Clinical Judgement

Question 1

The interpretation or conclusion about a patient’s needs, concerns, or health problems, & or decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response.

Answer 1

Clinical Judgement

Question 2

The thinking process by which a nurse reaches a clinical judgement (noticing, interpreting, & responding.)
*It also involves the patient & how they respond to the nurse’s actions.

Answer 2

Clinical Reasoning

Question 3

A process where you have to think about the situation & use the knowledge you have already to fix a problem.

Answer 3

Critical Thinking

Question 4

What is the scope of clinical judgement?

Answer 4

There are rules/algorithms to use to help patient based off of what is going on with them.

Question 5

Problem solving approach to clinical practice that combines the deliberate & systematic use of best evidence in combination with a clinician’s expertise, patient preferences, values, & available healthcare resources to make the best practice decisions about patient care.

*Nurses are involved in evidence & research. Nurses practice in it every day.

Answer 5

Evidence-Based Practice

Question 6

Originates from the belief that life experiences are culturally bond, that individuals interpret these experiences on the basis of their encounters within a given culture, & that one approach is not for everyone.
*(Everything is not for everyone; ex. Tylenol is not for every baby with a fever).

Answer 6

Interpretation + Perspective

Question 7

“Rule of Thumb” Methods & be intuitive (Gut feeling). Engaging & using common sense. (Recognizing the Right client)

5 Rights of Clinical Reasoning
1. Right Cues (Recognizing the situation)
2. Right Patient (Pediatric or elderly)
3. Right Time
4. Right Action (Did we do the correct action)
5. Right Reason

Answer 7

Clinical Reasoning

Question 8

Steps nurses use every day to help their patients.
1. Assessment (Information collection/gathering data)
2. Diagnoses (Stating problem)
3. Plan (Planning care for patient-Goals/Outcomes)
4. Implementation (Doing the action)
5. Evaluation (Evaluate my plan or goal) If goal is met or not
*If goal isn’t met then go back to reassess

Answer 8

Nursing Process

Question 9

1.Recognize Cues (Recognizing something abnormal)
2. Analyzing Cues (Listening for something abnormal)
3. Prioritize Hypothesis (What you think is going to happen)
4. Generate Solutions
5. Take action (Doing the action)
6. Evaluate Outcomes (Goals met or not)

Answer 9

Clinical Judgement Process

Question 10

Holistic View of Patient Situation
*Nurses have to deal with the whole picture & even use natural ways to help people.
*M.D.- Specialty of Family Medicine & D.O.-Doctor of Osteopathic
*(Not focused on one thing that brought the patient in (looking at everything to see what could be going on)

Process Orientation
*Circular, moving flowingly between & among all of the aspects of the process (so the nurse looks at the situation, asks questions, & uses her knowledge/experiences to know what to ask the patient to help them.)

Reasoning/Interpretation
*Reasoning leads to clinical judgement (Nurse use analytic, intuitive, & narrative-deep knowledge & experience). Which one used will depend on the situation & nurse’s experience.

Ethical Compartment
*Doing what is right for the patient!

Answer 10

Attributes & Criteria

Question 11

Reflecting while doing the action. (Reflecting-doing CPR right)

Answer 11

Reflection-In-Action (Type of Reflection)

Question 12

Reflecting after the action has been done. Ex. (Debrief after process of CPR, Time started & ended).

Answer 12

Reflection-On-Action (Type of Reflection)

Question 13

Intrapersonal Characteristics of the Nurse
*Box 38.1

Answer 13

Ex. *Trustworthiness-Asking questions/seeking help when unsure
*Ethical grounding/Personal sense of importance
*Skill in using various ways of knowing, empirical, experiential, & ethical

Question 14

Interpreting (Understanding something)

Responding

Answer 14

Nurse will assemble info., make sense of it, & establish priorities (gather info.)
You respond based off of what you found.

Question 15

Context to Nursing & Health Care

Answer 15

Whole process we use as a nurse from gathering data, to realizing on it, & seeing if the action is working or not. (Clinical Judgement)

Question 16

Figure 38.2

Answer 16

Clinical Judgement-Interrelated concepts that involves (leadership, safety, quality patient care, determining when/how patient education on a patient or family needs, evidence from research studies, clinical guidelines, & standards of care).

Question 17

Maslow’s Hierarchy of Needs
*Priority is most important

Answer 17

Bottom then up
*Physiological (Basic needs)-Food, water, sleep, sex, shelter, air, clothing, elimination
*Safety (Security, Health, Finances of job
*Love/Belonging (Friendship, Family (Feeling loved or belonging)
*Esteem (Self-esteem, Confidence, Respect of others, competent)
*Self-Actualization (Acceptance of self, achieving one’s full potential)

Question 18

Failure to Rescue has been defined as the inability to prevent death after the development of a complication.

Ex. A woman with no known comorbid conditions who undergoes an abdominal hysterectomy & develops difficulty breathing & tachycardia on the 2nd post op day. The failure to perform appropriate testing & institute treatment for an ultimately fatal complication, would be consistent with the concept failure to rescue.
*Pulmonary Embolism-Woman at risk for blood clot

Answer 18

Failure to Rescue

Question 19

The worst possible complications

Answer 19

1.Chest pain
2. Increased respiratory distress
3. Hypotension
4. Change in level of Consciousness (LOC) or neurologic status
5. Falls

Question 20

-An essential component of client care
-An essential component of the management of nursing units involving the designation of a competent individual to the responsibility of carrying out a specific group of nursing task in the provision of care for certain clients.
-Allows health care-managers to maximize the use of caregivers who are educated at multiple levels
-Allows nurses to meet the requirements of quality care for all clients
-A basic skill that RN must learn
*Know what the RN, LPN, CNA, & etc. can do

*Goal of delegation it to meet the cost restraints of limited health-care budgets by using less expensive personnel that maximize the use of time by RNs & promote teamwork.

Answer 20

Delegation

Question 21

Designating tasks for ancillary personnel that fall under their own level of practice according to facility policies, position descriptions & if applicable, state-practice act (licensed practical nurse-(LPN) & licensed vocational nurse (LVN)

Answer 21

Assignment

Question 22

1. Right Task (The task that is being delegated )
2. Right Circumstance (The context in which the task is being delegated, including the patient’s condition and the healthcare setting)
3. Right Person(Person delegating the task)
4. Right Direction (How the task will be directed and communicated )
5. Right Supervision (How the task will be supervised and evaluated, including follow-up to ensure it is completed correctly )

*When nurses delegate nursing tasks to non-nurses, the RNs are always legally responsible for supervising that person to ensure that the care given meets the standards of care.
-Legally, the power to delegate is restricted to professionals who are licensed & governed by a statutory practice act.

Answer 22

Five Rights of Delegation

Question 23

*RNs have to assess first before delegating
*Look for stable, unstable, acute, & chronic conditions
1. Assess the client.
2. Know staff availability.
3. Know the legalities in the nurse practice act.
4. Know the job description.
5. Educate the staff members.

RNs
*T-Teaching
*A-Assessment
*P-Planning Care
*E-Evaluating

Answer 23

Nursing Responsibilities When Delegating

Question 24

*Can’t do admission assessments
*Can’t do IV push medication
*Can’t write nursing diagnoses
*Can’t do most teaching (Some teaching)
*Can’t do complex skills
*Can’t take care of clients with acute conditions
*Can’t take care of unstable clients

Answer 24

A Licensed Practical Nurse

Question 25

*Look for the lowest level of skill required for the task.
*Look for the most uncomplicated task.
*Look for the most stable client.
*Look for the client with the chronic illness.

Answer 25

Unlicensed assistive personnel (UAPs), Certified nursing assistants (CNAs), & Aides

Question 26

Careful monitoring
*Are they doing what they should be doing?
*Do they understand the responsibilities involved in the client’s care?
*Help them!
*Say “Thank you-good job!” when they are done.

Answer 26

Key Skills for Delegation

Question 27

*Before delegating any task, RNs should give careful consideration to the condition of the client & the client’s health-care needs.
*Assessing clients is a designated responsibility of RNs.

Answer 27

Key Skills (Assessing the Client)

Question 28

*Know the availability of staff.
*Know their education & competency levels.
*Match staff with the level of care required by the client.
*Determine how often the delegatee has performed the required tasks or care for this type of client.
*Know what units the delegatee has worked on & feels comfortable in.

Answer 28

Key Skills (Knowing staff availability & Skills

Question 29

Know the institution’s official position description for the UAP, LPN/LVN, & others.

Answer 29

Key Skills (Knowing the job description)