I recently attended the American Assembly for Men in Nursing convention held locally here in Minneapolis. In addition to presenting on the topic of the struggles that men in nursing education continue to experience, I had the opportunity to meet and network with other nurses and nurse educators.
One colleague I met was a professor at the University of Minnesota by the name of Daniel Pesut, PhD, RN, CS, FAAN who co-wrote a textbook in 1999 titled Clinical Reasoning: The Art & Science or Critical & Creative Thinking with JoAnne Herman, PhD, RN, CSME.
Since I am passionate about the value and importance of clinical reasoning to nursing practice, I promptly ordered the book and just finished reading it. I found this book to contain some highly relevant information that I am excited to share as the topic of today’s blog!
Students Need the Right Attitude!
In an early chapter, the authors stress that nurses are knowledge workers and that knowledge is a prerequisite for effective clinical reasoning and that in order to clinically reason, nurses must possess certain skills and attitudes.
I never really considered the importance of mindset or attitudes required to think like a nurse, but the authors identified six prerequisite attitudes that prepare the way for the nurse to properly and correctly think and clinically reason.
It is imperative that these six attitudes be identified and understood by nurse educators as well as students in order to strengthen and develop their ability to clinically reason.
To help students reflect on these important attitudes I have included some relevant questions that will help them go deeper and see if these attitudes are a current weakness or a strength for them.
Excellent and correct nurse thinking is not random and does not just happen by accident, but is intentional by the nurse. When the nurse is intentional in clinical practice, you understand the rationale of how the plan of care and nursing interventions are going to advance the plan of care.
The nurse has a deliberate plan of thinking and reasons with the end in mind by having a clearly defined purpose or outcome guiding the plan of care.
- How well do you understand the rationale and reason for nursing care priorities with each patient you care for?
- Do you have a clearly defined outcome that you are working towards with each patient you care for?
This is an essential skill that is foundational to both clinical reasoning as well as making a correct clinical judgment. Everything that nurse does in practice, must also be reflected upon by the nurse and determine if the actions and interventions are effective and working towards the outcome that is needed to advance the plan of care.
Christine Tanner and her work on clinical judgment also identified the importance of reflection. Reflection-in-action as well as reflection-on-action.
Clinical reasoning is strengthened and developed when the nurse is able to reflect on past and current clinical experiences and situations and be intentional to ask WHY you are engaging and choosing specific nursing interventions in the present as well as reflecting afterwards.
Stated another way, reflection is thinking about your thinking and determining what can be learned, affirmed, or done differently to grow and develop as a nurse.
- How well are you able to integrate reflection and learn as a result while you are caring for patients?
The nurse must be eager and ask questions and acquire needed information and knowledge. The origin of curiosity is “cura,” which means to care. Reflection and curiosity are a perfect fit and need to be used together. Nursing is curiosity or care with a purpose.
When the nurse is inquisitive about everything that takes place in the clinical setting including the ways that the patient acts, thinks, and presents, the less judgmental the nurse will be. The greater the level of curiosity, the more compassion the nurse will possess.
- Do you have a strong desire to deeply understand aspects of your patient that you do not understand?
4. Tolerance for ambiguity
This is the ability of the nurse to feel comfortable even when the current situation is unclear and the best outcome is undefined or unknown. Since students are concrete, textbook learners, this aspect of practice can be difficult for them to integrate into their practice.
It is imperative to let students know that the textbook is simply the textbook and clinical situations are rife with ambiguity, moral and ethical conflict, as well as family dynamics that are interrelated and contribute at times to ambiguity and volatility in practice.
- What is your comfort level in the clinical setting when ambiguity is present?
The nurse must possess a certain amount of mojo that is balanced and healthy that believes in yourself, can feel good about your abilities as a nurse though still inexperienced and confident that you have what it takes to be a nurse!
An important aspect of self-confidence is to be aware and know your strengths as well as weaknesses, and be willing to do what is needed to turn those weaknesses into a strength.
- Are you your own worst enemy or do you have a healthy sense of your abilities as a nurse?
6. Professional motivation
The nurse must be committed to the vision, values and mission of the nursing profession that is embodied in the ANA code of ethics. These values must be known, assimilated, and lived out by the nurse.
The nurse must choose to act differently and hold themselves to the highest level of moral and ethical practice. This practically means that the nurse becomes self-monitoring and will self-report if a medication error is made or other deficiency in practice occurs.
By using the attitude and skill of reflection, this same nurse will learn from any error made and be the better as a result.
- Do you consistently hold yourself to the highest standards of ethical conduct and have a strong desire to be the best nurse possible?
How well-established are these essential prerequisite attitudes for nurse thinking present in you as a nurse or your students?
I found the attitude of intent and professional motivation especially helpful and makes it clear that good nursing care and thinking does not just happen but must be intentional and fueled by a desire to be a consummate professional nurse.
These six attitudes would make an excellent post conference topic so consider sharing these attitudes with your students including the reflective questions to help strengthen and develop clinical reasoning in their practice!
What do you think?
Which attitudes are present or which are works in progress with you or your students? What can be done to strengthen these attitudes in clinical practice?
Comment below and let the conversation begin!
Pesut, D.J. & Herman, J. (1999). Clinical reasoning: The art and science of critical & creative thinking. Albany, NY: Delmar Publishers.
Keith Rischer – Ph.D., RN, CCRN, CEN
As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…
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