Professionals use critical thinking and problem solving strategies daily in their work environment. Take for instance a health plan managing their member’s health, consisting of a staff of social workers, RN’s and LPN’s they will manage all kinds of medical conditions. The case manager is expected to apply critical thinking skills to each case and prioritize what that individual member needs. As an organization in healthcare they are to effectively encourage behavior change in members towards a healthier life that will avoid gaps in their healthcare treatment. The case manages are also required to achieve the business goals of the company by submitting state required forms timely to AHCA (Agency for Healthcare Administration). With each member that the case manager interacts with, they will be advising them of what care is covered under their plan, how they can best utilize the health plan to empower them to live a healthier lifestyle by complying with such things as attending their doctor’s appointments, taking their medications and reporting changes in their health, socioeconomic status or if their living arrangements are no longer safe for them.
Every organization can improve the critical thinking of their staff, but the reality is that it is the staff member that needs to utilize their critical thinking skills to make that change. One thing I learned is that “To provide quality care in this environment, nurses need to develop critical thinking (CT) skills that will provide them with expertise in flexible, individualized, situation-specific problem-solving.” (Brunt, 2005, p.60) When I think of how some case managers use critical thinking skills, I become concerned. For example, I will share a story of a time that a social worker went out on a field visit with a nurse to a nursing home. The social worker had already informed the accompanying nurse that the member was non responsive and she will either sleep through the visit or have a blank stare. One of the first things the nurse noticed when she came in the room was that she had slipped in her hospital bed to the side. It is noted that the insurance company case managers do not do hands on care, so the social worker will have to let the nursing home staff know to readjust her.
Second the nurse accompanying the social worker noticed that she had a big bump on her forehead, she questioned the case manager but she did not know where that came from. The nurse quickly used her critical thinking skills to scan the situation and see that the member probably had slipped. During the nurse’s visit, she noticed that the member had too many pillows behind her back; she was a light weight and was slipping to the side about ready anytime to hit her head on the same spot with side rail. This led the nurse to believe that this was not the first time this had happened to this member. The nurse and social worker let the staff know on the way out of the member’s room.
However, in thinking about the list of 17 Dimensions of Critical Thinking in Nursing, a few critical thinking skills stand out in my mind for this situation that I was hearing about. When analyzing a situation, if the case manager is not a nurse who is used to doing head to toe assessments, would she have known that bump on her head was the result of the member falling sideways and hitting it on the side rail in the very same position that she was found in? If the social worker did not seek information from the nursing staff to ask about the bump on the member’s forehead and was only concerned for what is in the member’s chart, then she would not have the correct information to formulate a plan of care that will benefit that member. If the social worker could predict what would happen if the member continued sleeping sideways on the bed propped by pillows, then she would be using her critical thinking skills to avoid an incident. Transforming knowledge can only happen when you have a working knowledge on any subject. If you have not been taught how to do a physical assessment on someone, then you are not able to transfer what you were taught in a book to a real life situation that will require critical skills thinking to resolve a problem. (Rubenfeld & Scheffer, 2005, p. 2)
Rubenfeld, M. G., & Scheffer, B. K. (2005). Critical Thinking TACTICS for Nurses: Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571
Written by Rosie Moore, RN, BSN, LNC