Clinical Wisdom and Interventions in Critical Care: A Thinking-In-action Approach

Abbreviations of Clinical Units . Common Medical Abbreviations Used in Critical Care . Thinking-in-Action and Reasoning-in-Transition: An Overview . Background of the Work . Sample and Method . The Skills of Expert Judgment, Thinking, and Clinical Comportment . Thinking-in-Action and Reasoning-in-Transition . Skilled Know-How . Response-Based Practice . Agency . Perceptual Acuity and the Skill of Involvement . The Links Between Ethical and Clinical Reasoning . The Links Between Emotion, Judgment, and Narrative Accounts . The Role of Narrative in Experiential Learning . The Logic of Practice and Narrative Pedagogy . Clinical Grasp and Clinical Inquiry: Problem Identification and Clinical Problem Solving . Making Qualitative Distinctions . Engaging in Detective Work, Modus Operandi Thinking, and Clinical Puzzle Solving . Recognizing Changing Clinical Relevance . Developing Clinical Knowledge in Specific Patient Populations . Clinical Grasp and Response-Based Practice . Teaching and Learning Clinical Grasp, Reasoning-in-Transitions, and Modus Operandi Thinking . Clinical Forethought: Anticipating and Preventing Potential Problems . Future Think . Clinical Forethought About Specific Diagnoses and Injuries . Anticipation of Crises, Risks, and Vulnerabilities for Particular Patients . Seeing the Unexpected . Diagnosing and Managing Life-Sustaining Physiologic Functions in Unstable Patients . The Inseparable Link Between Diagnosis and Intervention . Diagnosing and Managing Emergent and/or Life-Threatening Situations . Diagnosing, Monitoring, Titrating, and Providing Instantaneous Interventions to Maintain Vital Functions and Physiologic Stability in Unstable Patients . Diagnosing, Monitoring, Preventing, and Managing Vital but Nonemergent Fluctuations in Physiologic Functions . Coordinating and Managing Multiple Instantaneous Therapies . Coaching and Assisting Patients in Weaning From Life-Support Technologies . The Skilled Know-How of Managing a Crisis . Setting Up the Environment for the Management of a Crisis . Sequencing and Managing the Logistics of Rapid Multiple Therapies in Response to a Crisis . Organizing the Team and Orchestrating Their Actions During a Crisis. Exhibiting Experiential Leadership in Managing the Patient When a Physician Is Present . Taking Necessary Medical Action to Manage a Crisis When a Physician Is Absent . Recognizing Clinical Talent and Skilled Clinicians and Marshaling These for the Particular Situation . Modulating One's Emotional Responses and Facilitating the Social Climate . Care of the Body as a Source of Comfort . Comforting Through Connection and Relationship. Providing Adequate Stimulation, Distraction, and Rest While Limiting Disruption . Taming the Technical Environmen . Being Available Without Being Intrusive . Weighing the Ethics of Pain Medication, Sedation, Paralysis, and Comfort Measures . Limiting the Impact of Painful . Procedures . Comforting Through Familiar Rituals and Routines . Caring for Patients' Families . Ensuring That the Family Can Be With the Patient . Providing the Family With Information and Support . Encouraging Family Involvement in Caregiving Activities . Preventing Hazards in a Technological Environment . Performing Practical Technology Assessments . Engaging in Safety Work . Using Equipment and Interpreting Its Performance . Facing Death: End-of-Life Care and Decision Making . Decision Points and Transitions . Assessing and Organizing a Reasonable Level of Care . Recognizing and Communicating the Transition From Curative to Palliative Care . Planning and Implementing Attentive, Palliative Care . Facing Death . Discussion: Current Ethical Debates About End-of-Life Care and Decision Making . Communicating Multiple Clinical, Ethical, and Practical Perspectives . Communicating About Clinical Transitions . Communicating Missed Timetables and Unexpected . Changes in Clinical Trajectories . Changing Practices and Developing New Clinical Knowledge . Developing Clinical Knowledge About Experimental Interventions . Team Building: Developing a Community of Attentiveness, Skill, and Collaboration . Monitoring Quality and Managing Breakdown The Role of Agency in Managing Breakdown . Frontline Quality Improvement, Monitoring, and Risk Management . Shoring Up Imminent or Actual Breakdown . Team Building in the Context of Breakdown . Repairing and Redesigning the System to Prevent Future Breakdown . Contrast Cases: Working Against All Odds and Acceptance of Breakdown . Minimizing Healthcare System Failures in Destabilized Work Environments . Providing Highly Technical Medical Care Without Adequate Nursing Care and Social Services . The Skilled Know-How of Clinical Leadership and the Coaching and Mentoring of Others . Facilitating the Clinical Development of Others . Coaching Others in Interpreting, Forecasting, and Responding to Patient Transitions . Bridging the Gaps in Patient Care . Building and Preserving Collaborative Relationships . Transforming Care Delivery Systems . References . APPENDIX A. Description of Research Design and Data Analysis . APPENDIX B. Educational Strategies and Implications . Glossary . Index