Chapter 15: Clinical Judgement in Nursing Practice Flashcards
What is clinical judgment?
combination of critical thinking and decision making skills
what is truth-seeking?
be objective when asking patients questions
- ex: “do you drink/smoke/do drugs?”
what is open- mindness?
being tolerant of the patient’s views and beliefs
- ex: the impact of culture and religion it has on the patient
what is analyticity?
anticipate how a patient may respond to a treatment
what is systematically?
based your nursing care on patient priorities
- ex: what the nurse will do first
what is self- confidence?
trusting your own reasoning process
what is inquisitiveness?
value learning for its own sake
- ex: what you are learning in nursing school is a speck of dust, you will learn more on the field
what is mature?
reflecting your own judgments
- a great way to improve your critical thinking skills
what is critical thinking defined?
thinking in a logical manner and in a systematic way
what does the “R” stand in reflect model?
Recall the events during the simulation
what does the “E” stand in reflect model?
Examine your responses
- how you act in the simulation
what does the “F” stand in reflect model?
Acknowledge feelings
- tell me one word how you felt during the simulation
what does the “L” stand in reflect model?
Learn from the experience
- taking the information and applying it when you become a nurse
what does the second “E” stand in reflect model?
Explore options
- the next time you are in this situation, how will you handle it differently
what does the “C” stand in reflect model?
Create a plan of action
- how you will improve your critical thinking skills (reading observations)
what is problem solving?
working with an elderly patient who can’t see their medication label, after assessing the patient we realize they are having problems with their vision
- result: we would recommend the pharmacist to make the pill box label bigger
what is decision-making?
presenting both roles to the patient and letting the patient make the decision
- ex: presenting both roles as a physician and as a midwife
what would a decision-making question be about a problem?
is the problem clear and understandable?
what would a decision-making question be about your perspective?
you are looking at the problem from the view of __. Why?
- ex: the nurse had a perspective that the patient is a drug seeker, you as a nurse need to look at what the patient says the pain is
what would a decision-making question be about assumptions?
you are assuming __. How does that affect your analysis of the problem?
what would a decision-making question be about evidence?
what evidence supports your assumption?
- everything we do is based on evidence or evidence based practice
what is inductive reasoning?
go to specific to general
- ex: a patient is weak in the legs, unsteady on their feet and has a history of falls
conclusion: the patient is at risk for falls
what is deductive reasoning?
going to very general to specific
- ex: using a theorist in your clinical practice or Maslow’s Hierarchy of Needs
how do you get to know your patient?
by caring for a group for a long period of time and evidence based practice
A nurse is caring for a patient who has poor pain control. The patient has a history of opioid abuse. During the day the patient made frequent requests for a pain medication. In order to make an effective clinical decision about this patient, the nurse needs to ask questions about the data available on the patient to make a thorough and thoughtful decision. The nurse asks herself, “How does my view about the patient’s pain tolerance compare with the patient’s, and does that pose a problem?” This is an example of:
A. A question about assumptions.
B. A question about evidence.
C. A question about procedure.
D. A question about perspective
D. A question about perspective
A nurse is assigned to care for a woman who is expecting her first child. The nurse is organized and plans to gather data about the patient by applying Pender’s health promotion model, including the patient’s characteristics and experiences and situational influences. She plans to observe the patient’s behavior and consider the patient’s psychosocial issues. Such data will offer a clear understanding to help the nurse identify the patient’s needs. This is an example of which of the following concepts? (Select all that apply.)
A. Diagnostic reasoning
B. Deductive reasoning
C. Inductive reasoning
D. Assessment
E. Problem solving
B. Deductive reasoning
D. Assessment
One element of clinical decision-making is knowing the patient. Which of the following activities affect a nurse’s ability to know patients better? (Select all that apply.)
A. Caring for similar groups of patients over time
B. Reading the evidence-based practices appropriate to patients
C. Learning how patients typically respond to their clinical situations
D. Observing patients
E. Engaging with patients experiencing illness
A. Caring for similar groups of patients over time
B. Reading the evidence- based practices appropriate to patients
what is competence?
hands on procedures and physical examination techniques
what is an example of hands-on procedure?
sterile dressing changes
what is an example of physical examination techniques?
- working with a baby: you want to do a head-to-toe assessment
- working with a mom: you want to use the body system method: check the lungs, heart, abdomen
we teach these methods because we can do things systematically (won’t skip things)
what is specific knowledge base?
- schooling in a foundation
- CEU are to renew your license and maintain your certification
- reading journals to help you
what is experience?
in clinical they will teach you how to make clinical decision-making skills
what is the nursing process competency?
A Delicious Pie
- how you will apply your critical thinking skills
Which of the following describes a nurse’s application of a specific knowledge base during critical thinking? (Select all that apply.)
A. Initiative in reading current evidence from the literature
B. Application of nursing theory
C. Reviewing a policy and procedure manual
D. Considering a colleague’s view of a patient’s needs
E. Previous time caring for a specific group of patients
A. Initiative in reading current evidence from the literature
B. Application of nursing theory
what is confidence?
need to be prepared before clinical
- ex: learning how to give an injection in therapeutics, reviewing procedures if you forget how to do it
what is thinking independently?
reading the literature (subscribing to at least one journal)
talking to other nurses to get recommendations
what is fairness?
there is always 2 sides of a story
what is responsibility and accountability?
asking for help in clinical
refer to policies and procedures manuals
report problems immediately
follow standards of patient care
what is risk-taking?
a physician will write an order, and you will question it
try different techniques with the patient
what is discipline?
need effective time management, be organized, and learn how to prioritize
what is perseverance?
given missing information, you need to find out from the patient directly
what is creativity?
if a certain intervention does not work for the patient, you need to find a new intervention
- ex: if a patient is in pain, medication is not the solution to the problem. you need to do alternative techniques like distractions (watching tv), deep breathing
what is curiosity?
always asking why, don’t be afraid to ask questions
what is integrity?
don’t compromise nursing standards
- ex: making sure you know the medication you are giving to the patient
what is humility?
always be willing to ask for help
- ex: if you are on a new unit, make sure to get orientation
A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the doctor’s order. At the bedside, the nurse checks the patient’s name against the medication order as well. The nurse is following which critical thinking attitude?
A. Responsibility
B. Humility
C. Accurate
D. Fairness
A. Responsibility
A nurse has been caring for a patient with a chronic wound that has not been healing. The nurse talks with a nurse specialist in wound care to find alternative approaches from what the health care provider ordered for dressing the wound. The two decide that because of the patient’s allergy to tape a nonallergenic dressing will be used. The nurse obtains an order from the health care provider for the new dressing. After two days there is improvement in the wound. This is an example of which critical thinking standards? (Select all that apply.)
A. Clear
B. Broad
C. Risk taking
D. Creativity
C. Risk taking
D. Creativity
what is intellectual standards?
guidelines for rational thoughts
- this will help prevent you from using your critical thinking haphazardly
what is professional standards?
ethics, evidence based practice and professional criteria
what is professional criteria?
what you might learn from your professional organization
- ex: years ago they told you to put alcohol around the umbilical cord, now they tell you to use soap and water
The use of diagnostic reasoning involves a rigorous approach to clinical practice and demonstrates that critical thinking cannot be done:
A. logically.
B. haphazardly.
C. independently.
D. systematically.
B. haphazardly
A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of:
A. Creativity.
B. Fairness.
C. Clinical reasoning.
D. Applying ethical criteria.
D. Applying ethical criteria
how can you develop critical thinking skills?
by reflecting journaling (what you saw and how the day went)
meeting with colleagues/ faculty and preceptors
concept mapping
how can meeting with colleagues/faculty/preceptors develop critical thinking skills?
its a great way to network with others
can give tips about clinical/ theory courses
what is concept mapping?
a visualization of a paper patient problem and interventions
what can the outcome be if you don’t manage stress?
it can lead to decrease work productivity which can cause errors at work and poor decision making skills
what is critical thinking synthesis?
critical thinking and the nursing process go hand in hand making quality decisions about patient care
- the nursing process is NOT complete without critical thinking
The nursing process organizes your approach while delivering nursing care. To provide the best professional care to patients, nurses need to incorporate nursing process and:
A. decision making.
B. problem solving.
C. intellectual standards.
D. critical thinking skills.
D. critical thinking skills
In The Caputi Clinical Judgment Framework, what is getting the information?
similar to the assessment stage of the nursing process
- subjective: what the patient says
- objective: what you obtain through your senses
In The Caputi Clinical Judgment Framework, what is making meaning of the information?
similar to the diagnosis stage of the nursing process
- doing the analysis data and identify what the problem is
In The Caputi Clinical Judgment Framework, what is determining actions to take?
similar to the planning stage
- Make goals: asking the patient on a scale from 0-10 what they want their pain level to be at
In The Caputi Clinical Judgment Framework, what is taking action?
similar to the implementation stage
- putting your nursing interventions into action
- ex: If the patients pain level is at a 6, we have to do interventions (giving them medication, watching tv, giving them a warm blanket)
In The Caputi Clinical Judgment Framework, what is evaluation outcomes and your thinking?
where you use reflection
- ex: going back to check up on your patient an hour later, the patient says their pain improved, but it is at a 5 now. we need to revise the plan (look at the goals with the patient and try something else)
what are the 2 reflections you use in evaluation outcomes and your thinking?
Reflection- IN- Action
Reflection-ON-Action
what is Reflection-In-Action?
working through the problem and deciding to revise/modify the plan
- working with the patient, accomplish the goal with the patient, but something happened where we have to revise the plan
what is Reflection-ON-Action?
how can you improve your nursing for next time and how can you do things differently
- Ex: for a patient who fainted, it is important to bring an ammonia inhaler to revive them
what are the important steps when getting the information?
- determining important information to collect
- scanning the environment
- identifying signs and symptoms
- assessing systematically and comprehensively
- ensuring accurate information
what is an example of determining important information to collect?
if a patient who just had surgery is complaining about dizziness, it is important to look at the BP, look at the surgical dressings, look at the blood glucose and how much urine they are putting out
what is an example of scanning the environment?
scan the patient and the equipment
- if the mom is sleeping while holding her baby, wake her up and put the baby in the crib
what 2 data do you need to collect when identifying signs and symptoms?
subjective and objective data
what are examples of systematic and comprehensive methods?
- assessing the baby head to toe
- assessing the mother using the body system
- pain assessment
what are examples to ensure accurate information?
- using professional websites
- asking your professor or experienced nurses
- making sure you have a textbook with current copyrights (5 years or less)
- ask families or look at the chart to draw appropriate conclusions if a patient is confused
what are the important steps when making meaning of the information?
- clustering-related information
- identifying assumptions
- recognizing inconsistencies
- distinguishing relevant from irrelevant information
- judging how much ambiguity is acceptable
what are the important steps when making meaning of the information? (continued)
- comparing and contrasting
- predicting potential complications
- collaborating with healthcare team members
- determining patient care needs/ healthcare environment issues
what is an example of cluster-related information?
if a patient has a temperature, you need to cluster your data by not only looking at their temperature, but the full set of body signs
what is an example of identifying assumptions?
a woman that is a victim of domestic abuse: an assumption people say is “why doesn’t she leave”
- may not have a place to go, can be afraid to leave
what is an example of recognizing inconsistencies?
the patient can say “i’m burning up” but their temperature is 98.6
- important to collect both subjective and objective data
what is an example of distinguishing relevant from irrelevant information?
if a mom is hemorrhaging, it is important to collect their blood pressure and their pulse, the temperature would be irrelevant
what is an example of judging how much ambiguity is acceptable?
reporting abnormal blood pressure: when you take vital signs in clinical you were told to report anything that is not in the range of 120/80: 2 patients: one has a B.P of 100/60 and the other 130/85
- important to look at trending data
what is an example of comparing and contrasting?
if the patient says “I think my hand is swollen, we will take one hand and compare it to the other
what is an example of predicting potential complications?
after a mom has a baby, she is at risk for orthostatic hypotension (fainting), predicting potential complications could be providing socks with treads on them so she doesn’t slip or having an ammonia inhaler with you
what is an example of collaborating with healthcare team members?
anytime you have an assessment that you think can be abnormal, you need to collaborate with the nurse/professor to double check to validate your data
what is determining patient care needs/healthcare environment issues?
coming up with a nursing diagnosis
