Clinical Judgment and Nursing Process

Question 1

Describe the Nursing Process and each of its five steps.

Answer 1

1.Assess the patient to determine the need for nursing care

2. Determine nursing diagnoses for actual and potential health problems and needs
3. Identify expected outcomes and plan care
4. Implement the care
5. Evaluate the results.

Question 2

List five characteristics of the Nursing Process.

Answer 2

1. Systematic
2. Dynamic
3. Interpersonal
4. Outcome Oriented
5. Universally Applicable in Nursing Situations

Question 3

Systematic

Answer 3

Each nursing activity is part of an ordered sequence of activities.

*Without a complete and accurate database, the nurse cannot identify patient strengths and problem

Question 4

Dynamic

Answer 4

No single phase in the nursing process is a one-time phenomenon; each phase flows into the next. In some nursing situations, all five phases occur almost simultaneously.

Question 5

Interpersonal

Answer 5

ensures that nurses are person centered rather than task centered

*Ex: Rather than simply approaching a patient to take vital signs, the nurse might ask, “How are you today, Mr. Byrd? Are we helping you to achieve your goals?”

Question 6

Outcome Oriented

Answer 6

The nursing process offers a means for nurses and patients to work together to identify specific outcomes related to health promotion, disease and illness prevention, health restoration, and coping with altered functioning; to determine which outcomes are most important to the patient; and to match them with the appropriate evidence-based nursing actions.

Question 7

Universally Applicable in Nursing Situations

Answer 7

When nurses have a working knowledge of the nursing process, they find that they can practice nursing with well or ill people, young or old, in any type of practice setting.

Question 8

Contrast three approaches to problem-solving

Answer 8

Trial and Error

Intuitive

Scientific

Question 9

Trial and error

Answer 9

involves testing any number of solutions until one is found that works for that particular problem.

Question 10

Intuitive

Answer 10

a direct understanding of a situation based on a background of experience, knowledge, and skill that makes expert decision making possible

Question 11

Scientific

Answer 11

a systematic, seven-step problem-solving process that involves; used most commonly in a controlled laboratory setting

-Problem identification
-Data collection
-Hypothesis formulation
-Plan of action
-Hypothesis testing
-Interpretation of results, and
-Evaluation, resulting in a conclusion or revision of the hypothesis

Question 12

List three patient benefits of using the nursing process correctly.

Answer 12

• Achieves scientifically based, holistic, individualized care

-The opportunity to work collaboratively with nurses and continuity of care

-Clear, efficient plan of action results in the achievement of the best results for the patient

Question 13

List three nursing benefits of using the nursing process correctly.

Answer 13

-Achieve a clear, efficient, and cost-effective plan of action by which the entire nursing team can achieve the best results for patients

-The satisfaction that they are making an important difference in the lives of their patients

-The opportunity to grow professionally as they evaluate the effectiveness of interventions and variables that contribute positively or negatively to the patient’s achievement of valued outcomes

Question 14

Assess one’s capacity for competent, responsible, and caring practice.

Answer 14

Nurses are responsible for a unique dimension of health care: “the diagnosis and treatment of human responses to actual or potential health problems”

Nurses are knowledgeable, competent, and independent professionals who work collaboratively with other healthcare professionals to design and deliver thoughtful, person-centered care

Provision of a caring relationship that facilitates health and healing

Question 15

Apply Tanner’s Clinical Decision Making Model when making clinical judgments and decisions.

Answer 15

The core elements of the model include:

1. Noticing
2. Interpreting
3. Responding
4. Reflecting

Question 16

Noticing

Answer 16

initial grasp and perceptions of the situation that are impacted by context, the nurse’s practical experience, knowledge of expected versus unexpected data, ethical perspectives, and the nurse–patient relationship

Question 17

Interpreting

Answer 17

attributing meaning to the data through multiple reasoning patterns

Question 18

Responding

Answer 18

deciding on an action (or inaction) and monitoring outcomes

Question 19

Reflecting

Answer 19

in-action and on-action

Question 20

Develop a personal plan to develop interpersonal skills essential to quality care.

Answer 20

• Interpersonal skills: promoting human dignity and respect; establishing caring relationships; enjoying the rewards of mutual interchange

-Promoting human dignity and respect: it is being sensitive to a patient’s needs and showing them respect, being sensitive with their looks, speech and touch communication, most important of interpersonal skill

-Establish a caring relationship: by regarding the patient as a person and not a job, not letting the tasks take over that you are with a person

-Rewards of a mutual interchange: giving a little bit of you with each patient that you come in contact with and to take a little for them also

Question 21

Identify personal strengths and weaknesses in light of nursing’s essential knowledge and skills.

Answer 21

for self reflection

Question 22

Value reflective practice as an aid to self-improvement.

Answer 22

Reflective practice is a purposeful activity that leads to action, improvement of practice, and better patient outcomes. It is about looking at an event, understanding it, and learning from it.

Question 23

Reflection IN action

Answer 23

happens in the here and now of the activity and is also known as “thinking on your feet.”

Question 24

Reflection ON action

Answer 24

occurs after the fact and involves thinking through a situation that has occurred in the past.

*It is used as a means of evaluating the experience and deciding what could have been done differently.

Question 25

Reflection FOR action

Answer 25

the desired outcome of the first two types of reflection: it helps the person to think about how future actions might change as a result of the reflection.

Question 26

Describe the concept of critical thinking

Answer 26

thought that is disciplined, comprehensive, based on intellectual standards, and, as a result, well- reasoned; a systematic way to form and shape one’s thinking that functions purposefully and exactingly

Question 27

Describe the concept of clinical reasoning

Answer 27

a specific term usually referring to ways of thinking about patient care issues (determining, preventing, and managing patient problems);

for reasoning about other clinical issues (e.g., teamwork, collaboration, and streamlining workflow)

Question 28

Describe the concept of clinical judgment.

Answer 28

the result or observed outcome of critical thinking and decision making

Question 29

Discuss the six cognitive operations of the NCSBN’s Clinical Judgment Measurement Model (CJMM) layer 3.

Answer 29

1. Recognizes cues
2. Analyze cues
3. Prioritize hypotheses
4. Generate solutions
5. Take action
6. Evaluate outcomes

Question 30

recognize cues

Answer 30

relevant information is identified (medical hx, vital signs)

Question 31

analyze cues

Answer 31

cues are linked & organized (organizing & linking recognized cues to client’s clinical presentation)

Question 32

prioritize hypotheses

Answer 32

hypotheses are evaluated and ranked according to priority (may include urgency, likelihood, risk, difficulty, and/or time

Question 33

generate solutions

Answer 33

interventions are defined based on hypotheses (identifying expected outcomes and using hypotheses to define a set of interventions for the expected outcomes)

Question 34

take actions

Answer 34

highest priority solutions are implemented

Question 35

evaluate outcomes

Answer 35

observed outcomes are compared with expected outcomes

Question 36

Nursing Process

Answer 36

outlines the way nurses think; it represents the unique, shared language of nurses.

Question 37

Tanner’s clinical judgment model

Answer 37

Clinical judgment for this model is defined as “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response”

Question 38

NCSBN’s CJMM

Answer 38

The action model aligns the six cognitive operations from layer 3 of the CJMM (recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluation outcomes) with specific situational factors from layer 4 including environmental, client observation, medical record, and time pressure cues.

based on the humanistic–intuitive, information-processing, and cognitive continuum cognitive theories and models