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Critical Thinking a Necessary Factor in Nursing Workload

Kiekkas and colleagues¹ offer a thorough evaluation of tasks associated in patients with fever as an indicator of nursing workload in the intensive care unit (ICU). In this study, nursing workload was measured by the number of tasks or activities the nurse performed. However, the number of tasks is only partially indicative of the overall care the patient receives. Studies that exclude evaluation of the nursing process continue to ignore critical thinking as the true measure of the work of nursing.

Evaluating nursing based only on the number of tasks performed is like rating a pilot solely on the number of buttons he or she has pushed on a typical flight. Unless consideration is given to the thought processes behind these activities, it is impossible to accurately measure the pilot’s overall performance. Similarly, ICU nurses must be capable of assessing all forms of relevant information presented during patient care. The nursing care of a patient presenting with fever and signs and symptoms of systemic inflammatory response syndrome, for example, requires the nurse not only to perform tasks, but to apply critical thinking. In such a case the nurse might draw inferences from data, patient presentation, and nursing assessment to conclude that the patient is (or potentially will be) in severe sepsis or septic shock and alert the physician. This nursing process involves critical thinking rather than specific tasks, and supports the implementation of early goal-directed therapy.

Critical thinking is fundamental to the work nurses contribute daily and must be included in future studies that measure workload. A first step might be to perform a qualitative study to determine patterns and central themes in critical thinking of a nurse caring for a patient with fever. An algorithm could be constructed from identified critical thinking elements or key data points noted from this study. Next, studies could incorporate the use of this algorithm to validate that the workload of the nurse is significantly more complex than one might think based only on the number of tasks performed. Analysis of critical thinking will get us closer to understanding the hours of nursing care required to provide accurate nurse to patient ratios, thereby promoting patient safety.

FINANCIAL DISCLOSURES
None reported.

REFERENCE

1. Kiekkas P, Sakellaropoulos GC, Brokalaki H, et al. Nursing workload associated with fever in the general intensive care unit. Am J Crit Care. 2008;17(6):522–531.[Abstract/Free Full Text]

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