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A nursing skill, and one that’s important in nursing education, is the ability to understand the arguments that relate to patients. Nurses regularly assess patients, consult research, interpret research results, and use evidence to guide their decisions, which are specific to individual patient’s needs. But, a successful nursing argument must go beyond the medical facts. Should give rationale for the approach being recommended, include evidence to support the recommendation, and include consideration of patient’s preferences.
Evidence-based practice is supported by clinical guidelines, research findings and nursing judgment. If these elements are employed in an effective manner, nurses can build strong arguments drawing on scientific knowledge and the care that is provided to patients. This is especially beneficial for nursing students working on Case Studies, Evidenced Based Practice assignments and Clinical Analysis papers.
By grasping this integration of the three components, students will be able to create a clearer academic product, and enhance critical thinking skills that are essential in the profession of nursing.
Understanding How to Develop Patient-Centered Arguments
A patient-centered argument presents information about a clinical issue, reviews the evidence and backs up a recommendation, which is made in the context of the patient’s situation. It isn’t only a diagnosis and/or treatment plan, it’s physical health, emotional health, preferences, culture and real world barriers to care.
For example, if you are a hypertensive, your medication, lifestyle changes, exercise and regular monitoring may help. Other factors like the patient’s motivation to change their lifestyle, cost of their care, tolerance to medications and any underlying health issues will all play a role in the optimal care plan.
For a good argument, the following three points must be made:
Clinical Relevance: determine the main problem and give reasons for its importance.
Evidence based reasoning: Offer evidence for proposed interventions from credible research and applicable clinical guidelines.
Individually tailored care: How the recommendation is in line with the patient’s aims, preferences and situation.
The following will contribute to the general direction of health care practice towards a more specific and defensible nursing argument.
Safety for Clinical Guidelines supporting Nursing Recommendations
Clinical practice guidelines are a collection of suggestions grounded in science and the professional’s expertise. They support nurses in knowing effective methods for assessment, the prevention, treatment, and continued management of patients.
Students building an academic argument should be able to find guidelines which are directly related to the clinical problem being discussed. Sources may include professional nursing organizations, recognized agencies in the healthcare field and specialty organizations.
But, guidelines are not guidelines for all patients. Recommendations should be considered in the context of patient presentation and context of care.
Evaluating the Relative Value of Clinical Guidelines
Always look at the date of the guideline’s publication/revision, the body that made the guideline, the population and clinical use of the guideline. Make sure its recommendations remain pertinent to the patient.
For instance, advice for diabetes care could recommend that a person wants to test their blood sugar level on a regular basis and customize care to the person. When discussing a patient who has difficulty with consistent glucose monitoring, the discussion should include the guideline as well as the available resources, understanding and treatment preferences of the patient.
AHRQ puts great importance on translating scientific evidence into clinical decisions, taking patient factors into account. This helps to promote a guiding style, rather than a commanding style in which guidelines supplement professional reasoning. (EBP Resources from the Agency for Healthcare Research and Quality)
Supporting Arguments with Textual Evidence
The research findings can give scientific evidence as to why a nursing intervention might be helpful. But a mere stringing together of the findings of the study cannot be considered as critical thinking. The student will analyze the strength of the evidence and how it relates to the patient.
Evaluating Research Quality and Applicability
Consider study design, sample characteristics, methodology, limitations and the importance of the study question. Depending on the question that is being asked, evidence may be useful from systematic reviews and good quality clinical trials.
Qualitative data, such as observation, and patient-reported data, such as experience, can also provide valuable information, especially when exploring the issues of access to care, adherence to treatment, and patient satisfaction.
For an educational intervention to newly diagnosed diabetes patients, for example, the literature will also be reviewed. Based on research, structured education may be recommended to aid in disease management. A good argument would outline what educational methods were investigated, if the people studied are like the patient being discussed and any restrictions that would impact upon the results.
Comparing Research Findings Rather Than Listing Studies
Good academic writing involves a skill in finding conclusions, making comparisons and resolving unanswered questions that will at least tie together or integrate research.
If there are several studies that indicate that patient education should be performed, however, the results are different, consider the possible contributing factors. The differences in follow-up period, methods of intervention, patients or measures may affect the results.
This is a fairer balance and understanding of evidence for practice. It also prevents unproven promises of effectiveness of an intervention from entering into the equation.
Applying Nursing Judgment to Individual Patient Care
While clinical guidelines and research findings provide an important set of evidence, the nursing judgment is used to apply the evidence to the specific patient.
Nurses apply their knowledge, skills and experience to identify the risk of a problem and prioritize their care. They should be able to also recognise when a patient’s condition is to be reviewed or escalated based on clinical protocols.
Consider an older adult that might have difficulty taking medication as directed. Research can be used to support medication education and medication guidance can recommend medication reconciliation. Nursing judgement is helpful to identify the problem, e.g. memory issues, misinformation/instructions, side effects and/or prescription costs.
The recommendation should tackle the specific barrier, rather than just giving the patient more information.
When building an academic argument, give reasons for the intervention selected. Recognize assessment data, explain possible risk and why action is deemed appropriate. Recommendations should be consistent with the professional scope of practice, organizational policies and patient clinical needs.
Using PP & SDM in Practice
Patient centered care respects and embraces the patient’s priorities/values, beliefs, concerns and expectations. If an intervention is not feasible with a patient’s situation or preferences, it may be difficult to put the intervention into clinical practice.
Shared decision making enables health care providers and patients to discuss the options, potential benefits, risks, and real-life alternatives.
An individual with a long-term disease, for instance, might favor a treatment that works into the current way of life. A nurse can inform the patient of the evidence available and discuss the patient’s concerns and assist in deciding on the best choice in the clinical plan.
The argument should demonstrate the influence of the patient’s perspective on the recommendation, and not neglect safety or evidence quality.
The AHRQ SHARE Approach is a template to support collaborative decision making in healthcare.
If relevant, the student should also consider issues for consideration in a conversation about health literacy, language barriers, cultural needs, as well as accessibility and financial limitations. Some of these aspects are responsible for the fact that a recommendation should not only be clinically supported, but also be feasible.
Structuring an Effective Nursing Argument
A well structured argument enables the reader to follow the argument from the clinical problem to the recommendation.
The student is required to give the Clinical Problem.The student should then give an introduction to the Clinical Problem.
Include the patient’s salient features and point out the key problem. Do not use irrelevant background information which is not part of the argument.
Present the Evidence
Summarize evidence from clinical practice guidelines and/or research to support the intervention. Recognize trustworthy sources and assess recommendations based on the findings as trustworthy or not.
Critically Evaluate Evidence
Discuss the value, pros and cons of evidence. Discuss whether research is relevant to patients and any major limitations.
Apply Nursing Judgment
Relate evidence to assessment results, potential risks and patients’ individual needs. Provide justification for the proposed intervention as to why it is the best alternative to the intervention.
Justify the Recommendation
Make a well-informed suggestion, on the basis of the evidence, professional opinion and the patient’s wishes. If applicable, define measurable outcomes that might provide a measure of effectiveness of the intervention.
This will assist the nursing student in developing a focused case analysis, research paper or evidence-based practice paper.
Avoiding Common Mistakes in Nursing Arguments
However, there are several problems that can mar a patient-centered argument:
Adequate use of old sources: Ensure guidelines and research is timely for the clinical question.
Treatment of all evidence as equal: To examine the quality of research, not take all publications at face value.
Failure to consider patient preferences: Give an example of how personal goals and barriers have an impact on the suggested plan for treatment.
Making unconfirmed claims: Link recommendations to good evidence and appropriate assessments.
Identify conflict in the evidence: Accept that there is uncertainty, and articulate their reasons for taking the selected action.
Mixing opinion with clinical judgment: Justify professional judgments in terms of assessment data, evidence and accepted nursing principles.
Students can view course content, get assistance from teacher(s) and use relevant academic support. Those who want to pursue a RN to BSN program without the Internet, such as a Capella RN to BSN program, or services that are claimed to be for “Class Takers Online” should attend to independent study, accurate citations and academic integrity requirements for their institution.
Conclusion
Nurses need to develop a patient-centred argument by connecting the clinical guidelines, research evidence and clinical judgements with a specific patient. Guidelines provide guidance, evidence-based approach is used for the evidence, and nursing judgment is used to translate the evidence into a clinical recommendation.
Patient preferences and shared decision-making also enrich this process, by making sure that recommendations are relevant to real-life situations. Critically assessing sources, appreciating clinical reasoning, identifying limitations and making sound recommendations will further enable nursing students to construct a stronger academic argument and improve their knowledge about evidence-based practice.
The last thing is to endure the protection of an intervention. To justify the approach that has been taken with the patient, evidence for the approach and how this can be evaluated. Thoughtful nursing is based on the use of knowledge, experience and application of knowledge and understanding for a particular person.
