© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 5 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Phenomenon © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR ofSALE Interest OR DISTRIBUTION Katherine Moran Rosanne Burson © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OVERVIEW Nursing practice is guided by science and theory. Nursing, as a profession, his- torically has been considered a practice discipline that is complex, varied, and © Jones & Bartlettunderdetermined. Learning, There LLC is an inherent societal obligation© Jones for the & nurseBartlett to use Learning, LLC NOT FOR SALEgood OR clinical DISTRIBUTION judgment based on evidence-based practiceNOT FORthat is SALE informed OR by DISTRIBUTION research. The nurse must “attend to changing relevance as well as changes in the patient’s responses and nature of his clinical condition over time” (Benner, Tanner, & Chesla, 2009, p. xiv). However, because practice in the individual © Jones & Bartlett Learning,case LLCis open to variations that are© notJones necessarily & Bartlett accounted Learning, for by science LLC NOT FOR SALE OR DISTRIBUTION(underdetermined), the nurse mustNOT use clinical FOR reasoningSALE OR to select DISTRIBUTION and use rel- evant science (Benner et al., 2009). This means that the nurse must be able to recognize important changes and/or trends in the patient’s condition and use good clinical judgment when providing nursing care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 91 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 6648 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CH05.indd 91 10/24/2012 10:05:14 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 92 CHAPTER 5 THE PHENOMENON OF INTEREST © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OBJECTIVES After completing this chapter, the learner will be able to: 1. Understand the meaning of nursing phenomena in relation to the © Jones & Bartlettidentification Learning, of issues LLC that are in need of change© Jones & Bartlett Learning, LLC NOT FOR SALE2. Consider OR DISTRIBUTION personal practice interests and expertiseNOT in contemplating FOR SALE OR DISTRIBUTION phenomena 3. Scan the literature for potential areas of interest 4. Evaluate potential nursing theories as a framework for the nursing © Jones & Bartlett Learning,phenomenon LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION5. Explore the phenomenon throughNOT patterns FOR of SALEknowing OR DISTRIBUTION 6. Apply the process of concept analysis to the phenomenon or a characteristic of the phenomenon © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION This complex nature of nursing practice provides many opportunities to explore nursing phenomena. The focus of this chapter is to explore phenomena © Jones & Bartlettof interest Learning,for the doctor LLC of nursing practice (DNP) scholarly© Jones project. & Bartlett Nursing Learning, LLC NOT FOR SALEtheory ORand nursingDISTRIBUTION knowledge are briefly explored toNOT help FORthe DNP SALE student OR DISTRIBUTION understand the significance of nursing phenomena. Along with the guidance received from his or her advisor and/or committee, a variety of strategies are introduced to help the DNP student select a phenomenon of interest for the DNP scholarly project. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The nurse must be able to recognize important changes and/or trends in the patient’s condition and use good clinical judgment when pro- viding nursing care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION In this day of attention to patient-centered care and outcomes, the aspects of care delivery that nurses provide by their inherent under- © Jones & Bartlettstanding Learning, of phenomena LLC require further examination,© Jones demonstration, & Bartlett Learning, LLC NOT FOR SALEand OR dissemination. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 6648 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CH05.indd 92 10/24/2012 10:05:14 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION THE EXPERTISE OF NURSING PRACTicE 93 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTTHE FOR EXPERTISE SALE OR DISTRIBUTION OF NURSING PRACTICENOT FOR SALE OR DISTRIBUTION In 2011, the Institute of Medicine and the Robert Wood Johnson Foundation put forth a report that highlights the value of nursing and outlines the central role that nurses will play in the future health of our nation. In this report, The © Jones & BartlettFuture of Learning, Nursing: Leading LLC Change, Advancing Health,© nursesJones are & called Bartlett to lead Learning, LLC NOT FOR SALEand manageOR DISTRIBUTION collaborative efforts with other healthcareNOT practitioners FOR SALE to improve OR DISTRIBUTION healthcare. Understanding the unique attributes of the expert nurse and expert nursing practice will help the nursing profession meet the challenges set forth by Institute of Medicine (2011). © Jones & Bartlett Learning,According LLC to Morrison and Symes© Jones(2011), expert& Bartlett nursing Learning,practice includes LLC a NOT FOR SALE OR DISTRIBUTIONdegree of involvement and engagementNOT with FOR patients SALE that ORdemonstrates DISTRIBUTION intuitive knowledge and skilled know-how through knowing the patient, reflective prac- tice, and risk taking. According to Benner et al. (2009). “Expert nursing practice occurs when the nurse is able to see the situation in © Jonesalternative & ways, Bartlett either through Learning, introspection LLC or by consulting others; allowing© Jones the & Bartlett Learning, LLC NOTnurse FOR to realize SALE the true OR meaning DISTRIBUTION of the present and past events. The nurseNOT reflects FOR SALE OR DISTRIBUTION on the goal or perspective that seems evident to them and on the action that seems appropriate to achieving their goal; referred to as deliberative rationality” (p. 16). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The hidden work of the nurse is what influences the patient’s experi- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ence and often positively affects clinical outcomes. This unique skill set places the practicing scholar in the best position to iden- © Jones & Bartlett Learning,tify thoseLLC areas of clinical concern© that Jones require & furtherBartlett research/improvement Learning, LLC NOT FOR SALE OR DISTRIBUTIONand to help ensure that the healthcareNOT needs FOR of patientsSALE within OR DISTRIBUTION the community, organization, or healthcare unit are being addressed. The ability of the nurse to be tuned in to the meaning of the eventto the patient and to choose individualized interventions that are unique for this patient at this ©time Jones is the ultimate& Bartlett contribution Learning, that he LLC or she offers. This hidden work© isJones what & Bartlett Learning, LLC NOTinfluences FOR the SALE patient’s OR experience DISTRIBUTION of the relationship and often affects clinicalNOT FORout- SALE OR DISTRIBUTION comes. The profession has not articulated well the skill set nurses bring to the table that enhances the work that is done. This is partly because the relationship and caring aspect of nursing has been seen as the soft side of nursing and historically is © Jones & Bartlettnot valued Learning, as much as theLLC science-based technical aspects.© Jones For example, & Bartlett within the Learning, LLC NOT FOR SALEadvanced OR DISTRIBUTIONpractice role, the perceived value from organizationsNOT FOR and other SALE practitio OR- DISTRIBUTION ners has been the utilization of the medical model in providing care. Nursing care © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 6648 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CH05.indd 93 10/24/2012 10:05:14 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 94 CHAPTER 5 THE PHENOMENON OF INTEREST © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC is notNOT measured, FOR SALEalthough OR in fact DISTRIBUTION they may be the very thing that assists patientsNOT in FOR SALE OR DISTRIBUTION meeting outcomes. In this day of attention to patient-centered care and outcomes, the aspects of care