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Clinical reasoning and decision making
Clinical reasoning and decision making
Reflection and deconstruction of the clinical reasoning essay
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Clinical Reasoning is the process of improving and understanding patient situations. This essay will outline what Clinical Reasoning is, discussing its importance in nursing and midwifery practice, and highlighting the Clinical Reasoning Process.
Clinical Reasoning is a thinking process and learning tool for nursing students to improve facts to form into judgements. According to Levett-Jones, Hoffman, Dempsey, Jeong, Noble, Norton, Roche & Hickey (2009), it is a process to assist nurses to improve their understanding of a patient problem. Clinical Reasoning is ‘feedback for self-evaluation to guide for formulating higher level thought questions to shape students’. Therefore, improving their knowledge and skills during practice. (Lasater,
2011, p.86-92). Moreover, Clinical Reasoning helps improve nursing students to evaluate their logic and reasoning. According to Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., Zevinsky, K., (2001), Clinical Reasoning is important in nursing and midwifery practice to achieve challenging clinical problems without having a negative outcome. Nurses and midwifes are responsible for their actions in healthcare every day, so they need accurate and logical decisions to not ‘fail to rescue’ (Needleman et al., 2001). Clinical Reasoning assists nurses and midwifes to improve clinical situations without having to make a mistake. To further support, Levett-Jones et al (2009) created the Clinical Reasoning process to describe the strategies to understand a patient’s problem. Nurses and midwifes can combine one or more stages before deciding. ‘Evaluate outcomes’ (Levett-Jones et al., (2010) can help nurses identify any strengths or weaknesses, whilst using ‘Take action’ (Levett-Jones et al., (2010) to help the nurse to decide what is the best solution to receive the best possible outcome. Levett-Jones created the Clinical Reasoning process to enhance nurses understanding of an individual’s situation. Clinical Reasoning is a process of understanding a patient problem or situation. This essay has explored Clinical Reasoning and its importance to nursing and midwifery practices, and describing the Clinical Reasoning process. Clinical Reasoning is a learning tool for nursing students to improve facts into judgements. The importance in nursing and midwifery practices is that so they are able to respond to difficult clinical problems.
Introduction The College of Nurses of Ontario (CNO) is the governing body of all registered nurses in Ontario and is regulated. The CNO provides expectations and guidelines to follow, which need to be met by each Registered Practical Nurse (RPN) individually. As a nursing student, I am taught about the CNO and the importance of referring back to the guidelines while caring for patients. While gaining experience in the nursing field through my clinical settings, I have realized as a nursing student there are areas I need further development in. In this paper, I will address two of my learning needs and my goals for each.
This essay will demonstrate an understanding of the clinical reasoning cycle which describes the procedure by which nurses gather prompts, process the data, come to an understanding of a patient’s problem, design and implement interventions, assess results, and reflect on and learn from the process (Hoffman, 2007; Kraischsk & Anthony, 2001; Laurie et al., 2001). The clinical reasoning cycle consists of five main stages, it comprises of; considering the persons condition, collecting indications and data, processing the information, recognizing problems/issues and detailing the assessment (Levett-Jones 2013). Throughout this essay these five main parts of the clinical reasoning cycle will be discussed and put into context. The first step of
LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-surgical nursing: Critical thinking in patient care (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Senior nursing students will complete a QSEN weekly clinical journal requirement learn how to self-assess their progress toward demonstrating these nationally-based competencies. The students will select a different competency each week to address and discuss how they applied that competency to patient care or how they hope to better achieve that competency as a graduate nurse. By the end of the clinical rotation each student will have had a chance to focus on each of the six QSEN competencies: patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. The students’ reflection on their clinical experiences each week will teach them how to integrate the core competencies required before graduation. According to Use of self-evaluative practices puts the power back upon the student to direct and think critically about their learning (Dickensen, 2015). Demonstrating these competencies supports safety and excellence in clinical practice (QSEN,
Critical thinking and knowledge are the foundation of nursing practice, and the most essential elements in providing quality nursing care. Nu...
It is important that students have the ability of being competent in a clinical setting. To be deemed competent in skills according to nursing regulations and requirements. This is a challenging factor for many students, as they enter transition period. This is due to students feel they do not have the desired clinical competency that promotes the skills and authorities of a registered nurse (Harsin, Soroor & Soodabeh, 2012). Clinical research studies have found that students do have the required expected levels of knowledge, attitude and behaviour’s. However, the range of practical skills aren’t sufficient for the range of practice settings (Evans, 2008). This research has also found that other evidenced based studies found that competency in nursing skills is still lacking (Evans, 2008). These skills are lacked by students and newly graduated nursing how are in the first or second year of
Wiles, L.L. Simko, L.C. & Schoessler, M. (2013). What do I do now? Clinical Decision making
According to Bandman & Bandman (1995), critical thinking is defined as the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs and actions. In this subject ‘Critical Thinking in Nursing’ has emphasized critical thinking as an essential nursing skill and its definition of critical thinking have evolved over the years. In short, the general definition of critical thinking is self-directed, self-disciplined, self-monitored and self-corrective thinking. Every nurses must cultivate rigorous standards for critical thinking, however they cannot avoid completely the situatedness and structures of the clinical traditions and practices. They must make decisions and act quickly according to
One of the most essential aspects of doing a job well, no matter what job it is, is the ability to think critically about a situation. Finn (2011) defines critical thinking as “the ability and willingness to assess claims and make objective judgments on the basis of well-supported reasons and evidence rather than emotion or anecdote”. The difference between assessing a certain situation critically and assessing it without any evidence to corroborate your claims is that when you look at something critically, you are using your ability to “come up with the alternative explanations for events, think of research findings and apply new knowledge to social and personal problems” (Finn, 2011). When you can come up with other explanations using evidence, you can also create an alternative way of enhancing the situation. Critical thinking skills are especially important to nurses in a fast-paced setting. Nursing is a very demanding and rewarding field to enter into; it becomes enjoyable when you are good at it. In order to be good at their jobs, nurses need to learn the skills required to think critically and also, relate those skills to their everyday routines. This is known as evidence-based practice. Evidence-based practice is defined as “using the best scientific evidence available to guide clinical decisions and interventions with the goals of fostering self-management skills and improving health outcomes” (Miller, 2011). This paper examines the skills required for critical thinking, how to learn these skills, and how to apply them in clinical settings. (Miller, 2011; Finn, 2011; Noonan, 2011; Lunney, 2010; Wangensteen, Johansson, Bjorkstrom & Nordstrom, 2010; Chitty & Black, 2011).
Utilizing nursing theory can help nurses develop a more focused and individualized plan of care for their patients. By understanding the nurse’s metaparadigm and how to apply theory to each concept, nurses can develop increased insight on their patients and promote interventions that are more likely to produce a greater quality of care for the patient.
Knowledge can be seen as the main focus of nursing qualities as it is a lifelong skill that is learned throughout a nurse’s career. In nursing, knowledge can be classified as theoretical or practice-based. Practice-based knowledge is attained through the nurse-patient encounter. According to Mantzoukas and Jasper (2008), a nurse’s nonverbal and verbal communication exhibits the nurse’s practice- based knowledge. When nurses demonstrate appropriate communication patients feel understood and comfortable within the relationship. It is difficult for a nurse to obtain this knowledge without taking an autonomous and individual approach for each patient (Mantzoukas & Jasper, 2008). Taking an autonomous approach allows for the nurse’s critical thinking to improve as well. Good critical thinking skills increases the chances of achieving desired patient outcomes as the nurse is able to analyze the situation effectively. Theoretical knowledge is acquired through education. This type of knowledge is expressed through what nurses know and the logical information the nurse possess in relation to their practice. Theoretical knowledge is also important as it makes the nurse competent and capable of carrying out simple tasks. From the coat of arms, it is evident that knowledge is a unifying quality that is the foundation for acquiring other qualities necessary for
My past philosophy of cyclical time functions only as a fragment under the umbrella of my present philosophy. This cyclical time portion of my philosophy carries great significance as it conscripts the recollection of my nursing roots (Ondrejka & Barnard, 2011). Mental commemoration of such events potentiates my capacity to provide empathetic care (Ondrejka & Barnard, 2011). My present nursing philosophy is pragmatically grounded in reason. I feel that nursing science is an attempt to explain health-related affairs through the lens of truth as opposed to unsupported claims. With this in mind, I believe that nursing science and evidence-based research is simply the application of reason in its most concentrated and purest form. Retrospectively, I feel that much of the great lessons taught by my clinical preceptors ultimately boiled down to reason. Additionally, I think that reason also provides much of the structural framework for ethically sound care: an increasing concern among nurses across health care organizations globally (Dauwerse & Abma, 2012). A philosophy of reason respects the interchangeability of perspectives and the disapproval of privileging personal needs over the needs of others. Applying reason to any healthcare circumstance ensures that I refrain from egotistic views of grandiosity. In practice, this is performed by caring for a patient as I would want to
I believe placing student nurses in the clinical setting is vital in becoming competent nurses. Every experience the student experiences during their placement has an educative nature therefore, it is important for the students to take some time to reflect on these experiences. A specific situation that stood out to me from my clinical experience was that; I didn’t realize I had ignored the patient’s pain until I was later asked by the nurse if the patient was in any pain.
Compared with medical professionals, nurses appear to be reluctant to rely on professional rationales for their actions, preferring to use managerial justifications and implementing ‘top down’ approach to care. (Adamson, 2013). When a gap in nursing care is perceived, theory is often used to improve these outcomes. Theory provides an overall vision and understanding of the profession of nursing by offering guidance. Not only in nursing, but theory can be applied to any profession as it serves as a tool for guidance of practice. The legitimacy of a profession is based on its ability to generate and apply theory (McCrae, 2012). Without nursing theory, nursing would be a profession guided by by medicine and physicians. Theory guides nurses by shaping its professional boundaries and helps nurses make decisions on current and potential patient needs.
In the healthcare setting, a systematic process to ensure maximum care and maximum recovery in patients is needed, which is called the nursing process. This process consists of four steps: assessment, diagnosis, planning, implementation, and evaluation (Walton, 2016). The nursing process is important to ensure quality care and to get the preferred outcome. In the nursing process, critical thinking is used to recognize the issue and come up with a logical solution to solving it. One important aspect of the nursing process is that the plan is not set in stone; it is meant to be manipulated in order to better suit the patient. Nurses must be able to think critically in order to recognize the issue, develop a way to correct it, and be able to communicate the issue to others. Throughout the nursing process, critical thinking is used to determine the best plan of care for a patient based on their diagnosis.