REASONING IN A SPECIALITY AREA NURS 8100
A Sample Answer For the Assignment: REASONING IN A SPECIALITY AREA NURS 8100
Application of Reasoning Strategies
According to literature review on this matter, terms such as clinical reasoning, problem-solving, decision making, critical thinking and clinical judgment are mostly used interchangeably. However, in nursing practice, clinical reasoning can be defined as the process by which nurses collect cues, process the collected data, understands the patient problem or situation, plan and implement treatment intervention, evaluate the outcome and reflects on the whole process and learns from it (Pirret, Neville, & La, 2015).
In critical care or among nurse educators, clinical reasoning plays an instrumental role in supporting the delivery of safe and effective patient care. Nurse educators for instance employ both their experience through clinical reasoning and acquired knowledge and skills to adequately prepare future nurses.
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The three dominant clinical reasoning strategies utilized frequently in the specialty area especially in critical care or by nurse educators include intuitive knowing, diagnostic reasoning, and pattern recognition. Firstly, intuition is habitually applied to the care of critically ill patients. For example, irregularities in a patient’s vital signs usually imply deterioration.
An experienced nurse uses intuitive reasoning to decide on how to respond to a deteriorating patient. According to Pirret, Neville, and La (2015), intuition enables nurses to discover delicate changes in the condition of the patient, which then allows them to clearly reason, deliberate on their thoughts, prepare for a proper intervention, and administer confirmatory tests.
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Secondly, pattern recognition is utilized frequently when revising the patient’s HPI and findings from the physical examination. For example, uncontrolled blood glucose in patients with diabetes implies nonadherence to both medication and lifestyle interventions. Pattern recognition makes it possible for the clinicians to utilize their grounded knowledge in specific areas of healthcare to treat patients without the need for extended or prolonged diagnostic procedures.
A combination of intuition and pattern recognition then form the basis for diagnostic analysis. Pattern recognition and intuition are subjective, which raises concerns over the validity and reliability of decisions (Dalton, Gee, & Levett-Jones, 2015). Thus, diagnostic analysis entails testing diagnostic hypotheses analytically. For example, vaginal discharge implies a sexually transmitted infection, based on intuitive knowledge, but lab tests and diagnostics are necessary to identify and treat the responsible microorganism.
Refinement of EBP Project
In conclusion, the EBP question focuses on finding out whether self-care and productive interaction with an interdisciplinary team enhance outcomes for adult cancer patients with diabetes. Intuition and pattern recognition helps come up with a possible hypothesis from the evidence-based practice question. Specifically, previous experiences and encounter with similar patients provide essential cues about the possible answer to the question.
Practice knowledge past clinical knowledge has shown that multidisciplinary teams ensure that people with complex chronic disease receive comprehensive care (Smallheer, Hunt, & Smith, 2018). Thus, it can be hypothesized that cancer patients with diabetes will have better health outcomes if they receive care from a multidisciplinary health care teams.
On the other hand, a diagnostic analysis will focus on evaluating the findings from the EBP project to determine the effectiveness of multidisciplinary approach and self-care. Evaluation of the outcome measures of a project will then help test the accuracy and veracity of the hypotheses that were developed from intuition and pattern recognition.
References
Dalton, L., Gee, T., & Levett-Jones, T. (January 01, 2015). Using clinical reasoning and simulation-based education to ‘flip’ the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33, 2, 29-35.
Pirret, A. M., Neville, S. J., & La, G. S. J. (March 01, 2015). Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: A comparative study. International Journal of Nursing Studies, 52, 3, 716-726.
Smallheer, B., Hunt, J., & Smith, J. (2018). Using Critical Care Simulations to Prepare Nursing Students for Capstone Clinical Experiences. (Dimensions of critical care nursing.) Lippincott Williams & Wilkins.
In this week’s learning resources we reviewed how healthcare is provided in various countries impacting the international continuum of care. This international continuum of care has been a topic of interest for centuries, but really pick up momentum as individuals gained access to convenient and fast international travel. Bodenheimer & Grumback (2020) shared that there is no universal design for healthcare delivery.
This discrepancy can be a barrier and opportunity for each country to tailor the delivery system to what their population of citizens. For example, social determinants of health are addressed differently in each country. Additionally, various nursing organizations are also focused on the international continuum of care. The International Council of Nursing (n.d.) is focused on several international nursing policies like socio-economic welfare. This is a demonstration of the role of an international organization in developing policy.
I am currently working in collaboration with a university in Rwanda creating curriculum content for a Nursing Leadership and Midwifery graduate level program. I am also an international nursing mentor and am working with students in Rwanda and Kenya on implementing quality improvement projects. The country that I am comparing to the U.S. is Rwanda.
A policy that Rwanda’s Ministry of Health (n.d.) is working on is related to how social determinants of health are addressed. Rwanda is currently rebounding from civil war in the mid 1990’s. In the past several decades they have made significant improvements in address it’s citizens social determinants of health.
However, the country has an opportunity to optimize this effort due to persistent extreme poverty, overexploited land, and effects of climate change on housing and healthcare (Government of the Republic of Rwanda Ministry of Health, n.d.). The country’s nursing population is also largely midwives due to lack of providers in the country. Bazirete et. al. (2020) shared how social determinants of health impact maternal mortality and morbidity in rural Rwanda.
Social determinants of health is also a policy that is address in the U.S. The American Academy of Nursing has a policy from 2019 which prioritizes a focus on social determinants of health for nursing (Kuehnertet. al., 2022).
We’ve incorporated social determinants of health into screening tools and electronic health records to provide targeted population health to support our existing healthcare system and reduce the burden on resources. Bedside nursing is incorporating social determinants of health into clinical practice by allowing the information to impact clinical decision making for improved health outcomes (Phillips et. al., 2020).
From the comparison between how Rwanda and the U.S. are creating policy around social determinants of health I’ve gained an understanding of how different the social needs of each country can be. Additionally, I’ve gained an understanding that it’s challenging to compare a third world and first world healthcare system. Each country is working with vastly different healthcare resources, infrastructure, and population health needs.
References
Bazirete, O., Nzayirambaho, M., Umubyeyi, A., Uwimana, M. C., & Evans, M. (2020). Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives. BMC Pregnancy and Childbirth, 20(1), 678. https://doi.org/10.1186/s12884-020-03389-7
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.
Government of the Republic of Rwanda Ministry of Health. (n.d.). Policies. https://www.moh.gov.rw/publications/policies
International Council of Nurses. (n.d.). https://www.icn.ch/nursing-policy
Kuehnert, P., Fawcett, J., DePriest, K. N., Chinn, P., Cousin, L., Ervin, N., Flanagan, J., Fry- Bowers, E., Killion, C., Maliski, S., Manughan, E., Meade, C., Murray, T., Schenk, B., & Waite, R. (2022). Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing. Nursing Outlook, 70(1), 10-27. http://doi.org/10.1016/j.outlook.2021.08.003
Phillips, J., Richard, A., Mayer, K. M., Shilkaitis, M., Fogg, L. F., & Vondracek, H. (2020). Integrating the social determinants of health into nursing practice: Nurses’ perspectives. Journal of Nursing Scholarship, 52(5), 497–505. https://doi.org/10.1111/jnu.12584
Discussion: Reasoning in a Specialty Area
Bring to mind an important practice-related decision you have made recently. How did you approach this decision? What aspects of your specialty expertise informed your decision-making?
Evaluate your decision now in light of the principles of clinical reasoning presented in the Learning Resources this week. What new insights arise about your decision making as you look at it through this lens? What questions emerge as you reflect how you use reasoning in your practice?
In this Discussion, you and your colleagues examine the application of reasoning strategies in your specialty area of practice, particularly as it is connected to your EBP Assignment question.
To prepare:
- Consider the definition of clinical reasoning and how it is distinguished from other terms in the Simmons article.
- Bring to mind key characteristics of your specialty area. Is the concept of clinical reasoning relevant and sufficient to describe the process you utilize as you make decisions and solve problems in your area of specialization? Why or why not? If not, what terminology would be more useful for defining or characterizing this process?
- Review the literature to identify at least two specific examples of reasoning strategies used in your specialty area. These may be part of your literature review related to your EBP Assignment question(s).
- Reflect on your EBP Assignment question(s). Reexamine your project question(s) through this lens of clinical, or alternately termed, reasoning.
By Day 3
Post a cohesive scholarly response that addresses the following:
- How are reasoning strategies most often applied in your specialty area? Provide at least two specific examples supported by the literature.
- How can you apply reasoning strategies to the refinement of your EBP Assignment question(s)?
Read a selection of your colleagues’ responses.
By Day 6
Respond to two of your colleagues in one or more of the following ways:
- Ask a probing question, substantiated with additional background information, evidence, or research.
- Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
- Offer and support an alternative perspective, using readings from the classroom and/or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
- Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
- Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.