Intro to Clinical Judgement Model Flashcards
__% of nurses are involved in some type of error (NCSBN)
50%
__% of nurses make errors due to poor clinical judgment
65%
Recognizing cues aka
Assessment
Analysis equivalent to
Analyze cues and prioritize hypotheses
Planning if equivalent to…
Generate solutions
Take action is equivalent to…
Implementation
Evaluate outcomes is equivalent to…
Evaluation
The NCSBN created the __ to provide framework to support evaluation clinical judgement as part of the NCLEX
CJMM: Clinical Judgement Measurement Model
The observed outcome of critical thinking and decision making
Clinical judgement
CJMM clinical judgement process #1
Cue recognition
CJMM clinical judgement process #2
Hypothesis generation
CJMM clinical judgement process #3
Hypothesis evaluation
CJMM clinical judgement process #4
Taking actions
CJMM clinical judgement process #5
Evaluating outcomes
Education, experience, knowledge, communication, consequences/risks, emotions/perceptions are…
internal contextual factors
Distractions, interruptions, time pressures, task complexity, profession autonomy are…
external contextual factors
Nurses may repeat components of CHMM to continually improve outcomes
nonlinear process
Layer 0 of CJMM
Client needs (starts CJMM) Clinical decision (ends CJMM)
Layer 1 CJMM
clinical judgement
Layer 2 of CJMM
form, refine, evaluate, hypothesize
Layer 3 of CJMM (6)
Recognize cues, analyze cures, prioritize hypothesis, generate solutions, take action, evaluate outcomes
Layer 4 CJMM
Outlines contextual factors that can influence CJMM
Plan of care for patients in community based settings includes… (#1)
Educating patient and/or family on care techniques and precautions
Plan of care for patients in community based settings includes… (#2)
Teaching patient and/or family how to integrate care within family activities
Plan of care for patients in community based settings includes… (#3)
Guiding patient and/or family on how to assume a greater percentage of self care over time
Plan of care for patients in community based settings includes… (#4)
Including nurse and the patient’s evaluation of expected outcomes
What is needed or desired to improve overall health
Patient needs
What initiates the process of clinical judgement?
Identification of patient needs
What concludes the clinical judgement process?
Clinical decisions
Clinical decisions are influenced by…
the entire clinical judgement process
Clinical judgement is essential because it allows the nurse to… (3)
1) Observe changes in patient status
2) Recognize potential problems
3) Take immediate action when needed
Depending on the patient’s response to layer 2, the nurse may…
Work through cognitive processes in layers 3 and 4 to achieve optimal outcomes
Hypotheses identify issues that the nurse should address to… (#1)
Meet that patient’s needs
Hypotheses identify issues that the nurse should address to… (#2)
Make the patient feel better
Hypotheses identify issues that the nurse should address to… (#3)
Alleviate problems
The hypothesis can be actual problems the patient’s is facing or…
Problems the patient is at risk for developing
Commonly understood sets of terms
nomenclatures
Developed a unified nursing language that can be used to document nursing practice
International Classification for Nursing Practice (ICNP)
A label assigned by a RN who makes decisions about a patient after assessing
Nursing diagnosis
Once hypotheses are made, nurses __ them to meet the individual’s needs
refine
How to refine a hypothesis
Prioritize hypotheses and generate solutions
Questions to evaluate outcomes
What signs indicate decline or improvement? Has patient status changed? Were interventions effective? What may be more effective? Should the plan of care be revised?
Questions to consider when collecting data
What info is relevant?
What is more significant?
What information requires immediate attention?
Hypotheses are evaluated and ranked based on priority (3)
Likelihood of occurrence
Urgency
Risk for complications
Examples of nurse actions
Teaching, requesting, performing, administering, documenting, communicating
Effective clinical judgement is dependent on __
context
Layer 4 influences the __ functions of the other layers of the CJMM
cognitive