The Critical Thinking Toolkit

The critical thinking challenge

Nationwide, hospitals are caring for more complex patients while experiencing a dramatic decrease in patient length of stay. And now, frontline nurses are implementing an expanding set of clinical protocols. These three forces combine to create a perfect storm: frontline nurses must accomplish more in less time and often default to "task-focused tunnel vision."

To ensure safe patient care in today's fast-paced environment, nurse leaders must take action to ensure frontline staff overcome "task-focused tunnel vision" and readily see a holistic picture of their patients' conditions.

Expanded course offerings during new-graduate nurse orientation are an excellent starting place for bolstering critical thinking skills. But mounting evidence indicates they're not enough.

Orientation courses are typically limited in scope, and don't provide the level of depth needed to overcome critical thinking roadblocks in today's complex care environment. Moreover, the challenge of equipping nurses to think critically is scaling.

Nurses long recognized as strong critical thinkers are increasingly finding themselves challenged as the care environment becomes more complex.

How this toolkit helps

This toolkit contains 16 targeted exercises to enhance bedside nurse performance on five core components of critical thinking. The exercises are designed for nurses at every career stage—tenured nurses as well as new graduates.

To complement didactic training and reflect adult learning theory, the exercises are highly interactive. Activities include role-playing, structured peer feedback, targeted patient observation, and guided self-reflection.

Ideally, the managers, educators, and preceptors using the toolkit should first identify their frontline nurses' most pressing improvement needs and then prioritize the most relevant exercises. To assist with this mapping, each section begins with a brief overview of the targeted critical thinking competency and supporting tools. Additionally, each tool contains a user guide, evaluation criteria, and prompts for facilitated discussion.

16 tools to address 5 critical thinking components

Problem recognition

• Change in Patient Status Exercise
  Guided observations and analysis to help nurses quickly identify key clinical signs


• "Unusual" Patient Progression Exercise
  Investigative activity to help nurses detect emerging clinical patterns worthy of concern


• Unit-Level Problem Identification and Prioritization Exercise
  Investigative activity to provide an opportunity to apply systems thinking to daily unit practice


• Root Cause Analysis
  Guided analysis to determine the root cause of suboptimal care


• In-the-Moment Safety Concern Scripting
  Detailed scripting and advice on how to apppropriately voice concerns about potentially unsafe practices

Clinical decision making

• Evidence-Based Nursing Practice Analysis and Application Exercise
  Written exercise, requiring research, to practice accessing nursing research studies and assessing their applicability


• Concept Mapping Exercise
  Observational and written exercise to better enable nurses to build holistic pictures of patients


• Solution Assessment and Trade-Off Exercise
  Reflection-based exercise to assist nurses in identifying when a patient's condition has multiple potential treatment options

Prioritization

• Delegation Decision Tree
  Exercise to improve nurses' ability to delegate effectively to appropriate care team members


• Individual Patient Goal Prioritization Exercise
  Thought exercise to assist nurses in prioritizing nursing interventions across a patient's length of stay


• Patient Assignment Prioritization Scenarios
  Scenario-based practice in prioritizing across multiple patients with competing care needs

Clinical implementation

• Plan of Care Customization Exercise
  Thought exercise to help nurses incorporate patient, family, and community needs into care plans


• SBAR Template and Role-Play
  Written exercise and role-play to equip nurses to communicate clearly and concisely with physicians and other providers

Reflection

• Peer Feedback Request Exercise
  Discussion and guided self-relfection to provide nurses with scripting and techniques to solicit concrete feedback from peers


• Individual Self-Assessment and Development Plan
  Written self-reflection to guide nurses in identifying specific improvement goals and develop action steps


• Clinical Narrative Exercise
  Composition exercise to provide an opportunity to reflect on the care delivered to a specific patient

Download the full toolkit