Ch. 3 Theory, Research, Reasoning

IRUEPIC Model Reflection

"...to give ongoing thought or consideration to variables and related propositions that are influencing decisions related to patient care.", p. 57 What is the role of reflection in reasoning?

Experience

"Change, not passage of time, it is the definitive characteristic of experience" (Benner et al., 1996 in text p.65) "Nursing experience refers to the process of defining, refining & evolving personal & professional knowledge, skill, values, meaning & experiences (KSVME) used in clinical reasoning as a result of actively engaging in nursing situations over time" p. 65 Engagement in the experience of learning can not be taught • We must do this for ourselves

Critical thinking vs Reasoning: how are they different and why are they important?

-Nursing focuses on increasing students ability to critically think to provide safe care

Abductive Reasoning

-more complex form of inductive reasoning -abduct -it is also "bottom-up" -instead of following traditional lines of logical adequacy or inductive logic, abductive reasoning lead the thinker toward non-traditional propositions in an effort to explain phenomena

The Nursing Process: 1. 2. 3. 4. 5. But

1. Assess the patient 2. Identify specific problems based on assessment 3. Identify patient and nursing goals related to the problem 4. Select nursing interventions to meet goals 5. Evaluate the effectiveness of the interventions But • not all nursing practice is problem-focused • nursing problems do not always have clearly defined resolution or ends

IRU-EPIC

1. Identify 2. Relate 3. Understand 4. Explain 5. Predict 6. Influence 7. Control

Step 7

Control one or more variables in an attempt to bring about a desirable outcome • Usually when the client is not in a position to be influenced to take action • For example: emergency-based actions • Locus of control then becomes the nurse • However the client's right to self-determination still exists • This is part of our ethical practice and our responsibility toward clients e.g. referring a post-concussion patient with suicidal ideations to psychiatry

People approach reasoning using a variety of individual and combined methods. 3 of the most common are D,IA reasoning, they are distinctively different but may be used in combination with each other, which is referred to as...

DIALECTICAL REASONING

Types of reasoning

Deductive Inductive Abductive

Step 4:

Explain Propositions • What needs to be understood? • Involves interpreting information and communicating the significance of the information to others (clients, other care givers) • e.g. addressing anxiety might improve recovery and allow youth to get back to their normal activities. (school, sports) in a timely fashion • Explaining effectively involves choosing words & meanings that will connect with another person

Nursing is defined as the intent and obligation to apply relevant KSVME for, with, or on behalf of those requiring assistance in achieving a desired state of health and well-being KSVME:

Factors influencing reasoning: • Knowledge • Skills • Values • Meanings • Experiences Effective reasoning involves the intersection of the personal, the professional, & other KSVME

Step 1:

Identify variables observed in a phenomenon ex. anxiety in concussed youth

Step 6:

Influence one or more variables in order to bring about a desirable outcome: • The majority of nursing actions are directed toward influencing clients and others • But the locus of control is the client and their right to self-determination • e.g. offering mindfulness programs (relaxation, meditation, yoga) may reduce anxiety and improve symptom recovery in concussed youth

What we learned from Socrates

Intentional and purposeful approach can be traced back to ancient Greek philosophers and teachers. The most important of these was Socrates, his student Plato, and Plato's student, Aristotle -discussed religion, knowledge, virtue, justice, and wisdom -Socrates wanted his students to strongly support and believe in these topics as they were supported by truth and reality -To achieve this he used a purposeful inquiry called the Socratic Method

Step 5

Predict possible related future events • predicting is anticipating what might happen in the future ... • does one or more variables need to be changed to bring about a more desirable outcome? • e.g. anxiety scores and post-concussion symptom inventory scores (PCSI) are directly correlated; children with less anxiety will have lower post-concussion symptom inventory scores

Socrates: -Reasoning through the wisdom of Socrates. Socratic Method: - , , , , , -This process helps with...

Reasoning through Who, What, When, Why, What if? -Define, describe, clarify, explain, and justify to decrease any bias -truthfulness, validity, reliability, accountability

Step 2:

Relate: Put observed variables into relationship with each other • Naming & framing a proposition...identify variables & analyze how they are in direct relationship with one another ex. increased anxiety affects post concussion symptoms • "Ruling in & Ruling Out".....what are the variables?...are they independent, dependent or confounding?...and What, if any, are the assumptions?

Critical thinking

The utilization of scientific facts, principles, and laws to identify and relate, understand, explain, predict, influence, and control nursing phenomena critical thinking relies on empirical science and not qualitative perceptions or experince Historical limitations - based on empirical science & limited integration of qualitative perceptions

Step 3:

Understand the relationships among variables • What do we Know vs. what do we Understand • It is understanding that promotes effective reason skills • Identifying patterns in client data & tracking these patterns over time is fundamental to reasoning in nursing practice...selection of effective interventions e.g. persistent anxiety slows symptom recovery following a head injury

inductive reasoning constructs new,

creative concepts, variables, and propositions in an effort to identify, relate, explain, predict, and influence or control phenomena. However, unlike deductive, inductive DOES NOT ensure accuracy or predictability of outcomes

abductive reasoning allows for

creativity and imagination as tools for reasoning

WEBBER'S IRU-EPIC REASONING MODEL

ech letter represents the first steps

Predicting

explaining what may happen in the future based on known variables, propositions, and assumptions

The Socratic Method

involves helping students and others to explore their thoughts and opinions about a particular issue by asking WHO, WHAT, WHEN, WHERE, WHY, AND WHAT IF, AND justify their thoughts and opinions in an attempt to reach a truth free of bias -this form of reasoning encourages students to think beyond the basics and reason through multidimensional meanings, cause, effects -it also increases the truthfulness and reliability and validity and accountability for ones thoughts and opinions

Influencing

is an attempt to alter a situation indirectly by persuading someone else to alter or change one or more variable in order to bring about a desirable outcome

Inductive Reasoning

it is the opposite of deductive -"induce" referred to as "Bottom-Up"

Deductive Reasoning

known as "TOP-DOWN" reasoning -uses established (true) propositions in the form of facts, principles, laws, and theory(knowledge) to identify , relate, understand, predict, influence, anc control phenomena

abductive reasoning involves making

leaps or educational guesses about potential concepts, variables, propositions that are based on personal experience, beliefs, patterns

The significance in identifying patterns

pattern= recognizable and reoccurring of events identifying patterns in patient data is significant in the reasoning process. -helps choose app nursing interventions to improve pt health outcomes

Reasoning: -Moves beyond critically thinking to include

the utilization of scientific facts, laws, and phenomenological and experimental information to identify, relate, and understand explain, and predict, influence and control actual, potential, & perceived nursing phenomena", (p. 45). -Moves beyond critically thinking to include perceptions, experiences & the uniqueness of client experiences.

with deductive reasoning, your answers, solutions, and explanations are assumed to be

true bc the facts principles and laws and theory used to explain them are true

To operationalize something means to

use or make ready for use -reasoning allows nurses to operationalize or use knowledge

Nursing Diagnosis Criticisms

• Added in 1970s • Categorizes common patient problems and nursing responses according to very prescriptive and narrow language Criticisms • Does not emerge from a coherent philosophical approach or theoretical domain • Does not support multidimensional reasoning and nonanalytical a nonconscious aspects of thinking (expert nursing practice) • Rigid does not support effective reasoning at the bedside • Has not improved safe, effective reasoning • Remove from curriculum...

Skills are a demonstration of knowledge

• Application of knowledge through skills requires reasoning • Skills: • Cognitive • Psychomotor • Competence • Experiential learning

Inductive reasoning

• Bottom > Up: creates new & creative constructs to identify what the phenomena are or what's going on • No guarantee of accuracy & can not predict -observation- hypothesis- theory

Meanings

• Define context, purpose & intent of language • Nursing, medicine and law are examples of professions that have their own subset language • Share words, abbreviations, acronyms, prefixes/suffixes: ex. BP, TPR Symbols • Nightingale's lamp • Stethoscopes & syringes • "Learning meanings of nursing's language & symbols is essential for us to provide safe & effective care and is fundamental to our developing professional identity" p. 64

Values

• Foundation to decision making • Formed throughout a lifetime • Personal and family • Social, cultural, religious • Professional • Honesty, integrity, ethics, dignity, truth, justice • Emancipatory Understanding & Knowledge • capacity to identify injustice and to analyze • Caring • needs to be empathetic, intentional & purposeful

deductive reasoning

• Top- Down: • General to specific -use what is already established to identify smaller & more specific conclusions -theory-hypothesis-observation-confirmation • Assumption of truthfulness, correctness

Knowledge -use off.... &..... - -

• Use of established and speculative theory • We continue to develop knowledge over time • Requires personal motivation & an inquisitive spirit! (p.59)

Reasoning allows nurses to operationalize or use nursing knowledge to...

• We can explain the past • Predict the future • Understand events • Develop a capacity to control events

Summative

• influencing or controlling one or more variables within a proposition in order to bring about a desired outcome (p.68)

Formative

• moving from one reasoning step to the next