...Clinical reasoning, evidenced based practice and my application of both in nursing practice Clinical reasoning, evidenced based practice and my application of both in nursing practice Simmons (2009) states “clinical reasoning guides nurses in assessing, assimilating, retrieving, and/or discarding components of information that affect patient care” (p. 1151). I feel that without clinical reasoning nurses would just be going through the motion of caring for a patient with no specific outcome in mind. Because of the autonomous work of the nurse in many settings clinical reasoning is a skill that must be fine-tuned. There will not always be others to collaborate with on the care of patients and therefore the practicing nurse must feel confident in her decision of what type of care to provide, this is where her skills of clinical reasoning (cognitive process) come in and she is able to decide on the type of care to be given based off of her skills alone. The following are some of the different types of clinical reasoning out there. 1. Subjective expected utility theory, which explains how, decisions ‘ought’ to be made using mathematical estimation of highest probability. (Simmons, 2009, p. 1153). 2. Information processing theory, which focuses on how decisions are made, not how they should be made. (Simmons, 2009, p. 1153). 3. Hypothetico-deductive method which is a medical descriptive model based on information processing. (Simmons, 2009, p. 1153)...
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...Nurses use clinical reasoning to assess their patients, make decisions surrounding interventions, and evaluate these interventions every day in their clinical practice. Having just finished a rotation on a busy surgical unit I had the opportunity to see nurses using their clinical reasoning skills and experience in order to facilitate safe patient care: this paper will discuss clinical reasoning and the processes involved used by nurses to make critical decisions in regards to visibly distressed postoperative patients. Defining Clinical Reasoning Clinical reasoning is an essential part of nursing practice and has even been identified as what could be called “the ‘hallmark’ of an expert nurse” (Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003,...
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...accessory muscles, cyanosis, retraction of intercostal spaces - wheezing Predominant on expiration Emphasema - irreversible damage to alveoli, increase airway resistnece - enlargement of air sacs , on expiration - hyperinflated lungs - altered breathing - barrel chest, use of accessort muscles, tripod position, SOB - decreased breath sounds Pleural friction rub - inflammation of the pleura - pain Pneumothorax - free air in the pleural space of the lung causes a collapse - inspection: unqual chest expansion, tachynopnea, cyanosis, bulging in inerspaces - palpation: tracheal shift, unequal chest expansion, tachycardia, decrease B - no sound The clinical reasoning cycle - way of thinking that allows the nurse to make clinical judgements - has a positive impact in the patient normal steps are - patient situation, collect cues, process information, identify issues, establish goals, action, evaluate goals, reflect Patient context: within their context of care Cues: what already know, what new information is needed and recall what is needed Process information: - normal/abnormal - relevant and irrevant information - cluster cues - infer - match - predict a potential outcome indentify problems: synthesis the facts and inferences to make a definitive diagnosis about the patient and define the most urgent issue or problem for the patient establish goals: what you want to happen take action: select a course of...
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...This essay will follow the steps as described within the Clinical Reasoning Cycle; introducing Mrs Alice Palmer a 54-year-old who has recently suffered an ischaemic stroke and is now undergoing further care and rehabilitation in the acute stroke unit. Firstly, the implications of stroke and the risk factors will be briefly observed, secondly, how her demographic is affected by the issue at hand will be discussed. Thirdly, handover information will be analysed and further required information will be identified in regards to the collected cues. Health assessments and histories needed to be undertaken will then be determined as well as how they will be performed, and reasons why. An ischaemic stroke is characterised by accelerated brain cell...
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...Case study 76 Endocrine Disorders 1. Interpret Y.L.'s laboratory results • HbA1C is elevated at 8.8% and the goal for diabetics is to keep that value below 7% Hemoglobin A1c. Her number is concerning because it indicates that her blood sugar has been way too high over the past few months. The A1c is an indication of glycosylation in the body which is damaging to the blood vessels and peripheral nerves. It causes thickening of the basement membrane which will impair oxygen transport to the tissues and carbon dioxide removal. • High BP • Total Cholesterol is elevated at 256mg/dL, normal value is below 200mg/dL • Fasting glucose is high at 184mg/dL, normal value is below 126mg/dL • Triglycerides are elevated at 346 mg/dL, normal levels are below 150mg/dL. Y.L. indicates levels that are high. • LDL levels are elevated at 155mg/dL and ideal values are below 100mg/dL; LDL is the value you want to be the lowest. • HDL levels are low and the HDL levels need to be high, 40-60mg/dL is desired. • Urine Analysis indicates that Y.L. is spilling glucose into her urine. 2. Identify the three methods used to diagnose DM. - Fasting blood glucose of > 126 mg/dl - Random Glucose Level >200 mg/dl (plus presence of other symptoms) - A1C > 6.5% 3. Identify three functions of insulin. • regulates glucose metabolism • stimulates lipogenesis • stimulates growth 4. Describe the major pathophysiologic difference between type 1 and type 2 DM. • Type 1 diabetes,...
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...Description of Evidence Evidence 1: The first piece of evidence demonstrating the criteria related to critical thinking is a concept analysis paper written on the topic of Critical Thinking in Nursing, completed for NUSC 5003, Theory in Nursing, in the Spring Semester of 2015 (Appendix A). The purpose of this paper was to expand on the interpretations of critical thinking including the analysis of the characteristics or qualities of critical thinking in nursing based on selected literature reviews from multiple disciplines using the Walker and Avant model. Incorporates multiple perspectives in the advanced practice learning process (i.e. diverse ways of thinking, roles). In this paper, I analyzed diverse concepts of critical thinking by...
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...One scholarly writing sample that I chose to analyze was "Thinking in Pharmacy Practice: A Study of Community Pharmacists' Clinical Reasoning in Medication Supply Using the Think-Aloud Method" by Hayley Croft, Conor Gilligan, Rohan Rasiah, Tracy Levett-Jones, and Jennifer Schneider. In summary, the article discussed the examination of the thought processes of ten pharmacists when working in a community setting. From the qualitative data that was collected, the researchers derived seven core thinking processes and find these processes essential to emphasize while teaching and in pharmacy practice. The seven core thinking processes were considering prescription in context, retrieving information, identifying medication-related issues, processing...
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...Thinking and Decision Making Joshua Bustos, Markethia Hughes, William Huntzinger, Gabriella Nava, and Patricia Williamson MGT 350 February 27, 2012 Courtney Wilson Thinking and Decision Making Logical Thinking Everyone is born with the ability to reason, even on a primary level. Logical thinking is a process in solving problems that requires reasoning. The word logic is from ancient Greek. Logic is a science that studies the principles of correct reasoning. There are two types of logical reasoning induction and deduction. Inductive reasoning is also known as inductive logic is the process of reasoning for specific evidence, observation, or experimentation. Inductive reasoning individuals do every day in his or her lives. Deductive thinking is also known as deductive logic the process of reasoning based on common knowledge. A logical thinker needs to recognize illogical thinking. Critical thinkers will ask questions to determine if the issue is logical or illogical for instance; do the pieces fit together logically? Are you really sure this makes sense? Are you certain it is in the publication? It is imperative the questions that are asked needs to be specific and precise to the situation or issue. If there is any inconsistences exist when finish asking the questions it is more likely the thinking path is illogical. It is important for logical thinkers to follow the facts for creditability to the situation or issue. In another words “When the combined thoughts...
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...Critical Thinking Notes for Quiz 1)Collection of Information Skill and defination | Why important | How | Question to ask | a) Identifying assumption: Recognizing when something is taken for granted or presented as fact without supporting evidence (e.g., you might assume a woman on a maternity unit has just had a baby) | By identifying assumptions, you begin to apply logic to the situation and avoid jumping to conclusions and making errors in judgment. | To identify assumptions, make sure that you have a complete picture of what's going on with the patient | What's being taken for granted here?” and “How do I know that I've got the facts right?” | b)Assessing systematically and comprehensively: Using an organized, systematic approach that enhances your ability to discover all the information needed to fully understand a person's health status (e.g., What are the actual and potential problems? What needs aren't being met? What are the person's strengths and resources?) | Having an organized approach to assessment prevents you from forgetting something Use both subjective and objective data | You must decide the purpose of your assessment and use an approach that gets the information needed to achieve your purpose. For example, medical assessments focus on identifying diseases or organ or system problems, rather than problems with human responses or activities of daily living | What infor I Need to know in order to treat this person?What would be my approach for this...
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...business decisions. Other points in this paper will cover importance, benefits regarding the example provided and how they relate. Before the conclusion is stated the last point in this paper will cover how critical thinking is used in my current position. Critical Thinking Explained Critical thinking is the introspectively and orderly method of cleverly and vigorously applying, synthesizing, analyzing, conceptualizing, and classifying information collected from, or produced by, reasoning, experience, observation, reflection, or communication, as a compendium to action and belief. In its ideal form, it is based on global intellectual principles that go beyond the matter of which a thing is formed: accuracy, clarity, consistency, precision, sound evidence, relevance, depth, good reasons, fairness, and breadth. Critical thinking also involves the exploration of these elements and or structures of understanding in all purpose, assumptions, concepts, problems, or question-at-issue, concepts, reasoning leading to conclusions, empirical grounding, consequences and implications, objections from alternative viewpoints; and frame of reference. Critical thinking is being proactive to different issues, purposes, and subject matter in which it is included in a wide variety of thinking, among them: mathematical thinking, scientific thinking, anthropological thinking, historical thinking, moral thinking, economic thinking, and philosophical thinking. Example / Importance / Benefits Trying...
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...Running head: FAILURE TO RESCUE Failure to Rescue Barbara Combes Breckenridge School of Nursing ITT Technical Institute July 15, 2014 FAILURE TO RESCUE Abstract This paper describes failure to rescue (FTR), according to recent studies. Failure to rescue is discussed in terms of importance to nursing. The paper speculates on how knowing about failure to rescue may help in the nursing course studies and critical thinking skills. FAILURE TO RESCUE Introduction According to a 2007 article in Med Care, use of failure to rescue as an indicator of hospital quality and patient safety has increased over the past decade. Researchers have used different sets of complications and deaths to define this measure. (Silber JH, Romano PS, Rosen AK, Wang Y, Even-Shoshan O, Volpp KG, 2007). This paper gives a description of failure to rescue, discusses the importance to nursing and nursing students, in regards to course studies and critical thinking skills. References for this paper are research studies that used the “original” FTR (using all deaths) description. Description Failure to Rescue is generally defined as the inability to save a hospitalized patient’s life when he/she experiences a complication. A complication is a condition that is not present on admission, such as cardiopulmonary arrest/shock, pneumonia, upper GI bleed, venous thromboembolism (VTE), and sepsis. Failure to rescue does not necessarily imply wrong doing. (Silber, JH, 2007) Importance to Nursing ...
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...Jarvis: Physical Examination & Health Assessment, 6th Edition Chapter 1: Evidence-Based Assessment Key Points – Print This section discusses key points about assessment and critical thinking. ⦁ Assessment is the collection of subjective and objective data about a patient’s health. ⦁ Subjective data consist of information provided by the affected individual. 1 Objective data include information obtained by the health care provider through physical assessment, the patient’s record, and laboratory studies. ⦁ The database is the totality of information available about the patient. The purpose of assessment is to make a judgment or diagnosis. 1 Diagnostic reasoning is the process of analyzing health data and drawing conclusions to identify diagnoses. This process has four major components: ⦁ Attending to initially available cues, which are pieces of information, signs, symptoms, or laboratory data; 1 Formulating diagnostic hypotheses, which are tentative explanations for a cue or a set of cues and can serve as a basis for further investigation; 2 Gathering data relative to the tentative hypotheses; 3 And evaluating each hypothesis with the new data collected, which leads to a final diagnosis. ⦁ The nursing process includes six phases: assessment, diagnosis, outcome identification, planning, implementation, and evaluation. It is a dynamic, interactive process in which practitioners move back and forth within the steps. 1 Nurses apply the process...
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...Six Caps Case Study University of Phoenix Undergraduate Nursing Studies Introduction In the words of Albert Einstein, “the world we have created is a product of our thinking; it cannot be changed without changing our thinking.” Today more and more nurses have to change their thinking process to ensure clients receive quality care. Therefore, clinical judgments cannot be based on speculation but on outcome, directed thinking. As the client health status changes, the nurse must be able recognize, assess, and evaluate all the presenting information to make an outcome decision that is best for the client and client’s family. To make appropriate decisions require nurses to put on their thinking caps. Edward de Bono’s six thinking caps integrates knowledge, comprehension, application, analysis, and evaluation allowing the nurse to make quality, outcome based decision. The purpose of this paper will focus on a case study using six thinking caps to critically analyze and make clinical decisions in promoting client safety and quality care. White Cap Thinking Looking at the case study with the White, Ms. Marianne first presented with a severe headache. The nurse uses her knowledge base about hemorrhagic stroke to decide what additional information is needed. Since information cannot be obtained from the patient, the nurse ask the patient’s family questions about the patient’s health problems, family health problems, medical history, medication regimen...
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...From Lecture & Handouts: A. Know the steps in Halpern's framework for critical thinking. Reviewed below. B. Know the names of the eight activities (each has an alternate term, but just need to know the main ones on the picture), and be able to match up descriptions of these activities with the correct name. SEE YOUR HANDOUT. C. Know the steps in the paramedic method, and be prepared to apply them to a problem sentence. Steps given below. Diana Halpern's (1996) Framework for Critical Thinking Definition: Critical thinking is the use of cognitive skills or strategies that increase the probability of a good outcome. CT is purposeful, reasoned, and goal-directed. Answer the following questions: 1. What is the goal? First step in improving thinking is to be clear about the goal or goals. Sometimes there are multiple goals; sometimes the goal changes as we work on a problem. If the overall goal is not OPERATIONAL (i.e., "get a good grade" or "reach a good decision"), then identify operational goals (write clearly, address all elements of the assignment, evaluate the consequences of alternative decisions). 2. What is known? Review what is known. You may know more than you realize, once you start taking a census. You may also realize that some of the apparently information is not certain at all. If you are completing an assignment or solving a problem for someone else, review guidelines for the assignment and ask yourself what the person cares about and...
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...Logical Reasoning The Logical Reasoning Section The focus of this book is on the Logical Reasoning section of the LSAT, and each Logical Reasoning section contains a total of 24 to 26 questions. Since you have thirty-five minutes to complete the section, you have an average of approximately one minute and twenty-five seconds to complete each question. Of course, the amount of time you spend on each question will vary with the difficulty of each question and the total number of questions per section. For virtually all students the time constraint is a major obstacle, and as we progress through this book we will discuss time management techniques as well as time-saving techniques that you can employ within the section. The Section Directions Each Logical Reasoning section is prefaced by the following directions: “The questions in this section are based on the reasoning contained in brief statements or passages. For some questions, more than one of the choices could conceivably answer the question. However, you are to choose the best answer; that is, the response that most accurately and completely answers the question. You should not make assumptions that are by commonsense standards implausible, superfluous, or incompatible with the passage. After you have chosen the best answer, blacken the corresponding space on your answer sheet.” On average, you have 1 minute and 25 seconds to complete each question. Because these directions precede every Logical Reasoning section...
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