Nurs 207 - Clinical Judgement Flashcards

1
Q

Define clinical judgement

A

“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.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Clinical Reasoning

A

An interactive process of noticing, interpreting, and responding
It is the thinking process in which a nurse receives a clinical judgement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Critical Thinking

A

Cognitive process used for analysis of an issue or problem

  • knowledge-based
  • not dependent on a particular situation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Critical Thinking and Critical Reasoning

A

are the process that leads to clinical judgement (conclusion, decision, or opinion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Novice to Expert - Patricia Benner

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Scope of Clinical Judgement

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

True or False. Nursing care is linear

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Attributes of Clinical Judgement

A
  • Holistic View of the Patient situation
  • Process Orientation
  • Reasoning and Interpretation

Ethical Comportment (in readings not in lecture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Holistic View of the Patient Situation

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Process Orientation

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Reasoning and Interpretation

A
  • Nurses use at least 3 types of reasoning: analytic, intuitive, narrative
  • Type of reasoning depends on the caregiving situation and the nurses previous experience
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of reasoning would an inexperienced nurse use?

A

unfamiliar nurse = analytic reasoning process, consider the possibilities, come to a conclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of reasoning would an experienced nurse use?

A

experienced nurse = recognize the situation and act intuitively and tacitly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Narrative form of reasoning

A

recognizing the significance of the situation - engage in interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ethical Comportment

A

Nurses come to a patient situation with an outlook of what is right/good for the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nursing Knowledge

A

Borrows from other disciplines

Nursing theorists further build and define nursing as a practice and nursing science

New knowledge comes from nursing research

17
Q

True or False. Nursing knowledge is always changing

A

True

18
Q

What is knowledge of discipline?

A

Knowledge that has been collectively judged by standards that are shared by members of a disciplinary community and that is taken to be a valid and accurate understanding of elements and features that comprise the discipline

19
Q

List Carpers Ways of Knowing (5)

A
● Empirical knowing
● Personal knowing
● Ethical knowing
● Aesthetic knowing
● Emancipatory knowing
20
Q

Methods of turning knowledge into knowledge

A

Problem-based learning

Clinical Supervision

Structured reflection on practice

21
Q

Problem-based learning

A
  • an instructional method in which students work in small groups
  • used to gain knowledge and problem-solving skills
22
Q

Clinical Supervision

A
  • exchange between practicing professionals to enable the development of professional knowledge and skills
23
Q

Structured reflection on practice

A
  • learning gained from the experience

- “how has this experience changed my ways of knowing?”

24
Q

Ethical Knowing

A

Refer to the moral aspects of nursing
- Encompass knowledge of what is right or wrong, attention to standards and codes in making moral choices, responsibility for one’s actions, and protection of one’s autonomy and rights

25
Q

Ethical Pattern of Knowing Focus is on…

A

a) Matters of obligation, what ought to be done
b) Right, wrong, and responsibility
c) Ethical codes of nursing
d) Confronting and resolving conflicting values, norms, interests or principles

26
Q

Moral Distress

A

Ethical situation in conflict with one’s values

27
Q

Personal Knowing

A

Acceptance of self that is grounded in self-knowledge and confidence
- occurs when a nurse is able to intuitively understand and treat individual clients as unique human beings because of the nurses own personal experience and awareness of his/her own humanness

28
Q

Personal Knowing is concerned with:

A

Becoming self-aware - grows over time through interactions with others

Personal reflection - informed by the response of others

Openness to experience

29
Q

Aesthetic Way of Knowing

A

The art of nursing

  • The seamless interactive process in which nurses combine knowledge, skills, and scientific medical understandings with an individualized knowledge of the humanity of each client as a unique individual with physical, cognitive, emotional, and spiritual needs
30
Q

Aesthetic way of knowing

Knowing what to do without conscious deliberation involves:

A

Deep appreciation of the meaning of a situation

Moves beyond the surface of a situation

Often shared without conscious exchange of words

Brings together all the elements of a nursing care situation to create a meaningful whole

31
Q

Aesthetic way of knowing uses the nurses ______ and _______. It is based on the ____ of the nurse in a given situation.

A

intuition and empathy

skill

32
Q

Empirical Knowing

A

The science of nursing

Based on the assumption that what is known is accessible through seeing, touching, and hearing

Responds to questions such as “what is this? and “how does this work?”

Research-based interventions that we know are effective

33
Q

Emancipatory Knowing

A

Addresses the social and political context of nursing and healthcare and critiques the four fundamental patterns of knowing

Recognizes social barriers to health and well-being

Requires seeing the larger picture and correcting social processes, patterns, and structures that create social inequities and injustices

How are things inappropriate or unjust

How can we advocate and support our patients

34
Q

Examples of Emancipatory Knowing

A

Why do we have this problem/injustice in the first place?

How can we make changes?

How can we create opportunities for women in the workplace? (Gender Inequality)

How can we overcome the stigma of HIV?

  • Emancipatory knowing demands that an individual work toward the elimination of these situations
35
Q

Define Nursing Metapartigram

A

Consists of four basic concepts that address the patient as a whole, the patient’s health and well-being, the patient’s environment and the nursing responsibilities.

36
Q

Nursing Metapartigram concepts

A

Person - The individuals receiving care
(can refer to an individual, family, group, community, province, country)

Health - State of illness or health

Environment - Where the nursing happens?

Nursing - The care provided for patients

Each nursing theorist has their own way to define these