Clinical Wisdom and Interventions in Critical Care: A Thinking-In-action Approach

This brilliant work examines how expert critical care nurses use scientific knowledge, professional experience, and a careful attention to each patient's changing condition to provide excellent nursing care. Based on descriptive interviews and observational studies of 205 nurses, it helps readers at all levels develop the critical-thinking, reasoning, judgment, and intervention skills they need to become superior critical-care nurses.

Abbreviations of Clinical Units · Common Medical Abbreviations Used in Critical Care · Thinking-in-Action and Reasoning-in-Transition: An Overview · Background of the Work · Sample and Method · The Skills of Expert Judgment, Thinking, and Clinical Comportment · Thinking-in-Action and Reasoning-in-Transition · Skilled Know-How · Response-Based Practice · Agency · Perceptual Acuity and the Skill of Involvement · The Links Between Ethical and Clinical Reasoning · The Links Between Emotion, Judgment, and Narrative Accounts · The Role of Narrative in Experiential Learning · The Logic of Practice and Narrative Pedagogy · 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 · 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 · Diagnosing and Managing Life-Sustaining Physiologic Functions in 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 Physiologic Stability in Unstable Patients · Diagnosing, Monitoring, Preventing, and Managing Vital but Nonemergent Fluctuations in Physiologic Functions · Coordinating and Managing Multiple Instantaneous Therapies · Coaching and Assisting Patients in Weaning From Life-Support Technologies · 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 Clinical Talent and Skilled Clinicians and Marshaling These for the Particular Situation · Modulating One's Emotional Responses and Facilitating the Social Climate · Care of the Body as a Source of Comfort · Comforting Through Connection and Relationship· Providing Adequate Stimulation, Distraction, and Rest While Limiting Disruption · Taming the Technical Environmen · Being Available Without Being Intrusive · Weighing the Ethics of Pain Medication, Sedation, Paralysis, and Comfort Measures · Limiting the Impact of Painful · Procedures · Comforting Through Familiar Rituals and Routines · Caring for Patients' Families · Ensuring That the Family Can Be With the Patient · Providing the Family With Information and Support · Encouraging Family Involvement in Caregiving Activities · Preventing Hazards in a Technological Environment · Performing Practical Technology Assessments · Engaging in Safety Work · Using Equipment and Interpreting Its Performance · 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 · Communicating Multiple Clinical, Ethical, and Practical Perspectives · Communicating About Clinical Transitions · Communicating Missed Timetables 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 · Monitoring Quality and Managing Breakdown The Role of Agency in Managing Breakdown · Frontline Quality Improvement, Monitoring, and Risk Management · Shoring Up Imminent or Actual Breakdown · Team Building in the Context of Breakdown · Repairing and Redesigning the System to Prevent Future Breakdown · Contrast Cases: Working Against All Odds and Acceptance of Breakdown · Minimizing Healthcare System Failures in Destabilized Work Environments · Providing Highly Technical Medical Care Without Adequate Nursing Care and Social Services · The Skilled Know-How of Clinical 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 · Building and Preserving Collaborative Relationships · Transforming Care Delivery Systems · References · APPENDIX A. Description of Research Design and Data Analysis · APPENDIX B. Educational Strategies and Implications · Glossary · Index