NUR4153CBE Impact of Relational Inquiry in Nursing Paper

NUR4153 Clinical Reasoning Deliv 2 Material. Grading Rubric Context and Culture Context is circumstances or settings for a situation that influence meaning and outcomes. Culture is the collection of beliefs, social norms, traits and characteristics, a way of life. Context and culture exist symbiotically in nursing practice as dynamic processes integrated into clinical reasoning. Clients and nurses influence and are influenced by context around and within a situation. Multiple types of contexts exist throughout the process of clinical reasoning including historical, sociopolitical, material or economic, physical and linguistic or discursive (Doane, G. H., and Varcoe, C., 2015). Culture Beliefs, values, and customs create cultures and are often inseparable from the context of a situation. In the past, cultures influenced nursing practice and clinical reasoning through categorization of clients based on ethnicity, race or nationality. This antiquated method of viewing clients through a single lens often led nurses to incorrectly stereotype individuals and groups and approach care decisions unilaterally as one size fits all. However, relating to individuals and inquiring rather than assuming cultural influences on healthcare has led nurses to recognize culture and context exist simultaneously and defined by the client. The relationship between culture and context support clinical reasoning in three ways. 1. Culture and context can’t divide into distinct categories. Perspectives and life experiences provide an onging framework for shaping culture and context. 2. Even though clients might exist in the same culture, they are not the same person and may not value the same components of a culture. 3. Integrating culture and context into clinical reasoning promotes openness to differences as a way to lessen conflict and bias. How would culture and context influence your decisions, communication, and perspectives? Consider the relationship of culture and context when attempting clinical reasoning with a 30 year old Hispanic Male diagnosed in primary care clinic with a sexually transmitted disease and a new diagnosis of positive HIV status. He is married with two children. He and his family moved from Puerto Rico six years prior, and he speaks and reads fluent English. When you enter the room, he immediately states, “You can’t tell my wife I am HIV positive, she does not know I also sleep with men. If she knows she will divorce me and my family will disown me since I am a homosexual.” His wife is the primary bread winner as he recently lost his job, so he is worried she won’t pay for his medical care. His family in Puerto Rico are wealthy but will never take care of a gay son. He appears healthy, but you remember when your brother passed away from an AIDS related illness years earlier and the emotional trauma family members suffered when they had no idea he was sick. References: Doane, G.H., Varcoe, C. (2015. How to nurse relational inquiry with individuals and families in changing health and heatlh care contexts. Wolters Kluwer, Philadelphia. Peters, A., Vanstone, M., Monteiro, S., Norman, G., Sherbino, J., & Sibbald, M. (2017). Examining the influence of context and professional culture on clinical reasoning through rhetorical- narrative analysis. Qualitative Health Research, 27(6), 866 Hypotheses for Client care To conceptualize nursing clinical judgment imagine cognitive processing occurring within five iterative stages: Cues • • Process internal and external cues Link outcomes and contextual influences. Create Hypotheses • • Select and analyze relevant cues Generate hypotheses to make decisions and take action. Judge Hypotheses • Evaluate hypotheses to prioritize clinical decisions. Take Action • • Prioritize hypotheses and take action Test hypotheses based on client needs and expected outcomes. Evaluate Outcomes • • NUR4153CBE Impact of Relational Inquiry in Nursing Paper

Evaluate the outcomes for expected and unexpected results. Evaluation is ongoing and iterative. (Dickison, et al., 2016) Cues Visualize the client and think which external and internal cues you find most relevant and use the analysis of those cues to generate two hypotheses in order of priority. H. G is a 58 year old male admitted 7 hours prior with complaints of right calf pain after falling down a stairwell at a construction site. He is obese, does not exercise and smokes two packs per day for the past 30 years. He has a stent in the right coronary artery and an artificial right hip; he believes both surgeries were about 5-6 years ago. He was diagnosed with peripheral arterial disease when he had the stent placed but sees no reason to stop smoking at his age. He is upset he is in the hospital and is only staying because the pain in the right calf won’t stop and now he the pain is greater in the right leg when he walks to the bathroom. He wants the leg fixed today, or he is going to see his regular doctor. He can’t catch his breath lying in bed, and he can’t sleep with all the noise in the hospital. You are nervous as the client is confrontational and as a new graduate you struggle with assertiveness. (Harding and Presseur, 2016) Hypotheses Pause and consider internal and external cues presented with this scenario and then analyze the cues for relevancy. What factors are most important and why? Remember a client’s status is dynamic and requires timely action and evaluation of outcomes to generate and prioritize more relevant hypotheses quickly. Based on the context at this moment in this clinical scenario the most relevant cues are: • • • • • Decreased oxygen saturation Increased calf pain in affected extremity Client complaint of shortness of breath and dizziness Diminished breath sounds in both lung bases. New graduate nurse, concerns with knowledge of respiratory and vascular symptoms You think back to a simulation you had in nursing school where a client was experiencing shortness of breath and quickly generate two hypotheses aligned with expected client outcomes. 1. Increase oxygen delivery to increase oxygen saturation. 2. Assist the client to lie down with the head of the bed and rails up to create a safe environment and promote breathing. Certainly, many cues are present with this client and once you take action with these hypotheses evaluation of outcomes may require revised hypotheses to take subsequent appropriate actions. Nursing clinical judgment is an ongoing, iterative process requiring conscious cognitive processing to lead to expected behaviors and outcomes. References: Dickison, P., Luo, X., Kim, D., Woo, A., Muntean, W., and Bergstrom, B. (2016). Assessing higher- order cognitive constructs by using an information-processing framework. Journal of Applied Testing in Technology. 17(1). p. 1-19, Retrieved from https://ncsbn.org/AssessingHigherorderCognitiveConstructs_2016.pdf Harding, M. M., Snyder, J. S., & Preusser, B. A. (2016). Winningham’s critical thinking cases in nursing : medical-surgical, pediatric, maternity, and psychiatric. Saint Louis, Missouri : Elsevier, 2016. …