Critical Thinking In Nursing

The experience I went through was the complete opposite of linear thinking. I had to dig deep into my cognitive abilities for each obstacle I was challenged with. There were times in which metacognition kicked in. For instance, while breastfeeding Madelyn, I would get anxious and question if she was okay. Should I stop feeding her or keep going? Is she turning blue or is it my imagination? Should I call the nurse over? Mental images of her not breathing replayed through my head. Metacognitive monitoring became habitual for me when it came to hearing the monitor alarms that the twins were hooked up to. I knew that the slightest stretch of the leg or that any movement encountered during a diaper change would falsely set off the alarms. It became
a habit for me to check the monitor and make sure everything was safe and sound. Metacognitive awareness was extremely important in the overall experience. Asking questions and being able to apply what I had learned ultimately had positive effects on my twins. For instance, serious complications may have occurred if I was unable to comprehend the specific directions given to me on how to keep breast milk fresh. Not being aware could have caused the twins to become extremely sick and/or to have lost important nutrients needed to help their premature bodies grow. Demonstrating what I had learned from my breastfeeding coach proved that my comprehension abilities were strong and my willingness to learn was evident. Lacking metacognitive awareness and the abilities to put learning into action was not an option. The approach learned from each nurse made the actions easier and more manageable. The documenting of feeding times and how many ounces each twin ate was a way to effectively, yet efficiently, set a routine. I was not wasting my time wondering why the twins were crying or when the next feeding time was. This was opposite of my husband, whose lack of perseveration and not documenting information would throw off the twins’ routine and made it difficult for him to understand why they were crying. Collaboration between the medical team and I allowed for higher cognitive performance. Working together, sharing information, and being able to discuss ideas and concerns really allowed my metacognitive abilities to blossom. If I did not understand something, being silent was not an option. I needed to comprehend everything in order to provide the best care for Owen and Madelyn. Being able to spend the final night with my twins in the hospital was a way to prove my comprehension and apply the solutions I had learned to the many complex situations I endured. It was a strategy the NICU used to test my cognitive abilities and a way for me to solve problems and perform critical thinking without the nurses doing it for me. When my babies left the hospital the next day, I was confident in my learning and believed taking care of the twins at home would be successful. Critical thinking, trial and error, and recalling information I had learned from the medical staff were methods I used to problem solve at home.
“What do you do when you don’t know what you are doing?” (Martinez, 2010). In the NICU the twins each had their own nurse. When my husband went back to work, it was just me at home having to comfort two crying babies at once. This was not something I had experienced in the NICU. Heuristics such as trial and error through means-end analysis would help me “make progress towards the goal” of figuring out how to soothe both babies. Problem solving and critical thinking allowed me to ask myself questions to make the situation better. Sometimes the solution was food while other times it was as simple as changing out the toy they were playing with. I just kept trying different options until something worked and the crying stopped. Although, there were times when nothing soothed the crying. When this happened the emotions I felt became overwhelming. Metacognition would kick in again where I questioned myself but didn’t have an answer. At times my emotions turned into frustration, anxiety and guilt because I had to just let them cry. This turned out to be a solution within itself. After they finished crying, they would fall asleep and wake up happy. Over time, I was able to set routines that made my day manageable. The habits I formed let the solutions to problems fall into place. Though I couldn’t solve every problem that arose, I had a
purpose, and that was to be a good mom. Crying is how babies communicate. Crying cued my brain to figure out the problem. I will always remember the problem I faced when Madelyn had intense crying moments at home. She would get so upset that she would take a breath to let out a cry, but instead of taking the breath, she would get stuck on a long inhale thus forgetting to breathe. In this scenario, it was quick critical-thinking abilities that helped me find solutions to get her to take a breath. Shouting her name and rubbing her head usually worked, but the best method was blowing air into her face. Thinking critically allowed me to search for answers as to why she was not breathing. I determined that anytime she was excessively upset, the situation escalated. Calming her down as quickly as possible was crucial. Through inferential reasoning, I realized that even though Owen and Madelyn are twins, their needs are different.
I had to use critical thinking and problem solving differently for each of them. One may think that twins achieve things together. Inductive reasoning may generalize twins as being best friends and doing what the other does. From the situations I went through, I can tell you first hand that this generalization of twins couldn’t be any different. Owen could coordinate his eating while breathing, but Madelyn would forget to breathe. Owen needed more monitoring while sleeping, as he would only fall asleep on his belly, whereas Madelyn would sleep on her back. Owen needed his pacifier to sleep, but Madelyn didn’t want anything to do with a pacifier. In the NICU, the physical therapist worked one-on-one with each baby, recognizing each as an individual and working on areas that needed further development. Identifying the needs of each twin gave me insight into assisting each one and discovering development needs that would allow me to work with them at home. Deductive reasoning became clear as I learned the individual needs of my twins. One negative syllogism I always had in the back of my brain that scared me the most about being home with Madelyn was “If I breastfeed her, then she is going to stop breathing”. I knew that if I lost Owen’s pacifier then he was going to cry until I could find another solution. I knew if Madelyn couldn’t be soothed, even after trying multiple
ideas, I found that putting her in the swing would soothe her. Identifying outcomes to problems assisted me for future encounters.