Key Concepts, Chapter 13, Blended Competencies, Clinical Reasoning, and
Processes of Person-Centered Care

A thoughtful nurse is considerate and compassionate, keeping the person at
the center of all deliberations in order to promote the humanity, dignity, and
well-being of the person being cared for.

Professional nursing requires cultivated personal attributes, mastery of the
science of nursing, and reflective clinical experience in which nurses develop
the blended and QSEN competencies that promote thoughtful and effective
patient-centered practice.

Nurses who practice patient-centered care are committed to developing
caring professional relationships based on respect and mutual trust. This
holistic approach, which is consistent with theories based on human caring,
seeks to promote humanism, health, and quality of living. Caring is viewed
as universal and is practiced through interpersonal relationships.

Personal attributes that prepare you for thoughtful patient-centered care
include open-mindedness, a profound sense of the values of the person, selfawareness and knowledge of your own beliefs and values, a sense of
personal responsibility for your actions, motivation to perform to the best of
your ability because you care about the well-being of those entrusted to your
care, leadership skills, and bravery to question “the system.”

Nurses aim to design and manage each patient’s care scientifically,
holistically, and creatively. To do this successfully, you need many cognitive,
technical, interpersonal, and ethical and legal competencies. You must be
willing to use these competencies creatively and critically when working with
patients to promote or restore health, prevent disease or illness, and
facilitate coping with altered functioning.

Critical thinking is a systematic way to shape your thinking. It functions
purposefully and exactingly. Critical thinking is thought that is disciplined,
comprehensive, based on intellectual standards, and, as a result, wellreasoned. Nurse critical thinkers work methodically through five types of
considerations: the purpose of thinking, adequacy of knowledge, potential
problems, helpful resources, and critique of judgment/decision.

When a procedure demands manual dexterity or a complex series of steps,
practice the necessary skill until you feel confident in its execution before
attempting to perform it with a patient. Never be ashamed to ask for help
when feeling unsure of how to perform a procedure or manage equipment.

Interpersonal skills are essential to the practice of thoughtful patientcentered practice. Interpersonal caring involves promoting the dignity and
respect of patients as people and establishing a caring relationship. As a
result, both you and the patient experience mutual enrichment.

Nurses who prize their role in securing patient well-being are sensitive to the
ethical and legal implications of nursing practice. Although it can take years
to master effective patient advocacy skills and become proficient in
mediating ethical conflict, even beginning nurses are responsible for certain
basic ethical skills and for legally prudent practice.

The overall goal of the Quality and Safety Education for Nurses (QSEN)
project is to meet the challenge of preparing future nurses who will have the
knowledge, skills and attitudes (KSAs) necessary to continuously improve the
quality and safety of the health care system within which they work.

Many use the terms critical thinking, clinical reasoning, and clinical judgment
interchangeably. Clinical reasoning---a specific term---usually refers to ways
of thinking about patient care issues (determining, preventing, and managing
patient problems). For reasoning about other clinical issues (e.g., teamwork,
collaboration, and streamlining work flow) nurses usually use critical
thinking. Clinical judgment refers to the result (outcome) of critical thinking
or clinical reasoning---the conclusion, decision, or opinion you reach.

While clinical reasoning can be broken down into steps---look, collect,
process, decide, plan, act, evaluate and reflect---in reality, the phases merge
and the boundaries between them are often blurred. Clinical reasoning
includes the ability to recognize clinical problems and solve them using the
cognitive skills of critical thinking, creative thinking, and intuitive thinking.

The nursing process is a systematic method that directs the nurse, with the
patient’s participation, to accomplish the following: (1) assess the patient to
determine the need for nursing care, (2) determine nursing diagnoses for
actual and potential health problems, (3) identify expected outcomes and
plan care, (4) implement the care, and (5) evaluate the results.

The nursing process is systematic, dynamic, interpersonal, outcome oriented,
and universally applicable.

The ability to communicate clearly is a critical nursing skill. Accurate, concise,
timely, and relevant documentation provides all the members of the
caregiving team with a picture of the patient. The patient record is the chief
means of communication among members of the interdisciplinary team.

Concept mapping is an instructional strategy in which learners identify,
graphically display, and link key concepts. Concept maps---also called
cognitive maps, mind maps, and meta cognitive tools for learning---are a
proven means to promote critical thinking and self-directed learning.

Reflective practice is a purposeful activity that leads to action, improvement
of practice, and better patient outcomes. It is about looking at an event,
understanding it, and learning from it. Learning from reflection is not
automatic; it requires a deeper understanding of how and why reflection
contributes to the competence of the effective nurse.