Academic journal article Nursing Education Perspectives

Nursing Process and Clinical Reasoning

Academic journal article Nursing Education Perspectives

Nursing Process and Clinical Reasoning

Article excerpt

FROM TALKING WITH EDUCATORS to following listserv discussions to reading my inbox, I've become aware of a rumor that the nursing process is being replaced by other models. I've encountered two suggestions for replacing the nursing process: the use of concept mapping and the development of new clinical reasoning models.

If you're not sure whether your students should learn the nursing process, think of the house of cards that has to fall for it to be abandoned:

* American Nurses Association and most (if not all) specialty organization standards would have to be rewritten.

* The NCLEX® examination would have to be completely revised.

* Key players with testing services, such as the NLN, would have to revamp their courses and exams.

* All health care organizations would have to change their documentation systems.

* Nurses would have to agree that thinking in a framework different from that of all other health care disciplines is a good thing.

What a mess there would be as we try to develop nurses who demonstrate Quality and Safety Education for Nurses (QSEN) and Institute of Medicine competencies for working in collaborative teams!

The nursing process - assess, diagnose, plan, implement, and evaluate - forms the foundation for clinical reasoning. It underpins virtually all care models as an organizing framework and should resonate at the point of care. For example, skip the principles of assessment and diagnosis and it's easy to jump to conclusions, miss risks, and give care based on assumptions rather than evidence. Assessment errors and omissions are a major cause of adverse outcomes. If you fail to plan before implementation, the risk of adverse outcomes also increases. Skip evaluation, and reflective nursing practice (not to mention patient safety) goes out the door. …

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