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Concepts of clinical judgment
1. Safety
2. Healthcare quality
3. Leadership
4. Patient education
5. Evidence
6. Professionalism
7. Care coordination
objective data (noticing)
information that is seen, heard, felt, or smelled by an observer; signs
Analytic reasoning
Situation is unfamiliar
subjective data (noticing)
things a person tells you about that you cannot observe through your senses;
symptoms
,Intuitive reasoning
Able to recognize the situation immedialy. Pattern based
factors that influence "Noticing"
-intrapersonal characteristics of the nurse
-theoretical and experiential knowledge of the nurse
-knowing the patient
-context or environment of care
Narrative reasoning
Situation to patient experience with illness.
Interpreting (tanners)
comparing and contrast data, clustering related information, recognizing
inconsistencies, checking accuracy, distinguishing relevant from irrelevant,
determine importance of info, judge how much ambiguity is acceptable (ie b/p
dt condition), determine legal ethical
professional guidelines, (predicting and) *managing potential complications
Noticing
1. Identify signs and symptoms
2. Complete and accurate date
3. Assessing systemically and comprehensively
4. Predicting and managing patient complications
5. Identifying assumptions
, analytic reasoning (interpreting)
based on theoretical knowledge. nurse makes a hypothesis or best guess about
the pt care situation and then tests. typically students and novice nurses
Interpreting
Understanding of the situation
intuitive reasoning (interpreting)
based on unstated but understood knowledge about the pt, the care giving
context, and their previous experiences. typically expert nurse.
Responding
Based on what you interpreted the nurse will determine appropriate actions
narrative reasoning (interpreting)
way of making sense of a situation through telling and interpreting stories. nurse
hears pt stories of past medical experiences, helps nurse understand specific pt
experiences,
setting the stage for individualized care
Reflection in action
Observing patient reaction to the action the nurse chose and deciding if the
situation was fixed