Julie Tollefson

Critical Thinking
I have been an ER nurse for approximately nine years and critical thinking is
something that I use every shift, and everyday. Throughout the years my critical thinking
skills have improved ith education and experience.
!ne experience that sticks out in my mind that I encountered recently involved a
male patient that as in his "#$s and as in the end stage of pancreatic cancer. The man
as on hospice care and his last ish as to go to %as &egas before he died, so he took
his dream trip and did everything he anted to do. !n the plane flight back, the man
became very ill ith shortness of breath, pain, and nausea and vomiting, and as
transported to my ER from the airport, and I as the primary nurse. 'fter e stabili(ed
the patient and made him comfortable, I discussed ith the attending )* and the
residents hat our plan as, and as told the patient as dying and probably ould not
make it through the night, so e ould +ust keep him in the ER and give palliative care. I
then ent to the patient$s room and talked to the family and patient about the plan of care.
The family and patient expressed concern that the patient$s ishes as to die at home.
,o I thought to myself, ho can I make this happen- I decided to talk to the doctor$s
about the patient$s anting to go home, they stated that he ould be able to go home if
comfort measures could be given, but ho could e get to care for this patient at home, it
as .#/## at night. ,o I thought to myself, ho can I get this patient home to die in
dignity and not in a busy, croded, loud ER. I decided to first call case management and
tell them about the situation and then social ork. I thought that if some ho e could
arrange for the patient to be transported home, and arrange for comfort care to be given
by a hospice or home health nurse, the patient could safely and comfortably go home.
,o I orked collaboratively ith the case manager and social orker, e made phone
calls to the hospice agency, ho agreed to send a nurse to the home, arranged for
palliative care orders to be ritten, and arranged for a ambulance ride home. I heard
later on that the patient died early the next morning. The patient and family thanked me
repeatedly for helping them out so the patient could die ith dignity.
I feel that I used my critical thinking skills to handle a situation that could have
been easily dismissed by other healthcare providers, and my decisions and actions
resulted in making a difference in the lives of my patient and his family.