CLINICAL WISDOM AND INTERVENTIONS IN ACUTE AND CRITICAL CARE

Author: Patricia Benner, RN, PhD, FAAN, Patricia Kyriakidis, RN, PhD, Daphne Stannard, RN, PhD, CCRN, CCNS, FCCM
Affiliation: University of California, San Francisco
Publisher: Springer Publishing Company
Publication Date: 2011
ISBN 10: 0826105734
ISBN 13: 9780826105738
Edition: 2nd

Description:

This second edition of a classic text in nursing education describes the major domains of nursing practice in acute , critical and perioperative care within today's complex and technologically driven health care industry. Its focus on clinical reasoning - what it is and how it works - provides for a substantial text intended for undergraduate and graduate nursing students who are learning critical and acute care, for educators teaching clinical reasoning, and for those seeking to improve systems of care and leadership in clinical practice. Revised and updated to current pedagogy and practice needs, this second edition will expand upon the success of the first edition and become a classic on its own. Originally based on a three-year research project with interviews and observations of 205 RNs and APNs in critical care, emergency departments, perioperative areas, and emergency transport services, the second edition includes new interviews from acute care, critical care and perioperative nurses, and new commentary, among other improvements. Attention is paid to current IOM and nursing guidelines for system approaches to patient safety, with education and leadership implications described throughout. The authors bring to the second edition over a decade of experience using the first edition in the classroom and in-service settings.

Table of Contents

Front Matter

  • ABOUT
  • About the Author
  • Foreword
  • Foreword II
  • Preface
  • Acknowledgments
  • Abbreviations

Thinking-in-Action and Reasoning-in-Transition: An Overview

  • BACKGROUND OF THE WORK
  • SAMPLE AND METHODS
  • THE SKILLS OF EXPERT CLINICAL COMPORTMENT, THINKING, AND JUDGMENT
  • DEVELOPING A SENSE OF SALIENCE
  • SITUATED LEARNING: INTEGRATING KNOWLEDGE ACQUISITION AND KNOWLEDGE USE
  • ENGAGED REASONING-IN-TRANSITION
  • SKILLED KNOW-HOW
  • RESPONSE-BASED PRACTICE
  • AGENCY
  • PERCEPTUAL ACUITY AND INTERPERSONAL ENGAGEMENT
  • INTEGRATING ETHICAL AND CLINICAL REASONING
  • THE LINKS BETWEEN EMOTION, JUDGMENT, AND NARRATIVE ACCOUNTS
  • THE ROLE OF NARRATIVE IN EXPERIENTIAL LEARNING
  • DEVELOPING CLINICAL AND MORAL IMAGINATION
  • THE LOGIC OF PRACTICE AND NARRATIVE PEDAGOGY
  • SUMMARY
  • REFERENCES

Clinical Grasp and Clinical Inquiry: Problem Identification and Clinical Problem Solving

  • MAKING QUALITATIVE DISTINCTIONS
  • ENGAGING IN DETECTIVE WORK, MODUS OPERANDI THINKING, AND CLINICAL PUZZLE SOLVING
  • RECOGNIZING CHANGING CLINICAL RELEVANCE
  • DEVELOPING CLINICAL KNOWLEDGE IN SPECIFIC PATIENT POPULATIONS
  • CLINICAL GRASP AND RESPONSE-BASED PRACTICE
  • TEACHING AND LEARNING CLINICAL GRASP, REASONING-IN-TRANSITIONS, AND MODUS OPERANDI THINKING
  • SUMMARY
  • REFERENCES

Clinical Imagination and Clinical Forethought: Anticipating and Preventing Potential Problems

  • FUTURE THINK
  • CLINICAL FORETHOUGHT ABOUT SPECIFIC DIAGNOSES AND INJURIES
  • ANTICIPATION OF CRISES, RISKS, AND VULNERABILITIES FOR PARTICULAR PATIENTS
  • SEEING THE UNEXPECTED
  • SUMMARY AND IMPLICATIONS
  • REFERENCES

Diagnosing and Managing Life-Sustaining Physiologic Functions in Acutely Ill and Unstable Patients

  • THE INSEPARABLE LINK BETWEEN DIAGNOSIS AND INTERVENTION
  • DIAGNOSING AND MANAGING EMERGENT AND/OR LIFE-THREATENING SITUATIONS
  • DIAGNOSING, MONITORING, TITRATING, AND PROVIDING INSTANTANEOUS INTERVENTIONS TO MAINTAIN VITAL FUNCTIONS AND PHYSIOLOGICAL STABILITY IN UNSTABLE PATIENTS
  • DIAGNOSING, MONITORING, PREVENTING, AND MANAGING VITAL, BUT NON-EMERGENT FLUCTUATIONS IN PHYSIOLOGIC FUNCTIONS
  • COORDINATING AND MANAGING MULTIPLE INSTANTANEOUS THERAPIES
  • COACHING AND ASSISTING PATIENTS IN WEANING FROM LIFE-SUPPORT TECHNOLOGIES
  • SUMMARY
  • REFERENCES

The Skilled Know-How of Managing a Crisis

  • SETTING UP THE ENVIRONMENT FOR THE MANAGEMENT OF A CRISIS
  • SEQUENCING AND MANAGING THE LOGISTICS OF RAPID MULTIPLE THERAPIES IN RESPONSE TO A CRISIS
  • ORGANIZING THE TEAM AND ORCHESTRATING THEIR ACTIONS DURING A CRISIS
  • EXHIBITING EXPERIENTIAL LEADERSHIP IN MANAGING THE PATIENT WHEN A PHYSICIAN IS PRESENT
  • TAKING NECESSARY MEDICAL ACTION TO MANAGE A CRISIS WHEN A PHYSICIAN IS ABSENT
  • RECOGNIZING TALENT AND SKILLED CLINICIANS AND MARSHALING THESE FOR THE PARTICULAR SITUATION
  • MODULATING ONE’S EMOTIONAL RESPONSES AND FACILITATING THE SOCIAL CLIMATE
  • SUMMARY
  • REFERENCES

Providing Comfort Measures for the Critically and Acutely Ill

  • CARE OF THE BODY AS A SOURCE OF COMFORT
  • COMFORTING THROUGH CONNECTION AND RELATIONSHIP AND RECOGNITION OF THE PERSON
  • PROVIDING ADEQUATE STIMULATION, DISTRACTION, AND REST WHILE LIMITING DISRUPTION
  • TAMING THE TECHNICAL ENVIRONMENT
  • BEING AVAILABLE WITHOUT BEING INTRUSIVE
  • WEIGHING THE ETHICS OF PAIN MEDICATION, SEDATION, AND COMFORT MEASURES
  • LIMITING THE IMPACT OF PAINFUL PROCEDURES AND THE USE OF RELAXATION, VISUALIZATION, DISTRACTION AND FUN
  • COMFORTING THROUGH FAMILIAR RITUALS AND ROUTINES
  • SUMMARY
  • REFERENCES

Caring for Patients’ Families

  • ENSURING THE FAMILY CAN BE WITH THE PATIENT.
  • PROVIDING THE FAMILY WITH INFORMATION AND SUPPORT
  • ENCOURAGING FAMILY INVOLVEMENT IN CAREGIVING ACTIVITIES
  • SUMMARY
  • REFERENCES

Preventing Hazards in a Technological Environment

  • PERFORMING PRACTICAL TECHNOLOGY ASSESSMENTS
  • ENGAGING IN SAFETY WORK
  • EFFECTIVE USE AND ASSESSMENT OF PERFORMANCE OF TECHNICAL DEVICES
  • SUMMARY
  • REFERENCES

Facing Death: End-of-Life Care and Decision Making

  • DECISION POINTS AND TRANSITIONS
  • ASSESSING AND ORGANIZING A REASONABLE LEVEL OF CARE
  • RECOGNIZING AND COMMUNICATING THE TRANSITION FROM CURATIVE TO PALLIATIVE CARE
  • PLANNING AND IMPLEMENTING ATTENTIVE, PALLIATIVE CARE
  • FACING DEATH
  • DISCUSSION: CURRENT ETHICAL DEBATES ABOUT END-OF-LIFE CARE AND DECISION MAKING
  • SUMMARY
  • REFERENCES

Making a Case: Communicating Clinical Assessments and Improving Teamwork

  • COMMUNICATING ABOUT CLINICAL TRANSITIONS
  • COMMUNICATING MISSED TIME TABLES AND UNEXPECTED CHANGES IN CLINICAL TRAJECTORIES
  • CHANGING PRACTICES AND DEVELOPING NEW CLINICAL KNOWLEDGE
  • DEVELOPING CLINICAL KNOWLEDGE ABOUT EXPERIMENTAL INTERVENTIONS
  • TEAM BUILDING: DEVELOPING A COMMUNITY OF ATTENTIVENESS, SKILL, AND COLLABORATION
  • SUMMARY
  • REFERENCES

Patient Safety: Monitoring Quality, Preventing and Managing Practice Breakdown

  • THE ROLE OF AGENCY IN MANAGING PRACTICE BREAKDOWN
  • FRONT LINE QUALITY IMPROVEMENT, MONITORING, AND RISK MANAGEMENT
  • SHORING UP IMMINENT OR ACTUAL PRACTICE BREAKDOWN
  • TEAM BUILDING IN THE CONTEXT OF PRACTICE BREAKDOWN
  • REPAIRING AND REDESIGNING THE SYSTEM TO PREVENT FUTURE PRACTICE BREAKDOWNS
  • CONTRAST CASES: WORKING AGAINST ALL ODDS AND ACCEPTANCE OF PRACTICE BREAKDOWN
  • MINIMIZING HEALTHCARE SYSTEM FAILURES IN DESTABILIZED WORK ENVIRONMENTS
  • PROVIDING HIGHLY TECHNICAL MEDICAL CARE WITHOUT ADEQUATE NURSING CARE AND SOCIAL SERVICES
  • SUMMARY
  • REFERENCES

The Skilled Know-How of Clinical and Moral Leadership and the Coaching and Mentoring of Others

  • FACILITATING THE CLINICAL DEVELOPMENT OF OTHERS
  • COACHING OTHERS IN INTERPRETING, FORECASTING, AND RESPONDING TO PATIENT TRANSITIONS
  • BRIDGING THE GAPS IN PATIENT CARE
  • NEGOTIATING CONFLICT WITH ANGRY AND DEMANDING PATIENTS AND/OR FAMILIES; FROM CONTROL TO CONNECTION AND UNDERSTANDING
  • BUILDING AND PRESERVING COLLABORATIVE RELATIONSHIPS
  • TRANSFORMING CARE DELIVERY SYSTEMS
  • SUMMARY
  • REFERENCES

Educational Strategies and Implications

  • THE CHALLENGE OF EDUCATING NURSES FOR INTELLIGENT, SKILLFUL AND ETHICAL PRACTICE
  • SITUATED LEARNING: LEARNING IN THE MIDST OF CARING FOR PATIENTS AND FAMILIES
  • A THINKING-IN-ACTION APPROACH: INTEGRATING CLASSROOM AND CLINICAL EDUCATION
  • REFLECTION ON PRACTICE
  • GUIDELINES FOR WRITING NURSING NARRATIVES
  • EVALUATING NARRATIVES
  • THE CALL FOR INTEGRATIVE CLASSROOM AND CLINICAL LEARNING IN ACADEMICS
  • SUMMARY
  • REFERENCES

Appendix

Glossary