Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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interrelationships between such aspects as reflection and crit- ical thinking are very strong. Each of the chapters in Unit 3 explains the processes of care through a more detailed discus- sion of assessing, identifying health problems, planning care, implementing care and evaluating care. Critical thinking activities and reflective cues are used throughout this chapter and throughout this text. As well as learning the skills necessary for thoughtful prac- tice, you must understand the influences that shape your reasoning and judgements. Figure 14-1 illustrates the trajec- tory and interrelationships of the components of thoughtful practice, and portrays these influences as personal attributes, knowledge base and clinical experience. You must draw on a broad knowledge base to underpin the decisions you make in clinical practice. The knowledge that progresses from these perspectives must be supported by sound and well-developed thinking skills gained through parallel clinical experience. Applied skills in clinical reasoning enable you to identify options for care and to choose a course of action that provides a solution or temporary relief of a health problem. This is called clinical judgement. Clinical judgement involves deci- sion making and can be influenced by your personal attributes and by how you respond within the specific health setting. The following section explains how clinical reasoning in the

context of nursing and midwifery practice emerges from these combined influences. The processes of clinical reasoning and the types of thinking involved are then explored, followed by an explanation of clinical judgement and decision making. The chapter concludes with an example of a clinical situation explored through a clinical reasoning framework.

CONTEXT OF THOUGHTFUL PRACTICE

In Chapter 13, the professional context of thoughtful nursing and midwifery practice is discussed, and the professional attributes that the clinician should bring to the clinical encounter are explained. The first component of thoughtful practice, reflective practice, is outlined. This chapter contin- ues the discussion of thoughtful practice and outlines its second component—clinical reasoning. The following section explores the influence of personal attributes, knowledge and experience on clinical reason- ing, and then the next section looks at problem solving, ways of thinking, clinical judgement and decision making, each of which interrelate with reflective practice to form thoughtful practice.

Clinical reasoning

Personal attributes

Clinician’s actions

Clinical judgement Decision making

Problem solving Critical thinking Creative thinking Intuitive thinking

Context of thoughtful nursing and midwifery practice

Knowledge base

Process of care

Clinical experience

Evaluation and reflection

Figure 14-1 Clinical reasoning and the process of care trajectory Source: Adapted from Fowler, 1998, p. 85; Martin, 2002, p. 244; and Tanner, 2006, p. 208.