One of the most commonly heard phrases right from day one of nursing school is “critical thinking.” The common consensus is that everyone has to develop sound critical thinking in order to be a safe and effective, registered nurse (RN). This necessity is magnified when it comes to critical care areas where one decision by the RN can change the patient’s outcome. Nursing has changed from a simple caregiving job to a complex and highly responsible profession. Hence, the role of nurses has changed from being task-oriented to a team-based, patient-centered approach with an emphasis on positive outcomes. Strong critical thinking skills will have the greatest impact on patient outcomes.
So, what is critical thinking and how do we develop this? A precise definition was proposed in a statement by Michael Scriven and Richard Paul at the Eighth Annual International Conference on Critical Thinking and Education Reform during the summer of 1987. “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness,” reads the document.
Simply put, critical thinking in nursing is a purposeful, logical process which results in powerful patient outcomes. “Critical thinking involves interpretation and analysis of the problem, reasoning to find a solution, applying, and finally evaluation of the outcomes,” according to a 2010 study published in the Journal of Nursing Education. This definition essentially covers the nursing process and reiterates that critical thinking builds upon a solid foundation of sound clinical knowledge. Critical thinking is the result of a combination of innate curiosity; a strong foundation of theoretical knowledge of human anatomy and physiology, disease processes, and normal and abnormal lab values; and an orientation for thinking on your feet. Combining this with a strong passion for patient care will produce positive patient outcomes. The critical thinking nurse has an open mind and draws heavily upon evidence-based research and past clinical experiences to solve patient problems.
How does one develop critical thinking skills? A good start is to develop an inquisitive mind, which leads to questioning, and a quest for knowledge and understanding of the complex nature of the human body and its functioning. A vital step in developing critical thinking for new nurses is to learn from those with a strong base of practical experience in the form of preceptors/colleagues. An open-minded nurse can learn valuable lessons from others’ critical thinking ability and will be able to practice for the good of their patients.
Critical thinking is self-guided and self-disciplined. Nursing interventions can be reasonably explained through evidence-based research studies and work experience. A strong sense of focus and discipline is also important for critical thinking to work. If thinking is unchecked, nurses can be easily misguided and deliver flawed patient care. A constant comparison of practice with best practices in the industry will help guide a nurse to think critically and improve care. This makes it easier to form habits which continue to have a positive impact on patients and colleagues. Every decision a critical thinking nurse makes affects not only the patient but also his or her families, coworkers, and self.
In summary, the take-home message for nurses is that critical thinking alone can’t ensure great patient care. A combination of open-mindedness, a solid foundational knowledge of disease processes, and continuous learning, coupled with a compassionate heart and great clinical preceptors, can ensure that every new nurse will be a critical thinker positively affecting outcomes at the bedside.
According to the Centers for Disease Control, more than 100 million Americans have diabetes or pre-diabetes, making it the seventh leading cause of death in the U.S. as of 2015. As a result, a number of nurses work with patients who have this disease.
Joyce M. Knestrick, PhD, APRN, CFNP, FAANP, president of the American Association of Nurse Practitioners (AANP), says that one of the most alarming and interesting factors is that many patients who come to see their nurse practitioners (NP) have no idea that they have the disease. “Roughly a third of Americans with the disease do not know it, and every 21 seconds, another person is diagnosed. And it is for this reason that diabetes is called the ‘silent killer,’” explains Knestrick.
What can nurses do to help these patients? “As NPs, we discuss things like obesity, poor eating, and bad exercise habits as risk factors that drastically increase patients’ chances of becoming pre-diabetic or diabetic. That’s really what we do on a daily basis—examine patients for warning signs; get to know them by discussing their history, their lifestyles, and their families; and, if need be, order various tests to help us gain more information that allows us to put patients on a proper track towards better health,” explains Knestrick. “As NPs, the key is threefold: active listening to your patients, adaptability to each patient’s unique set of needs, and the flexibility to lead or assist a care team all the way through the patient’s care continuum. So it is really NPs who are on the front lines, so to speak, with the patients battling this disease, and we work very closely with organizations who are working hard to raise awareness about diabetes and how it can be prevented, mitigated, and treated.”
Diabetes, Knestrick says, has devastating effects on patients’ bodies. “NPs have a daily responsibility to understand the risk factors and work with patients to mitigate those risks before they become diabetic. Like with so many diseases, NPs help patients focus intensely on prevention efforts and ways to take better control of their daily health,” she says.
In addition to what diabetes can do to people’s bodies and affect their overall health, Knestrick also points out that there are also astronomical economic costs associated with this disease. “A lack of overall awareness had led to over $322 billion spent annually treating diabetes. This means that health care costs are almost two-and-a-half times higher for someone with diabetes, and that is largely because of additional and devastating complications that result,” she says. “That is why we cannot emphasize enough that it is not just about people with diabetes, but that everyone has a responsibility to elevate awareness so we can avoid the human and economic costs of this terrible disease.”
In this season of reflection, today’s World AIDS Day is a time to think of the incredible life-saving advances accomplished since the early 1980s and to be reinvigorated to do the continual work that is still necessary.
The Secretary’s Minority AIDS Initiative Fund of the US Department of Health and Human Services has designated this year’s theme as “Increasing Impact through Transparency, Accountability, and Partnerships.”
As a nurse, December 1 is a time to help patients break the stigma of HIV and AIDS and to offer support, information, and treatment to those affected by the disease. December 1 is also a time to honor those who died from this disease and to help their families and loved ones know the fight against AIDS continues.
In 1988, World AIDS Day was first recognized, only five years after the AIDS virus was first identified and in the middle of the crisis surrounding the disease. According to the National AIDS Trust, nearly 37 million people live with HIV and AIDS-related diseases right now – just slightly more than the number of people who have died from it.
According the the Centers for Disease Control and Prevention, minorities are especially hard-hit with infection rates. African American men, particularly those who are gay or bisexual, have higher proportional rates of infection than other populations. Part of the challenge in AIDS eduction and awareness is understanding some of the cultural, ethnic, socio-economic, and regional influences that influence behaviors; prevent access to information, treatment, and prevention; and deepen a stigma around AIDS.
Many nurses today remember the near-hysteria that greeted the outbreak of AIDS-related illness and the resulting misinformation, discrimination, and hostility that followed. Just as nurses back then treated their gravely ill patients with respect and dignity, they continue to do so today. The difference is that today’s treatments and advances have given nurses a reason to offer hope to those diagnosed or living with HIV and AIDS illness. There is so much more known about the disease, its causes, its transmission, and effective treatment approaches.
Today, treatments that were never imagined 35 years ago are possible. Post exposure treatment (known as post-exposure prophylaxis) is available as is pre-exposure treatment. Drug therapies can keep the disease from advancing as rapidly as it once did.
Wear a red ribbon today, the long-standing traditional representation of AIDS awareness, in honor of those impacted by AIDS. Use #WAD2017 on your social media channels to spread awareness and call attention to this day. Each time it is brought out into the open, a bit of the stigma will fade.
The modern holiday season has become more of a mad dash from November though the new year. There are so many school plays to see, cookies to bake, family and friends to visit, shopping to do, packages to ship. With all that added to a normally jammed work and life schedule, the holidays become a blurred jumble to get thorough rather than enjoy.
Here are five easy ways to make your holiday season a little nicer, a little kinder, and a lot more satisfying.
1. Give What You Can
Part of the reason giving is so satisfying is because it requires you to share something valuable to you with someone else. If you have money to give, buy some extra presents for kids who might not get much. Spend some of your extra on gift cards to grocery stores and drop them off at a local food pantry. If you have extra goods in your home (unused sweaters, coats, blankets) find places that need those items and drop them off.
2. Spend Your Time
If you don’t have much extra money, spend your time in ways that are equally valuable. Take an afternoon to visit with shut-ins in your town. Bake some homemade goodies to share with neighbors or a senior center. Volunteer your nursing know how to teach a group of kids about health and wellness. Walk some dogs at the pet shelter. Knit baby caps or pack up hurricane relief boxes for areas hard hit this year. The world needs a lot of things right now and time is in short supply. Give some of yours and watch what an impact it has.
3. Work Hard to Spread Cheer
Hustle and bustle doesn’t always make for happy people. The lines in stores, the traffic on the roads, and the time spent on extra errands can make even the most even-keeled person cranky. But a lot of cranky people make everything that much worse. Make an effort to be the person who is kinder than the next. Feed the birds. Hold the door open for someone. Let the person with two items go ahead of you in line. Chat with someone sitting next to you at a community event or a professional gathering. When you are kinder, it spreads to others.
4. Reflect Alone and Together
Take time to think about what the season means to you. Dig deep and uncover what will make the season more joyful and more joy-filled. Do you want to hear more music or do you need silence? Do you need to be around people or do you need a day to yourself? What purpose do you want to fulfill in the new year? Find others who have similar thoughts about this time of year and spend some time talking and hearing each other. Then move into the next month with intention and a vision for making the season better for you.
5. Connect with Others
Connect face-to-face with people you care about or with people you have lost touch with. It’s easy to lose connections in today’s online environment, but the real joys of something as simple as a cup of coffee with a friend can soothe your soul. Reach out to others. Heal old wounds or repair the relationships worth fixing (don’t even consider wasting your time on the ones that aren’t). Recognize that we all carry our own burdens and that together they may be lessened.
How will you make the world a kinder place this year?
As we get ready to turn our calendars to December, we reflect on the passing month of November, and its designation as Lung Cancer Awareness Month. Throughout this past month, advocacy groups and organizations have pushed to raise awareness and educate readers en masse about the deadly illness. As the leading cause of death from all cancers, lung cancer remains a tough battle to fight for patients. According to the CDC, lung cancer affects 215,951 people in the United States, with nearly 75% of all patients succumbing to their illness. It is important during the month of November to not only to focus on lung cancer, but on respiratory illness as whole – such as COPD and mesothelioma.
What is Lung Cancer?
Lung cancer can refer to both small-cell and non-small cell lung carcinoma, which is characterized by the uncontrollable growth of cells in the lung tissue. While tobacco smoking and secondhand smoke are by-and-large the primary causes of the disease, heredity and environmental factors can also contribute to the diagnosis. Radon, a radioactive gas found in the soil, and other airborne pollutants, like arsenic and diesel exhaust, are also known causes.
The symptoms of lung cancer are chest tightness, shortness of breath, chronic cough, coughing up blood, and fatigue. Once a biopsy is performed and the cancer is officially diagnosed, patients can expect to undergo a regimen of advanced treatment, but there remains no definitive cure. It is important to note that prognosis varies highly based on the stage of the cancer—which generally dictates the type of treatment a patient can expect to receive. Currently, chemotherapy, immunotherapy, radiation, and surgical removal of tissue are the most prevalent forms of care.
Advanced Respiratory Illness
While the awareness of lung cancer is widely known, many other serious illnesses lack cognizance. Two of the most rampant respiratory diseases aside from lung cancer are Chronic Obstructive Pulmonary Disease, commonly known as COPD, and mesothelioma. COPD is an umbrella term for several different ailments, the most common being emphysema and chronic bronchitis. Like lung cancer, COPD is most commonly caused by smoking, but many environmental hazards can cause the illness. Air quality issues, such as pollution and chemical fumes, can cause the disease. There is no cure for COPD, and most patients are faced with progression of the illness as they age, many times causing death.
The exposure to asbestos, a silicate mineral formerly used in construction, has also proven to be extremely dangerous to human health. The material is known to break and fragment, creating small particle dust that is inhaled. Once inhaled, the accumulation of asbestos dust settles in the lining of the organs indefinitely, where it can begin to cause illness. Asbestos is most commonly linked to mesothelioma, a rare and aggressive cancer. Mesothelioma most commonly affects the lining of the lungs, but can also affect other areas of the body. Prognosis for the disease is very poor, as most patients are faced with 12-21 months of life expectancy. Treatment of the disease generally consists of a combination of radiation, chemotherapy, and sometimes, surgical removal of the affected area.
How to Promote Wellness
While lung cancer, COPD, and mesothelioma all pose very serious health risks, there are steps we can take to continue to maintain health and wellness. The most important step to take to ensure lung health is to stop smoking today. Tobacco smoke accounts for 85% of all lung cancer diagnoses, and can greatly exacerbate the severity of any other lung disease. Steps to ensure respiratory safety on the job site, especially for construction workers, can greatly reduce the chances of exposure to carcinogens. Buildings constructed before 1980 in the United States run the risk of asbestos contamination; if you suspect your home may contain asbestos, do not remove it yourself – use a licensed professional. Above all, a continued healthy lifestyle and exercise can safeguard your well-being, and keep you at your best for years to come.
As families and friends gather for Thanksgiving Day this year, there will likely be oft-repeated tales about favorite recipes or the family stories that always make everyone laugh. In the midst of these gatherings is an excellent opportunity to learn more about what makes your family unique – in every sense of the word.
In 2004, the Surgeon General, through the Department of Health & Human Services, designated Thanksgiving as National Family History Day. This is an opportunity for all families to learn more about the common and rare diseases that can run through several generations.
As you all reminisce about holidays gone by, it’s a good time to begin documenting the various health conditions family members have. If you have high blood pressure and other relatives do too, it’s a great opportunity to educate the younger family members about the disease in an open, honest, and informed manner. The teens in the family don’t need to be terrified about the potential for heart disease or diabetes, but they should be armed with information about how they can help keep themselves healthy.
National Family History Day gives families a chance to uncover common threads they might not have realized. While the Surgeon General’s office found that most Americans believe in the important of knowing a family history, only about one-third have ever tried to document their own family’s health history.
What should you ask about? Really anything that might help you. Once you know the common threads, you can all learn about how to stay healthy or manage those specific conditions. For instance, are there relatives with breast and ovarian cancer (especially early onset) from generations ago? What about testicular cancer? When everyone is together, you can act as an educated group to make sure family members are getting appropriate testing or monitoring.
Because the Surgeon General considers family history as such an important health indicator and screening approach, the office has created the My Family Health Portrait online monitoring tool to help families document conditions and diseases. This tool means the documented history can be shared among family members and updated as health changes occur. Family members can even bring a copy of the document to healthcare visits to help inform their health team about important information.
Nurses don’t need anyone to tell them what kind of a predictor family history is. Each day, they see families with shared conditions. But if they don’t discuss their own detailed family health histories and if they don’t always ask the right questions, they could be missing some important health information of their own. Many families don’t talk about things like reproductive health problems or of mental health issues. Some might not discuss alcoholism or addiction. But each of these health conditions provides an essential piece of a family’s health picture.
Before you begin this process, the Surgeon General’s office has prepared some tips to help you. You’ll want to be ready to get the information, but realize you might not get everything on the first try. Make sure you are clear about what you are doing and why. Some people don’t like to talk about their health issues, but if they realize it could help save a loved one, they might look at your information gathering in a very different light.
Consider this an ongoing conversation among family members, and that Thanksgiving is just a start. Realize not everyone will be on board. Get as much information as you can without upsetting anyone. Be encouraged by what you can find out – you are helping your family now and for generations to come.