IT'S ALL FREE! Critical vs. Analytical Thinking

One of the most desirable traits of legal nurse consultants is analytic ability.  Analytical thinking starts with critical thinking and then takes it a step further.  The typical definitions of critical and analytical thinking are much too academic for me, so let's look at some alternates specific to nursing and legal nurse consulting.  Then let's focus on differentiating critical thinking skills and analytical thinking skills for LNCs.

When I imagine critical thinking in the nursing setting, I think of nurses who are able to identify a patient's signs and symptoms and intervene in a timely, appropriate, and effective manner.  For example, imagine a patient who has a precipitous drop in blood pressure.  A critically thinking RN would assess the patient's other vital signs, note the patient's history for conditions that could cause hypotension, and assess other parameters such as complaints of dizziness, history of vomiting and/or diarrhea, abnormal lab results, etc.  After gathering this information, the nurse would protect the patient (especially if dizzy), give the patient something to drink (if dehydrated and capable of taking oral fluids), and contact the patient's physician.  The nurse would also carry out further interventions per the physician's orders.

A nurse who is not thinking critically doesn't notice subtle or even obvious information.  It seems like we've all worked with some nurses like that.  The nurse might overlook the hypotension entirely, assess the patient inadequately, assess the patient but not until much later, fail to contact the physician in a timely manner, or fail to execute the physician's orders appropriately.  Have you ever started a shift and found that an off-going nurse had done nothing for a patient whose condition had deteriorated hours earlier?  Those are signs of a nurse who doesn't have critical thinking skills.

Here's where analytical thinking comes in.  For legal nurse consultants, analytical thinking involves reviewing records in a critical way, then determining if the 4 Ds of medical malpractice (duty, dereliction of duty, direct causation, and damages) apply to the case.  Duty is almost a given if the patient is in the healthcare system.  Dereliction of duty (breach of duty) refers to failure to conform to standards of care.  Standards of care refer to actions that a reasonable and prudent nurse would do in a similar situation.  A reasonable and prudent nurse would think critically and act accordingly.  In the case of the hypotensive patient, the legal nurse consultant would review documentation to determine if the nurse appropriately assessed the patient and intervened in a timely manner.  If the nurse did, there's no medical malpractice.  If the nurse didn't, the nurse is negligent. 

The next part of thinking analytically is to determine causation and damages.  Causation is the link between carelessness (negligence) and injury to the patient (damages).  In the case of a hypotensive patient, the legal nurse consultant would review medical records to determine if the nurse's actions or lack of action led to the patient's injury.  In the case of the hypotensive patient, let's say that the patient was dehydrated, and the nurse failed to assess the condition immediately.  However, the nurse hydrated the patient with extra IV fluids a few hours later and the patient suffered no sequelae.  In this situation, the nurse was negligent, but the negligence didn't result in damages.  Therefore, there's little basis for a medical malpractice claim.

Now, let's add a different set of facts to the case of hypotensive patient.  Let's say that the nurse immediately assessed the patient and notified the physician who provided orders that the nurse meticulously carried out.  However, the patient died of septic shock.  Death from septic shock is certainly a bad outcome.  But is the nurse the link to the patient's damages?  The answer is, "It depends."  Just because a patient has a bad outcome, it doesn't mean that there's a case for medical malpractice. 

However, if the nurse failed to assess the patient adequately or failed to communicate the patient's condition appropriately to the physician, the nurse could be a link to the patient's death.  In addition, if the physician failed to provide appropriate orders, the physician could also be a link to the patient's death.  When there are links, there is causation.  In this scenario, the legal nurse consultant would find duty, dereliction of duty, causation, and damages - all the elements of a medical malpractice claim.

Like all registered nurses, legal nurse consultants need to use critical thinking skills.  However, legal nurse consultants also need to apply analytical thinking when reviewing claims of medical malpractice.  Using both critical and analytical thinking helps the LNC determine the validity, strengths, and weaknesses of medical malpractice claims.

...Katy Jones