Nurs 207 - Clinical Judgement Flashcards
Define clinical judgement
“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.”
Define Clinical Reasoning
An interactive process of noticing, interpreting, and responding
It is the thinking process in which a nurse receives a clinical judgement
Define Critical Thinking
Cognitive process used for analysis of an issue or problem
- knowledge-based
- not dependent on a particular situation
Critical Thinking and Critical Reasoning
are the process that leads to clinical judgement (conclusion, decision, or opinion)
Novice to Expert - Patricia Benner
Novice - Has no professional experience
Beginner - Can note recurrent meaningful situational, components, but not, prioritize between them
Competent - Begins to understand actions in terms of long-range goals
Proficient - Perceives situation as wholes, rather than in terms of aspects
Expert - Has an intuitive grasp of the situation and zeroes in on the accurate region of the problem
Scope of Clinical Judgement
Standards-based approach
- rules, algorithms, guidelines based on evidence/research
Interpretivist Perspective
- one clear cut path is probably not appropriate for most patients
- intuitive way of thinking
- consider unique patient situation and context
- take what they know, their values, as well as their knowledge of the patient
Evidence-based Practice and Clinical Judgement
- use the best available evidence to inform their practice and to support good outcomes for patients
- safe and effective care requires that the nurse knows enough information to apply to the situation
Generally an integration of all 3
True or False. Nursing care is linear
False. Nursing care is NOT linear
One must consider multiple complex variables for clinical reasoning
There are multiple factors and unknowns
No clear cut answers
Attributes of Clinical Judgement
- Holistic View of the Patient situation
- Process Orientation
- Reasoning and Interpretation
Ethical Comportment (in readings not in lecture)
Holistic View of the Patient Situation
Willingness to consider all factors involved in patient care including:
- certain characteristics of the nurse (theoretical + experimental knowledge, values, biases)
- the relationship with the patient
- context of care
Process Orientation
- Clinical Judgement is circular and interactive
- Nurse employs a deep understanding of the individual patient situation as well as her own background, experience and values
- Nurse recognizes salient (or relevant) features of a unique situation and intervenes
- Observe patients response, determine what next steps will be (outcome of clinical judgement)
- Utilize reflection
Reasoning and Interpretation
- Nurses use at least 3 types of reasoning: analytic, intuitive, narrative
- Type of reasoning depends on the caregiving situation and the nurses previous experience
What type of reasoning would an inexperienced nurse use?
unfamiliar nurse = analytic reasoning process, consider the possibilities, come to a conclusion
What type of reasoning would an experienced nurse use?
experienced nurse = recognize the situation and act intuitively and tacitly
Narrative form of reasoning
recognizing the significance of the situation - engage in interventions
Ethical Comportment
Nurses come to a patient situation with an outlook of what is right/good for the patient