Cognitive Continuum Theory: Intuition And Analysis

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

Within the practice of nursing, situations often arise where nurses are forced to make decisions regardless of their level of experience in the profession. Providing care and following the physician’s orders historically were the nurse’s sole responsibilities. However, social change, changes in health care finances, increasing international perspectives, and demographic population changes, have resulted in a significant evolution of the roles and responsibilities emplaced on today’s nurses (The National Association of Clinical Nurse Specialists (NACNS), 2007). Kelly and Crawford (2013) believe budget cuts, higher client acuity and clients with complex needs, mergers of hospital corporations as well as a general shortage of qualified nurses has made it necessary for nurses to play a role in decision making. Decision making is defined as “cognitive process leading to the selection of a course of action among alternatives” (Kelly & Crawford, 2013, p. 352).

Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour logical, precise analytical models which are held to be testable, unambiguous and repeatable, therefore satisfying scientific principles. These represent important ideas of certainty and rationality that are intended to provide a sense of security and reliability. When used correctly a nursing model should give direction to nurses working in a particular area, as it should help them understand more fully the logic behind their actions. It should also act as a guide in decision-making and so reduce conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency of the nursing care received by patients according to Pearson et al (1999,p ).

Johnny Obrien aged 79 years, presented to the Emergency Department after a fall at the RSL, resulting in a laceration on his left elbow which required 3 stitches. He lives by himself with no family close by, and has a history of hypertension and alcohol addiction. Clinical reasoning is a cyclic process, where cues are collected and their data processed to come to a conclusion of the patient situation so that appropriate interventions can be implemented and evaluated through reflective practices which allows for further learning (Levett-Jones 2013). Applying these clinical reasoning skills in practice is important as it has a positive impact on patient outcomes, resulting in less adverse effects due to the detection of patient deterioration throughout this process to ensure safe and effective care (Levett-Jones 2010).Subjective data is information from the patient’s point of view, including their feelings, perceptions and concerns, whereas objective data is information that is observable or measurable (Delmar Cengage Learning 2015).

The advanced practice nurse (APN) brings the combined training and experience received in school and the clinical practice to enhance patient care. Clinical decisions require problem solving, critical thinking, ethical judgment, and evidence-based practice to ensure patients receive the best care (Pearson, 2013). This unique set of skills allows the APN to determine areas needing further study to improve patient outcome. This paper will introduce the author’s phenomenon of interest and primary philosophic viewpoint for providing patient care, discuss an alternative or opposing philosophic viewpoint to patient care, and summarize the four patterns of knowing in nursing identified by Barbara Carper in 1978.

A problem solving approach is a process of planning care for a patient (McFerran and Martin, 2003) using ASPIRE, based on APIE (Yura and Walsh, 1988); Assessment, Plan, Implementation and Evaluation. ASPIRE is a nursing process which includes six stages: assess, a systematic nursing diagnosis, plan, implement, recheck and evaluate (Barrett et al, 2012). Using a range of assessment tools, some potential risks can be identified although, these tools should be used as guidance for treatment and not used in the decision making process as to who and who does not receive treatment, (National Institute for Health and Care Excellence (NICE), 2011) but through gaining consent during each process, as it should be before any care or treatment (NMC, 2008).

However the research study would have been better if they used qualitative methods to find out the nurse’s perceptions, knowledge and barriers towards evidence based practice in clinical decision making. Majid, et al. (2011) could have interviewed some of the participants to get detailed descriptions of how they feel about evidence based practice in clinical decision making. This would allow the researches to get an in-depth understanding making the study more valid (Saris and Gallhofer, 2007).

Anderson, J.R. & Lebiere, C. (2003). The Newell Test for a theory of cognition. Behavioral and

This paper will discuss three theories of decision-making that can be adopted in nursing practice, additionally how decision-making theories are able to be implemented and used. Decision-making in nursing is adopted through the critical thinking process that provides each nurse a model to make the best choices, solve problems and to meet goals in clinical practice (Berman & Kozier 2018, pp. 199-200; Levett-Jones & Hoffman 2013, pp. 4-5). Effective decision-making in nursing is a vital component and part of the role of a registered nurse; each year a substantial number of patients die due to medical errors and poor decision-making (Levett-Jones & Hoffman 2013, pp. 4-5; Nibbelink & Brewer 2017, p. 3). Through the use of

Though we may not realize it nor want to acknowledge it, Cognitive Psychology is a part of every human 's daily life. Cognitive Psychology is the scientific study of the mind as an information processor. In a simpler definition, it is the study of how our minds interpret and process things that we either are informed of or something we take into thought. Cognitive Psychology is a part of our attention process, language use, our memory for both long and short term, perception, problem solving, creativity, and the way we think. Each of these different features are a part of how we perceive information, think, remember, and use the information we gather. Through this branch of psychology, researchers are able to observe the relationship

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

Underlying both the clinical decision-making process and the nursing process is the skill of critical thinking. Critical thinking has been described as the ability to gather and process data in such a way as to arrive at the best conclusion using the filters of prior knowledge, experience and external resources to overcome personal emotions, biases, and assumptions. (This description was developed during NUR/300 class, University of Phoenix, S. Colorado, March 16, 2006) Note that critical thinking is described as a

The data-information-knowledge-wisdom (DIKW) continuum is a concept of the transformation of data into wisdom through cognitive processes. DIKW was initially used to illustrate principles of information management for the designing of information systems (Davenport & Pursak, 1989)(Saltworks, 2009). DIKW models utilized by nursing such as the model by Englebart & Nelson (2002), incorporate principles of increasing complexity due to increasing interactions What is important and unique to nursing is the DIKW concepts and models also help describe the critical thinking processes that nurses use to transform knowledge into the delivery of patient care, into education and learning and

As a knowledge worker, a nurse moves from the role of a “data gatherer, information user, knowledge user, and knowledge builder, respectively” (McGonigle & Mastrians, 2015, p. 114). It is in the role of a knowledge user that the nurse starts to take “notice of the trends in a patient’s clinical data and determines whether the clinical data fall within or outside the normal data range” (p. 114). In measuring the final outcome of the patient as suggested by O’Grady and Malloch (2003)

Leon Festinger created the cognitive dissonance theory as an attempt to explain why people desire to have consistency between their behaviors and actions. Cognitive dissonance is the distressing mental state people feel when they find themselves doing things that don’t fit with what they know, or having opinions that do not fit with other opinions they hold (Festinger, 1957; as cited in Griffin, 2009). Thus, people are motivated to change either their behavior or their belief when feelings of dissonance arise.