Activité de réflexion guidée pour affiner le jugement clinique en contexte d’incertitude dans la gestion de la douleur en centre d’hébergement
In long-term care homes, ambiguous pain assessment situations can cause uncertainty for nurses and some errors in their clinical judgment. The goal of this practicum was to develop and implement a guided reflective activity with nursing working in these settings in order to refine their clinical judgment in the context of uncertainty for the management of pain in cognitively impaired resident who cannot self-report pain. To this end, we used the clinical judgment model of Tanner (2006) to structure a reflective approach guided by the reflection model for clinical judgment of Lavoie, Boyer, Pepin, Goudreau, and Fima (2017). A guided reflection activity in small groups was implemented with 24 nurses. During this guided reflection process, they shared their experiences and explained their clinical reasoning from which the clinical judgment ensues. The implementation of this reflective activity resulted in outcomes described in the scientific literature. In clinical practice, nurses indicated the need to recognize their sense of uncertainty to trigger a process of validating various hypotheses in addition to increasing confidence in their pain assessment in a context of uncertainty. Recommendations concerning the integration of such a reflective activity as an educational strategy for continuing education are proposed.
Older people Long-term care Nurse Ambiguity Uncertainty Clinical reasoning Clinical judgment Pain assessment Neurocognitive disorders