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Key Concepts, Chapter 10, 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 approach is consistent

with theories based on human caring, which use a holistic approach to promote

humanism, health, and quality of living. Caring is viewed as universal and is practiced

through interpersonal relationships.

Personal attributes that prepare nurses for thoughtful patient-centered care include open-

mindedness, a profound sense of the individual, self-awareness and knowledge of your

own beliefs and values, 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 patients care scientifically, holistically, and

creatively. To do this successfully, nurses need many cognitive, technical, interpersonal,

and ethical/legal competencies. They 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 ones thinking. It functions purposefully

and exactingly. Critical thinking is thought that is disciplined, comprehensive, based on

intellectual standards, and, as a result, well-reasoned. 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 and/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 patient-centered practice.

Interpersonal caring involves promoting the dignity and respect of patients as people and

establishing a caring relationship. As a result, both the nurse and 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


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 reasoninga specific termusually 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 reasoningthe conclusion, decision, or opinion

you reach.

While clinical reasoning can be broken down into stepslook, collect, process, decide,

plan, act, evaluate and reflectin 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 and patient as they

accomplish the following together: (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


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 and requires a deeper understanding of

how and why reflection contributes to the competence of the effective nurse.