The Disciplined Clinical Inquiry (DCI) Model

This discussion question is based on a case study. As in all case studies, review the facts of the case and consider the various steps of the nursing process in order to address the critical thinking questions.

The College of Nurses of Ontario’s mission statement is to “protect the public’s right to quality nursing services by providing leadership to the nursing profession in self-regulation” (CNO, 2012). The College of Nurses recognizes that self-regulation is a privilege granted by proving that they are capable of putting the interests of the public before their own. By establishing a number of requirements for entry to practice, articulating and promoting practice standards, administering quality assurance, and enforcing standards of practice and conduct, the College fulfills it’s

Nursing practice is controlled by the individual, state’s Board of Nursing, which oversees and defines the nurses’ scope of practice; hence, ensures that nursing practice is guided by the nurse practice act of that state. Legislation also influences nursing practice, with technology facilitating new break-through in scientific research; the need for changes and or advances in healthcare are detrimental to new and improved regulations within the individual states or at a national level. Additionally, private and or public corporations also affect the practice of nursing in different ways; the policies and funding within these entities may limit the resources

Working Stage—When patients are ready, the work toward changing their thoughts, feelings, and behaviors can begin. However, drastic changes might not be the goal for some patients, particularly the chronically ill. Stabilization with meds, reduction of symptoms, and development of supportive relationships are valid goals. The parts of this working stage begin with in depth data collection. This is where the nurse facilitates awareness, analysis, and interpretation through in-depth exploration of issues and identification of priority issues. Reality testing is the next part, and is an important strategy in the

The second step that I used in the nursing process was diagnosing. Based on my results from my assessment, I was able to use that information to come up with a couple nursing diagnoses. This step is used to offer effective nursing care because it helps me set an intervention and plan of care to help my patient’s health outcomes for the better.

(The class will be split into two groups. When you deliver your group presentation for P3, the other group will act as the newly qualified nurses. Your teacher will take on the role of a particularly difficult nurse, who will ask you lots of questions about your strategies. This will lead to a discussion about how you intend to implement your strategies for M2.)

The ASPIRE framework, also referred to as the nursing process (Barratt, Wilson and Wollands, 2012) was used to structure and develop Susan’s care plan. Introduced by Barrett, Wilson and Wollands (2012), following on from APIE developed by Yura and Walsh (1967), ASPIRE stands for assessment, systematic nursing diagnosis, planning, implementation, recheck and evaluation. Hogston and Marjoram (2006) believe that systematic nursing diagnosis was added to offer direction and time for the nurse to reflect on gathered information and systematically develop a diagnosis. Also the aspect of rechecking is to enable the nurse to monitor and plot a patient’s progress contributing to the final stage of evaluation of care and if its successfulness (Barratt, Wilson and Wollands, 2012).

The benefits of having a defined frame of theory in nursing produces superior patient care, heightened professional repute for nurses, progressed interaction among nurses, and direction for exploration of the practice and education. Theories also illustrate the quality of the nursing profession, and serves as a reservoir of knowledge with the examination of the essential requirements of patients and necessary interventions. In addition, specialized rationales are provided. Succeeding medical doctors orders are not exclusively to the context of nursing care.

Directions: Refer to the Milestone 2: Nursing Diagnosis and Care plan guidelines and grading rubric found in Doc Sharing to complete the information below. This assignment is worth 250 points, with 10 points awarded for clarity of writing, which means the use of proper grammar, spelling and medical language.

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 ).

The healthcare industry has intensely advanced throughout the world, in turn changing the principles that incorporate the practice and culture of nursing practice. Altering the model of care to a patient-centered mode signifies an organizational culture shift and requires the participation of executives at the senior level (Cliff, 2012). To practice this care to provide the best care possible, it goes beyond the nurse to all healthcare professionals and senior leadership. The days of patients and nurses following a physician’s order without favor to care has now loaned themselves to more of an interdisciplinary approach to practice. Though, it is encouraged that the patient makes decisions for themselves, after receiving the proper education and information on their condition. Part of the patient-centered care is to be the patients’ advocate, by letting them know you are there for them when they are unable to speak and advocate for themselves and what is in their best interest. That goes in hand with educating them on “self-management of care, health literacy, patient, and family education through nurse-patient communication and interaction (Finkelman & Kenner, 2016, p. 271).”

In doing this it uses the questions What? So what? and Now what? These 3 steps make this a straight forward model to follow, stimulating reflection at both a novice and advanced level, thus making it suitable for use by the student nurse and also for continuing professional development (Taylor 2000).

The aim of this essay is to demonstrate the assessment process of a patient using the Roper Logan and Tierney (RLT) model of nursing framework and to show how the nursing process works alongside this model. This will be shown by a holistic history of the patient being shown, followed by how the RLT model is applicable to this patient. This is then followed by one nursing intervention being discussed showing how the nursing process is applied to patient care. The patient will be referred to as Mr Frederick Valentine to protect the patient’s anonymity as stated in the Nursing and Midwifery Council Code of Conduct (2008) guidelines.

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.

The third standard of practice is outcomes identification. During this phase, the registered nurse identifies expected outcomes for a plan individualized to the patient or the situation (“American Nurses Association,” 2010). During this step outcomes must be derived from the nursing diagnosis and must be measurable, realistic and attainable by the patient. The registered nurse involves the patient, family, heath care providers, and others in formulating expected outcomes when possible and appropriate. The registered nurse must also consider associated risks, benefits, costs, current scientific evidence, expected trajectory of the condition, and clinical expertise when formulating outcomes (“American Nurses Association,” 2010). Example of an