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
Nursing Knowledge
Borrows from other disciplines
Nursing theorists further build and define nursing as a practice and nursing science
New knowledge comes from nursing research
True or False. Nursing knowledge is always changing
True
What is knowledge of discipline?
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
List Carpers Ways of Knowing (5)
● Empirical knowing ● Personal knowing ● Ethical knowing ● Aesthetic knowing ● Emancipatory knowing
Methods of turning knowledge into knowledge
Problem-based learning
Clinical Supervision
Structured reflection on practice
Problem-based learning
- an instructional method in which students work in small groups
- used to gain knowledge and problem-solving skills
Clinical Supervision
- exchange between practicing professionals to enable the development of professional knowledge and skills
Structured reflection on practice
- learning gained from the experience
- “how has this experience changed my ways of knowing?”
Ethical Knowing
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
Ethical Pattern of Knowing Focus is on…
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
Moral Distress
Ethical situation in conflict with one’s values
Personal Knowing
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
Personal Knowing is concerned with:
Becoming self-aware - grows over time through interactions with others
Personal reflection - informed by the response of others
Openness to experience
Aesthetic Way of Knowing
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
Aesthetic way of knowing
Knowing what to do without conscious deliberation involves:
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
Aesthetic way of knowing uses the nurses ______ and _______. It is based on the ____ of the nurse in a given situation.
intuition and empathy
skill
Empirical Knowing
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
Emancipatory Knowing
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
Examples of Emancipatory Knowing
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
Define Nursing Metapartigram
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.
Nursing Metapartigram concepts
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
