Use Critical Thinking: It takes Only a Second for an Error to Occur
Submitted by Maureen Kroning, RN EdD
Written by Maureen Kroning RN EdD and Lauren Lebo, BSN Student, Nyack College, NY
Working in an acute care hospital, provides many opportunities for learning. As healthcare workers, we must recognize and confront situations that put our patients at risk for harm. A recent situation occurred in the hospital that did provide an opportunity for learning and the need for an action plan.
The other day while working in the hospital, a very sick ventilated patient was wheeled past me on a stretcher accompanied by both a respiratory therapist and a nurse's aide. The patient was being brought back to his room after having an electroencephalogram (EEG) performed in the EEG lab on the first floor of the hospital. An EEG is a test used to measure and record the brain's electrical activity (WebMD).
I took a second look as the patient was wheeled past me and thought, something is wrong with this situation.
At this point in the article, I hope you are asking yourself, what is wrong with this situation? If you are asking yourself this, then you are using an essential step in critical thinking. Assessing is a vital step in utilizing critical thinking. As I assessed the situation, I asked myself the following questions:
- Where was the nurse from the EEG lab?
- Wasn't a nurse supposed to be accompanying a sick vented patient back to his unit?
- Does our hospital policy clearly state how we should transport ventilated patients back from tests or from other units?
- Was report given to the patient's nurse on the unit?
- Did the unit nurse know the patient was coming back unaccompanied by a nurse?
If you were also using critical thinking while reading this article, then you most likely are asking yourself some of the very same questions. Asking yourself questions is an important element in using critical thinking. The patient's nurse on the unit did recognize the same issues with the patient being brought back to the unit unaccompanied by a Registered Nurse and confirmed that she was not given report from the nurse in EEG lab.
As a nurse leader, confronting and educating staff about situations like this is a must. It is important to assess the entire situation and learn why this occurred in the first place and how can it be prevented in the future. The nurse from the EEG lab was asked to provide her side of this incident. The EEG lab nurse informed me she did call the patient's unit and gave report to the unit assistant since she was told that the nurse on the unit was busy. The unit assistant also failed to use critical thinking by not ensuring that the nurse on the unit was given report. The EEG lab nurse also informed me that the Anesthesiologist was going to accompany the patient back to his room and she thought that he had done so. The nurse's account of the situation required further discussion with the Anesthesiologist. When the Anesthesiologist was questioned, he said he could not fit into the elevator and let the respiratory therapist and the nurse's aide accompany the patient while he waited for the next elevator. Clearly, the Anesthesiologist was also not utilizing the skill of critical thinking.
The one thing evident about this scenario is that during this patient's care an essential skill had been left out by not only one healthcare worker but by several. The nurse in the EEG lab, the Anesthesiologist and the unit assistant failed to use the essential skill of critical thinking which could have been detrimental to the safety of this patient.
Critical thinking involves examining the situation at hand, analyzing what is occurring, and acting based on what will create the best outcome and highest level of care. According to, The Critical Thinking Community, "Critical thinking is that mode of thinking "” about any subject, content, or problem "” in which the thinker improves the quality of his or her thinking by skillfully analyzing, assessing, and reconstructing it. Critical thinking is self-directed, self-disciplined, self-monitored, and self-corrective thinking. It presupposes assent to rigorous standards of excellence and mindful command of their use.
According to Chit Ming, Section Head of Paramedic and Emergency Care at the School of Applied & Health Sciences in Singapore, critical thinking includes "interpretation, analysis, evaluation, inference and explanation of a specific situation based on evidence, methods, concepts, criteria and contexts, with the ability of self-correction and regulation" (Chit Ming, 2014, pg. 2). Critical thinking is essential in making high stakes decisions and healthcare providers need to develop competency using critical thinking. This skill is especially essential for nurses as more autonomy is being given to nurses to make more independent patient care decisions. This scenario required an immediate action plan.
The Action Plan
The action plan involved confronting the situation as it was unfolding. First, assessing that the patient was safe and in no distress was a priority and thankfully the patient was safe without any distress. Second, the EEG nurse was educated about the importance of providing report or hands-off-communication to the unit nurse.
A hand off communication is an accurate, clear, and specific summary of the patient passed from one healthcare provider to another. It is a comprehensive report on the patient's condition, with a focus on the patient's safety. There are many different methods of hands-off communication, one of the most common being an SBAR report. In an SBAR report, the Situation, Background, Assessment, and Recommendation are communicated from one provider to another (Amato-Vealey, Barba, & Vealey, 2008, pg. 763). What is most important is that no matter what method used, seamless transition of patient care occurs from one provider to the other.
The nursing staff and doctors that day were educated about the necessity of accompanying patients back to their unit by a licensed professional. Ensuring the patient was safety returned to the unit was ultimately the nurse's responsibility. Everyone present that day was provided education on the hospital's policy on hand-off-communication and transporting patients from one unit to another especially patients who are on ventilators. We need to hold healthcare workers accountable and provide continual education on policies and procedures that keep our patients safe.
This story is unfortunately not uncommon in many healthcare institutions. According to a study done by Wolters Kluwer Law & Business mistakes in hospitals account for 98,000 deaths a year and the cost to Americans of these mistakes is estimated to be nearly $1 trillion annually (Andel, Davidow, Hollander, & Moreno, 2012). Today's healthcare environment is often hectic. Nurses are accountable to administer medications, perform procedures, educate patients, document, and communicate between other healthcare professionals, among many other tasks throughout the day which leaves the possibility of an error occurring not so unfathomable. Therefore, it is essential that nurses as well as all healthcare workers, use critical thinking when providing patient care. Nurses need to remember that it takes a second to make a medical error that can result in patient harm, cause the nurse to lose his or her nursing license and even cause the healthcare facility to be liable for damages.
- Amato-Vealey, E., Barba, M., & Vealey, R. (2008). Hand-off communication: a requisite for perioperative patient safety. AORN Journal,88(5), 763-774 12p. doi:10.1016/j.aorn.2008.07.022
- Andel, C., Davidow, S. L., Hollander, M., & Moreno, D. A. (2012). The Economics of Health Care Quality and Medical Errors. Journal Of Health Care Finance, 39(1), 39-50 12p.
- Chit Ming, Y. (2014). Concept mapping: A strategy to improve critical thinking. Singapore Nursing Journal, 41(3), 2-7 6p.
- The Critical Thinking Community (2015) Website
- WebMD (2015). Website