N 522PE 20A Module 1 Assignment 1

N 522PE 20A Module 1 Assignment 1

Assignment 1 Instructions:

Write a three-page paper on the use of clinical reasoning in developing and applying advanced health history and physical assessment skills at the graduate level. Consider contemporary nursing literature on the development of clinical reasoning and decision-making. How does the use of the nursing process enhance critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level. Please use the submission parameters and rubric below to guide you when completing this assignment.

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 3 pages, which does not include the cover page and reference page(s).

IIntroduction (including purpose statement)

II. Clinical Reasoning

■ Describe how clinical reasoning is used in developing and applying advanced health history and physical assessment skills at the graduate level.

III. Nursing Process

■ Describe how the use of the nursing process enhances critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level.

IV. Clinical Example

■ Discuss an example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning.

■ Discuss how nursing care is provided when each of these concepts are evidenced in nursing care of the patient.

V. Conclusion

VI. References (consider contemporary nursing research studies or reliable electronic sources)

In regards to APA format, please use the following as a guide:

■ Include a cover page and running head (this is not part of the 3 pages limit)

■ Include transitions in your paper (i.e. headings or subheadings)

■ Use in-text references throughout the paper

■ Use double space, 12 point Times New Roman font

■ Apply appropriate spelling, grammar, and organization

■ Include a reference list (this is not part of the 3 pages limit)

■ Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

Discussion 1

Post to the discussion board a planned approach to communicating with someone who speaks another language. What type of questions will you need to ask? Was there any communication issues discussed this week in Shadow Health? How does communication impact the concept of clinical reasoning in nursing? Please discuss the issues completely, citing your sources so that your classmates can reference the information. Include one insight gained this week from your readings or interaction in Shadow Health.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

Discussion 1 Solution Example

A planned approach to communication:

 Communication is a key element in every aspect of life. When an individual is in the hospital, at any age, they are frightened, having a fear of the unknown. Just being in the hospital may raise a person’s level of anxiety. When you combine anxiety with the inability to communicate this sets up a whole potential negative environment, one where an error could occur. The key to patient care is making the patient feel that they were heard and understood while educating them to be competent in caring for themselves when they leave the hospital.

There was a communication barrier between my patient and me this past weekend. The mother I was caring for and her husband just moved to the United States from Puerto Rico a few weeks before delivering their twin boys at 37 weeks-gestation on September 18th, 2020. This was extra difficult because not only was I educating the new first-time mom on caring for herself, the changes she would experience, and the postpartum warning signs, but I was also educating the couple on how to care for their newborn twins as well. This was very overwhelming for the patient and her husband.

My first thought was to utilize the interpreter’s phone. Unfortunately, the interpreter phone was nowhere to be found. I then tried to utilize my cell phone and was not able to secure a consistent site due to sporadic internet connections, making communication

unreliable. I finally utilized the language line from my vocera, securing a fluent Spanish speaking interpreter. Using my vocera was convenient for both the patient and me as well as the assurance of not violating the Health Insurance Portability and Accountability Act (HIPAA).

Fortunately, the vocera was accessible through my place of employment with the interpreter in my vocera giving me her name and identification information which I needed to place in the Electronic Medical Record (EMR). The Physician Assistant (PA-C) and I were then able to go into the patient’s room together, decreasing traffic, to address the daily plan of care (POC) utilizing our vocera for communication/translation.

Questions asked:

From the moment I entered the room, I began asking the patient questions. These questions are going to be open-ended questions directed to yield specific answers regarding the assessment, bleeding, pain, and how the patient is currently feeling. Before assessing the patient, I asked her permission to examine her as I would be palpating her uterus, incision, and legs for warmth, redness, and edema.

I asked the patient if I could listen by auscultating her heart, lung, and bowel sounds. I also informed my patient that I would be doing a neurological exam since she was pre-eclamptic throughout her last few weeks of pregnancy. Not only was I asking questions while assessing my patient, but I was also educating her along the way. 

When the patient is admitted we begin to educate them with discharge in mind, this is done to provide the patient with continual reinforcement of education. Breastfeeding, supplemental formula feeding, related to late preterm twins, as well as assessments of the twin, was another topic of conversation.

Without proper communication, due to language barriers, this would have not been possible. This would have been disastrous and frustrating for the patient as well as potentially causing adverse effects for the patient who is the one that should be excited, enjoying her newborns rather than being stressed.

How communication impacts the concept of clinical reasoning in nursing: Communication, as previously mentioned, is essential in all aspects of life. When caring for a patient, you want to make them feel comfortable with the care you are providing while educating them. The more comfortable the patient is with you, the more likely they will trust you. This dedication and trust that is established between you and the patient will be associated with positive patient compliance (Ali & Watson, 2018).

The more you understand the patient’s needs, the better you will be meeting their needs. Errors in communication could potentially cause medication errors, treatment errors, as well as great dissatisfaction, creating a negative environment placing a negative impact on decreasing patient compliance (Ali & Watson, 2018).

In conclusion;

Learning disabilities, education level, and language barriers should all be taken into consideration while caring for the patient. Being attentive to the needs of the patient, how they communicate, understanding the best way to educate them will enhance patient experience thus achieve positive patient compliance (Ali & Watson, 2018).

I did not feel there was a language barrier while viewing the orientation video by Shadow Health; however, care must be taken while talking to Tina or other patients to speak clearly, utilizing words they understand, not medical jargon, so the patient can understand the question being asked of them (Facp, 2016, pp. 65-94). When talking to patients, interviewing them, or caring for them, always speak to them meeting their educational needs to enhance their medical experience which will lead to positive compliance (Facp, 2016, pp. 65-94).

Ali, P. A., & Watson, R. (2018). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses’ perspectives. Journal of Clinical Nursing, 27(5–6), e1152–e1160. https://doi.org/10.1111/jocn.14204

Facp, M. L. B. S. (2016). Bates’ Guide to Physical Examination and History Taking (Twelfth, North American ed.). LWW.

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N522PE 20A Module 1 Assignment 1 In reply to Diane

Re: Discussion 1

by Dona – Friday, September 25, 2020, 5:52 AM

Well done. Discuss another culture and how cultural practices may impact health. 12 words

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In reply to Dona

Re: Discussion 1

by Diane – Thursday, October 1, 2020, 12:47 PM Thank you Dr Clarin,

The clinician should be aware of the individual’s culture, religion, beliefs, and ethnic customs to gain a better understanding of how the patient is perceiving information about their health (Consider Culture, Customs, and Beliefs: Tool #10., 2020). The patient’s culture and cultural practices influence how they care for themselves, their health, and what guides their decisions.

According to (Consider Culture, Customs, and Beliefs: Tool #10., 2020) the following are tips to keep in mind when caring for patients of another culture or ethnic background: Health benefits: Depending on the culture, some individuals believe that talking about negative outcomes will cause negative outcomes to occur.

Health customs: Family members in some cultures play a large role in being the medical decision-maker.

Ethnic customs: In some cultures, it is the role of the women to be the decision-maker versus man, in other cultures it is the opposite.Religious beliefs: Religious faith, beliefs, and spiritual needs play a large role in the health care setting. The patient’s religious and cultural needs regarding timing,preference, or denial of treatment need to be considered related to their beliefs.

Dietary Customs: Trying to have the patient conform to our disease-related dietary advice will be difficult if we do not take the patient’s needs and customs into consideration.

Interpersonal customs: Eye contact or physical touch may be expected in one culture, while in another this would appear inappropriate or insulting.An example of this is caring for a patient who is of the Jewish (Judaism) faith. Thepatient may request a Kosher diet and follow the rule not to participate in activities on the Sabbath, from sundown Friday night until sundown on Saturday night. While another patient may request a Kosher diet and not follow the rule of the Sabbath. The patient’s testing, procedure, or even discharge may be delayed if occurring during the Sabbath.

When caring for your patient it is essential to be respectful, meeting their specific needs as noted above; however, there are times when an individual is part of a specific religion or culture, but they do not follow guidelines as strictly as some do, for that reason, communication with the patient is extremely essential.Consider Culture, Customs, and Beliefs: Tool #10. (2020, September). Agency for Healthcare Research and Quality.

https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html 390 words

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In reply to Diane

Re: Discussion 1

by Ihuoma – Friday, September 25, 2020, 9:40 AM Adding to your good post-Diana,

According to an article by the U.S. Department of Health and Human Services (HHS), Health literacy is the extent to which a person has the ability to obtain, process, and understand the basic information they need to make appropriate health decisions.

Adequate health literacy may include an individual not being able to read and understand the important health-related instructions such as appointment slip or the instruction on their prescription bottles.

It can also increase a patient’s ability to take care of their health or for their family’s health (Healthy People 2020). This article indicated that the blame of health literacy cannot be placed on the individuals alone, but also on the health-literacy related stresses and complexities of the healthcare system. Healthy people 2020(2020) suggested that organizations that value health literacy should implement a system for intervention such as counseling and visual aids to help increase an individual’s understanding and promote patient safety. Reference

Health People 2020(2020). Healthy Literacy. Retrieved from

 https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-healt h/interventions-resources/health-literacy

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In reply to Diane Koutavas

Re: Discussion 1

by Dawn – Friday, September 25, 2020, 5:42 PM

 Thank you, Diane, for your discussion post on communication as a critical element to patient care for limited English proficiency patients. Planning for patients involves utilizing approved interpreters and, if need be, language lines—inability to communicate with patients impacts timely and effective care delivery (Ali & Watson, 2018). Language, in addition to cultural influences, affects the response and ability to follow personal care plans. Language concordant care aligns assessment of physical status and improved cultural respect for the patients’ ethnic background (Ali & Johnson, 2017).

 Clinical reasoning supports health assessment and enables the practice gap from education to real-life (Bargagliotti & Davenport, 2017). Limited practice hours in the time of a pandemic creates issues with mastery of clinical skills. Simulation formats provide opportunities to hone psychomotor and critical thinking skills (Starkweather et al., 2017). The approach in communication styles and messaging allows for open dialogue with our patients. Practice allows competent clinical care delivery.

References

 Ali, P. A., & Johnson, S. (2017). Speaking my patient’s language: bilingual nurses’ perspective about the provision of language concordant care to patients with limited English proficiency. Journal of Advanced Nursing, 73(2), 421–432. https://doi.org/10.111/jan.13143 Ali, P. A., & Watson, R. (2018). Language barriers and their impact on the provision of care to patients with limited English proficiency: Nurses’ perspectives. Journal of Clinical Nursing, 27(5-6), e1152–e1160. https://doi.org/10.1111/jocn.14204

Bargagliotti, A. L., & Davenport, D. (2017). Entrustables and entrustment: Through the looking glass at the clinical making of a nurse practitioner. The Journal of Nurse Practitioners, 13(8), e367–e374. https://doi.org/10.1016/j.nurpra.2017.05.018 Starkweather, A., Sargent, L., Nye, C., Albrecht, T., Cloutier, R., & Foster, A. (2017).

Progressive assessment and competency evaluation framework for integrating simulation in nurse practitioner education. The Journal for Nurse Practitioners, 13(7), e301–e310. https://doi.org/10.1016/j.nurpra.2017.04.012 

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Assignment 1 Rubric

 Assignment 1 Rubric Competency

30

27

25

 0

 Points

Define, compare and contrast clinical reasoning and decision-making. How is this related to critical thinking and clinical judgment in graduate level nursing practice? Defines, compares, and contrasts clinical reasoning and decision-making with cited references in addition to course readings for Week 1.

Answers posed questions.

Defines, compares, and contrasts clinical reasoning and decision-making with cited references from course readings for Week 1.

Answers posed questions.

Describes clinical reasoning and decision-making. Briefly answers how this is related to critical thinking and clinical judgment in graduate level nursing practice?

Does not define, compare and contrast clinical reasoning and decision-making. Does this answer relate to critical thinking and clinical judgment in graduate level nursing practice?

/30

30

27

25

0 

Consider contemporary literature and apply the concept of clinical reasoning to advanced physical assessment in nursing.

Considers contemporary literature and applies the concept of clinical reasoning to advanced physical assessment in nursing.

Considers textbook literature and references within text books without further consideration of external literature support.

Considers and applies the concept of clinical reasoning to advanced physical assessment in nursing without reference to expert opinion or research literature. Does not consider and apply the concept of clinical reasoning to advanced physical assessment in nursing.

/30

30

27

25

0

Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. How is nursing care provided or modified when each of these concepts are evidenced in nursing care of the well-adult, family, and one special population?

Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. Discusses how nursing care was provided or modified when each of these concepts were evidenced in nursing care of the well-adult, family, and one special population.

Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. Discusses how nursing care was provided or modified when each of these concepts were evidenced in nursing care of the well-adult, family, or one special population.

Demonstrates the nurse’s use of critical thinking, clinical judgment, or clinical reasoning. Discusses how nursing care was provided or modified when these concepts were evidenced in nursing care of the well-adult, family, or one special population.

Does not demonstrate the nurse’s use of critical thinking, clinical judgment, or clinical reasoning. Does not discuss how nursing care was provided or modified when these concepts were evidenced in nursing care of the well-adult, family, or one special population.

/30 

10 

9

8

0  

APA Format, grammar, punctuation and spelling. 

APA Format, grammar, punctuation and spelling is accurate with no errors.

APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.

APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.

APA Format, grammar, punctuation and spelling is accurate with more than five types of errors.

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