1. Samba, Clara BSN, Wendy Unger, BSN, RN, CCRN
  2. Wheeler, Susanne BSN, RN, CCRN, Faculty Advisor
  3. Lyon, Brenda DNS, RN, FAAN

Article Content


The purpose of the presentation is to demonstrate the use of the clinical reasoning model (CRM), a critical thinking model developed by the Indiana University Adult Health CNS faculty, as used by clinical nurse specialist students to explore etiologies of intensified pain in patients with 3 treatment devices (endotracheal tubes, central lines, and chest tubes) and development of etiology-specific nursing interventions. The poster will present the model, its concepts, and how it was used to aid in students' diagnostic and interventional reasoning.



Pain is common in inpatients. The CRM helps identify etiologies of symptoms and functional problems amenable to nursing interventions. The CRM provides a framework for pinpointing etiologies of problems and guiding development of etiology-specific nursing interventions to alleviate problems.



Through implementation of the CRM, etiologies contributory to somatic discomfort or decreased functioning can be identified, and nursing interventions to eliminate those etiologies can be generated.



Pain associated with endotracheal tubes, central lines, and chest tubes was examined separately using the CRM, which revealed that the primary etiology of pain for all 3 groups was mechanical tissue tension, causing nociceptive firing and sensitization, leading to intensified pain.



The CRM provided a structured method for uncovering the etiology (mechanical tissue tension) associated with pain caused by these treatment devices. The etiology guided the development of 3 nursing interventions to reduce the pain, all aimed at stabilizing the devices and preventing mechanical tissue tension and nociceptive stimulation.



The CRM was effective in revealing the prime etiology of intensified pain associated with the use of 3 medical devices and guided clinical reasoning in the generation of nursing interventions to relieve the pain.


Implications for Practice:

The CRM is a potential tool to be used by clinical nurse specialists and students to isolate contributory etiologies of patient problems and focus on the interventions on eliminating those etiologies.