Discussion: Reasoning in a Specialty Area
Bring to mind an important practice-related decision you have made recently. How did you approach this decision? What aspects of your specialty expertise informed your decision-making?
Evaluate your decision now in light of the principles of clinical reasoning presented in the Learning Resources this week. What new insights arise about your decision making as you look at it through this lens? What questions emerge as you reflect how you use reasoning in your practice?
In this Discussion, you and your colleagues examine the application of reasoning strategies in your specialty area of practice, particularly as it is connected to your EBP Assignment question.
• Consider the definition of clinical reasoning and how it is distinguished from other terms in the Simmons article.
• Bring to mind key characteristics of your specialty area. Is the concept of clinical reasoning relevant and sufficient to describe the process you utilize as you make decisions and solve problems in your area of specialization? Why or why not? If not, what terminology would be more useful for defining or characterizing this process?
• Review the literature to identify at least two specific examples of reasoning strategies used in your specialty area. These may be part of your literature review related to your EBP Assignment question(s).
• Reflect on your EBP Assignment question(s). Reexamine your project question(s) through this lens of clinical, or alternately termed, reasoning.
This week you begin to develop your small-scale Evidence-Based Practice (EBP) Assignment in your practicum setting. In Application 1—the first in a series of assignments in which you will convey your insights and analysis of the EBP Assignment—you are asked to identify an issue related to practice in which an outcome is different from what would be expected according to the research literature. This issue provides the foundation for future development of the project.
• Apply reasoning strategies in a nursing specialty area
• Evaluate outcomes in a specialty practice area that differ from the research evidence
Developing an Evidence-Based Practice (EBP) Project Question
With the delicate nature of the clients in the mental health outpatient clinical setting with different kinds of symptoms, it is important for all staff members to be informed about cultural differences and put the knowledge into practice with the admission, treatment, and follow-up care of patients.
According to (Kathleen et al., 2021), – “Culture can be defined as a blueprint for our way of living, thinking, behavior and feeling”. This is important in how will assess and treat mental health patients. We need not assume that something is odd or bizarre without first understanding the culture of a client.
What are the Best Practices that can Promote Cultural Awareness in Outpatient Clinical Settings?
Do the best practices that can promote cultural awareness improve patient care and treatment in outpatient mental health clinics in the Southwestern part of the United States?
P: Age 6 years to the geriatric population in an outpatient mental health clinic.
I: Increase awareness of cultural differences, improves assessment, treatment, and de-escalate discomfort situations of clients. in the plan of care and improves health care services.
C: No comparison.
O: Increase in knowledge of staff members (satisfaction measured by Qualtrics with pre- and post-questionnaires)
According to (Kleinman, 1988). To increase understanding of other people’s cultures in rendering health care services we will need to answer some questions including:
– “What is the problem?
-What do you think caused the problem?
-Why do you think it started when it did?
-What do you think the sickness does/how does it work?
-How severe is the sickness?
-What kind of treatment should be given? What results do you want to achieve?
-What problems has it caused?
-What do you fear most about the sickness?”
In mental health settings, there are varying beliefs in mental health diagnosis. Some cultures do not accept any diagnosis that has to do with hallucinations, psychosis, or bizarre thoughts. They classify all diagnoses as mood disorders and have challenges understanding the need for antipsychotics.
The mental health outpatient admission settings with patients with varying symptoms may prove to be of concern to patients and family members.
The outpatient clinical settings’ organizational culture will affect how the staff members will adopt Evidenced-Based Practice –(EBP) and will affect their willingness to develop new cultural understandings, embrace new knowledge and implement learning.
I plan to use the Qualtrics Survey Tool with pre-knowledge questionnaires, evaluate barriers to knowledge, staff culture, and behavior to education and training, and compare them to the post-knowledge questionnaires to evaluate the improvement in knowledge and quality of health care services.
I would like to study the effect of an increase in knowledge of varying cultural groups to improve staff members’ understanding and improve care in the outpatient clinic, this is referred to as the “Emic perspective” according to (Allison J. Terry 2018).
Allison. Terry Clinical Research for The Doctor of Nursing Practice (2018). Clinical research for the Doctor of Nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Kathleen M. White, Sharon Dudley-Brown, Mary F. Terhaar, (2012) Translation of Evidence into Nursing and Healthcare. Third Edition.
Melnyk, B.M., Fineout-Overhold, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53.
Walker, E. R., & Druss, B. G. (2016). A Public Health Perspective on Mental and Medical Comorbidity. JAMA, 316(10), 1104–1105. https://doi.org/10.1001/jama.2016.10486
Two pages Assignment
Post a cohesive scholarly response that addresses the following:
• How are reasoning strategies most often applied in your specialty area?
• Provide at least two specific examples supported by the literature.
Terry, A. J. (2018). Clinical research for the doctor of nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
• Chapter 1, “The Importance of Research in the Doctor of Nursing Practice Degree”
Read pages 12-18 beginning with “The DNP Graduate With an Aggregate
In this section of Chapter 1, the author explains relationship between the DNP clinician, the research process, and developing an effective evidence-based practice. The author also discusses facilitating change in practice based on critically appraised and validated evidence. In addition, Carper’s four essential patterns of “knowing” in nursing and Rosswurm and Larrabee’s six-phase model for reviewing research are highlighted.
Balakas, K., Sparks, L., Steurer, L., & Bryant, T. (2013). An outcome of evidence-based practiced education: Sustained clinical decision-making among bedside nurses. Journal of Pediatric Nursing, 28, 479-485.
Harkanen, M., Voutilainen, A., Turunen, E., & Verhvilainen-Julkunen, K. ( 2016). Systematic review and meta-analysis of educational interventions designed to improve medication administration skills and safety of registered nurses. Nurse Education Today, 41, 36-43.
Lee, J., Lee, Y., Bae, J., & Seo, M. (2016). Registered nurses clinical skills and reasoning process: A think-aloud study. Nurse Education Today, 46, 75-80
Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing, 66(5), 1151-1158