NUR 4153CBE Application of clinical reasoning Paper

NUR4153 Clinical reasoning Deliv 5 Material Debriefing provides an opportunity for a nurse to reflect on cognitive, psychomotor and affective events after a situation concludes (Moran, Winderlish, and Rubbelke, 2018). Dr. Patricia Benner (2018) identified clinical debriefing as a strategy to connect complex clinical concepts and phenomena necessary for effective clinical judgment (Benner, 2018). The process of debriefing can be informal and intrapersonal, or formal and collaborative. Debriefing The basic function of effective debriefing is reflective practice, “a process of learning and development through examining one’s practice, including experiences, thoughts, feelings, actions, and knowledge (Schutz and Bulman, 2013).” Reflective practice to support purposeful clinical judgment involves: Self-awareness is a conscious connection with an innate system of beliefs, values, and honest socialization to internal and external perceptions of responses based on context. The judgment of our thoughts and actions by self and others is difficult and requires courage and confidence to understand the necessity for improvement in nursing practice. Objectively describing the context of a situation is difficult as we often want the power of description to highlight our abilities in a positive light with minimal judgment. However, the clear description of the context for effective reflection must be comprehensive and include these five key elements: • • • • • Situational context including background Logical details for the timing and sequence of events Cognitive processing occurring within the context Affective processing occurring within the context Expected and unexpected outcomes To reflect, you must first tell the entire story, even if parts of the story are difficult to ponder and reveal individual weaknesses. Critical analysis during reflection involves breaking the components of a situation into small, manageable parts amendable to critique of strengths and weaknesses. When analyzing a situation don’t force the reflection into a linear process but include emotional aspects and recognize the powerful dynamics of feelings and attitudes when making decisions. Don’t be afraid to approach critical analysis as an organic process growing out of the small, yet impactful small experiences. Nurses performing critical analysis during reflection must integrate these four essential features: • • • • Be honest regarding your existing knowledge relevant to the situation Be honest about your feelings and the influences on decisions Challenge your decisions and be accountable for actions Be open to alternative courses of actions Synthesis is a higher level of reflection and involves integrating new knowledge and perceptions with existing knowledge and perceptions in an attempt to create a novel solution or gain confidence with a current decision. Evaluation is the highest and most difficult level of reflection and includes judgment of decisions and behaviors against established criteria and outcomes. The key to effective evaluation is to focus on the future implications as positive changes rather than mistakes in the past as failures. Impact of Debriefing on Clinical Judgment Purposeful, active debriefing as a strategy to analyze actions, examine rationales and plan future actions has a statistically significant impact on clinical reasoning. The reflective practice provides a method for nurses to integrate contextual and cognitive components into new situations with curiosity and confidence (Forneris, 2015). Like clinical judgment, debriefing (reflective practice) is an iterative, dynamic process improved through deliberate practice. Nurses must commit the time and energy to think about their thinking and question why and how they can evolve within the complexities of nursing practice. Remember to embrace the emotional components of a situation and consider client needs as a priority when debriefing to impact clinical judgment. Remain open to ideas of others and recognize reflection is not complete until the evaluation is integrated and openly accepted as necessary feedback for positive growth within the role of a professional nurse. References: Benner, P. (2018), Higher-order productive thinking in clinical teaching and learning. Retrieved from https://www.educatingnurses.com/higherorderproductivethinkinginclinicalteachingandlearning/ Forneris, S. G. (2015). Enhancing clinical reasoning through simulation debriefing: A multisite study. Nursing Education Perspectives (National League for Nursing), 36(5), 304–310. doi: 10.5480/15-1672 Moran, V., Wunderlich, R., & Rubbelke, C. (2018). Simulation: Best Practices in Nursing Education. Cham: Springer. Schutz, S., & Bulman, C. (2013). Reflective Practice in Nursing (Vol. 5th ed). Hoboken: Wiley- Blackwell. Detailed Contextual Description Example Objectively describing the context of a situation is difficult as we often want the power of description to highlight our abilities in a positive light with minimal judgment. However, the clear description of the context for effective reflection must be comprehensive and include these five key elements: • • • • • Situational context including background Logical details for the timing and sequence of events Cognitive processing occurring within the context Affective processing occurring within the context Expected and unexpected outcomes Higher Level of Reflection Example …