Question

I need 10 pages essay and it should cover these 3 main points below. this is the end of the internship paper I have to write what I have done. I've attached my responsibility below.

- Enable me to use clinical reasoning procedures to understand data to cultivate a clinical management plan.

- Enable me to be able to analyze patient symptoms and derive the best way to approach their problem.

- Ensure that I execute an accurate and detailed examination and make choices based on proper reasoning using evidence-based medicine.

Duty description added below

Purpose: 1. To improve patient experience & patient satisfaction 2. Act as liaison between patient, family/loved ones, and the staff and to facilitate/improve communication by providing an additional link between hospital staff and patients. 3. Provide emotional and psychological support to patients and their families/loved ones. 4. To enhance patient safety by conducting unit rounds to reduce & prevent patient falls. Primary Responsibilities: 1. Assist nursing with rounding (visiting patient rooms). (Use Patient Safety&Comfort Measures Checklist) Respond to patient call lights and communicate needs to nursing staff or assist patient with pushing the appropriate call button. (Use Patient Safety&Comfort Measures Checklist) Refer patients and family members to appropriate staff to obtain quick resolution to issues. Observe the environment to identify safety hazards. Pick up any trash from the floor Maintains effective communication with nursing leadership and other key professionals to achieve effective patient advocacy. Circulate among patients, family/loved ones who are in waiting rooms and treatment areas providing comfort measures as identified (ie: blanket, water, etc.) Provide support to patient and family/loved ones during Critical Events. Reach out to Spiritual Care if needed. Attempt to maintain an orderly and welcoming waiting area. Pick up any clutter or trash. 2. 3. 4. 5. 7. 8. Other Responsibilities: 1. 2. 3. Assist with making clean beds as needed Assist with stocking linens and/or supplies as needed. Assist registrar/unit secretary with light clerical support as needed (ie: filing, copying, faxing or alphabetizing) Assist in running errands and provide non-professional support services to the staff. Assist with placing shredding in locked bins Assist with taking recycling bags to trash bin 4. 5. 6. Physical Requirements: Ability to communicate orally & audibly 2. Must be able to walk & stand for up to 2 to 4 hours

Answer 1

In the literature, the terms clinical reasoning, clinical judgment, problem-solving, decision making and critical thinking are often used interchangeably. Clinical reasoning to describe the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process (Hoffman, 2007; Kraischsk & Anthony, 2001; Laurie et al., 2001).

The clinical reasoning process is dependent upon a critical thinking „disposition‟ (Scheffer & Rubenfeld, 2000) and is influenced by a person‟s attitude, philosophical perspective, and preconceptions (McCarthy, 2003). Clinical reasoning is not a linear process but can be conceptualized as a series or spiral of linked and ongoing clinical encounters.

In clinical practice, experienced nurses engage in multiple clinical reasoning episodes for each patient in their care. An experienced nurse may enter a patient‟s room and immediately observe significant data, draw conclusions about the patient and initiate appropriate care. Because of their knowledge, skill, and experience the expert nurse may appear to perform these processes in a way that seems automatic or instinctive.

Thus we can say that clinical reasoning is the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process.

Clinical reasoning is the process that therapists use to evaluate clients and design and carry out intervention cognition and skills thinking and feeling based on evidence-based practice.

*Thought process during clinical reasoning:

1. Formation of pre-assessment image
2. Cue acquisition
3. hypothesis generation
4. cue interpretation
5. hypothesis evaluation

Clinical management objectives:

1. Clarity and accuracy in assessment and reassessment
2. Setting clear treatment goals that are specific to the data collected
3. Establishing informed consent
4. Performance of safe treatment
5. Delivery of effective and efficient techniques to address established goals
6. Measurable and recognizable results (reassessment) to both therapist and patient
7. Delivery of safe, effective, and measurable home care
8. Constructing a management plan

Management plan:

Summary of the patient's medical conditions and the methods a therapist would use to address each condition. Used to create an overview of long term planning for the patient's eventual discharge/maintenance.

Sections of a clinical management pan:

• Active/inactive problems/precautions
• Phase of care
• Domain of involvement
• Conditional factors
• Home Instructions
• Work restrictions/modifications
• Treatment modality
• Treatment frequency
• Treatment goals/outcome markers
• Management plan
• Home care plan

Thus clinical reasoning procedures is very important to understand data to cultivate a clinical management plan thus results in the effectiveness of health promotion and maintenance and avoid future complications related to health manners.

Techniques to improve clinical reasoning:

• Chunking - remember things and apply to other clients with the same issue
• Supervision - learn from others who have more experience
• Coaching - same as supervision
• Role modeling - same as supervision, how to speak to someone, model successful people
• Self-awareness - know when you're effective, know when you're not
• Observation -
• Setting personal goals - work in areas that challenge you

Clinical reasoning is critical to providing occupational therapy services. Clinical reasoning takes practice, education, and self-reflection.

*When a diagnosis is accurate and made in a timely manner, a patient has the best opportunity for a positive health outcome because clinical decision making will be tailored to a correct understanding of the patient’s health problem (Holmboe and Durning, 2014).

Once a patient seeks health care, there is an iterative process of information gathering, information integration and interpretation, and determining a working diagnosis. Performing a clinical history and interview, conducting a physical exam, performing diagnostic testing, and referring or consulting with other clinicians are all ways of accumulating information that may be relevant to understanding a patient’s health problem. The information-gathering approaches can be employed at different times, and diagnostic information can be obtained in different orders. The continuous process of information gathering, integration, and interpretation involves hypothesis generation and updating prior probabilities as more information is learned. Communication among health care professionals, the patient, and the patient’s family members is critical in this cycle of information gathering, integration, and interpretation.

In working with older adults with memory loss, with children, or with individuals whose health problems limit communication or reliable self-reporting. It may be necessary to include family members or caregivers in the history-taking process. The time pressures often involved in clinical appointments also contribute to challenges in the clinical history and interview. Limited time for clinical visits, partially attributed to payment policies, may lead to an incomplete picture of a patient’s relevant history and current signs and symptoms.

The patient symptoms can be best analyzed by the thorough history taking, physical examination, thorough clinical examination, subjective and objective data thus we can accurately make the diagnosis and to provide better treatment options.

*Evidence-Based Practice is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population.

Evidence-based practice (EBP) is one such technique and is quickly gaining popularity due to its potential to effectively handle clinical issues and provide better patient care.

Moreover, as nurses are increasingly more involved in clinical decision making, it is becoming important for them to utilize the best evidence to make effective and justifiable decisions.

A number of studies investigating nurses' perceptions show that nurses generally view EBP positively and consider it important to better patient care.

Implementation of EBP places additional demands on nurses to apply credible evidence to individual client situations through searching related evidence, using clinical judgments and considering client values and system resources to effectively apply the EBP process, in addition to the basic skills required to undertake nursing work, a nurse must have the ability to:

(1) identify knowledge gaps

(2) formulate relevant questions

(3) conduct an efficient literature search

(4) apply rules of evidence to determine the validity of studies

(5) apply the literature findings appropriately to the patient's problem

(6) appropriately involve the patient in clinical decision making.

Like many other disciplines, the health care sector is experiencing major changes due to extensive research and development activities. As nurses play a crucial role in the delivery of health care, they need to embrace new and innovative techniques to provide effective and best possible treatment to their patients. However, at the same time, it was found that several institutional and personal barriers were hindering nurses from adopting EBP. Hospital management can easily overcome some of these barriers through arranging EBP training and providing time off from work for nurses to learn and implement new techniques. Nurses preferred to consult their supervisors and colleagues to obtain the needed information. Hospital management can create a conducive environment and provide socializing opportunities for nurses to promote peer-to-peer information and knowledge sharing. Similarly, as EBP is an information-intensive activity, library and information professionals working in hospitals can play a significant role in developing basic information literacy skills, particularly literature searching skills, among nurses and other medical practitioners.