Justify Your Conclusions

Beliefs. My beliefs about nursing were influenced especially by my husband and by one of my lifetime friends. Both taught me that nursing is a profession that one never stops learning and learning is the only way to acquire knowledge to improve and excel as a professional. I also have an enthusiastic mentor that instructs and encourages me to expand my knowledge in other areas of nursing rather than just being a bedside nurse. My beliefs in my career, also, have been greatly influenced by my mother who continuously reminds me to always put myself in the patient’s place before any decision or judgment is done. Through it, she taught me what compassion and true care means. Besides the people mentioned above, there are many others that in one way or another influenced and shaped my beliefs about nursing.

Alfaro-LeFevre, R. (2013). Critical thinking, clinical reasoning, and clinical judgment : A practical approach (Fifth ed.).

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.

Nursing is a unique profession which is built upon theories that guide everyday nursing practice. According to Taylor, Lillis, & Lynn (2015), “Nursing theory differentiates nursing from other disciplines and activities in that it serves the purposes of describing, explaining, predicting, and controlling desired outcomes of nursing care practices” (p. 27). Many nurses may unknowingly apply a theory or a combination thereof, along with critical thinking to get the best outcome for a patient. Theories are used in practice today because they have been supported by research and help the profession uphold its boundaries. Most nursing theories consist of four concepts which are the patient, the environment, health, and nursing. Each patient is at the center of focus and they have the right to determine what care will be given to them using informed

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 ).

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 national league for nurses defines critical thinking in the nursing process as “a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns” (Kozier, 2008). This definition is imperative to help a nursing student learn how to think in terms of nursing care. Nursing students must achieve a comprehensive understanding of critical thinking in order to understand the nursing process. The purpose for this paper is for nursing students to learn how to use the nursing process, how to properly document their findings and assessments, and correctly implement APA formatting in a formal paper.

Clinical reasoning is “the process of applying knowledge and expertise to a clinical situation to develop a solution” (Carr, 2004 cited in Banning, 2008, p.177). Poor clinical reasoning skills can lead to a “failure to recue” (Aitken et al., 2003) the deteriorating patient. Additionally, studies by Hoffman et al. have compared the way in which the expert nurse and the novice nurse accurately collect cues from which they base their decisions. Effective clinical reasoning is therefore linked to “the ability to collect the right cues and take the right action for the right patient at the right time and for the right reason” (Levett-Jones et al., 2010). The ability to apply these “five rights of clinical reasoning” (Levett-Jones et al., 2010) will be discussed in more detail in Nursing Actions and Interventions: A Reflection.

As a nurse I will use my knowledge of critical thinking skills with in the nursing process: assessment, analysis, planning, implementation, and evaluation. Furthermore as a member of the nursing profession, I will assume accountability and responsibility for the quality of nursing care that I provide to clients, act as an advocate to promote quality health care for all clients, and take part in activities that promote the development and practice of professional nursing.

The major study variables in this investigation were critical thinking and clinical judgment skill of nursing students. Critical thinking was operationally defined with the ATI Critical Thinking Test and clinical judgment was operationally defined with the Lasater’s Clinical Judgment Rubric (Mann, 2012). The independent variable was identified as the Level II baccalaureate nursing students. The dependent variable was identified as the critical thinking and clinical judgment skills of the nursing students. The demographic variables included the gender and age of the

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

Nursing is a unique profession which is built upon theories that guide everyday nursing practice. According to Taylor, Lillis, & Lynn (2015), “Nursing theory differentiates nursing from other disciplines and activities in that it serves the purposes of describing, explaining, predicting, and controlling desired outcomes of nursing care practices” (p. 27). Many nurses may unknowingly apply a theory or a combination thereof, along with critical thinking to get the best outcome for a patient. Theories are used in practice today because they have been supported by research and help the profession uphold its boundaries. Most nursing theories consist of four concepts which are the patient, the environment, health, and nursing. Each patient is at the center of focus and they have the right to determine what care will be given to them using informed

Critical thinking and clinical reasoning are similar in the fact that each term represents a set of methods that guide the nurse to reliable evidence-based practice while delivering care. Critical thinking and clinical reasoning are centered on knowledge base that is associated with the discipline of nursing. With each concept, the nurse must have an existing developed knowledge base in which to apply each concept to. Nurses apply critical thinking and clinical reasoning skills when patient care decisions are made. With both critical thinking and clinical reasoning, information about the patient is collected and examined. They work together to produce clinical judgment. They both direct nursing care to meet patients’ needs resulting in higher quality of care and better patient outcomes.

The nursing process and Watson’s theory both provide a framework to promote critical thinking by the nurse so conclusions can be made and they can have a caring moment. This is completed by “assessment, plan, intervention, evaluation.” (Nursing Theories, 2012, p.4) The theory is well organized, not complex and “can be used to guide and improve practice.”(Nursing Theories, 2012, p.4)

Orlando does not credit any theoretical sources in the development of her theory (Necor, 2014, p. 5). She formulated the deliberative nursing process from the considerable amount of data she recorded on nurse patient observations. She evaluated facts from those observations to develop her theory. Orlando proclaimed that her theory is valid and applied it in her work with patients and nurses and the teaching of students (Necor, 2014, p. 5).