Application of Cognitive and Behavioral Perspectives in Nursing Practice
Cognitive and behavioral perspectives are the two important schools of thought in psychology. The behavioral perspective focuses on the behaviors and how they are learned and reinforced. Whereas, cognitive area of psychology as defined by Feist and Rosenberg (2009) explores internal mental processes and studies how people perceive, remember, think and solve problems. Both of these perspectives have its implications in all the aspects of life whether it is related to dealing with people in daily lives, working in an organization or in the nursing profession.
In nursing practice, cognitive and behavioral theories enable the nurse to formulate nursing process, choose appropriate interventions and bring changes in patient's life. Moreover, nurses are also responsible for the daily monitoring and management of the quality of health care delivered to patients, detection of any change in patient's clinical status, patient's behavior and reinforcement of desirable behaviors. These all require the use of cognitive and behavioral skills. Although, in our society nurse's role is to follow doctor's orders but nurses should not neglect the use of reasoning and critical thinking skills. Thus an essential characteristic of a competent nurse is the use of theory in practice in providing or directing patient care. As well said by the great Leonardo da Vinci €He who loves practice without theory is like the sailor who boards ship without a rudder and compass and never knows where he may cast€. Therefore, practice without applying theory is not beneficent.
These were the reasons which urged me to write on this topic. This paper will briefly focus on problem solving, judgment, systematic desensitization, flooding whereas critical thinking, decision making, cognitive behavioral therapy, shaping and token economy will be discuss in detail.
The major implications of cognitive perspective in nursing practices are observed in critical thinking, decision making, judgment and problem solving skills. Once on one of my clinical rotation, there was a patient who was admitted due to some renal problems. When the nurse went to that patient, he saw that the patient's abdomen was distended and he was also feeling drowsy. The nurse picked up the problem immediately and took patient's blood pressure which was very low. He instantly gave rush call as the patient was in severe fluid retention. Doctors came and saved patient from potential worst condition. In this scenario, nurse's role was extraordinary. He picked up the problem and took correct step at right time to save patient which truly depicts the use of cognitive skills by the nurse.
Looking at this scenario, it would not be wrong to say that €Behind every healed patient is a critical thinking nurse€. In my opinion critical thinking is a skill that helps us to analyze the problem promptly. Johnson (2000) indicates, €Critical thinking is a type of thinking where we organize, analyze, or evaluate given information€. It requires knowledge, skills and experiences. The literature repeatedly stresses that nurse should be able to think critically in order to process complex data and make correct clinical judgments in the planning, management and evaluation of patient's health care (Raines, 1996). The use of critical thinking is an important aspect in nursing process which includes four steps of assessment, planning, implementation and evaluation in which a nurse uses previous knowledge as well as thinking and reasoning. Sedlak and Ludwick (1996) stated that the nursing process and critical thinking cannot be separated from each other. It has been observed in the clinical settings that some nurses do not think critically but the research says that nurses are expected to have this skill because it makes nursing a profession. According to Distler (2007), critical thinking in nursing is an essential constituent of professional liability and quality nursing care. Hence, nurses who are critical thinkers can contribute to bring changes in health care to improve it (Bevis and Watson 2000).
Another cognitive skill that comes as a result of critical thinking is the decision making which is an essential part of the daily care that nurses provide to the patients. Referring to the above mentioned scenario, after identifying patient's problem, nurse immediately took a step and decided to give a rush call. Thus as care provision becomes more complex, nurses have to rely on their decision making skills to achieve good outcomes (Muir 2004). Although, in clinical setting it has been observed that doctors take most of the decisions related to patient's health and nurses usually follow their orders. But nurse's role cannot be forgotten as they are along with the patients all the time and if there's any change they can identify it. Therefore, it is nurse's responsibility that if they identify any problem they should immediately make decision for the betterment of the patient. According to Pugh (2000), decision making is not a simple process and it incorporates cognitive, instinctive and experiential processes. Literature says that there could be two ways to make decisions, hyopthetico-deductively and intuitively (Buckingham and Adams, 2000). Hypothetico-deductive reasoning occurs when nurses meet the patient, they gather data related to illness, which enable them to make inferences involving conscious formulation of clinical hypotheses that are scientific and open to inquiry (Riley, 2003). Another type is intuitive, which involves the €immediate knowing' of something without conscious thought and based on past experience (Thompson and Dowding, 2002). For example, when nurses recognize patterns of clinical findings they may compare it to the previous findings. In clinical settings it has been observed that both of the ways are used but the important thing is to make correct decision for the patient at right time.
Other cognitive skills are problem solving and judgment which also depend upon person's critical thinking and decision making. According to Baker (2011), problem solving involves identifying a problem, evaluating alternatives, and making a decision to manage a problem and in the clinical practice problems are typically very difficult. Whereas, judgment means an interpretation or conclusion about a patient's needs, anxieties, or health problems (Tanner, 2006). Both of these skills were used by the nurse mentioned in above scenario.
Cognitive theories not only help nurses to acquire above mentioned skills but also in some interventions for the patient. One of the interventions widely used for mentally ill patients is cognitive behavioral therapy. The concept of CBT based on both the theories is that people's expectations and perceptions of the events cause problems or maladaptive behaviors not the events themselves and those maladaptive behaviors can be altered by dealing directly with a person's thoughts and beliefs (Stuart and Laraia, 2001). Once in psychiatric ward, I observed that one patient with low self esteem was treated with CBT. In this therapy he identified his automatic thought patterns i.e. €I am nothing and worthless€ then the therapist encouraged him to learn ways to interrupt this thought patterns and replace it with the positive self concept. This helped the patient to boost up his self esteem. Furthermore, in clinical settings, it has been observed that those mentally ill patients who are treated with medicines only show fewer tendencies to live a normal life as medicine compliance is a big question in such patients. Thus in such patients CBT can help to a great extent. According to a research conducted by Turkington, Kingdon and Turner (2002), the clients receiving CBT show a potential for improved adherence, better use of coping skills and minimum hospital stay. Thus, nurses should follow proper assessment techniques which are important in CBT as it is well integrated in their practice.
The CBT technique was based on both the cognitive and behavioral theories, but there are some other therapie
In nursing practice, cognitive and behavioral theories enable the nurse to formulate nursing process, choose appropriate interventions and bring changes in patient's life. Moreover, nurses are also responsible for the daily monitoring and management of the quality of health care delivered to patients, detection of any change in patient's clinical status, patient's behavior and reinforcement of desirable behaviors. These all require the use of cognitive and behavioral skills. Although, in our society nurse's role is to follow doctor's orders but nurses should not neglect the use of reasoning and critical thinking skills. Thus an essential characteristic of a competent nurse is the use of theory in practice in providing or directing patient care. As well said by the great Leonardo da Vinci €He who loves practice without theory is like the sailor who boards ship without a rudder and compass and never knows where he may cast€. Therefore, practice without applying theory is not beneficent.
These were the reasons which urged me to write on this topic. This paper will briefly focus on problem solving, judgment, systematic desensitization, flooding whereas critical thinking, decision making, cognitive behavioral therapy, shaping and token economy will be discuss in detail.
The major implications of cognitive perspective in nursing practices are observed in critical thinking, decision making, judgment and problem solving skills. Once on one of my clinical rotation, there was a patient who was admitted due to some renal problems. When the nurse went to that patient, he saw that the patient's abdomen was distended and he was also feeling drowsy. The nurse picked up the problem immediately and took patient's blood pressure which was very low. He instantly gave rush call as the patient was in severe fluid retention. Doctors came and saved patient from potential worst condition. In this scenario, nurse's role was extraordinary. He picked up the problem and took correct step at right time to save patient which truly depicts the use of cognitive skills by the nurse.
Looking at this scenario, it would not be wrong to say that €Behind every healed patient is a critical thinking nurse€. In my opinion critical thinking is a skill that helps us to analyze the problem promptly. Johnson (2000) indicates, €Critical thinking is a type of thinking where we organize, analyze, or evaluate given information€. It requires knowledge, skills and experiences. The literature repeatedly stresses that nurse should be able to think critically in order to process complex data and make correct clinical judgments in the planning, management and evaluation of patient's health care (Raines, 1996). The use of critical thinking is an important aspect in nursing process which includes four steps of assessment, planning, implementation and evaluation in which a nurse uses previous knowledge as well as thinking and reasoning. Sedlak and Ludwick (1996) stated that the nursing process and critical thinking cannot be separated from each other. It has been observed in the clinical settings that some nurses do not think critically but the research says that nurses are expected to have this skill because it makes nursing a profession. According to Distler (2007), critical thinking in nursing is an essential constituent of professional liability and quality nursing care. Hence, nurses who are critical thinkers can contribute to bring changes in health care to improve it (Bevis and Watson 2000).
Another cognitive skill that comes as a result of critical thinking is the decision making which is an essential part of the daily care that nurses provide to the patients. Referring to the above mentioned scenario, after identifying patient's problem, nurse immediately took a step and decided to give a rush call. Thus as care provision becomes more complex, nurses have to rely on their decision making skills to achieve good outcomes (Muir 2004). Although, in clinical setting it has been observed that doctors take most of the decisions related to patient's health and nurses usually follow their orders. But nurse's role cannot be forgotten as they are along with the patients all the time and if there's any change they can identify it. Therefore, it is nurse's responsibility that if they identify any problem they should immediately make decision for the betterment of the patient. According to Pugh (2000), decision making is not a simple process and it incorporates cognitive, instinctive and experiential processes. Literature says that there could be two ways to make decisions, hyopthetico-deductively and intuitively (Buckingham and Adams, 2000). Hypothetico-deductive reasoning occurs when nurses meet the patient, they gather data related to illness, which enable them to make inferences involving conscious formulation of clinical hypotheses that are scientific and open to inquiry (Riley, 2003). Another type is intuitive, which involves the €immediate knowing' of something without conscious thought and based on past experience (Thompson and Dowding, 2002). For example, when nurses recognize patterns of clinical findings they may compare it to the previous findings. In clinical settings it has been observed that both of the ways are used but the important thing is to make correct decision for the patient at right time.
Other cognitive skills are problem solving and judgment which also depend upon person's critical thinking and decision making. According to Baker (2011), problem solving involves identifying a problem, evaluating alternatives, and making a decision to manage a problem and in the clinical practice problems are typically very difficult. Whereas, judgment means an interpretation or conclusion about a patient's needs, anxieties, or health problems (Tanner, 2006). Both of these skills were used by the nurse mentioned in above scenario.
Cognitive theories not only help nurses to acquire above mentioned skills but also in some interventions for the patient. One of the interventions widely used for mentally ill patients is cognitive behavioral therapy. The concept of CBT based on both the theories is that people's expectations and perceptions of the events cause problems or maladaptive behaviors not the events themselves and those maladaptive behaviors can be altered by dealing directly with a person's thoughts and beliefs (Stuart and Laraia, 2001). Once in psychiatric ward, I observed that one patient with low self esteem was treated with CBT. In this therapy he identified his automatic thought patterns i.e. €I am nothing and worthless€ then the therapist encouraged him to learn ways to interrupt this thought patterns and replace it with the positive self concept. This helped the patient to boost up his self esteem. Furthermore, in clinical settings, it has been observed that those mentally ill patients who are treated with medicines only show fewer tendencies to live a normal life as medicine compliance is a big question in such patients. Thus in such patients CBT can help to a great extent. According to a research conducted by Turkington, Kingdon and Turner (2002), the clients receiving CBT show a potential for improved adherence, better use of coping skills and minimum hospital stay. Thus, nurses should follow proper assessment techniques which are important in CBT as it is well integrated in their practice.
The CBT technique was based on both the cognitive and behavioral theories, but there are some other therapie
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