Critical thinking, critical reasoning and validation define three key elements to a successful nursing practice. As nurses deal with daily challenges, they require vigilance on behalf of their patients, both fighting for the needs and desires of each individual they care for. Validation must also play a key role. All daily battles with life and death decisions begin with keeping all nursing staff striving for absolute excellence.
Critical reasoning, critical thinking and validation all go hand in hand. Without one, it becomes hard to define all others. To become a successful nurse, it requires all three pieces.
Stedman’s medical dictionary defines critical as “involving skillful judgment as to truth, merit, etc, judicial: a critical analysis” (The American Heritage® Stedman's Medical Dictionary, 2013). Similarly, it states listening as “ thought; judgment, reflection” (The American Heritage® Stedman's Medical Dictionary, 2013). Likewise, the definition of reasoning shows “the process of forming conclusions, judgments, or inferences from facts or premises”(The American Heritage® Stedman's Medical Dictionary, 2013). Lastly illustrating validation, “to make valid; substantiate; confirm” (The American Heritage® Stedman's Medical Dictionary, 2013).
Critical thinking, critical reasoning and validation exist as building blocks for any profession, especially one where you deal with people’s lives. A survey of 11 deans or directors of nursing programs, 82 nurse administrators, 117 nurse educators, and 23 new and 96 experienced baccalaureate nurses inquired about critical thinking at a patients bedside and it showed “critical thinking was listed consistently among the most important competencies but was ranked as the lowest observed competency” (Robert and Petersen, 2013 p. 88). How do we as nurses change this? Countless numbers of people die needlessly because of a lack of critical thinking, reasoning and validation in our world today. An example of this very situation is as follows:
A nurse is reviewing the cardiac monitors for 30-year-old Jacob, admitted to the telemetry floor for cellulitis of the leg. Jacob had a peripherally inserted central catheter (PICC) in place to allow infusion of broad-spectrum antibiotics. He had no previous history of cardiac problems, but the nurse noticed frequent runs (4-5 beats) of ventricular tachycardia. The nurse entered the room and assessed the patient. He told the nurse that since his PICC was inserted, he felt fluttering in his chest with any movement. In reflecting on this finding, the nurse reviewed the radiologist’s report after the PICC insertion. The X-ray showed a PICC in the right ventricle rather than in the superior vena cava, so the nurse immediately called a doctor and explained the concerns. The physician arrived quickly and adjusted the PICC catheter, and the patient’s ventricular tachycardia resolved. Two days after completing his course of antibiotics, the patient was discharged to his home in stable condition (Robert and Petersen, 2013 p. 89).
This situation happens in every hospital most likely everyday. What if a nurse would not take time to listen to