Chapter 10

Blended Competencies, Clinical

Reasoning, and Processes of
Person-Centered Care

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ANA Definitions of Nursing

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 patients
physical and social environments
Integration of assessment data with knowledge gained
from an appreciation of the patient or groups 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 (cont.)

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
Individual and unique
The professional nurse
Blended competencies
Reflective practice leading to personal learning
Awareness of self to develop a therapeutic relationship
Clinical reasoning, judgment, and decision making
Analyze, make judgments, take action
Person-centered nursing process
The nurses action in response to individual clinical need
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10 Guiding Principles of Person-Centered

Care
1. All team members are considered caregivers.
2. Care is based on continuous healing relationships.
3. Care is customized and reflects patient needs, values,
and choices.
4. Knowledge and information are freely shared between
and among patients, care partners, physicians, and
other caregivers.
5. Care is provided in a healing environment of comfort,
peace, and support.

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10 Guiding Principles of Person-Centered

Care (cont.)
6. Families and friends of the patient are considered an
essential part of the care team.
7. Patient safety is a visible priority.
8. Transparency is the rule in the care of the patient.
9. All caregivers cooperate with one another through a
common focus on the best interests and personal goals
of the patient.
10.The patient is the source of control for ones care.

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Beliefs of the International Association of

Human Caring
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.
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
Self awareness, motivation, leadership
Knowledge base
Educational foundation
Blended competencies
Cognitive, technical, interpersonal, ethical, and legal
skills

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Critical Thinking

An organized method of concentrating ones thinking in

order to problem solve and attain results
Four areas of critical thinking are sometimes thought to
be:
Thought
Abilities and skills
Affective- attitudes and traits
Intellectual characteristics

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Blended Competencies

Developing cognitive competencies

Developing the method of critical thinking
Purpose of thinking
Adequacy of knowledge
Potential problems
Helpful resources
Critique of judgment/decision
Developing the personal attributes to think critically

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Blended Competencies (cont.)

Developing technical competencies
Hands on skills
Developing interpersonal competencies
Promoting human dignity and respect
Establishing caring relationships
Enjoying the rewards of mutual exchange
Developing ethical/legal competencies
Develop accountability for ones own actions
Report incompetent, illegal, or unethical practice
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QSEN Competencies
Quality and Safety Education for Nurses (QSEN)
Knowledge, skills, and attitudes (KSA)
Person-centered care
Teamwork and collaboration
Evidence-based practice
Quality improvement
Safety
Informatics

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Problem Solving
Trial-and-error problem solving
Testing various interventions
Scientific problem solving
Organized method of research
Intuitive problem solving
Based on knowledge and skills of an idividual
Critical thinking: intuitive, logical, or both?
Potential errors in decision making may include:
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 plan of care
Evaluating: measuring extent to which patient achieved
outcomes

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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
Scientifically based, holistic individualized patient care
Continuity of care
Clear, efficient, cost-effective plan of action
Nurse
Opportunity to work collaboratively with other health
care workers
Satisfaction of making a difference in lives of patients
Opportunity to grow professionally

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Steps in Concept Mapping

1. Develop a basic skeleton diagram.

2. Analyze and categorize data.
3. Analyze nursing diagnoses relationships.
4. Identify goals, outcomes, and interventions.
5. Evaluate patients responses.

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Reflective Practice

Reflection in action
Happens in the here and now of the activity and is
also known as thinking on your feet.
Reflection on action
Occurs after the fact and involves thinking through a
situation that has occurred in the past.
Reflection for action
Helps the person to think about how future actions
might change as a result of the reflection.

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