NUR 155 Theory Unit 1 + 2 (EXAM 1)
Clinical Judgement
sometimes referred to as clinical decision-making
Clinical Judgement (defined)
The observed outcome of critical thinking and decision making
Clinical Judgement is
An iterative (repetitious) process that uses nursing knowledge to observe, think,
prioritize, plan, act, and evaluate
Skills required for clinical judgement
critical thinking and clinical reasoning
Critical Thinking
Involves the application of knowledge and experience to identify patient problems and to
direct clinical judgements and actions that result in positive patient outcomes.
_______ is an essential skill required in the nursing diagnosis process and is defined as
an intentional judgment that results in the interpretation, analysis, evaluation, and
inference of data, as well as an explanation for evidence upon which the judgment is
based.
Critical Thinking
______ is the ability to focus and filter clinical data to recognize what is most important
/least important
Clinical reasoning
Differentiate Clinical reasoning and critical thinking
Critical thinking indicator
Logical and intuitive- draws reasonable conclusions, uses intuition as guide, acts on
intuition ONLY with knowledge of risks involved
As one of the key attributes of professional nursing, _________ refers to the process by
which nurses make decisions based on nursing knowledge (evidence, theories,
ways/patterns of knowing), other disciplinary knowledge, critical thinking, and clinical
reasoning.
clinical judgement
Clinical Judgement model
6 steps of the clinical judgment model describe the thinking nurses use within the
nursing process
Clinical Judgement model 6 steps include
,-recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action,
evaluate outcomes
Both the clinical decision-making process and the ______ are cyclical and dynamic
nursing process
Processes within the ________ model overlap with the nursing process.
clinical judgement
What information is relevant/irrelevant? What information is most important? What is of
immediate concern? (OVERLAPS ASSESSMENT)
Recognizing Cues
What client conditions are consistent with the cues? Are there cues that support or
contradict a particular condition? Why is a particular cue or subset of cues of concern?
What other information would help establish the significance of a cue? (OVERLAPS
DIAGNOSIS)
Analyze Cues
Which explanations are most/least likely? Which possible explanations are the most
serious? (OVERLAPS PLANNING)
Prioritize hypothesis
What are the desired outcomes? What interventions can achieve those outcomes?
What should be avoided? (OVERLAPS PLANNING)
Generate solutions
Which interventions are the most appropriate? How should the interventions be
accomplished/performed/taught/documented/administered? (OVERLAPS
IMPLEMENTATION)
Takes action
What signs point to improving/declining/unchanged status? Were the interventions
effective? Would other interventions be more effective? (OVERLAPS EVALUATION)
Evaluate outcomes
Clinical Judgement model overlaps nursing process
Tanner Clinical Judgment model
Identifies four key aspects of clinical judgment:
,Noticing, Interpreting, Responding, and Reflecting
Attributes required for successful Clinical Judgement
§ Strong knowledge base
§ Proficient technical skills
§ Early problem recognition
§ Effective communication
§ Trusting relationship with the patient (* trust is built by being present, listening,
follow-through, consistent, and compassionate. Become familiar with patient's
preferences)
§ Previous experience
§ Confidence
§ Intuition
§ Reflection
Environmental factors that influence clinical judgment skills
1. Task complexity (clinical decision-making ability decreases as the complexity of the
situation increases)
2. Time pressures
3. Interruptions (* medication prep area should be NO interruption zone)
4. Specialty area and autonomy
Strategies to develop strong clinical judgment skills
1. concept mapping (conceptual care maps)
2. collaborative group learning (lab)
3. reflection (clinical/student journaling)
Strategies to develop strong _____________ include utilization of unfolding case
studies, application of skills in appropriate clinical assignments, use of simulation
incorporating clinical scenarios, and concept mapping.
clinical judgment skills
Nursing Process
ADPIE-
Assessment
Diagnosis
Planning
Implementation
Evaluation
Assessment (Step 1 Nursing Process)
Data collection, Verification and Validation of data, Organization of data, Interpretation
of data, Documentation of data
Assessment (Nursing Process)
Is the organized and ongoing appraisal of patient's well-being (definition)
, data is gathered through observation (sight, hearing, smell), interviews, and physical
assessments. Cues are recognized
Data collection
begins at first direct/indirect encounter with patient
Data collection (types)
Primary data (patient interview)
Secondary data (information shared by family members, friends, or other healthcare
team)
Subjective data (spoken information or symptoms that are difficult to validate)
symptoms usually recorded as direct quotations from patient
Objective data (can be measured or observed) Signs Medical records, lab results,
observable information
Recognizing cues (Assessment)
validating data
Nonverbal cues- must be validated
Data interpretation- avoid inaccurate inferences
Methods of Assessment
-observation (sight, hearing, smell)
-patient interview
-physical assessment
Types of physical assessments
-comprehensive (head to toe)
-focused (a more detailed assessment that relates to a current medical condition or a
patient complaint)
-emergency (is performed during emergency procedures, when it is crucial to evaluate
the patient's airway, breathing and circulation)
Diagnosis (Step 2 Nursing Process)
Gather data from your nursing assessment and analyze clusters of defining
characteristics or risk factors to identify relevant nursing diagnoses. Include specific
related or contributing factors to individualize your nursing care.
For example, the nursing diagnosis "Risk for Falls" is associated with altered mobility or
sensory alteration (e.g., visual) risk factors. Altered mobility leads you to select such
nursing interventions as range-of-motion (ROM) exercises; more frequent supervised
ambulation; or teaching the proper use of safety devices such as side rails, canes, or
crutches.
Nursing Diagnosis
Clinical Judgement
sometimes referred to as clinical decision-making
Clinical Judgement (defined)
The observed outcome of critical thinking and decision making
Clinical Judgement is
An iterative (repetitious) process that uses nursing knowledge to observe, think,
prioritize, plan, act, and evaluate
Skills required for clinical judgement
critical thinking and clinical reasoning
Critical Thinking
Involves the application of knowledge and experience to identify patient problems and to
direct clinical judgements and actions that result in positive patient outcomes.
_______ is an essential skill required in the nursing diagnosis process and is defined as
an intentional judgment that results in the interpretation, analysis, evaluation, and
inference of data, as well as an explanation for evidence upon which the judgment is
based.
Critical Thinking
______ is the ability to focus and filter clinical data to recognize what is most important
/least important
Clinical reasoning
Differentiate Clinical reasoning and critical thinking
Critical thinking indicator
Logical and intuitive- draws reasonable conclusions, uses intuition as guide, acts on
intuition ONLY with knowledge of risks involved
As one of the key attributes of professional nursing, _________ refers to the process by
which nurses make decisions based on nursing knowledge (evidence, theories,
ways/patterns of knowing), other disciplinary knowledge, critical thinking, and clinical
reasoning.
clinical judgement
Clinical Judgement model
6 steps of the clinical judgment model describe the thinking nurses use within the
nursing process
Clinical Judgement model 6 steps include
,-recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action,
evaluate outcomes
Both the clinical decision-making process and the ______ are cyclical and dynamic
nursing process
Processes within the ________ model overlap with the nursing process.
clinical judgement
What information is relevant/irrelevant? What information is most important? What is of
immediate concern? (OVERLAPS ASSESSMENT)
Recognizing Cues
What client conditions are consistent with the cues? Are there cues that support or
contradict a particular condition? Why is a particular cue or subset of cues of concern?
What other information would help establish the significance of a cue? (OVERLAPS
DIAGNOSIS)
Analyze Cues
Which explanations are most/least likely? Which possible explanations are the most
serious? (OVERLAPS PLANNING)
Prioritize hypothesis
What are the desired outcomes? What interventions can achieve those outcomes?
What should be avoided? (OVERLAPS PLANNING)
Generate solutions
Which interventions are the most appropriate? How should the interventions be
accomplished/performed/taught/documented/administered? (OVERLAPS
IMPLEMENTATION)
Takes action
What signs point to improving/declining/unchanged status? Were the interventions
effective? Would other interventions be more effective? (OVERLAPS EVALUATION)
Evaluate outcomes
Clinical Judgement model overlaps nursing process
Tanner Clinical Judgment model
Identifies four key aspects of clinical judgment:
,Noticing, Interpreting, Responding, and Reflecting
Attributes required for successful Clinical Judgement
§ Strong knowledge base
§ Proficient technical skills
§ Early problem recognition
§ Effective communication
§ Trusting relationship with the patient (* trust is built by being present, listening,
follow-through, consistent, and compassionate. Become familiar with patient's
preferences)
§ Previous experience
§ Confidence
§ Intuition
§ Reflection
Environmental factors that influence clinical judgment skills
1. Task complexity (clinical decision-making ability decreases as the complexity of the
situation increases)
2. Time pressures
3. Interruptions (* medication prep area should be NO interruption zone)
4. Specialty area and autonomy
Strategies to develop strong clinical judgment skills
1. concept mapping (conceptual care maps)
2. collaborative group learning (lab)
3. reflection (clinical/student journaling)
Strategies to develop strong _____________ include utilization of unfolding case
studies, application of skills in appropriate clinical assignments, use of simulation
incorporating clinical scenarios, and concept mapping.
clinical judgment skills
Nursing Process
ADPIE-
Assessment
Diagnosis
Planning
Implementation
Evaluation
Assessment (Step 1 Nursing Process)
Data collection, Verification and Validation of data, Organization of data, Interpretation
of data, Documentation of data
Assessment (Nursing Process)
Is the organized and ongoing appraisal of patient's well-being (definition)
, data is gathered through observation (sight, hearing, smell), interviews, and physical
assessments. Cues are recognized
Data collection
begins at first direct/indirect encounter with patient
Data collection (types)
Primary data (patient interview)
Secondary data (information shared by family members, friends, or other healthcare
team)
Subjective data (spoken information or symptoms that are difficult to validate)
symptoms usually recorded as direct quotations from patient
Objective data (can be measured or observed) Signs Medical records, lab results,
observable information
Recognizing cues (Assessment)
validating data
Nonverbal cues- must be validated
Data interpretation- avoid inaccurate inferences
Methods of Assessment
-observation (sight, hearing, smell)
-patient interview
-physical assessment
Types of physical assessments
-comprehensive (head to toe)
-focused (a more detailed assessment that relates to a current medical condition or a
patient complaint)
-emergency (is performed during emergency procedures, when it is crucial to evaluate
the patient's airway, breathing and circulation)
Diagnosis (Step 2 Nursing Process)
Gather data from your nursing assessment and analyze clusters of defining
characteristics or risk factors to identify relevant nursing diagnoses. Include specific
related or contributing factors to individualize your nursing care.
For example, the nursing diagnosis "Risk for Falls" is associated with altered mobility or
sensory alteration (e.g., visual) risk factors. Altered mobility leads you to select such
nursing interventions as range-of-motion (ROM) exercises; more frequent supervised
ambulation; or teaching the proper use of safety devices such as side rails, canes, or
crutches.
Nursing Diagnosis
