Clinical Judgement

Question 1

Define clinical judgement

Answer 1

• 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

Question 2

Discuss the relationship between clinical reasoning, critical reflection and clinical judgement

Answer 2

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

Question 3

Identify key elements of clinical judgement

Answer 3

• Knowledge base
• Practical knowledge
• Knowledge of patient

Question 4

Knowledge base

Answer 4

 Anatomy and physiology
 Pharmacology
 Pathophysiology
• Ex knowing Hgb level

Question 5

Practical knowledge

Answer 5

o Practice based
 Knowledge from your practice as you’ve experienced
• Good vs bad lung sounds

Question 6

Knowledge of patient

Answer 6

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

Question 7

Cognitive Skills

Answer 7

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

Question 8

Identify factors affecting clinical judgements

Answer 8

1. Nurse

2. Context

Question 9

How does the nurse play a role clinical judgement?

Answer 9

•	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

Question 10

How does context play a role in clinical judgement?

Answer 10

• 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

Question 11

Describe use of decision-making tools in use in practice

Answer 11

• 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

Question 12

clinical judgement in nursing leads to…

Answer 12

• 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

Question 13

clinical judgement involves…

Answer 13

• 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

Question 14

What are the components of cognitive skills?

Answer 14

1. Intuition 
which includes:
- Pattern recognition
- Sequence
- Common sense
- Deliberate rationality

Question 15

Intuition

Answer 15

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

Question 16

Pattern recognition

Answer 16

o Seeing how disease manifests itself as a whole

Question 17

Sequence

Answer 17

o Having relevant evidence stand out as more or less important
 Changing prioritization when pt has respiratory issues

Question 18

Common sense

Answer 18

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

Question 19

Deliberate rationality

Answer 19

o Ability to stand back from original thinking and look at from different perspective and think of different alternatives

Question 20

issues with intuition

Answer 20

•	Prejudging 
o	Judging without reasoning
•	Snap judgements
o	Deciding before gathering enough evidence or information
•	Forming opinions too early

Question 21

Decision making

Answer 21

• 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

Question 22

critical thinking

Answer 22

• 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

Question 23

critical analysis

Answer 23

• To examine ideas, situations, arguments, & data to identify elements/factors and their possible relationship

Question 24

How can you increase critical judgement skills

Answer 24

1. Knowledge
2. Follow policies and procedures
3. Comprehensive and systematic assessments
4. Determine a system
5. Perform interventions
   a. Only if you know why they’re indicated
6. Learn from others
7. Learn new technology
8. Professional caring

Question 25

What is the purpose of tools to assist in clinical judgement?

Answer 25

• Critical pathways and clinical guidelines
o Tools that provide direction in care for a population of patients
o Purpose is to improve quality of care and patient outcome
o Developed by interdisciplinary team members within health authorities

Question 26

rule to utilize tools

Answer 26

• Record data in standardized way to reduce omission errors and promotes safety, consistency and efficiency
• Designed for a specific purpose
o 1 size does not fit all
• Tools DO NOT think for you

Question 27

variances from pathways and guidelines

Answer 27

• Deviations occur as situations and patients are never exactly the same
• Some variances are avoidable and some are not
• Deviations result from both system and patient issues

Question 28

do care paths and clinical guidelines reduce or eliminate the need for clinical judgement?

Answer 28

• No, you are accountable for ensuring that you have the most up-to-date information, for applying CT and for considering the context (big picture) to make ultimate decisions