Unit 1: Ch. 4 Clinical Judgement in Nursing Flashcards
The student nurse is preparing for the first clinical day of patient care. Which strategy of critical thinking would be an example of thinking ahead?
a. Researching evidence-based care strategies
b. Assessing the patient’s physical status
c. Identifying and preventing patient risk
d. Deciding what component of care could be improved
Answer: a
Thinking ahead requires being prepared, anticipating potential challenges, and identifying necessary resources that can provide helpful information. Thinking ahead is especially important for students and novice nurses. Ways in which student nurses can think ahead include reading textbooks, researching evidence-based care strategies, and becoming aware of resource people within the clinical setting. B and C are examples of thinking in action and D is an example of thinking back or reflecting.
Which educational activities will promote the development of clinical judgment skills in nurses and student nurses? (Select all that apply.)
a. Unfolding case studies
b. Clinical assignments
c. Simulation of clinical scenarios
d. Answering true/false test questions
e. Concept mapping
f. Completing math calculations
Answers: a, b, c, e
Strategies to develop strong clinical judgment skills include utilization of unfolding case studies, application of skills in appropriate clinical assignments, use of simulation incorporating clinical scenarios, and concept mapping. Answering true/false test questions and completing math calculations do not enhance clinical judgment.
The nurse is completing a patient assignment and will use information gathered to identify problems and work to prevent complications. In the National Council of State Boards of Nursing-Clinical Judgment Measurement Model (NCSBN-CJMM), this activity occurs in which step?
a. Take action
b. Outcome evaluation
c. Recognize cues
d. Analyze signs
Answer: c
Identify relevant and important information from different sources (e.g., medical history, vital signs), assessing what information is relevant/irrelevant and most important as well as what information is most important are all components of recognizing cues in the NCSBN-CJMM. Taking action and analysis of signs (cues) are other steps in the NCSBN-CJMM. Evaluation is the final step in the Nursing Process and the NGN Clinical Judgment Process.
The nurse recognizes that in Tanner’s Clinical Judgment Model, which statement best explains the step of interpreting?
a. The nurse engages in clinical reasoning to analyze what is occurring and to form a hypothesis.
b. After actions are considered for care, the nurse weighs the potential outcomes of those interventions.
c. The nurse gets the initial grasp of the patient’s situation.
d. The nurse “reads” the patient and adjusts interventions based on this assessment.
Answer: a
When the nurse uses clinical reasoning to analyze what is occurring and to form a hypothesis, this is the step of interpreting in the Tanner Clinical Judgment Model. It is responding when, after actions are considered for care, the nurse weighs the potential outcomes of those interventions. Noticing is when the nurse gets the initial grasp of the patient’s situation. Reflection-in-action is when the nurse reads the patient and adjusts interventions based on this assessment.
The nurse obtains a lower-than-normal (88% on room air) pulse oximetry reading on a patient. Which actions by the nurse result from accurately employing the clinical judgment attribute of early problem recognition? (Select all that apply.)
a. Assessing the patient for symptoms of hypoxia
b. Providing oxygen according to standing orders
c. Elevating the head of the bed, if not contraindicated
d. Allowing the patient to be alone to rest more comfortably
e. Discussing adaptations needed for daily activities with the patient
Answers: a, b, c
Early problem recognition is critical to safe patient care. Noticing slight or dramatic changes in a condition and preventing complications is expected of all nurses. Accurate and ongoing assessment is essential throughout nurse–patient interaction. In this case, early problem identification includes assessing the patient for symptoms of hypoxia (to determine the extent of air hunger), providing oxygen as ordered (which promotes increased gas exchange), and elevating the head of the bed (which helps ease the effort of breathing). Leaving a patient who has a low pulse oximetry reading alone is potentially dangerous and not early problem identification. Discussing nonemergent information with a patient experiencing air hunger requires increased oxygen consumption. This is inappropriate and, again, is not early identification of problems.
The nurse categorizes which nursing action as an example of professional autonomy?
a. The nurse working on a medical unit contacts the respiratory therapist to draw arterial blood gases (ABGs) for a patient with acute asthma.
b. The novice nurse seeks out an experienced colleague for guidance when preparing to administer blood.
c. The nurse contacts the PCP for clarification of a medication order.
d. The experienced nurse who works in the intensive care unit draws ABGs for an assigned ICU patient.
Answer: d
Professional autonomy implies self-sufficiency and independence. Often, each nursing unit within a medical center or hospital has different rules about what interventions nurses practicing on that unit are permitted to perform. For instance, a nurse practicing in the intensive care unit may be required to draw arterial blood gases (ABGs) on assigned patients. However, the same nurse may be required to call a respiratory therapist to draw ABGs when working on a medical surgical unit. The other choices indicate application of critical thinking skills at varying levels but do not indicate professional autonomy.
The nurse identifies that confidence is one of the attributes of successful clinical judgment. Which statements by the nurse are accurate regarding this attribute? (Select all that apply.)
a. “Nurses who are confident are more assertive.”
b. “Overconfidence occurs with increased experience.”
c. “Legitimate confidence results from knowledge and willingness to seek guidance from expert practitioners.”
d. “Overconfidence may lead to negative patient outcomes.”
e. “Confidence in actions is simply reacting to problems.”
Answers: a, c, d
Confidence is demonstrated by nurses who are more assertive, seek knowledge and guidance from experts, and recognize that overconfidence may lead to poor patient outcomes. B is not true, as overconfidence in nursing may lead to unsafe care. E is not accurate, as confidence is taking preventive actions rather than simply reacting to problems.
The nurse administers an IV pain medication that has an onset of 5 minutes to a patient who is reporting a pain level of 9/10. When the patient does not begin to get relief after the 5-minute time frame, the nurse immediately looks for interventions to help reduce the pain level. This response is an example of what aspect of Tanner’s Clinical Judgment Model?
a. Reflection-on-action
b. Reflection-in-action
c. Analysis of cues
d. Information seeking
Answer: b
When the nurse recognizes an issue during an action and then acts on that issue, that is reflection-in-action. Reflection-on-action takes place after the fact or retrospectively. Analysis of cues and information seeking are not steps in Tanner’s Clinical Judgment Model.
The nurse recognizes which environmental factors that influence clinical judgment skills? (Select all that apply.)
a. Cultural values
b. Literature review
c. Cue analysis
d. Complexity of tasks
e. Interruptions
Answers: a, d, e
A, D and E are all environmental factors that can impact clinical judgment skills. Cue analysis is a component of the NCSBN-CJMM. Literature review is a strategy to develop strong clinical judgment skills.
During the assessment of a patient admitted for a total hip replacement, the nurse asks the patient to explain prior hospital experiences and, more specifically, any operative experiences. These questions reflect the nurse’s use of which clinical judgment attributes? For each potential attribute, mark an X in the corresponding column, to indicate whether the attribute is effective, ineffective, or unrelated:
Clinical judgment attributes:
Early problem recognition: Effective
Strong knowledge base: Effective
Self-awareness: Unrelated
Reflection:
Intuition: Effective
Proficient technical skills: Unrelated
Effective communication: Effective
Courageous: Unrelated
Early problem recognition, strong knowledge base, intuition, and effective communication are the clinical judgment attributes that the nurse utilized when asking the questions of the patient. While proficient technical skills is an attribute of clinical judgment, it is unrelated in this context. Self-awareness and being courageous are not clinical judgment attributes.
The observed outcome of critical thinking and decision-making.
Clinical judgement.
Integrate data
Synthesize
Indicators that support or contraindicate a particular condition.
Cues
