13Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 13 Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care

A nursing student is committed to providing thoughtful, person-centered care. Which nursing actions demonstrate this type of care? Select all that apply.

a. Assisting patients to select meals based on their cultural observances

b. Providing nursing care based on patients’ needs and preferences

c. Documenting nursing interventions in the electronic health record

d. Reviewing fingerstick blood glucose levels with the primary nurse

e. Listening to a patient’s concern for their ill significant other

a, b, e.

a. Assisting patients to select meals based on their cultural observances

b. Providing nursing care based on patients’ needs and preferences

e. Listening to a patient’s concern for their ill significant other

The nursing process ensures that nurses are person centered rather than task centered. Attending to cultural preferences and needs and listening to a patient’s concerns are patient-centered actions. Documentation and communication with other members of the health care team are not specifically patient centered.

A patient who is receiving cancer chemotherapy tells the nurse, “The treatment for this cancer is worse than the disease itself. I’m stopping treatment.” Which nursing action best promotes a patient-centered, therapeutic relationship?

a. Determining if the patient database is adequate to address the problem

b. Considering whether to suggest a counseling session for the patient

c. Reassessing the patient and determining how to best support them

d. Identifying possible interventions and critiquing the merit of each option

c. . Reassessing the patient and determining how to best support them

Reassessing the patient allows the nurse and patient to clarify the patient’s goal(s) and develop interventions to best meet them. Once the problem is addressed, it is important for the nurse to judge the adequacy of the knowledge, identify potential problems, use helpful resources, and critique the decision.

The nursing philosophy in an acute care hospital includes a commitment to deliver thoughtful, person-centered care. Which description of the nursing process best supports this commitment?

a. Systematic

b. Interpersonal

c. Dynamic

d. Universally applicable in nursing situations

b. Interpersonal.

All other options are characteristics of the nursing process but focus on the patient best illustrates the interpersonal dimension of the nursing process.

A staff nurse tells a new graduate nurse not to bother studying too hard, since most clinical reasoning becomes second nature and intuitive once they begin practicing. Which response by the student is appropriate?

a. Intuitive problem solving comes with years of practice and observation based on nursing knowledge and science.

b. For nursing to remain a science, nurses must continue to be vigilant about avoiding intuitive reasoning.

c. The emphasis on logical, scientific, evidence-based reasoning has held nursing back; we need intuitive, creative thinkers.

d. The nurse’s preference dictates whether they are logical, scientific thinkers or intuitive, creative thinkers.

a. Intuitive problem solving comes with years of practice and observation based on nursing knowledge and science.

When intuition is used alone, increased risks and fewer benefits may occur. Beginning nurses must use nursing knowledge and scientific problem solving as the basis of care; intuitive problem solving comes with years of practice and observation. If the beginning nurse has an intuition about a patient, that information should be discussed with the faculty member, preceptor, or supervisor. There is a place for intuitive reasoning in nursing, but it will augment, not replace logical, scientific reasoning. Critical thinking is contextual and changes depending on the circumstances, not on personal preference.

The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which interventions reflect the use of cognitive skills? Select all that apply.

a. Monitoring for side effects of medications

b. Safely administering an injectable medication

c. Teaching a patient about diabetes and its management

d. Acting as witness by signing a surgical consent form

e. Helping a patient identify their progress in physical therapy

f. Comforting a patient who has received bad news

a, c.

Monitoring for side effects of medications

Teaching a patient about diabetes and its management

Using critical thinking to teach a patient about a disease process and management and monitoring for side effects of medications are cognitive competencies. Performing an injection correctly is a technical skill; witnessing/signing an informed consent form is a legal/ethical action, and comforting a patient is an interpersonal skill.

A nurse uses critical-thinking skills to develop the care plan for an older adult with dementia awaiting placement in a long-term care facility. Which statements describe characteristics of the critical thinking used by nurses engaged in clinical reasoning? Select all that apply.

a. Functions independently of nursing standards, ethics, and state practice acts

b. Based on the principles of the nursing process, problem solving, and the scientific method

c. Driven by patient, family, and community needs as well as nurses’ needs to give competent, efficient care

d. Avoids designs to compensate for problems created by human nature, such as medication errors

e. Constantly reevaluating, self-correcting, and striving for improvement

f. Focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care

b, c, e.

b. Based on the principles of the nursing process, problem solving, and the scientific method

c. Driven by patient, family, and community needs as well as nurses’ needs to give competent, efficient care

e. Constantly reevaluating, self-correcting, and striving for improvement

Critical thinking applied to clinical reasoning and clinical judgment is guided by standards, policies and procedures, and ethics. When applying principles of nursing process, problem solving, and the scientific method, clinical reasoning identifies the key problems, issues, and risks. This is driven by patient, family, and community needs as well as nurses’ needs to give competent, efficient care. It also calls for strategies that make the most of human potential and compensate for problems created by human nature. It is constantly reevaluating, self-correcting, and striving to improve the quality and safety of health care systems

A nurse is caring for a patient with type 2 diabetes who has an infected foot ulcer requiring dressing changes. Which nursing action best demonstrates the QSEN competency of patient-centered care?

a. Asking the patient if they would like their spouse to be present for a teaching session

b. Researching new procedures to care for foot ulcers when developing a care plan for this patient

c. Leading a grand rounds or unit-based discussion on complications of diabetes

d. Using the electronic medical record to review trends of the patient’s blood glucose levels

a. .Asking the patient if they would like their spouse to be present for a teaching session

Patient-centered care commits to developing caring relationships based on mutual trust to communicate and deliver care based on patient preferences and values. Evidence-based practice integrates the best current evidence for safe practice with clinical expertise. Teamwork and collaboration shares patient information or opportunities for learning with others. Informatics manages patient information, mitigates error, and supports decision making using the electronic medical record and other databases.

The nursing assessment of a patient with a diagnosis of anorexia nervosa reveals the patient consumes a vegan diet of 700 calories daily and has lost 30 lb in 4 months. The nurse’s recommendation to meet with a nutritionist is the outcome of which process?

a. Clinical judgment

b. Nursing process

c. Clinical reasoning

d. Critical thinking

a. Clinical judgment

Clinical judgment is the outcome of critical thinking and clinical reasoning, using the nursing process as a framework. Clinical reasoning refers to ways of thinking about patient care issues including weighing and validating options (determining, preventing, and managing patient problems). Critical thinking includes reasoning both outside and inside of the clinical setting.

A nurse working in a long-term care facility reviews the electronic health records of patients who have fallen in the last month to determine if there is a common risk factor. Which QSEN competency is the nurse demonstrating?

a. Patient-centered care

b. Evidence-based practice

c. Teamwork and collaboration

d. Informatics

d. Informatics

Informatics uses information and technology to communicate, manage knowledge, mitigate error, and support decision making. Thoughtful, patient-centered care emphasizes recognition of the patient or designee as the source of control and full partner in compassionate and coordinated care, based on respect for patients’ preferences, values, and needs. Evidence-based practice integrates the best current evidence with clinical expertise and patient and family preferences and values to deliver optimal health care. Teamwork and collaboration refer to effective functioning within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.

A new graduate nurse phones the surgeon to report their patient is having severe incisional pain. The surgeon asks about vital signs and appearance of the wound, causing the nurse to return to the bedside for additional assessments. Upon reflection with the preceptor, which characteristic of the nursing process should the nurse have remembered?

a. Centric

b. Dynamic

c. Interpersonal

d. Systematic

d. Systematic

The nursing process is systematic, iterative, and overlapping. By reporting an isolated symptom, the nurse has overlooked the benefit of systematic and inclusive assessment. While the nursing process is presented as an orderly progression of phases, there is a dynamic interaction and flow of phases into one another.

The nurse is formulating a care plan for a patient in a long-term care facility who has lost 12 lb in the last 2 months. To arrive at a patient-centered nursing judgment, what will the nurse do first?

a. Ensure the patient is receiving foods they like, including favorites.

b. Make sure the patient’s dentures are clean and inserted at mealtimes.

c. Assess the patient’s food intake and hydration over the last 1 to 3 days.

d. Request that the nursing assistant feed the client at mealtime.

c. Assess the patient's food intake and hydration over the last 1 to 3 days.

The nurse uses the nursing process to arrive at a clinical judgment. After analyzing the assessment data, the nurse determines, through clinical reasoning, whether the related factors in the patient's weight loss, such as dislike of menu options, lack of dentition, or inability to perform activities of daily living such as feeding, should be the focus of interventions.

When implementing a thoughtful, patient-centered care plan, which action does the nurse prioritize?

a. The patient’s loved ones are considered part of the team.

b. A caring relationship with mutual trust is established.

c. Measures for safety are visibly incorporated.

d. Transparent communication is observed.

c. Measures for safety are visibly incorporated.

Although developing a thoughtful, patient-centered approach is focused on caring and mutual trust, the nurse uses the nursing process and Maslow's hierarchy of needs to prioritize care. Safety is a higher-level need than love and belonging, and therefore the priority

An oncology nurse is analyzing a patient’s strengths and finds the patient is well educated, learns quickly, and is resilient. In which phase of the nursing process will the nurse use this information?

a. Diagnosing

b. Evaluating

c. Planning

d. Implementing

a. Diagnosing

Assessing for strengths and weaknesses is the first step of the nursing process, which has been completed. Next, the nurse clusters cues and develops diagnoses that give rise to interventions. Evaluating the plan is followed by completing or modifying the plan.