Case for Critical Thinking

Bristol, T. J., (2003). Critical thinking important to nursing. Nursing Matters, 14(2), 6-7.

As a nursing student, not only was I leery of Critical Thinking, but I simply did not understand what it was. Unfortunately, I was not alone. Critical Thinking has many definitions that all seem to point in the same direction. YOU! Critical Thinking is DISCOVERING new ideas through using what you already KNOW!

Here is a perfect example. If you have attended nursing school in the past decade, you probably have been taught that you do not need to aspirate before administering subcutaneous insulin. This teaching is based on research that displayed no blood return during aspiration of 204 subcutaneous injections (Peragalo-Dittko, 1995). In the Bible, the apostle Paul teaches his protégé Timothy (nice name) to not accept everything he hears and to “test the spirit.” In keeping with that advice, we are about to use critical thinking to “test the spirit” of this empirical data.

Answer the following questions.

1. Can an IV be started on the upper arm?

2. Can a patient have varicose veins on the abdomen?

3. Can a patient have varicose veins on the thighs?

4. When the RN starts an IV, is the insertion of the needle superficial (shallow)?

5. How differently will 6 units IV bolus of regular insulin affect a patient as compared to 6 units of SQ regular insulin?


We certainly do not teach aspiration to the patient who self-administers SQ insulin because it is such a difficult task. Research shows that the risk of hitting a vein is not great enough to justify complicating the already difficult task of injecting one’s self with insulin. However, based on a “yes” answer to questions 1-4 and a “big dangerous difference” answer to question 5, could one suggest that the RN may have the extra 4 seconds it takes to aspirate before administering SQ insulin?

I teach insulin aspiration to my students in clinical not only because of what was just discussed, but also because of the practice it provides in manual dexterity. However, I also tell my students that when they leave my clinical, they have to make a choice (because Nurse Tim won’t be peaking over your shoulder anymore). Will they practice based on what research tells us, or do they have the extra 4 seconds to provide one extra level of safety that “testing the spirit” has revealed?

Being a good nurse, means that one maintains a research based practice. NOT aspirating before administering insulin is a research based practice (American Diabetes Association, 2002). Therefore, the point of this discussion is to demonstrate how the nurse can use critical thinking to help define their practice. Critical thinking can cross into any area of practice or life. So use it often, and have FUN in the process.

References:

• American Diabetes Association. (2002). Position statement: Insulin administration. Diabetes Care, 25(1), 5112-5115.
• Peragallo-Dittko, V. (1995). Aspiration of the subcutaneous insulin injection: Clinical evaluation of needle size and amount of subcutaneous fat. Diabetes Educator, 21(4), 291-296.