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mod 5 ch 16 clinical judgement model Flashcards

1
Q

clinical judgement

A

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,

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2
Q

components of the clinical judgement measurement model

A
  • incorporates clinical judgment process
  • ids diff types contextual factors
  • defines nonlinear process
  • requires clinical judgment skills
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3
Q

incorporates clinical judgment process

A

cue recognition, hypothesis generation, hypothesis evaluation, taking actions, and evaluating outcomes

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4
Q

identifies diff types contextual factors

A
  • -Internal contextual factors: education, experience, knowledge, communication, consequences/risks, emotions/perceptions
  • –External contextual factors: distractions, interruptions, time pressures, task complexity, professional autonomy
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5
Q

defines nonlinear process

A

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

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6
Q

requires clinical judgment skills

A

acknowledges that because a nurse has knowledge, it does not necessarily mean the nurse has good clinical judgment skills

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7
Q

layers

A
  • observation - layer 0
  • cognitive operations - layer 1-3
  • contextual factors- layer 4
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8
Q

observation

A

Layer 0: Client needs (initiate the process of clinical judgment) and clinical decisions (end the process of clinical judgment)

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9
Q

Cognitive Operations

A
  • –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)
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10
Q

Contextual Factors

A

Layer 4: Outlines contextual factors that can influence cognitive operations throughout the CJMM.

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11
Q

Steps involved in putting the CJMM into action

A
  • –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.
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12
Q

planning for care

A

—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

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13
Q

Clinical judgment is defined as the observed outcome of which processes?

A

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.

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14
Q

Match the type of contextual factor influencing clinical judgment with the appropriate examples.

A

Education, experience, knowledge
—-Internal contextual factors
Distractions, time pressures, task complexity
—-External contextual factors

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15
Q

Match the layers of the Clinical Judgment Measurement Model with the concept addressed in each layer.

A 
Observation
---Layer 0
Hypotheses
----Layers 2 and 3
Clinical Judgment
----Layer 1
Contextual Factors
----Layer 4
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16
Q

layer 0 - observation

A 
clinical needs
- id pt needs
clinical decisions
- conclude clinical judgment process
- influenced by entire clinical judgment process
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17
Q

layer 1 cognitive

A

clinical judgment - critical thinking and decision making

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18
Q

Which components are addressed by layer 1 of the Clinical Judgment Measurement Model (CJMM)?

A

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.

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19
Q

Which characteristic describes patient needs as they relate to layer 0 of the Clinical Judgment Measurement Model?

A

Are influenced by clinical decisions

Clinical decisions made at the completion of the clinical judgment process affect patient needs.

20
Q

Which activities would the nurse perform when a clinical situation occurs according to layer 1 of the Clinical Judgment Measurement Model?

A

Seek new knowledge.

Respond appropriately.

Consider influencing factors..

Recognize what is happening.

Interpret the meaning of the situation.

21
Q

layer 2 - hypothesis , refine hypothesis, and evaluate outcomes

A

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?
22
Q

Which aspect describes the second function in layer 2 of the Clinical Judgment Measurement Model (CJMM)?

A

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.

23
Q

Which aspect describes the final function of layer 2 of the Clinical Judgment Measurement Model (CJMM)?

A

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.

24
Q

layer 3

A

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
25
Q

layer 3

A

recognize and analyze cues

26
Q

layer 3

A

prioritize hypotheses

  • id outcomes to generate solutions
  • generate solutions: supporting interventions (nurse-initiated, hcp initiated, collaborative)
27
Q

layer 3

A

take action and eval outcomes

28
Q

Which sources would the nurse use to collect objective patient cues?

A

lab report, med records, phys assessment

29
Q

Which step of layer 3 of the Clinical Judgment Measurement Model involves organizing and linking cues to the patient’s clinical condition?

A

Analyze cues

During the “analyze cues” step of layer 3, the nurse organizes and links cues to the patient’s actual or potential clinical condition, much like putting pieces of a puzzle together. The nurse places similar or related “puzzle pieces” (cues) together to form a picture (hypothesis).

30
Q

Which characteristic describes the influence of context on clinical judgment?

A

Affects the understanding of the patient situation

Context is defined as aspects that influence the understanding of an event, circumstance, or condition.

31
Q

Which description best explains how contextual factors affect the way nurses communicate?

A

Encourage the nurse to recognize new insights

Consideration of context during communication allows the nurse to recognize new insights that are shared during the conversation.

32
Q

Match the functions from layer 3 of the Clinical Judgment Measurement Model with the expected nursing behaviors of a nurse caring for a pediatric diabetic patient based on potential contextual factors from layer 4.

A 
Avoid glucose
---Prioritize hypotheses
Apply evidence to identify patient issues
---Analyze cues
Identify signs and symptoms of diabetes
---Recognize cues
Identify developmentally appropriate goals for diabetic patient
---Generate solutions
33
Q

Which characteristics describe the Clinical Judgment Measurement Model (CJMM)?

A
  • requires cue recognition
  • considers contextual factors
  • includes eval of outcomes
  • incorps hypothesis gen
34
Q

Layer 1 of the Clinical Judgment Measurement Model (CJMM) focuses on which concept?

A

clinical judgment

35
Q

Which questions can the nurse ask to complete the evaluation function of layer 2 of the Clinical Judgment Measurement Model (CJMM)?

A
  • should plan care be revised
  • were solutions/interventions effective
  • which signs would suggest pt staus not changed
  • what other solutions/interventions might be more effective
36
Q

Which variables would the nurse consider when prioritizing hypotheses in layer 3 of the Clinical Judgment Measurement Model?

A

urgency

  • risk complications
  • likelihood occurrence
37
Q

Which competencies did the American Nurses Association (ANA) identify as essential for evaluating outcomes?

A
  • include pt perspective
  • doc eval info
  • incorp ongoing assess data
  • collab to develop plan care
38
Q

Which statements describe the benefits of considering context when making nursing decisions during layer 4 of the Clinical Judgment Measurement Model (CJMM)?

A
  • nurse consider approp resources
  • nurse make pt-centered decisions
  • nurse have realistic understanding situation
  • nurses comm more effectively
39
Q

Which statement describes the impact of experience on clinical judgment?

A

-new and experienced nurse both expected apply clinical judgment prevent pt events

40
Q

Which concepts are examples of internal contextual factors that influence clinical judgment?

A

emotions, knowledge, comms,

41
Q

Which concept is addressed in layer 0 of the Clinical Judgment Measurement Model (CJMM)?

A

pt needs

42
Q

Which statement describes a characteristic of clinical judgment in nursing practice?

A

its foundation of safe, competent practice

43
Q

Which aspects describe layer 2 of the Clinical Judgment Measurement Model (CJMM)?

A

-eval pt outcomes
-connects cues form hypotheses
-forms hypotheses to address problems
-

44
Q

Place the three functions of layer 2 of the Clinical Judgment Measurement Model in the order in which they occur.

A

-formulate hypotheses
refine hypotheses
eval outcomes

45
Q

Match the type of nursing intervention with the appropriate example.

A

Inserting a Foley catheter
—Dependent
Teaching patients about medication management
–Independent
Encouraging exercise plan developed by physical therapist
—Collaborative

46
Q

Which concept is the focus of layer 4 of the Clinical Judgment Measurement Model (CJMM)?

A

contextual factors

47
Q

Which concepts are examples of external contextual factors that influence clinical judgment?

A

interruptions, task complexity, professional autonomy

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