When looking to develop a critical-thinking process in a facility, it’s best to start with the basics. “Critical thinking has been around for a couple of decades, but applying it in healthcare is something we’ve been looking at pretty closely for the last 10 years,” says Carole R. Eldridge, DNP, RN, NEA-BC, dean at St. John’s College of Nursing and Health Sciences of Southwest Baptist University in Bolivar, MO.

Critical thinking involves using skills to determine what’s appropriate in each scenario and facility setting and helping people to think about how they can approach situations in a different way, explains Janie Krechting, BSN, RN, C, MGS, LNHA, administrator at Wellspring Nursing Home in Cincinnati and assistant professor of Aging Services and Administration at the College of Mount St. Joseph.

Determining the root cause

“Root cause analysis is one of the key things to do when you’re looking at critical thinking,” Krechting says. A root cause analysis is the basis to critical thinking and involves determining why something happened, rather than simply fixing it and moving on. “If you don’t know why something happened, then it’s going to happen again,” she explains.

For example, look at a situation in which a call light remains unanswered for a long period of time. If the patient or resident said somebody answered it, turned it off, and went away, “saying ‘Answer the call light’ isn’t going to fix things. If you’re not figuring out what’s going on, they’re going to put that call light on again, and someone isn’t going to answer it if you don’t figure out why they didn’t answer it in the first place,” Krechting says.

Look at the factors involved in the issue to determine the cause of the problem. In this situation, ask yourself why the call light was not answered. Was it because:

• There weren’t enough staff members?
• The aide wasn’t being responsible?
• The call light was activated during mealtime when there weren’t enough workers to answer it?

“If you do root cause, you may find that there is more than one factor. If you just fix what is going on and don’t look at the root cause, then there is the likelihood of reoccurrence,” Krechting says.

After identifying the root cause, staff members should look at all issues prior to making a conclusion. When determining the root cause, the most important items to consider include:

• Who is involved?
• What happened?
• When did it happen?
• How did it happen?

“I think that critical thinking is a skill that can be learned at any educational level. What it requires more than anything is an open mind and the ability to understand that you may not always be right,” Eldridge says. “It’s an attitude.”

Editor’s note: This excerpt was adapted from Briefings on Long-Term Care, an HCPro, Inc., publication.