N522PE Advanced Physical Assessment Assignment 1

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Assignment 1

Assignment Instructions:

Write a three-page paper on the use of clinical reasoning in developing and applying advanced health history and physical assessment skills at the graduate level. Consider contemporary nursing literature on the development of clinical reasoning and decision-making. How does the use of the nursing process enhance critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level. Please use the submission parameters and rubric below to guide you when completing this assignment. N522PE Advanced Physical Assessment Assignment 1

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 3 pages, which does not include the cover page and reference page(s).

I. Introduction (including purpose statement)

II. Clinical Reasoning

Describe how clinical reasoning is used in developing and applying advanced health history and physical assessment skills at the graduate level.

III. Nursing Process

Describe how the use of the nursing process enhance critical thinking, clinical reasoning, and clinical judgment in professional nursing practice at the graduate level.

IV. Clinical Example

Discuss an example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning.
Discuss how nursing care is provided when each of these concepts are evidenced in nursing care of the patient.

V. Conclusion

VI. References (consider contemporary nursing research studies or reliable electronic sources)

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 3 pages limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 3 pages limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

Assignment 1 Rubric – N522PE Advanced Physical Assessment Assignment 1

Competency	30	27	25	0	Points
Define, compare and contrast clinical reasoning and decision-making. How is this related to critical thinking and clinical judgment in graduate level nursing practice?	Defines, compares, and contrasts clinical reasoning and decision-making with cited references in addition to course readings for Week 1. Answers posed questions. N522PE Advanced Physical Assessment Assignment 1	Defines, compares, and contrasts clinical reasoning and decision-making with cited references from course readings for Week 1. Answers posed questions.	Describes clinical reasoning and decision-making. Briefly answers how is this related to critical thinking and clinical judgment in graduate level nursing practice?	Does not define, compare and contrast clinical reasoning and decision-making. Does not answer how is this related to critical thinking and clinical judgment in graduate level nursing practice?	/30
	30	27	25	0
Consider contemporary literature and apply the concept of clinical reasoning to advanced physical assessment in nursing.	Considers contemporary literature and applies the concept of clinical reasoning to advanced physical assessment in nursing.	Considers textbook literature and references within text book without further consideration of external literature support.	Considers and applies concept of clinical reasoning to advanced physical assessment in nursing without reference to expert opinion or research literature.	Does not consider and apply concept of clinical reasoning to advanced physical assessment in nursing.	/30
	30	27	25	0
Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. How is nursing care provided or modified when each of these concepts are evidenced in nursing care of the well-adult, family, and one special population?	Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. Discusses how nursing care was provided or modified when each of these concepts were evidenced in nursing care of the well-adult, family, and one special population.	Provides one clinical example demonstrating the nurse’s use of critical thinking, clinical judgment, and clinical reasoning. Discusses how nursing care was provided or modified when each of these concepts were evidenced in nursing care of the well-adult, family, or one special population.	Demonstrates the nurse’s use of critical thinking, clinical judgment, or clinical reasoning. Discusses how nursing care was provided or modified when these concepts were evidenced in nursing care of the well-adult, family, or one special population.	Does not demonstrate the nurse’s use of critical thinking, clinical judgment, or clinical reasoning. Does not discuss how nursing care was provided or modified when these concepts were evidenced in nursing care of the well-adult, family, or one special population.	/30
	10	9	8	0
APA Format, grammar, punctuation and spelling.	APA Format, grammar, punctuation and spelling is accurate with no errors.	APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.	APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.	APA Format, grammar, punctuation and spelling is accurate with more than five types of errors.	/10

Discussion 1

Post to the discussion board a planned approach to communicating with someone who speaks another language. What type of questions will you need to ask? Was there any communication issues discussed this week in Shadow Health? How does communication impact the concept of clinical reasoning in nursing? Please discuss the issues completely, citing your sources so that your classmates can reference the information. Include one insight gained this week from your readings or interaction in Shadow Health.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

Discussion 1 Approach

Upon initial assessment of a patient it is always important to identify their preferred language for communicating as well as for learning. It’s always beneficial if a patient has someone to translate with them, however, that alone poses some risks for disconnect. Depending on how you say something, the tone you use or the insinuation that may come across, what you’re intending to relay to your patient may be miscommunicated to them unintentionally through the interpreter. Slang in different languages is not always easily translated for example. Questions you would expect to ask during an assessment include “What brings you to the hospital today”, and “Can you tell me what is hurting?”. Additionally, you’ll want to know how long the symptoms have been going on and if they’ve sought treatment for this issue prior. Our health care system utilizes an interpreter phone line with dozens of possible languages available for translation on it. Even with a company that specializes in such a thing, however, it’s so important to ensure your words are being communicated as intended. N522PE Advanced Physical Assessment Assignment 1

In Shadow Health it was made very clear that slang or nonspecific questions would likely not elicit the response we’re looking for from Tina. The digital clinical experience may present some communication barriers that we’ll have to work through to ensure a professional and productive assessment. Asking yes/no questions, rewording open ended questions and being specific in our wording should produce clarifying details.

This is important in clinical reasoning because you must document in the health record the patient’s description of what brought him in, subjective and objective assessment findings, your discussion with the patient regarding next steps and expectations and all of this must flow nicely and make sense to other clinicians needing to evaluate your charting for whatever reason (Bickley, 2017). It is also important because of the potential of an ongoing relationship the practitioner and patient may have in which clinical reasoning builds trust and understanding between parties (Dains, Baumann & Scheibel, 2016).

One insight from my reading this week came from Chapter 1 of Bates’ Guide to Physical Examination and History Taking in which the cardinal techniques of examination were reviewed; inspection, palpation, percussion and auscultation, in that order Bickley, 2017). This book informs the reader to “plan your sequence and scope of examination…” which was interesting to me because I remember learning, many years ago, that you should never palpate before auscultating, especially the abdomen, as this action can disrupt organs and get body fluids moving that will produce sounds that may not otherwise be present upon exam. The book did not make mention of this. Medicine is ever changing – all the more reason to stay on top of things.

References

Bickley, L. S. (2017). Bate’s guide to physical examination and history taking (12th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.

Dains, J., Baumann, L., & Scheibel, P. (2016). Advanced health assessment & clinical diagnosis in primary care (5th ed.). St. Louis, MO: Mosby Elsevier.