Pulling Back the Onion Layers or Can’t See the Frost for the Trees
by George Peraza-Smith
These are familiar idioms used by many to describe a process in searching for a deeper understanding to a clinical problem.
One of the joys I have in working with some older adults is the complexity of a clinical presentation with multiple layers and co-morbidities.
Pulling back the onion layers can help us understand each clinical sign or symptom “layer” and then examine the impact the sign or symptom has on the overall presentation.
As a visual thinker, a tool that has helped me to better understand a complex clinical presentation is mind mapping or concept mapping.
Mapping is a visual diagraming tool that can be used to represent a conceptual non-linear picture connecting competing indicators of the clinical presentation (e.g., heart failure: ). However, for those complex, multivariant presentations, applying a mapping process to your decision-making may be useful in pulling back the onion layers. [View examples.]
George Peraza-Smith, DNP, ARNP, GNP-BC, NP-C, CNE, GS-C, FAANP
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