Sheep No More: Apply Critical Thinking to the Veterinary Nursing Process

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If you desire to advance veterinary nursing on both a personal and professional level, Megan Brashear, CVT, VTS (ECC), a small animal hospital veterinary nursing manager at Purdue University College of Veterinary Medicine in West Lafayette, Indiana, has a word of advice for you (OK, 4 words to be exact): Don’t be a sheep. Sheep are known for being mindless followers, Brashear explained at this year’s American Veterinary Medical Association Virtual Convention. “That’s fine for sheep, but not for veterinary technicians.”

Brashear’s solution? Critical thinking. It’s what will take you from simply following directions, to fully understanding what your patient needs and how what you’re doing best meets those needs. It’s the difference between saying, “I’m giving the patient this medication because I was told to,” versus “I’m giving the patient this medication because I know what’s wrong. I know how it’s going to help. I know how to calculate what he needs and how to administer it, and I know the adverse effects to watch for after administration.”

A Crash Course in Critical Thinking

Brashear explained that critical thinking encompasses more than just the knowledge you gain from lectures, books, and journals. It also includes the knowledge you get through experience (via your patients and if you have your own pet) and by asking questions.

“Critical thinking is the ability to take what you’ve learned and adapt it to what’s happening,” she said. “We all know that medicine, for the most part, follows a kind of pattern: This animal has this disease process so this is how we’re going to treat it. But not every animal reads the textbook. Not every disease is going to show up in the same way in every patient.” The critical thinker can look at such situations, recognize that the usual checklist won’t work, and apply their collective knowledge and experience to appropriately respond.

“Critical thinking means triaging each and every patient,” Brashear said. “Get to the point where you have a baseline expectation for what a patient should look like, and when they don't meet that expectation, figure out why.” Don’t just look at your treatment sheet, complete the bare minimum, and walk away. Approach your patient thinking about what their heart and respiratory rates should be, what their blood pressure should be, what their gums should look like, etc. And if something is outside the norm, do something. “Younger technicians are often afraid to get a temperature or a blood pressure because it wasn’t ordered by the veterinarian,” she continued, “But those types of things—that’s what we’re entrusted to do.”

If this sounds a bit out of your scope—especially if you’re new to the profession—that’s OK. “Critical thinking is a skill, like drawing blood and placing catheters,” Brashear said. “We have to practice getting into the mode of thinking about what’s happening, asking questions, and learning more so we can continue to progress in our careers and help our patients.”

Applying Critical Thinking to the Nursing Process

“The nursing process is utilized much more frequently in human medicine, but there’s no reason we shouldn’t use it as well, especially with critically ill patients,” said Brashear, explaining that the process breaks down into 5 steps.

Assess

This step involves data collection. Assessment is when you put your hands on the patient and perform a physical exam. This is when you’re looking at the big picture and gathering as much information as you can. “This step also encompasses rounds,” she added. “Yes, we’re going to discuss a little bit about the disease process, but we’re not going to go through every blood chemistry result and how many lymphocytes the animal has unless it directly pertains to what’s wrong.” What’s more helpful, said Brashear, is to ask questions that will help you achieve continuity of care. For example, does the dog prefer to be hand-fed? Is he more comfortable urinating on pebbles or grass? Is this normal breathing for him?

Analyze

Because Brashear is a technician, she can’t make a diagnosis. However, she can contribute to it. “I can put my hand on that cat’s giant bladder and say, ‘I’m concerned. This cat has a history and physical exam that support urinary tract obstruction. I think we should probably take a look at them quickly.’ And I may not be able to diagnose a dog with a pneumothorax by looking at its lateral chest radiograph…but I can definitely take note that the heart is floating up in the chest, instead of sitting in the sternum like it should be. I can then take that dog off the table, knock on the exam room door, and say, ‘I think we need to look at this dog before things get significantly worse,’” she explained. The analysis step is about more than just writing down your patient’s stats and then walking away. Think through what you’re seeing, and bring any concerns to the veterinarian’s attention.

Plan and Prioritize

Brashear has worked in emergency veterinary medicine for over 20 years, so she knows all too well what it’s like to receive a long list of orders from the doctor in no particular order. Determining the best way to tackle that list is what this step is all about. “Let’s say you have 4 patients and they all need treatments,” Brashear posited. “A cat needs Lasix, a dog needs blood drawn, another cat needs radiographs, etc. What’s the most important thing? I’m going to argue that the poor cat who needs a Lasix injection should go first.” Once again, she stressed that this kind of critical thinking isn’t innate. If you’re new to nursing, just ask the doctor if there’s an order in which they’d like the list completed.

Implement

This step is Brashear’s favorite because it’s when you get to perform nursing care by following the prioritized plan you just developed. However, she noted that you may need to run your plan by someone else first. For example, you might need to get your team of technicians together and make sure everyone knows their respective roles in completing the to-do list.

Evaluate

“We want to make sure we’re evaluating how things went,” explained Brashear. “Did everything go according to plan? Did everything that needed to get done get done? Did our patients respond the way we needed them to? How is my team doing?” Assessing and communicating about how both your patients and your team members are doing are important, she noted. For example, perhaps one of your coworkers bonded with a patient who has to be euthanized. The rest of the team may need to rally around that technician and provide extra support for the rest of the day.

At the end of this process, you have more experience to put to use for the next patient when you start back at the beginning.

Be a Flight Attendant

Sheep may be poor role models for veterinary technicians, but according to Brashear, flight attendants are worthy of emulating. “Think about the stress you project at work. We need to remember that our patients really feed off of us and what we’re doing and how we’re behaving,” she explained. “I’m sure everyone knows a technician who gets a cat bite 4 or 5 times a year [and] you know when that technician has worked because every kennel has a “Will bite!” or caution sign.” As they try to get everything done at once, these technicians tend to exhibit anxious, fast movements and little patience, which is then reflected in the emotional state of the animals.

What the treatment area needs, said Brashear, is flight attendants. “Like anyone, I get nervous during turbulence,” she continued. “Any time it happens, I look for flight attendants. If they’re walking up and down the aisles with their beverage carts, pouring drinks, I’m fine because they’re fine. But if I see the flight attendants running down the aisle and clicking themselves into their 5-point harnesses, I’m going to be a little more nervous and grip the armrests tighter.”

The moral of this story? “Be the flight attendant who’s calmly passing out Diet Coke to all of your patients and helping them realize that all is OK,” Brashear said. “If you’re constantly running from one thing to another and visibly exhausted and overwhelmed, you’ll pass that anxiety over to your patients. Critical thinking isn’t just about understanding medicine. It includes understanding the behavior patterns of your patients, understanding what your clients need, and understanding what your teammates need.”

Sarah Mouton Dowdy, a former associate content specialist for dvm360.com, is a freelance writer and editor in Kansas City, Missouri.