Chapter 13 Blended Competencies Clinical Reasoning and Processes

ANA Definitions of Nursing • Provision of a caring relationship that facilitates health and healing • Attention to the range of human experiences and responses to health and illness within the patient’s physical and social environments • Integration of assessment data with knowledge gained from an appreciation of the patient or group’s subjective experience • Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking Copyright © 2019 Wolters Kluwer • All Rights Reserved

ANA Definitions of Nursing (cont. ) • Advancement of professional nursing knowledge through scholarly inquiry • Influence on social and public policy to promote social justice • Assurance of safe, quality, and evidence-based practice Copyright © 2019 Wolters Kluwer • All Rights Reserved

Thoughtful Person-Centered Practice • The person • The professional nurse • Reflective practice leading to personal learning • Clinical reasoning, judgment, and decision making • The nurse’s action in response to individual clinical need • Person-centered nursing process Copyright © 2019 Wolters Kluwer • All Rights Reserved

Components of Thoughtful Practice Copyright © 2019 Wolters Kluwer • All Rights Reserved

10 Guiding Principles of Person-Centered Care • All team members are considered caregivers. • Care is based on continuous healing relationships. • Care is customized and reflects patient needs, values, and choices. • Knowledge and information are freely shared between and among patients, care partners, physicians, and other caregivers. • Care is provided in a healing environment of comfort, peace, and support. Copyright © 2019 Wolters Kluwer • All Rights Reserved

10 Guiding Principles of Person-Centered Care (cont. ) • Families and friends of the patient are considered an essential part of the care team. • Patient safety is a visible priority. • Transparency is the rule in the care of the patient. • All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. • The patient is the source of control for their care. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Beliefs of the International Association of Human Caring • Caring is the human mode of being. • Caring is the essence of nursing and the moral imperative that guides nursing practice. • Caring is both spiritual and human consciousness that connects and transforms everything in the universe. • Caring in nursing is action and competencies that aim toward the good and welfare of others. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Beliefs of the International Association of Human Caring (cont. ) • Caring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity. • Care is culturally diverse and universal, and provides the broadest and most important means to study and explain nursing knowledge and nursing care practices. Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Professional Nurse • Personal attributes • Knowledge base • Blended competencies Copyright ©

Blended Competencies • Developing cognitive competencies – Developing the method of critical thinking • Purpose of thinking • Adequacy of knowledge • Potential problems • Helpful resources • Critique of judgment/decision – Developing the personal attributes to think critically Copyright © 2019 Wolters Kluwer • All Rights Reserved

Blended Competencies (cont. ) • Developing technical competencies • Developing interpersonal competencies – Promoting human dignity and respect – Establishing caring relationships – Enjoying the rewards of mutual exchange • Developing ethical/legal competencies Copyright © 2019 Wolters Kluwer • All Rights Reserved

Question #1 A nurse’s personal moral code is to assist all patients to the best of one’s ability. What blended skill would the nurse use when seeking out special services for a homeless patient with a diabetic foot ulcer? A. Cognitive B. Technical C. Interpersonal D. Ethical/Legal Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #1 Answer: D. Ethical/Legal Rationale: Using ethical/legal skills is the best answer as it involves following a moral code and acting professionally. Cognitive skills involve thinking through a situation to achieve outcomes. Technical skills relate to the proper use of equipment. Interpersonal skills are used to develop caring relationships. Copyright © 2019 Wolters Kluwer • All Rights Reserved

QSEN Competencies • Patient-centered care • Teamwork and collaboration • Evidence-based practice • Quality

Problem-Solving and the Nursing Process • Trial-and-error problem solving • Scientific problem solving • Intuitive problem solving • Critical thinking: intuitive, logical, or both? Copyright © 2019 Wolters Kluwer • All Rights Reserved

Potential Errors in Decision Making • Bias • Failure to consider the total situation

Historical Development of the Nursing Process • 1955: Nursing process term used by Hall • 1960 s: Specific steps delineated • 1967: Yura and Walsh published first comprehensive book on nursing process • 1973: ANA Congress for Nursing Practice developed Standard of Practice • 1982: State board examinations for professional nursing uses nursing process as organizing concept Copyright © 2019 Wolters Kluwer • All Rights Reserved

Five Steps of the Nursing Process • Assessing: collecting, validating, and communicating patient data • Diagnosing: analyzing patient data to identify patient strengths and problems • Planning: specifying patient outcomes and related nursing interventions • Implementing: carrying out the care plan • Evaluating: measuring extent to which patient achieved outcomes Copyright © 2019 Wolters Kluwer • All Rights Reserved

Question #2 Which step of the nursing process is a nurse using when analyzing patient data to determine a patient’s strengths following a CVA? A. Assessing B. Diagnosing C. Planning D. Implementing E. Evaluating Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #2 Answer: B. Diagnosing Rationale: The diagnosing step involves analyzing patient data to determine strengths and weaknesses. The assessing step refers to the collection, validation, and communication of patient data. In the planning step, the nurse determines patient outcomes and related nursing interventions, and in the implementing step, the nurse carries out the plan. When evaluating, the nurse measures the extent to which the patient achieved outcomes. Copyright © 2019 Wolters Kluwer • All Rights Reserved

The Steps of the Nursing Process are Dynamic and Interrelated Copyright © 2019 Wolters

Question #3 Which of the following characteristics of the nursing process describes the interaction and overlapping of steps within the process itself? A. Systematic B. Dynamic C. Interpersonal D. Universally Applicable Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #3 Answer: B. Dynamic Rationale: The nursing process is dynamic in that there is much interaction and overlapping of the steps. It is systematic since it is an ordered sequence of activities. Interpersonal refers to the human being at the heart of nursing. The nursing process is universally applicable in that it is a framework for all nursing activities. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Characteristics of the Nursing Process • Systematic: part of an ordered sequence of activities • Dynamic: great interaction and overlapping among the five steps • Interpersonal: human being is always at the heart of nursing • Outcome oriented: nurses and patients work together to identify outcomes • Universally applicable: a framework for all nursing activities Copyright © 2019 Wolters Kluwer • All Rights Reserved

Benefits of the Nursing Process • Patient – Scientifically based, holistic individualized patient care – Continuity of care – Clear, efficient, cost-effective plan of action • Nurse – Opportunity to work collaboratively with other health care workers – Satisfaction of making a difference in lives of patients – Opportunity to grow professionally Copyright © 2019 Wolters Kluwer • All Rights Reserved

Steps in Concept Mapping 1. Collect patient problems and concerns on a list. 2. Connect and analyze the relationships. 3. Create a diagram. 4. Keep in mind key concepts: the nursing process, holism, safety, and advocacy Copyright © 2019 Wolters Kluwer • All Rights Reserved

Question #4 Tell whether the following statement is true or false. Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts. A. True B. False Copyright © 2019 Wolters Kluwer • All Rights Reserved

Answer to Question #4 Answer: A. True Rationale: Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts. Copyright © 2019 Wolters Kluwer • All Rights Reserved

Reflective Practice • Reflection in action – Happens in the here and now of the activity and is also known as “thinking on your feet. ” • Reflection on action – Occurs after the fact and involves thinking through a situation that has occurred in the past. • Reflection for action – Helps the person to think about how future actions might change as a result of the reflection. Copyright © 2019 Wolters Kluwer • All Rights Reserved