mod 5 ch 16 clinical judgement model Flashcards
clinical judgement
The NCSBN (2019b) defined clinical judgment as “the observed outcome of critical thinking and decision making” (p. 1). Nursing clinical judgment is an essential nursing skill in the modern health care environment, as nurses manage a wide variety of information and select actions to provide safe,
components of the clinical judgement measurement model
- incorporates clinical judgment process
- ids diff types contextual factors
- defines nonlinear process
- requires clinical judgment skills
incorporates clinical judgment process
cue recognition, hypothesis generation, hypothesis evaluation, taking actions, and evaluating outcomes
identifies diff types contextual factors
- -Internal contextual factors: education, experience, knowledge, communication, consequences/risks, emotions/perceptions
- –External contextual factors: distractions, interruptions, time pressures, task complexity, professional autonomy
defines nonlinear process
nurse may repeat components of the process one or more times to continually move toward outcome improvement: recognizing cues, generating hypotheses, judging hypotheses, taking action, and evaluating outcomes
requires clinical judgment skills
acknowledges that because a nurse has knowledge, it does not necessarily mean the nurse has good clinical judgment skills
layers
- observation - layer 0
- cognitive operations - layer 1-3
- contextual factors- layer 4
observation
Layer 0: Client needs (initiate the process of clinical judgment) and clinical decisions (end the process of clinical judgment)
Cognitive Operations
- –Layer 1: Clinical judgment, defined by the observable aspects from layer 0 and the unobservable cognitive aspects of layers 2 and 3
- –Layer 2: Process related to hypotheses that can be repeated to improve outcomes; three cognitive functions identified (form, refine, and evaluate hypotheses)
- –Layer 3: Identifies six specific operations to complete each function identified in layer 2, that is, prioritizing hypotheses and generating solutions (operations identified in layer 3) are necessary to refine hypotheses (function identified in layer 2)
Contextual Factors
Layer 4: Outlines contextual factors that can influence cognitive operations throughout the CJMM.
Steps involved in putting the CJMM into action
- –The CJMM is not a linear process, so the nurse does not necessarily progress through the layers in order.
- –Layers 3 and 4 of the CJMM outline the process of how a nurse makes decisions in layer 2.
- –Based on the patient response from layer 2 (satisfactory or unsatisfactory), the nurse may move through layers 3 and 4 again.
planning for care
—Educating the patient/family about the necessary care techniques and precautions
—Teaching the patient/family how to integrate care within family activities
—Guiding the patient/family on how to assume a greater percentage of self-care over time
Including the nurse’s and the patient’s/family’s evaluation of expected outcomes
Clinical judgment is defined as the observed outcome of which processes?
Critical thinking
Clinical judgment is defined as the observed outcome of critical thinking and decision making.
Decision making
Clinical judgment is defined as the observed outcome of critical thinking and decision making.
Match the type of contextual factor influencing clinical judgment with the appropriate examples.
Education, experience, knowledge
—-Internal contextual factors
Distractions, time pressures, task complexity
—-External contextual factors
Match the layers of the Clinical Judgment Measurement Model with the concept addressed in each layer.
Observation ---Layer 0 Hypotheses ----Layers 2 and 3 Clinical Judgment ----Layer 1 Contextual Factors ----Layer 4
layer 0 - observation
clinical needs - id pt needs clinical decisions - conclude clinical judgment process - influenced by entire clinical judgment process
layer 1 cognitive
clinical judgment - critical thinking and decision making
Which components are addressed by layer 1 of the Clinical Judgment Measurement Model (CJMM)?
Unobservable cognitive operations
Layer 1 is a cognitive layer of the CJMM that includes unobservable cognitive operations.
Observable outcome of critical thinking
Layer 1 is a cognitive layer of the CJMM that includes the observable outcome of critical thinking.
Which characteristic describes patient needs as they relate to layer 0 of the Clinical Judgment Measurement Model?
Are influenced by clinical decisions
Clinical decisions made at the completion of the clinical judgment process affect patient needs.
Which activities would the nurse perform when a clinical situation occurs according to layer 1 of the Clinical Judgment Measurement Model?
Seek new knowledge.
Respond appropriately.
Consider influencing factors..
Recognize what is happening.
Interpret the meaning of the situation.
layer 2 - hypothesis , refine hypothesis, and evaluate outcomes
use cues
- can be actual problems or problems pt risk of developing
evaluating outcomes
- What signs would indicate improvement or a positive outcome?
- What signs would indicate a decline or a negative outcome?
- What signs would suggest that the patient’s status has not changed?
- Were the solutions/interventions effective?
- What other solutions/interventions might have been more effective?
- Should the nurse revise any components of the plan of care to best meet the patient’s needs?
Which aspect describes the second function in layer 2 of the Clinical Judgment Measurement Model (CJMM)?
Refinement of hypotheses
Once the hypotheses are developed, the nurse refines the hypotheses to ensure that the patient’s priority needs are met in the most appropriate manner.
Which aspect describes the final function of layer 2 of the Clinical Judgment Measurement Model (CJMM)?
Making a judgment about whether or not change has occurred
Evaluation, the final step of layer 2 of the CJMM, requires the nurse to make a judgment as to whether or not change has occurred.
layer 3
3 functions:
- Recognize and analyze cues (to form hypotheses in layer 2),
- prioritize hypotheses and generate solutions (to refine hypotheses in layer 2),
- take actions and evaluate outcomes (to complete the evaluation process in layer 2
