Framework in Nursing Education,

Evidence-based Practice, Competency Based

Approach, Critical Thinking and Clinical
Reasoning

By: Donnabelle Zita V. Pulanco, BSN, RN, BMTCN

 Evidenced-based Practice

Nursing had evolved from the time EBP practice process starts with a
of Florence Nightingale and up to clinical question then searches and
the present. Nurses through the appraises the evidence. Once you
years had developed autonomy and determine that a practice change is
strive for professional development. necessary, then you integrate the
We have terms now like evidence with clinical expertise and
evidence-based practice, patient preferences and values.
competency based approach,
critical thinking and clinical
reasoning. These are terms that
show how nursing discipline has
evolved and advanced.
 Barriers to EBP Change
1. Time and Knowledge
2. Resistance: changing the unit culture can be very challenging “because
we have always done it this way”
Basic Phases of the EBP Process:
Every EBP model have these basic process
ASK: Identify a clinical problem
ATTAIN: Review relevant literature
APPRAISE: Critically appraise evidence
APPLY: Evaluate the need for practice change and potential implementation
ASSESS: Evaluate outcomes
 Common EBP Model
The Iowa Model for
Evidence-Based Practice to
Promote Quality Care: The path
initiates with a clinical “trigger” that
identifies a clinical problem and
includes decision points with
evaluative feedback loops when
recommending and implementing
through piloting; ongoing
evaluation; and outcomes
dissemination.
Advancing Research and Clinical
Practice Through Close
Collaboration Model: This model is
for building resources and training
mentors who play a central role in
facilitating and sustaining EBP at the
point-of-care and throughout the
organization.
 Common EBP Model
The Johns Hopkins Nursing
Evidence-Based Practice Model:
This model is clinician focused,
allowing rapid and appropriate
application of current research and
best practices. It has three overall
steps: practice questions, evidence
and translation.
The Promoting Action on Research
Implementation in Health Services
(PARIHS) Framework: The
framework refers to
evidence-based change as practice
innovation. The framework
emphasizes the importance of
taking into consideration the
perspectives of all recipients of the
intended change
 Competency-Based Approach

You often hear this term in any magnet hospital on how they conduct their
onboarding training, competency-based approach. According to An Bord
Altaranais (2015, p.12) it is defined as the ability of the registered nurse to
practice safely and effectively, fulfilling his/her responsibility within his/her
scope of practice. A competency-based approach has the potential to
enable development of critical, analytical, problem solving and
decision-making skills (Cassidy et al., 2012).
 Competency-Based Approach

A competency-based approach is learner centered. It emphasizes that

learners are active, goal oriented, self actualized problem solvers with
accumulated life experiences that influences what is learned. It reduces
passive learning and dependence to the teachers. It focuses on knowledge
application rather than knowledge acquisition (Raines, 2008).
 Benefits of a Competency-Based System for Employers

● Ensures that organization-funded training and professional

development activities are cost-effective, goal-oriented and productive
● Enables employees to achieve a high level of competence in an efficient
manner
● Records the employee’s acquisition of the skills, knowledge, safety and
other procedures relating to each task
● Reduces cost overruns caused by poor performance or
miscommunication of job expectations
 Benefits of a Competency-Based System for Employers

● Improves communication between employee and management

● Increases internal employee mobility, providing the organization with
greater ability scale and flex as needed
● Establishes a framework for constructive feedback by management at
scheduled training and performance appraisal intervals
● Outlines employee development and promotional paths within the
organization
 Benefits of a Competency-Based System for Employers

● Sets clear performance expectations for employees, enabling them to

make better decisions and work for effectively
● Gives employees insights into the overall strategy of their team,
department and organization, leading to greater engagement and
motivation
● Enables employees to be more proactive beyond their individual roles,
by learning additional learning competencies that are valued by the
organization
● Provides clear direction for learning new job skills
 Benefits of a Competency-Based System for Employers

● Offers a reference resource for day-to-day requirements

● Increases the potential for job satisfaction
● Provides the mechanism for the recognition of employee’s abilities
● Ensures that individual professional development and training
milestones are recorded and acknowledged by the organization (The
Competency Group, 2018).
 Critical Thinking

Critical thinking is very important in any profession, most especially the

nursing profession. Nurses must have the knowledge and skills to think
beyond what is at point value. Nurses have evolved from task orientation to
skilled professionalism based on well-developed knowledge and a patient-
centered approach with an emphasis on positive outcomes. Strong critical
thinking skills will have the greatest impact on patient outcomes.
 Critical Thinking

Critical thinking is a thought process used by nurses for clinical

decision-making. Benner and Paul states that as novice nurses become
experts and develop clinical expertise through experience and the
acquisition of knowledge, critical thinking is developed and used for clinical
decision-making. It has been found that as nurses gain in experience and
knowledge, they develop expertise in decision-making and diagnostic
reasoning, practice with greater skill and demonstrate an increase in critical
thinking skills (Martin, 2002).
 Critical Thinking Attitudes and Virtues

● Inquisitiveness - that is an interest in acquiring knowledge and learning

new things, allowing the inclusion of learning experiences that enhance
the ability to think and to think critically
● Humility and intellectual honesty - the ability to recognize the limits of
one’s own knowledge and the possibility of needing help from others.
● Intellectual integrity and independent thinking - the commitment to
applying knowledge and scientific standards to determine the truth
without succumbing to unscientific or biased judgements
● Impartiality - the ability to be balanced and fair. This ensures that
decisions are not motivated by emotions but by the search for the truth
and the best outcome possible
 Critical Thinking Attitudes and Virtues

● Perseverance - the ability to persist in one’s nature and actions,

allowing one to maintain the attitudes required for critical thinking
● Logical reasoning - the concept of the truth is based on evidence
● Reflection - the process in which the mind learns about itself and its
functioning (Falco-Pegueroles et al., 2021).
● Self-confidence - the confidence in one’s self and the capability and
conviction to face challenges or problems as best as possible
 Critical Thinking Attitudes and Virtues

● Inquisitiveness - that is an interest in acquiring knowledge and learning new

things, allowing the inclusion of learning experiences that enhance the
ability to think and to think critically
● Humility and intellectual honesty - the ability to recognize the limits of one’s
own knowledge and the possibility of needing help from others.
● Intellectual integrity and independent thinking - the commitment to applying
knowledge and scientific standards to determine the truth without
succumbing to unscientific or biased judgements
 Critical Thinking Attitudes and Virtues
So how does one develop critical thinking skills? A good start is to develop
an inquisitive mind, which leads to questioning, and a quest for knowledge
and understanding of the complex nature of the human body and its
functioning. A vital step in developing critical thinking for new nurses is to
learn from those with a strong base of practical experience in the form of
preceptors or colleagues.You have to be open-minded, self-guided and
self-disciplined. If you continue to practice this, it will have a positive impact
on excellent patient care outcomes and your colleagues (Lakhanigam, 2017).
 Clinical Reasoning

Promoting the development of clinical reasoning is the crux of nursing

education. A nurse who is adept at clinical reasoning will be able to make
timely and effective patient-centered decisions. Sound clinical reasoning is
essential for preserving the standards of the nursing profession and promoting
good patient outcomes.

The decisions nurses make about a patient's health care needs are supported
by reasoning but also by intuition and knowledge gained from professional
experience (Koharchik et al., 2015).
 Clinical Reasoning

These domains guide the nurses foster clinical reasoning

and improve patient-centered care outcomes in our facility.
Nurses strive for excellence in the delivery of the highest
quality of patient care while demonstrating commitment to
the nursing profession.