NUR4153CBE Rasmussen College Impact of Relational Inquiry in Nursing Paper Competency Explain the impact of relational inquiry when recognizing and analyz

NUR4153CBE Rasmussen College Impact of Relational Inquiry in Nursing Paper Competency

Explain the impact of relational inquiry when recognizing and analyzing cues to action in the process of clinical reasoning.

Scenario

You are a nursing student in a BSN Program, currently enrolled in a Leadership course. As part of your current immersion experience, you are working with the charge nurse in the operating room. In pre-op on the first day of this clinical experience, you observe an upset client refusing to sign a surgery consent unless a small religious object could accompany him and stay attached to his body. This object is a key component of his cultural beliefs, and he will cancel the surgery if he is unable to keep the religious object attached to his body. The charge nurse states, “Let me check and see what we can do, I will need a bit of time to collaborate with others and see if we can identify a solution.” You observe the charge nurse gather a team of nurses in the pre-op area and begin reviewing the policy and procedure manuals for the facility to determine if a solution can be identified to allow the object to be taken into the operating room. While the healthcare team was looking for a solution, someone recommended that the object is wrapped in non-conductive material, and applied to the client under a sterile dressing. According to policy, this would work with Surgeon approval.

Instructions

In post-conference, you debrief with a faculty member and discuss this powerful example of healthcare team members working together to support and respect a client’s unique cultural needs and belief system. The clinical faculty tells you to complete a clinical journal entry which describes the process involved in this example of professional practice. Include the following in your journal entry:

Explain how relational inquiry was applied in this situation to promote the process of clinical reasoning.
From context and culture
Optimization of health and well-being
Collaborating across differences
Do you believe this action was appropriate, and why or why not?
Provide a supporting argument to defend choice for appropriate or non-appropriate response by the nurse and include personal biases.
Resources
APA Guide
Nursing Research
Hamilton, S. (2016). Reflective writing: a user-friendly guide. British Journal Of Nursing, 25(16), 936-937.
McMillan-Coddington, D. (2013). Reflection through journal writing to educate registered nursing students on patient care. Teaching And Learning In Nursing, 863-67. doi:10.1016/j.teln.2012.09.004
Regmi, K., & Naidoo, J. (2013). Understanding the processes of writing papers reflectively. Nurse Researcher, 20(6), 33-39. 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
•
•
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.

Purchase answer to see full
attachment