Clinical Judgment

Question 1

How does the NCSBN define clinical judgment?

Answer 1

the DOING that occurs after critical thinking. Clinical judgment is defined as the observed outcome of critical thinking and decision making. It is an iterative process that uses nursing knowledge to observe and assess presenting situations, identify a prioritized client concern and generate the best possible evidence-based solutions in order to deliver safe client care

Question 2

What are the steps of clinical judgment?

Answer 2

• Cue recognition
• Hypothesis generation
• Hypethesis evaluation
• Taking action
• Evaluating outcomes

Question 3

What are the measurabe coginitive aspects of clinical decision making (layer 3 of the model)?

Answer 3

• Recognize cues
• Analyze cues
• Prioritize hypotheses
• Generate solutions
• Take action
• Evaluate outcomes

Question 4

What is involved in the recognize cues stage?

Answer 4

Filtering information from different sources (e.g., signs, symptoms, medical history)

Question 5

What is involved in the analyze cues stage?

Answer 5

Linking the recognized cues to the client’s clinical presentation and establishing probable client needs, concerns, or problems

Question 6

What is involved in the prioritizing hypotheses stage?

Answer 6

Evaluating and ranking hypotheses according to priority (urgency, likelihood, risk, difficulty, time, etc.)

Question 7

What is involved in the generating solutions phase?

Answer 7

Identifying expected outcomes and using hypotheses to define a set of interventions for the expected outcome

Question 8

What is involved in the Take action phase?

Answer 8

Implementing the solution(s) that addresses the highest priorities; sometimes no action is an action itself

Question 9

What is involved in the Evaluating outcomes phase?

Answer 9

Comparing observed outcomes against expected outcomes

Question 10

How does the NCSBN model map to the nursing process?

Answer 10

Assessment —– Recognize cues
Diagnosis/Analysis ——– Analyze cues & prioritize hypotheses
Planning ———- Generate solutions
Implementation ——— Take action
Evaluation ——— Evaluate outcomes

Question 11

What are examples of environmental (external) factors that can affect clinical judgment?

Answer 11

• environment
• client observation
• resources
• medical records
• consequences and risks
• time pressure
• task complexity
• cultural considerations

Question 12

What are examples of individual (internal) factors that can affect clinical judgment?

Answer 12

• knowledge
• skills
• specialty
• candidate characteristics
• prior experience
• level of experience