Fundamentals of Nursing and Midwifery 2e

267 Chapter 14 Thoughtful practice: Clinical reasoning, clinical judgement, actions and the process of care

BOX 14-6 Example of the application of the clinical reasoning framework (continued)

• Ability to identify the components of clinical reasoning • Knowledge of the types of thinking used in clinical reasoning • Understanding of the relationship between clinical reasoning and the processes of care • How to apply a clinical reasoning framework to analyse current and potential health problems in order to reach a clinical judgement. Throughout the rest of this text there will be additional opportunities for you to develop your clinical reasoning skills through consideration of various scenarios relevant to the particular chapter you are reading. When you encounter the icon you will undertake critical thinking exercises that will enable you to apply the learning you are acquiring to a particular clinical situation. The questions relating to each scenario will require you to think through a problem and, in some instances, make a clinical decision. medications as ordered, taking measures to minimise adverse effects, and you encourage Matthew to use the inhaler correctly even though it is difficult. Your aim is to increase the amount of oxygen measured by the oximeter so that his supplemental oxygen may be reduced as his condition improves. When Matthew’s grandparents ask questions you try to answer them and keep them informed of management plans and actions. You enable his grandparents to stay with him, placing him in a quiet location and explaining all procedures and interventions. You discuss contacting his parents, you ensure access to the nurse call system and you maintain close observation of Matthew. After checking with a more experienced nurse you have determined that if Matthew’s response to inhaler medication is not favourable or if oxygen saturation is not kept over 95% by his supplemental oxygen, he will need an IV, which will exacerbate his anxiety further. problems to planning and implementation of her care. Each chapter will explore aspects of the scenario pertaining to the relevant component of the processes of care. Critical think- ing questions will be posed and some reflective cues will be included, to encourage you to reflect on the particular com- ponent, building your skills for thoughtful practice. At the end of Unit 3 you will be able to review what you have learnt in this unit by evaluating the plan of care that you have created for Claire.

assessment findings and with the care of Matthew’s grandparents, and medical staff for more detailed medical assessment and initiation of investigations and/or interventions. Physical assessment tools include a stethoscope, a tympanic thermometer and a pulse oximeter. Treatment resources include oxygen and suction equipment available and in working order. 5. The clinical judgements you make will be dependent on your appraisal of the urgency of intervening in Matthew’s breathing difficulties. One of your key objectives is to reduce his anxiety, so you spend a little time chatting with him to develop his trust in you, although you avoid directing questions at him to decrease his requirement to talk. You assess his respiratory function and oxygenation using vital signs, physical assessment and pulse-oximetry data. You compare the cues with normal so you can decide whether you need to report abnormalities and request medical assessment. Your decision is to administer Use the method demonstrated in Box 14-6 to work through an intellectually challenging situation you have faced during a clinical placement, and then critique the method in the light of the following standards for clinical reasoning. Was it is clear, precise, specific, accurate, rel- evant, plausible, consistent, logical, deep, broad, complete, significant and adequate (for the purpose)? Was it fair and free from prejudice and false assump- tions? Do you think you could apply this method in the future? Your learning in thoughtful practice will increase as you work through the remaining chapters in Unit 3. In each of these chapters you will be asked to consider a particular clinical scenario featuring ‘Claire’, a young university student who has a typically active social life and who has Type 1 diabetes. You will encounter Claire in various situa- tions, from the assessment and identification of her health

Developing knowledge skills

In this chapter you have been learning about clinical reason- ing as part of the processes of thoughtful practice and person-centred care. Once you have had the opportunity to put these skills into practice you will become more confi- dent in the identified competencies of thoughtful practice and person-centred care. What have you learnt? • Basic knowledge of the foundation elements upon which clinical reasoning is built

To enhance your learning and facilitate further understanding of this chapter, refer to thePoint and LNPS online resources.