Blended Competencies, Clinical

Reasoning, & Processes of

Person- Centered Care
296
 Defining the four Blended skills
1-Cognitive Skills;
• Nurses think about the nature of things

sufficiently to make sense of their world &

to grasp conceptually what is necessary to

achieve valued goals.

 Critical Thinking
• It is defined as a systematic way to form &
shape one’s thinking.

It is a discipline comprehensive based on

intellectual standards & as a result well-
reasoned .

• Cognitively skilled nurse are critical thinkers.

 2-Technical Skills
• Nurses manipulate equipments skillfully to

produce a desired goal.

 3-Interpersonal skills
• Nurse establish and maintain caring

relationships that facilitate the achievement

of valued goal.
 4-Ethical / Legal skills
• Nurse conduct themselves in a manner

consistent with their personal moral code &

professional role responsibilities.

*Blended Skills & Critical Thinking
The primary purpose of the nursing process is

to help nurses manage each patient’s care

scientifically, holistically, & creatively.

The nurse will use them creatively & critically

when working with the patient to:

• Promote or restore health
• Prevent disease or illness
• Facilitate coping with altered functioning.

( aims of nursing)
Quality & Safety Education for Nurses
(QSEN)
• The overall goal of QSEN project is to:
Meet the challenge of preparing future nurses

who will have the knowledge, skills & attitude,

(KSA) necessary to continuously improve the

quality & safety of health care systems within which

they work.
 *Clinical Reasoning, Judgments, and
Decision Making.
• Page. 312
 Critical thinking: is a broad term--- includes
reasoning both outside & inside of the clinical
setting
• Clinical reasoning,------ a specific term ---- usually
refers to ways of thinking about patient care
issues ( determining, preventing, & managing
patient problems).
• Clinical Judgment: refers to the result (outcome)
of critical thinking or clinical reasoning—the
conclusion, decision, or opinion you make.
 Problem Solving:
• One of the strengths of clinical reasoning is
that it is based on a methodology that is
familiar to most nursing students---- problem
solving----

• Problem Solving is a basic life skill; identifying

a problem & then taking steps to resolve it are
a matter of common sense.
• There are different approaches
of problem-solving methods:
 a) Trial-&-Error Problem Solving
*It involves testing any number of solutions
until one is found that works for that
particular problem.

This is not efficient for the nurse & can be

dangerous to the patient.

• Not recommended as a guide for nursing

practice.
 b) Scientific Problem Solving
It is a systematic, seven step problem solving
process that involves:
1-Problem identification
2-Data collection
3-Hypothesis formulation
4-Plan of action
5-Hypothesis testing
6-Interpretation of results
7-Evaluation
• Resulting in conclusion or revision of study. This
method is used most correctly in a controlled
laboratory setting.

• But is closely related to the more general

problem solving processes commonly used by

health care professionals as they work with patients

such as the nursing process.

 c) Intuitive Problem Solving;
It is the decision making in clinical setting.
• It needs previous knowledge & logical reasoning
& validating intuitions, careful monitoring of
patient should be found.

• Ongoing nursing research to be up to date with

the information.

• This is coming with years of practice &

observation.
 d) Critical thinking:
Intuitive, logical or both
• Critical thinking is contextual & changes depending on
the circumstances.

-When intuition is used alone, there are increase risks &

fewer benefits.

- Intuition often moves problem- solving forward quickly.

but it might result in a lot of trial- &– error approach.

• Logic is the safest approach, but it doesn't

foster out-of-box ideas & might inhibit

right-brain thinkers from getting started.

• So Using both methods can bring great

results.
 Creative Thinking
Critical thinking & clinical reasoning also involve

reflection & creative thinking.

• Creative thinking involves ,imagination.

Intuition & spontaneity, factors that underpin

‫ﯾدﻋم‬
the art of nursing. ‫ﺣدس‬
• Each reflective practice box that opens

a chapter invites readers to think outside the

box as they contemplate possible courses

of actions. ‫ﺗﺄﻣل‬
 Decision Making and Clinical
Reasoning
Nurses make decisions every day, we decide what
to eat, where to work, whether or not to exercise.
• While some use the phrases problem solving &
decision making synonymously, not all decisions
result from problems.

• Decision Making is “ purposeful , goal directed

effort applied in a systematic way to make a
choice among alternatives”.
Nursing Process, 316
 Historical Perspective
• The term of nursing process was first used by
Lydia Hall in 1955.

• In 1960, nursing theorists began to describe

nursing as a distinct entity among the health
care professions and also delineated
‫ﯾرﺳم‬specific steps in process approach to
nursing practice.
• The steps of the nursing process were

legitimized in 1973, when the ANA congress

for Nursing Practice developed Standards of

Practice to guide nursing performance.

• The foundation for the scope & standards of
nursing practice:

• Nursing is the protection, promotion, &

optimization of health & abilities, prevention
of illness, injury, alleviation of suffering
through the diagnosis & treatment of human
response & advocacy in the individuals,
families, communities & population.
Description of the Nursing Process
The nursing process is a systematic method

that directs the nurse & the patient as

they together accomplish the following:

1-Assess; the patient to determine the need for
nursing care
2-Determine Nursing Diagnosis, to determine
actual or potential health problems.

3- Identify expected outcomes, & Plan care

4-Implement the care

5-Evaluate the results

• In the steps of nursing process

the patient-centered & goal –oriented

are interrelated.

• Each step depends on the previous step.

• The process provides a framework that
enables the nurse & the patient to
accomplish the following:

*Systematically collect patient data (assessing)

*Clearly identify patient strength & problems

(diagnosing)
*Develop a holistic plan of individualized care that

specifies the desired patient goals & related out-

comes and the nursing interventions most likely to

assist the patient to meet those expected outcomes

(planning)
*Execute the plan of care (implementing)

*Evaluate the effectiveness of the plan of care

in terms of patient goal achievement.

(Evaluating).
 Nursing Process Trends
-The trend today in nursing process is

toward standardization & computerization.

-Characteristics of the Nursing Process
• 318
 1-Systematic
• Each nursing activity is part of an ordered
sequence of activities & depend on the previous
step.

• Without a complete & accurate database the

nurse cannot identify patient strengths &
problems.

• The nursing process directs each step of nursing

care in a sequential manner.
 2-Dynamic
• Although the nursing process is presented as
an orderly progression of steps, in reality,
there is great interaction & overlapping
among the five steps.

• In some situation all 5 stages occur almost

simultaneously.
 3-Interpersonal
• Nurses are patient's centered rather than task
centered.

• So the nursing process encourages nurses to

work together to help patients use their
strengths to meet all their human needs.

• The nurse can talk with the patient to help

him to cope with his situation.
 4- Outcome or Goal-Oriented
• The nursing process offers a means for nurses &
patients to work together to identify specific
goals related to:
• Health promotion
• Disease & illness prevention
• Health restoration
• Coping with altered functioning.

*knowing the goal in order to match with the

nursing activities or plan of care.
 5-Universally Applicable in Nursing
Situations
• When the nurse have a working knowledge

of the nursing process they find that they can

practice nursing with well or ill young or old

& in any type of nursing setting.

 *Documenting the Nursing Process
• Is the ability to communicate clearly in writing.

- The nursing skill must be , accurate , concise ,

timely & relevant.

-Documentation provides all the members of the

care giving team with a picture of the patient.

legally speaking the patient record is the chief

means of communication among members of

the interdisciplinary team.

(A nursing action not documented is a nursing

action not performed) .

 *Benefits of Nursing Process
Scientifically based, holistic, individualized care,

the opportunity to work collaboratively with

nurse & continuity of care.

The nurses who use nursing process continuously

achieve a clear, efficient & cost- effective plan of

action by all nursing team.

 Evaluating the Use of the Nursing
Process
The primary purpose of nursing process is to

help nurses committed to thoughtful

person- centered practice manage each

patient’s care scientifically, holistically, & creatively.

 To do this successfully
• The nurse needs;
1- The correct personal attributes,
2- a sound knowledge base,
3- Many competencies

Along with the willingness to use them creatively &

critically when working with patients to promote or

restore health, prevent diseases or illness & facilitate coping.

 Concept Mapping, 322

• It is an instructional strategy in which learners

identify, graphically display, & link key
concepts.

• Concept ma also called:

• (Cognitive map, mind map, meta cognitive
tools for learning)
 Steps in Concept Map Care Planning
1-Develop a basic skeleton diagram

2-Analyze and categorize data

3-Analyze nursing diagnoses relationship

4-Identify goals, outcomes, & interventions

5-Evaluate patient’s response.

 Reflective Practices
• Reflection is a normal human activity,

we frequently think about what has just

happened & know it has affect us

But often this reflection is superficial.

 Reflective Practices
• It is a purposeful activity that leads to action,

improvement of practice, & better patient

outcomes.

• It is about looking at an event, understanding

it & learning from it

• Learning from reflection is not automatic &

requires a deeper understanding of how &

why reflection contributes to the competence

of effective nurse.
 Types of Reflections

1-Reflection in action:

It happens in the here & now of the activity

& is also known as “thinking on your feet”

 2-Reflection on action:
It occurs after the fact & involves thinking through a

situation that has occurred in the past.

It is used as a means of evaluating the experience&

deciding what could have been done differently.

 3-Reflection for action
It is the desired outcome of the first two types of

reflection, & helps the person to think about

how future actions might change as a result of

the reflection.