Nurs 207 - Clinical Judgement

Question 1

Define clinical judgement

Answer 1

“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.”

Question 2

Define Clinical Reasoning

Answer 2

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

Question 3

Define Critical Thinking

Answer 3

Cognitive process used for analysis of an issue or problem

• knowledge-based
• not dependent on a particular situation

Question 4

Critical Thinking and Critical Reasoning

Answer 4

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

Question 5

Novice to Expert - Patricia Benner

Answer 5

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

Question 6

Scope of Clinical Judgement

Answer 6

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

Question 7

True or False. Nursing care is linear

Answer 7

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

Question 8

Attributes of Clinical Judgement

Answer 8

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

Ethical Comportment (in readings not in lecture)

Question 9

Holistic View of the Patient Situation

Answer 9

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

Question 10

Process Orientation

Answer 10

• 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

Question 11

Reasoning and Interpretation

Answer 11

• Nurses use at least 3 types of reasoning: analytic, intuitive, narrative
• Type of reasoning depends on the caregiving situation and the nurses previous experience

Question 12

What type of reasoning would an inexperienced nurse use?

Answer 12

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

Question 13

What type of reasoning would an experienced nurse use?

Answer 13

experienced nurse = recognize the situation and act intuitively and tacitly

Question 14

Narrative form of reasoning

Answer 14

recognizing the significance of the situation - engage in interventions

Question 15

Ethical Comportment

Answer 15

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

Question 16

Nursing Knowledge

Answer 16

Borrows from other disciplines

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

New knowledge comes from nursing research

Question 17

True or False. Nursing knowledge is always changing

Answer 17

True

Question 18

What is knowledge of discipline?

Answer 18

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

Question 19

List Carpers Ways of Knowing (5)

Answer 19

● Empirical knowing
● Personal knowing
● Ethical knowing
● Aesthetic knowing
● Emancipatory knowing

Question 20

Methods of turning knowledge into knowledge

Answer 20

Problem-based learning

Clinical Supervision

Structured reflection on practice

Question 21

Problem-based learning

Answer 21

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

Question 22

Clinical Supervision

Answer 22

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

Question 23

Structured reflection on practice

Answer 23

• learning gained from the experience

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

Question 24

Ethical Knowing

Answer 24

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

Question 25

Ethical Pattern of Knowing Focus is on...

Answer 25

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

Question 26

Moral Distress

Answer 26

Ethical situation in conflict with one's values

Question 27

Personal Knowing

Answer 27

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

Question 28

Personal Knowing is concerned with:

Answer 28

Becoming self-aware - grows over time through interactions with others Personal reflection - informed by the response of others Openness to experience

Question 29

Aesthetic Way of Knowing

Answer 29

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

Question 30

Aesthetic way of knowing Knowing what to do without conscious deliberation involves:

Answer 30

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

Question 31

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

Answer 31

intuition and empathy skill

Question 32

Empirical Knowing

Answer 32

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

Question 33

Emancipatory Knowing

Answer 33

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

Question 34

Examples of Emancipatory Knowing

Answer 34

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

Question 35

Define Nursing Metapartigram

Answer 35

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.

Question 36

Nursing Metapartigram concepts

Answer 36

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