Purpose:

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.

Significance:

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.

Background/Design:

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.

Methods:

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.

Findings:

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.

Conclusions:

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.