Are Critical Thinking Skills Becoming Extinct?

As an RN for nearly 30 years, I’ve seen many changes in the healthcare arena since I started as a Student Nurse Assistant in 1986. I recently had a discussion with other healthcare providers regarding the identification of patients with sepsis. The topic of young healthcare providers lacking critical thinking skills came up. This is a conversation that I’ve had with multiple healthcare providers over the past few years, but this time it just really frustrated me. The conversation brought up many potential contributing factors, such as patients entering the hospital more acute than they have been historically; shorter duration of hospital stays; and the emergence of technology.  After the conversation I began thinking that maybe today’s generation of healthcare providers is disadvantaged in that documentation is electronic and mainly checkboxes, placing a reliance on technology.  My theory is that maybe there is an association between actual writing, and learning the relationships and associations that are the foundation for critical thinking skills.

I began thinking of my own career as a Neonatal ICU nurse and remember how the first institution I worked at required an environmental assessment ….gasp…handwritten (actually EVERYTHING was handwritten, I even had a color coded pen, one color for day shift, another for evening and another for night) at the beginning of every shift. So, I had to start off my shift writing:  “Received infant in “name of warmer bed brand/isolette brand” set on “manual mode/servo mode” set at “__”. Infant on “type & brand of ventilator” settings at “list the settings” with “self-inflating bag or anesthesia bag at bedside.”  Infant attached to “brand of monitor” with heart rate alarms set at “…”, respiratory rate alarms set at “…”, B/P alarms set at “…” and O2 sat alarms set at “…”.”  Anyway, I think you get the idea.  But the point is that writing this assessment set into motion relations between what I was writing/observing and the condition of the infant.  It started the foundation for that “critical thinking process.”  I remember learning through writing my observations/assessment on a premature infant the association between hypothermia and hyperglycemia…that it usually meant the infant was stressed and we (the healthcare team) needed to be assessing possible causes. So going back to my theory of recognizing relationships/associations through writing what you’re observing had me going to Google (yes, I confess to absurd love of Google for all my questions!). What I found was a multitude of articles supporting my theory that writing notes does help your brain develop relationships and associations.  Now granted a Google search is definitely NOT scientific research of any kind, but it does provide a starting point.

That leads me to wondering how we can help the upcoming generation of healthcare providers develop these critical thinking skills. Technology is here to stay and to be honest I think it’s a good thing! But, I can see where the above mentioned factors can put up a barrier into the development of critical thinking skills.  Patients are more acute, they usually have a multitude of diagnosis, not just one.  The stay in the hospital is also shorter, which actually means that healthcare providers need to have those critical thinking skills as the opportunity to observe/assess your patient is shorter. So my question to other healthcare providers is threefold:

• What do you think? Are critical thinking skills becoming extinct?
• If so, what are some potential solutions to help develop critical thinking skills?
• How can we leverage technology to assist with the development of critical thinking skills?