Patient Care Management Flashcards
What does clinical judgement impact?
- Safety
- Quality of care
- Patient outcomes
- Agencies
- Communities
Define clinical judgement
Interpretations and inferences that influence actions in clinical practice
What does clinical judgement require?
- clinical reasoning
- priority setting
Define clinical reasoning
Thinking process by which a nurse reaches clinical judgement
Define priority setting
Ordering or ranking of problems for the purpose of delivering optimal care
Steps (aspects) of clinical judgement
- Noticing
- Interpreting
- Responding
- Reflecting
What does the novice nurse base noticing, interpreting, responding, and reflecting on?
- Standards of care
- guidelines
- mentorship/training
- miro care needs
- understanding of biophysical, psychosocial, and cultural knowledge
What does the experienced nurse base noticing, interpreting, responding, and reflecting on?
same as novice…
- personal experience
- understanding of complex and interconnected factors
- pattern recognition
- macro and micro care needs
Who is a novice?
student/ fresh out of school
Who is an advanced beginner
Little time out of school
-still task orriented
Who is a competent nurse?
After 2-3 years in practice.
-pattern recognition emerges
Who is a proficient nurse?
has Highly skilled responses
Who is a expert nurse?
3-5 years in practice
- intuitive grasp of multiple presentations
- highest level of clinical competence
How to help foster clinical judgment
- analyze situations
- wide range of clinical learning opportunities
- use of evidence
- telling stories about practice
- apply concepts to nursing
- reflective practice
Why we prioritize?
- if equal attention is given to major and minor problems, may not be able to resolve important problems and reach desired outcomes
- allows identification between problems and to developed a safe, effective plan
Two classifications categories of priority
- priority of importance
- priority of time (urgency)
Process of priority setting
- Identify problems
- Assign priority
- Select intervention for designed outcome
Factors that influence priority setting
- Patient acuity
- Availability of resources
- nurse-patient relationship
- Experience/expertise of provider
- unit/agency organization
- framework used
- philosophies of care
- nurse-specific factors
How to go about priority setting. (tools)
- Maslow
- ABC
- Consider the whole person
NCLEX question prioritization
-ABC (first)
-MAAUAR (second)
~Mental status change
~Acute pain
~Acute urinary elimination concerns
~Unaddressed and untreated problems
~Abnormal lab findings or other diagnostic date outside normal
~Risks (safety, skin breakdown, infection, other medical conditions.)
