I am still currently in nursing school, but I was in one of my first med-surg rotations in clinical. My patient had recurrent DVTs (Deep Vein Thrombosis), and he was on Warfarin. Luckily, we had just been discussing all the lovely anticoagulant therapies such as Warfarin, Heparin, Lovenox, etc. We had just learned that Heparin works by interfering with the liver’s synthesis of Vitamin K, which is essential for clotting. We also learned that with Warfarin therapy, they have to have their PT/INR monitored closely. The range recommended is an INR of 2.0-3.0 for patient’s on anticoagulant therapy (Hinkle & Cheever, 2014). When receiving report on this patient, the night nurse had told us that his most recent INR level was at 4.5. Immediately I recognized that the level was out of the therapeutic range, and I was very fortunate to have a nurse who was enthusiastic about teaching. She immediately asked me if I thought it was normal, I told her that it was out of the normal range. She proceeded to ask me if his level was at an increased risk for clotting or a decreased risk. I answered that his level meant that he is taking too long to clot, and that he would most likely need the reversal agent, which is Vitamin K.

I believe that I was able to use critical thinking to analyze about what was going on with the patient and determine the future actions. According to Petress’s criteria of critical thinking, I feel that I was able to use reasoned judgement to evaluate the scenario, selecting the best solution based on personal knowledge (although my solution was essentially just to see what I would do if I was the nurse, and the nurse would have corrected me if I was incorrect and used it as an educating moment), and that I was confident in my solution for the problem (Robert & Peterson, 2013). Although it was very early on in my nursing career, that moment was one of the first times in clinical that I felt that I was beginning to grasp the concept of critical thinking in nursing. One thing through the article written by Robert and Peterson that I believe will stay with me is that in “evidence-based nursing, a lack of conceptual clarity surrounds the concept of critical thinking in both education and practice” (Robert & Peterson, 2013). So, although throughout nursing school, I know that my clinical reasoning and judgment has greatly improved from nothing, that there is still so much knowledge, education, and practice for me to learn, but that it the amazing characteristic of nursing is that we are always seeking knowledge!

References

Hinkle, J., & Cheever, K. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA:

Wolters Kluwer Health | Lippincott Williams & Wilkins.

Robert, R. R., & Peterson, S. (2013). Critical thinking at the bedside: Providing safe passage to pateints. MedSurg Nursing, 22 (2), 85-

93.

Honor Pledge: I, Ryan Spanagel, pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violations of the Honor Code. I will report to a hearing if summoned. -Ryan Spanagel