NURS 8100 Week 2: Applying Complex Reasoning Strategies
You likely make countless decisions in your day-to-day practice—many with significant consequences. How do you gather and assess information? Evaluate its significance? Weigh possible actions? As a DNP-prepared nurse, it is essential to engage in self- reflection and further your awareness of how your decision-making processes and use of professional judgment can promote the application of effective practices in your specialty area.
Reasoning strategies guide current practice as well as the development and adoption of new, innovative approaches to improve practice in the specialty areas—a topic that will be explored in depth during upcoming weeks of this course. This week you begin to develop your small-scale Evidence-Based Practice (EBP) Assignment in your practicum setting. In Application 1—the first in a series of assignments in which you will convey your insights and analysis of the EBP. Assignment—you are asked to identify an issue related to practice in which an outcome is different from what would be expected according to the research literature. This issue provides the foundation for future development of the project.
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.
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.
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.