6. Evaluate the outcome.
7. Reflect and learn.
Revisit Table 14-2 and create a new, more detailed,
table merging the information in Table 14-2 with this
summary of the steps required for thoughtful
practice.
Although the actions taken following a judgement and
decision may be diverse and complex, they are not disorgan-
ised or unstructured. The actions may be described through an
organised series of steps called the process of care, as follows.
PROCESS OF CARE
The next component of thoughtful practice, as shown in
Figure 14-1, is the series of actions known as the
process of
care
. (See Figure U3-1 for how person-centred processes of
care fit within the model of thoughtful practice.) This term
refers to the way in which care is organised through a series
of actions undertaken in response to the individual needs of
the person. Although each care encounter, or clinical situa-
tion, is different, clinicians need a structured approach to
developing these processes. It is in the processes of care that
your skills in clinical reasoning and judgement are enacted in
a person-centred way, through a series of actions that meet
the needs of the person while preserving their humanity.
Figure 14-2 illustrates the process of care diagrammati-
cally. It is important to be cognisant of the fact that the real
world is complex and sometimes chaotic, and does not
always conform to a diagram. Despite this, Figure 14-2 does
allow for an understanding of the interrelated components
that constitute the process of care.
Each of the components of the process of care, as illus-
trated in Figure 14-2, is linked to steps within the clinical
reasoning process, and is described in one of the chapters in
Unit 3, as follows.
Unit III Thoughtful practice and the process of care
264
Assessing
(Chapter 15) is based on sound knowledge of
what is normal and what is abnormal, and involves the sys-
tematic collection of data and the use of intuition to decide
what data to collect.
Identifying health problems
(Chapter 16) involves skills in
interpretation, analysis and inference, as well as a well-
developed self-awareness that enables the identification of
biases and reduces erroneous assumptions.
Planning care
(Chapter 17) involves clinical judgement
and decision making, as well as identification of the appropri-
ate level of engagement, and incorporating creative solutions
to problems.
Implementing care
(Chapter 18) is dependent on knowl-
edge of best practice, and on decision making that is informed
by legal and ethical standards of practice.
Evaluating care
(Chapter 19) also requires skills in
analysis and inference.
The final chapter in Unit 3, Chapter 20, discusses
documen-
tation
, which involves the communication and explanation of
decision making and actions undertaken.
The common thread running through each of the interre-
lated components in the process of care is the need for active
clinical reasoning through the analysis of information or
data, the application of knowledge gained through education
and experience, and the recognition of the influences that we
each bring to the situation. Thoughtful practice should occur
throughout the process of care, and requires all the compo-
nents of clinical reasoning.
EVALUATION AND REFLECTION
In practice, clinical reasoning, problem solving and decision
making do not always occur in a linear fashion because prac-
tice does not take place in the controlled environment of the
laboratory, but in real life. Once the clinician has recognised
that there is a problem, the available information must be
processed by thinking critically, creatively and intuitively, a
judgement reached, a decision made and an action taken, or
not. Then the action needs to be evaluated: did the decision
and the action taken resolve the problem? Reflection on the
decision, the action and the outcome may be short and sharp,
occurring at the same time, or may occur later when the sit-
uation may allow for deeper reflection. The complete process
is often cyclical in nature; once you have completed the
process, you often go back to the beginning and repeat the
process again until the problem has been resolved.
Contemporary clinical practice has become extremely
complex. Clinicians may be caring for a number of signifi-
cantly ill people at any given time, and will be confronted
with a range of situations that require clinical reasoning,
judgement and decision making. In a normal shift, a clini-
cian may be required to make a decision every minute
(Bucknall, 2000). Not every decision is followed by an
action, as this might not be necessary. The clinician may be
involved in many of these cycles in any shift and make
countless decisions and take numerous actions. In addition,
Figure 14-2
Process of care
Assessing
Evaluating
care
Identifying
health problems
Planning care
Implementing
care
