Clinical Judgement Flashcards
Define clinical judgement
• Common sense thinking or practice reasoning directed towards solving problems
• Processes by which nurses reach their decisions by choosing what to observe, interpreting the observations and taking appropriate actions by modifying approaches and improvising new ones for patient needs
• Drawing valid conclusions and acting appropriately based on those conclusions
o Utilize previous observations and interpretations to recognize pt issues or concerns
Discuss the relationship between clinical reasoning, critical reflection and clinical judgement
Clinical reasoning
• Process nurses utilize to reach nursing clinical judgements
Critical reflection
• Process that critically examines ones experience to make meaning, to interpret and to develop insight and understanding, thereby improving ones practice
• A tool used to reflect on meaning of experiences
• Used to build scenarios to prepare for future experiences
• Is an aspect of clinical judgement
Critical thinking, critical reflection and critical judgement
• Patient care
• A conscious process
• Observing
• Attending to selected data
• Analyzing
• Responding to patient needs
• Awareness and ability to be observant is critical to making a safe clinical judgement
Identify key elements of clinical judgement
- Knowledge base
- Practical knowledge
- Knowledge of patient
Knowledge base
Anatomy and physiology
Pharmacology
Pathophysiology
• Ex knowing Hgb level
Practical knowledge
o Practice based
Knowledge from your practice as you’ve experienced
• Good vs bad lung sounds
Knowledge of patient
o Their story
Hx, status, assessment data
Taking a picture of what you walked into
Pt states certain pain medication doesn’t work for them
Pt states what non-pharmacological measures work for pain
• Warm compress
Cognitive Skills
o How we make conscious, holistic decision with our intuitive knowledge
o Intuition
o Conscious decision making
Conscious thinking about decision while utilizing knowledge and coming to conclusion about best action to take
o Critical thinking
Identify factors affecting clinical judgements
- Nurse
2. Context
How does the nurse play a role clinical judgement?
• Cognitive ability o Ability to think critically and apply it • Values and biases o We all have it o Impact our practice • Notion of good practice o Sense of what is right o Always trying to provide good care • Emotional attunement o Getting too involved or making a personal/emotional connection o Appearing cold and uncaring o Easily to become emotional involved with pts • Practical knowledge o Proficiency with clinical judgement o Increases as experience increases • Relationship with pt o Depending on how well you know pt determines ability to make clinical judgement
How does context play a role in clinical judgement?
• Demands of the situation
o Does the situation require immediate attention?
o If so - make quick clinical judgements
• Meaning of tasks
o Are you taking into account rationale for task or doing it that way because always been done that way?
• Workplace culture
o What is valued? Philosophy of unit? Who has status? Who has power?
• Workload
o Short staffed, short on ratio for pts, really sick pt will impact ability to make clinical judgement
Describe use of decision-making tools in use in practice
- Clinical judgment is similar to decision making however nurses make judgments as well as decisions about patient data and interventions
- The term decision-making is often used interchangeably with critical thinking but is not quite the same
clinical judgement in nursing leads to…
- Identification and logical interpretation of symptoms
- Planning care to alleviate or prevent complications/relapses
- Partnering with the patient to do for them what they would do themselves given the strength and knowledge
- Partnering with the patient to satisfy physical, psychological and spiritual needs
- Assisting the patient in dying with dignity PRN
clinical judgement involves…
• Practical reasoning of pt conditions
o Knowing what to observe
o Interpreting the observations
o Paying attention to subtle changes in conditions
o Taking appropriate actions by modifying the approach or improvising as necessary
What are the components of cognitive skills?
1. Intuition which includes: - Pattern recognition - Sequence - Common sense - Deliberate rationality
Intuition
o The immediate apprehension that something is so without the benefit of conscious reasoning
o Achieved by learning to describe common patient responses based on logical thinking and hunches which you then utilize to make a well-reasoned conclusion
Pattern recognition
o Seeing how disease manifests itself as a whole
Sequence
o Having relevant evidence stand out as more or less important
Changing prioritization when pt has respiratory issues
Common sense
o Understanding and grasping human experiences and illness experiences
o Trying to make sense of why they’re acting a certain way or responding to you in a certain way
Deliberate rationality
o Ability to stand back from original thinking and look at from different perspective and think of different alternatives
issues with intuition
• Prejudging o Judging without reasoning • Snap judgements o Deciding before gathering enough evidence or information • Forming opinions too early
Decision making
- Clinical judgment is similar to decision making however nurses make judgments as well as decisions about patient data and interventions.
- The term decision-making is often used interchangeably with critical thinking but is not quite the same
critical thinking
- The intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing and evaluating the information gathered from or generated by observation, experience, reflection, reasoning or communicating, as a guide to belief or action
- Required for clinical judgment
- A systematic and logical way of thinking
- Thinking about thinking
- A purposeful and deliberative process of generating, analyzing and evaluating alternatives
- Embedded in the nursing process
critical analysis
• To examine ideas, situations, arguments, & data to identify elements/factors and their possible relationship
How can you increase critical judgement skills
- Knowledge
- Follow policies and procedures
- Comprehensive and systematic assessments
- Determine a system
- Perform interventions
a. Only if you know why they’re indicated - Learn from others
- Learn new technology
- Professional caring
