Critical-Care Thinking Is More Than Knowing the Tasks

 

Critical-Care Thinking Is More Than Knowing the Tasks

One of the most important conversations I’ve had recently was with the respiratory therapist  who comes to our home to check equipment. 

The RT works for a company that specializes in helping individuals at home with complex medical situations. To get hired as a respiratory therapist at that company you have to have prior experience in a critical care setting. …ICU, PICU, or NICU. 

Not because they are bringing an ICU into someone’s home, but because ICU experience develops something she called:

Critical-care thinking.

It helped explain something I have observed since very early after Alex was injured.

There is a difference between learning how to perform a task and learning how to think when physiology is rapidly changing.

Those are not the same thing.

A caregiver can be taught how to:

• suction a tracheostomy,
• check a ventilator,
• transfer someone safely,
• administer medications,
• complete documentation,
• or perform routine care.

Those are essential skills.

But medically complex care often requires something beyond completing tasks.

It requires continuously asking:

• What is changing?
• Why is it changing?
• What is this person’s body trying to tell us?
• What is most likely to happen next if nothing changes?
• What can we do now to prevent a crisis or do if one happens. 

That is a different way of thinking.

In an ICU, clinicians are constantly learning to recognize subtle physiologic changes.

One number rarely tells the whole story.

Instead, they learn to integrate many pieces of information:

• vital signs,
• trends,
• breathing patterns,
• skin color,
• equipment,
• laboratory data,
• patient communication,
• and clinical experience.

They learn that the earliest clues are often the most important.

By the time an emergency becomes obvious, the opportunity to prevent it may already be narrowing.

That same kind of thinking becomes invaluable in high-acuity home care.

Because unlike a hospital, there is no rapid response team standing outside the door.

There is no respiratory therapist arriving in two minutes.

There is no ICU down the hall.

The people already in the home become the first responders and often that is only one person. 

They must recognize subtle changes, think through what those changes mean, and begin responding while additional help is still on the way if still needed. 

This is not a criticism of home-care nurses.

Nor is it a suggestion that every nurse should have ICU experience.

Many outstanding home-care clinicians develop extraordinary expertise through years of caring for medically complex individuals.

The point is different.

It is recognizing that critical-care thinking is a way of reasoning, and that reasoning should be intentionally developed and supported whenever someone is caring for an individual whose physiology can change rapidly.

For Alex, that means understanding much more than equipment.

It means understanding Alex.

His usual voice, color, breathing, autonomic system, communication, patterns, early warning signs, and body, because by the time a monitor alarms…Alex has often been telling us for several minutes that something is already changing.

Perhaps the question is not:

“Has this caregiver completed the required training?”

Perhaps the better question is:

“Has this caregiver developed the clinical reasoning and individualized competency needed to recognize change early, understand what it means for this particular person, and respond appropriately?”

Those are not the same question.

One Final Thought

Generalized training teaches someone what to do.

Critical-care thinking teaches someone how to think when what they planned to do is no longer enough.

For medically complex individuals, both are essential.

Because routines keep people healthy.

But thoughtful clinical reasoning is often what keeps a rapidly changing situation from becoming a life-threatening crisis.

TheGoalIsLife