Chapter 13
Blended Competencies, Clinical
Reasoning, and Processes of
Person-Centered Care
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ANA Definitions of Nursing #1
 Provision of a caring relationship that facilitates health
and healing
 Attention to the range of human experiences and
responses to health and illness within the patient’s
physical and social environments
 Integration of assessment data with knowledge gained
from an appreciation of the patient or group’s subjective
experience
 Application of scientific knowledge to the processes of
diagnosis and treatment through the use of judgment
and critical thinking
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ANA Definitions of Nursing #2
 Advancement of professional nursing knowledge through
scholarly inquiry
 Influence on social and public policy to promote social
justice
 Assurance of safe, quality, and evidence-based practice
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Thoughtful Person-Centered Practice
 The person
 The professional nurse
 Reflective practice leading to personal learning
 Clinical reasoning, judgment, and decision making
 The nurse’s action in response to individual clinical need
 Person-centered nursing process
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Components of Thoughtful Practice
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10 Guiding Principles of Person-Centered
Care #1
 All team members are considered caregivers.
 Care is based on continuous healing relationships.
 Care is customized and reflects patient needs, values,
and choices.
 Knowledge and information are freely shared between
and among patients, care partners, physicians, and other
caregivers.
 Care is provided in a healing environment of comfort,
peace, and support.
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10 Guiding Principles of Person-Centered
Care #2
 Families and friends of the patient are considered an
essential part of the care team.
 Patient safety is a visible priority.
 Transparency is the rule in the care of the patient.
 All caregivers cooperate with one another through a
common focus on the best interests and personal goals
of the patient.
 The patient is the source of control for their care.
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Beliefs of the International Association of
Human Caring #1
 Caring is the human mode of being.
 Caring is the essence of nursing and the moral
imperative that guides nursing practice.
 Caring is both spiritual and human consciousness that
connects and transforms everything in the universe.
 Caring in nursing is action and competencies that aim
toward the good and welfare of others.
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Beliefs of the International Association of
Human Caring #2
 Caring in nursing is a special way of being, knowing, and
doing with the goal of protection, enhancement, and
preservation of human dignity.
 Care is culturally diverse and universal, and provides the
broadest and most important means to study and explain
nursing knowledge and nursing care practices.
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The Professional Nurse
 Personal attributes
 Knowledge base
 Blended competencies
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Blended Competencies #1
 Developing cognitive competencies
o Developing the method of critical thinking
 Purpose of thinking
 Adequacy of knowledge
 Potential problems
 Helpful resources
 Critique of judgment/decision
o Developing the personal attributes to think critically
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Blended Competencies #2
 Developing technical competencies
 Developing interpersonal competencies
o Promoting human dignity and respect
o Establishing caring relationships
o Enjoying the rewards of mutual exchange
 Developing ethical/legal competencies
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Question #1
A nurse’s personal moral code is to assist all patients to
the best of one’s ability. What blended skill would the
nurse use when seeking out special services for a
homeless patient with a diabetic foot ulcer?
A. Cognitive
B. Technical
C. Interpersonal
D. Ethical/Legal
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Answer to Question #1
Answer: D. Ethical/Legal
Rationale: Using ethical/legal skills is the best answer as
it involves following a moral code and acting
professionally. Cognitive skills involve thinking through a
situation to achieve outcomes. Technical skills relate to
the proper use of equipment. Interpersonal skills are
used to develop caring relationships.
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QSEN Competencies
 Patient-centered care
 Teamwork and collaboration
 Evidence-based practice
 Quality improvement
 Safety
 Informatics
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Problem-Solving and the Nursing Process
 Trial-and-error problem solving
 Scientific problem solving
 Intuitive problem solving
 Critical thinking: intuitive, logical, or both?
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Potential Errors in Decision Making
 Bias
 Failure to consider the total situation
 Impatience
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Historical Development of the Nursing
Process
 1955: Nursing process term used by Hall
 1960s: Specific steps delineated
 1967: Yura and Walsh published first comprehensive
book on nursing process
 1973: ANA Congress for Nursing Practice developed
Standard of Practice
 1982: State board examinations for professional nursing
uses nursing process as organizing concept
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Five Steps of the Nursing Process
 Assessing: collecting, validating, and communicating
patient data
 Diagnosing: analyzing patient data to identify patient
strengths and problems
 Planning: specifying patient outcomes and related
nursing interventions
 Implementing: carrying out the care plan
 Evaluating: measuring extent to which patient achieved
outcomes
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Question #2
Which step of the nursing process is a nurse using when
analyzing patient data to determine a patient’s strengths
following a CVA?
A. Assessing
B. Diagnosing
C. Planning
D. Implementing
E. Evaluating
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Answer to Question #2
Answer: B. Diagnosing
Rationale: The diagnosing step involves analyzing patient
data to determine strengths and weaknesses. The
assessing step refers to the collection, validation, and
communication of patient data. In the planning step, the
nurse determines patient outcomes and related nursing
interventions, and in the implementing step, the nurse
carries out the plan. When evaluating, the nurse
measures the extent to which the patient achieved
outcomes.
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The Steps of the Nursing Process are
Dynamic and Interrelated
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Question #3
Which of the following characteristics of the nursing
process describes the interaction and overlapping of
steps within the process itself?
A. Systematic
B. Dynamic
C. Interpersonal
D. Universally Applicable
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Answer to Question #3
Answer: B. Dynamic
Rationale: The nursing process is dynamic in that there is
much interaction and overlapping of the steps. It is
systematic since it is an ordered sequence of activities.
Interpersonal refers to the human being at the heart of
nursing. The nursing process is universally applicable in
that it is a framework for all nursing activities.
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Characteristics of the Nursing Process
 Systematic: part of an ordered sequence of activities
 Dynamic: great interaction and overlapping among the
five steps
 Interpersonal: human being is always at the heart of
nursing
 Outcome oriented: nurses and patients work together to
identify outcomes
 Universally applicable: a framework for all nursing
activities
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Benefits of the Nursing Process
 Patient
o Scientifically based, holistic individualized patient
care
o Continuity of care
o Clear, efficient, cost-effective plan of action
 Nurse
o Opportunity to work collaboratively with other health
care workers
o Satisfaction of making a difference in lives of patients
o Opportunity to grow professionally
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Steps in Concept Mapping
1. Collect patient problems and concerns on a list.
2. Connect and analyze the relationships.
3. Create a diagram.
4. Keep in mind key concepts: the nursing process,
holism, safety, and advocacy
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Question #4
Tell whether the following statement is true or false.
Concept mapping is an instructional strategy that
requires learners to identify, graphically display, and link
key concepts.
A. True
B. False
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Answer to Question #4
Answer: A. True
Rationale: Concept mapping is an instructional strategy
that requires learners to identify, graphically display, and
link key concepts.
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Reflective Practice
 Reflection in action
o Happens in the here and now of the activity and is
also known as “thinking on your feet.”
 Reflection on action
o Occurs after the fact and involves thinking through a
situation that has occurred in the past.
 Reflection for action
o Helps the person to think about how future actions
might change as a result of the reflection.
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