Chapter 2 - Clinical Judgement Flashcards
What does Nursing Involve?
Nurses need to have technical skills, a sound knowledge base, and skills in therapeutic communication, critical thinking, and critical reasoning to develop sound clinical judgment.
Much of nursing emphasis is on thinking, which is the foundation of being activity oriented (doing), and now more than ever the importance of caring.
- Thinking
- Doing
- Caring
What is Clinical Judegment?
Common factors in definitions of clinical judgment are processes that promote safe client care decisions and outcome
- The National Council of State Boards of Nursing (NCSBN) (2019)
- Integrates critical thinking and decision-making. Nurses must apply nursing knowledge to generate the best possible evidence-based solutions
- Tanner (2006)
- Interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not)
- It emphasizes the importance of understanding the disease process, pathophysiology, diagnostic aspects, and impact of the illness experience on the client and family.
- Benner, Tanner, and Chelsa (2009)
- “ways in which nurses come to understand the problems, issues, or concerns of client and patients, to attend to salient information, and to respond in concerned and involved ways
Common factor: Utilization of processes that promote safe client care
Requirement of nurses: Recognize and interpret client problems, prioritize a response, take action, evaluate outcomes, and modify actions as needed
Different Kinds of Nursing Knowlege
Sound clinical judgment requires the nurse to integrate various types of knowledge
- Theoretical - class
- Information, facts, principles, and evidence-based theories
- Research findings and rationally constructed explanations of phenomena
- Practical
- Processes and procedures
- Practical knowledge requires an understanding of the “how and why” of correctly performing nursing skills.
- Self - knowledge
- Be aware of your beliefs, values, and cultural and religious biases. You can gain self-knowledge by developing personal awareness
- Ethical
- Knowledge of obligation, or right and wrong
Models of Clinical Judgement
A model is a set of interrelated concepts that represents a way of thinking about something
- Tanner model of clinical judgment
- Four aspects of the clinical judgment process used by experienced nurses N
- Noticing
- Interpreting
- Responding
- Reflecting - Process of examining the actions implemented
- Reflection-in-action
- During the implementation process
- Reflection-on-action
- Self-evaluation process to learn and refocus actions in future situations
- Reflection-in-action
- Four aspects of the clinical judgment process used by experienced nurses N
Lasater Clinical Judgement Rubric
- Identifies 11 dimensions that are used to measure each of the four aspects of Tanner’s clinical judgment model.
- It categorizes the progressive development of clinical judgment in each dimension, as the beginning, developing, accomplished, and exemplary.
National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement (CJM) Model
- The majority of new nurses do not possess the competencies necessary for entry-level practice in complex healthcare environments. They do not have the high level of clinical judgment as do more experienced nurses, who use their experience to readily anticipate a client’s needs.
- The NCSBN CJM model measures whether a test taker has the established degree of clinical judgment and decision-making abilities to be a safe practitioner.
- The model helps you to recognize, analyze, organize, prioritize, and use your knowledge to make safe client care decisions.
- Important in preparation for the licensure examination
NCSBN CJM Layers
The CJM model has five layers, 0 to 4, with the formulation of clinical decisions to meet the client’s needs as layer 0
Layer 0—clinical decisions
Layer 1—comprises the outcome (clinical judgment)
Layer 2—form, refine hypotheses; evaluation
Layer 3—contains the clinical judgment tasks (recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes)
Layer 4—context (individual and environmental factors)
Clinical Reasoning
- Synthesize facts, putting it all together for reasoning to develop clinical judgment
- The process of synthesizing knowledge and information from numerous sources and incorporating experience to develop a plan of care for a particular client or case scenario
- Requires a reliance on your knowledge and experience to form a conceptual image of a client’s problem and its effective management
Importance of Clinical Reasoning
- It is an essential component of developing clinical judgment and practicing safe care.
- The practice of professional nursing requires strong clinical reasoning skills due to a rapidly changing complex healthcare environment.
- Ineffective clinical reasoning skills are a major factor in the failure of nurses to respond appropriately to deteriorating client conditions.
What is Critical thinking?
- A combination of
- Reasoned thinking
- Openness to alternatives
- Ability to reflect
- A desire to seek truth
What are critical thinking skills?
- Objectively gathering information on a problem or issue
- Recognizing the need for more information
- Evaluating the credibility and usefulness of sources of information
- Recognizing gaps in one’s own knowledge
- Listening carefully; reading thoughtfully
- Separating relevant from irrelevant data and important from unimportant data
- Organizing or grouping information in meaningful ways
- Making inferences (tentative conclusions) about the meaning of the information
- Visualizing potential solutions to a problem
- Exploring the advantages, disadvantages, and consequences of each potential action
- Evaluating the credibility and usefulness of sources of information
- Recognizing differences and similarities among things or situations
- Prioritizing or ranking data as needed
What are Critical-Thinking Attitudes?
- Intellectual autonomy
- Intellectual curiosity
- Intellectual humility
- Intellectual empathy
- Intellectual courage
- Intellectual perseverance
- Fair-mindedness
- Confidence in reasoning
Why is Critical Thinking Important for Nurses?
- Nurses are faced with complex situations.
- Each client is unique.
- Nurses apply knowledge to provide holistic care.
- Nursing is an applied discipline.
- Nursing uses knowledge from other fields.
- Nursing is fast-paced.
- The scientific basis for client care changes constantly.
- Critical thinking is linked to evidence-based practice.
Critical Thinking Model
- Five-step/category process
- Contextual awareness
- Deciding what to observe and consider
- Inquiry
- Considering alternatives
- Analyzing assumptions
- Reflecting skeptically and deciding what to do
- Contextual awareness
How is the Nursing Process related to Critical Thinking?
- Critical thinking and the nursing process are interrelated but not identical.
- Nursing decisions that require critical thinking may not be related to the nursing process.
- Some nursing activities do not require reflective critical thinking, although they must be done skillfully.
- The nursing process is a problem-solving process.
- The nursing process correlates and overlaps with those of clinical judgment.
