we leave nature alone.
Sunday, November 20, 2011
Millenials in the Clinical Environment
Critical thinking in the millennial generation is something I have been thinking about all year. I happen to really enjoy millenials. Maybe its because I have three of my own, but they are a multi-tasking, multi-media get to the point generation. But, even though they have grown up with social media I still find they yearn for face to face relationship, sometimes they are not always sure how to fill that need. They are a generation -that energize me with their I-can-do-anything-I-put -my-mind-to attitude, we can't blame them, after all we raised them that way. And so to critical thinking, an important part of nursing. How does it compare between the generations? Are baby boomers more adept at higher level critical thinking than the millennial generation or is it the other way around?
Critical thinking in nursing is essential, you may even say it is critical! It is knowing the next step to do, think, ask intuitively, through experience and evidence presented at the moment. Critical thinking involves all of the senses and requires a maturity in verbal and non-verbal communication skills. Critical thinking is becoming a growing area of concern in nurse education and nursing practice. Gone are the days when nurses are called to be the physicians handmaidens, we are independent, thinking, breathing practitioners in our right, with a license and accountability to prove it!
Some of my students, the older ones, with more life experience seem to have better critical thinking skills, they almost know by osmosis they need to take the next step, sometimes nervous to go there, but just need a bit of coaching to make the leap. Other students, I have noticed, are very weak in their critical thinking skills, it is stopping them from being an OK, barely safe practitioner to an outstanding one. So, with information from my reading and a seminar I recently attended I have been trying to figure out is it osmosis or I'm-out-of-breath-with-trying, hard work that creates, promotes a clinician with excellent critical thinking skill? It is a make or break characteristic in nursing practice, worth the effort to dig deeper and see if I can take these students to the next step, taking the leap by themselves, connecting the dots, thinking the questions to ask in the first place.
To date I have been trying to be very clear with my expectations, pointing out (softly) where there are deficits in critical thinking skills and how they can turn that around, using role play and humor seem to help them feel less threatened. I am not convinced it can be taught to every student but I certainly think that most students get it.
I need to do some more exercises with the students to exaggerate my point, illuminate to them clearly when they have it and when they don't and build on these skills. If anyone has any tips, please share!! One of the things I am realizing with millenials is it is not good talking in code or implying with these students (so often my British humor gets lost in translation!!), you have to be concrete, clear, black and white, there is very little grey in their lives......there is sooooo much grey in nursing! Is this a good thing or not, its great and simple to think in black and white but sometimes there is fun, knowledge, insight and yes, danger in the grey.
Look for some guest bloggers coming up over the next few weeks. I have a very rich network of nursing peers and I am eager to hear their point of view on the burning issue du jour.
Happy Thanksgiving to all of you who celebrate, and to those of you who don't!!!!!
Critical thinking in nursing is essential, you may even say it is critical! It is knowing the next step to do, think, ask intuitively, through experience and evidence presented at the moment. Critical thinking involves all of the senses and requires a maturity in verbal and non-verbal communication skills. Critical thinking is becoming a growing area of concern in nurse education and nursing practice. Gone are the days when nurses are called to be the physicians handmaidens, we are independent, thinking, breathing practitioners in our right, with a license and accountability to prove it!
Some of my students, the older ones, with more life experience seem to have better critical thinking skills, they almost know by osmosis they need to take the next step, sometimes nervous to go there, but just need a bit of coaching to make the leap. Other students, I have noticed, are very weak in their critical thinking skills, it is stopping them from being an OK, barely safe practitioner to an outstanding one. So, with information from my reading and a seminar I recently attended I have been trying to figure out is it osmosis or I'm-out-of-breath-with-trying, hard work that creates, promotes a clinician with excellent critical thinking skill? It is a make or break characteristic in nursing practice, worth the effort to dig deeper and see if I can take these students to the next step, taking the leap by themselves, connecting the dots, thinking the questions to ask in the first place.
To date I have been trying to be very clear with my expectations, pointing out (softly) where there are deficits in critical thinking skills and how they can turn that around, using role play and humor seem to help them feel less threatened. I am not convinced it can be taught to every student but I certainly think that most students get it.
I need to do some more exercises with the students to exaggerate my point, illuminate to them clearly when they have it and when they don't and build on these skills. If anyone has any tips, please share!! One of the things I am realizing with millenials is it is not good talking in code or implying with these students (so often my British humor gets lost in translation!!), you have to be concrete, clear, black and white, there is very little grey in their lives......there is sooooo much grey in nursing! Is this a good thing or not, its great and simple to think in black and white but sometimes there is fun, knowledge, insight and yes, danger in the grey.
Look for some guest bloggers coming up over the next few weeks. I have a very rich network of nursing peers and I am eager to hear their point of view on the burning issue du jour.
Happy Thanksgiving to all of you who celebrate, and to those of you who don't!!!!!
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