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Using the Monologue of Doris Smith to Understand Situational Decision-Making

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Managing Complexity: Using the Monologue of Doris Smith to Understand Situational Decision Making

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Overview of Teaching Strategy

Older adults are among the nurse's most complex clients. They represent a broad spectrum of strengths, needs, and expectations.  Yet, nurses find themselves wondering if the care decisions they make produce the best outcomes for this population.  This teaching strategy will use a monologue of a nurse who provided care for older adult, Doris, to address the need for effective situational decision making.  This teaching strategy can be utilized in a variety of teaching/learning situations:  didactic lectures; clinical settings such as post- clinical conference/debriefings; simulation scenario debriefings; or small seminar discussions. In addition, the teaching strategy can be used with practicing nurses as a professional development activity, as well as when orienting new graduate nurses.

Learning Objectives
The student/nurse will: 

  • Assess the older adult’s individualized pattern and functional status using standardized assessment tools.
  • Describe the complexities involved in making care decisions for older adults.
  • Discuss the importance of situational decision making based on an assessment of the client when caring for older adults.
  • Discuss the importance and strategies for weighing risks versus benefits when caring for older adults.
  • Develop an understanding of integrating the RN’s concerns with ethics, policy, and judgment while respecting the older adult’s strengths, wishes and expectations. 

Essential Knowledge Domains 

  • Individualized Aging
  • Complexity of Care
  • Vulnerability During Transitions 

ACES Essential Nursing Actions 

  • Assess Function and Expectations
  • Coordination and Management of Care
  • Use Evolving Knowledge
  • Make Situational Decisions 

NLN Education Competencies 

  • Human Flourishing
  • Spirit of Inquiry

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