Module 4 - Think like a Nurse: Frameworks

Clinical Judgment Definition

The observed outcome of critical thinking and decision-making.

[Clinical Judgment] What kind of process is it?

An interactive process that uses nursing knowledge.

[Clinical Judgment] What does it use nursing knowledge to do?

1) Observe and assess presenting situations

2) Identify and prioritize client concerns

[Clinical Judgment] What is its goal?

Generate the best possible evidence-based solutions, to provide safe client care.

[Clinical Judgment] Formula

Critical thinking + clinical reasoning = clinical judgment.

[Clinical Judgment] Why learn the Caputi Method?

1) Transform everyday thinking to clinical judgment = safe patient care + improved outcomes

2) Become a self-directed thinker

3) Use situation-based thinking

4) Deal with unexpected occurrences and reduce errors in healthcare

5) Become resilient

6) Prepare for the NCLEX-RN exam

[Clinical Judgment] Everyday thinking is transformed into what?

Clinical judgment, leading to safe patient care and improved outcomes.

Which exam does the Caputi Method help prepare you for?

The NCLEX-RN.

Nursing Process

A systematic approach to patient care.

[Nursing Process] Major purpose

A step-by-step process used to identify, plan and evaluate nursing care related to individual patient needs.

Step 1: Assessment

Collecting, organizing, validating and documenting data.

Step 2: Identify Problem (nursing diagnosis)

A problem statement directly related to assessment findings; the basis for interventions.

Step 3: Planning

Prioritizing and goal setting for the problem; determines actions to take.

Step 4: Implementation

Interventions: what you will do.

Step 5: Evaluation

Reassess the problem: effectiveness and modifications.

What was 'Identify Problem' once called?

Nursing diagnosis.

What is the Caputi Clinical Judgment Framework?

An organized framework.

[Caputi Method] What are competencies?

The language used to describe specific thinking skills.

[Caputi Method] What does the method guide?

Real-time decision-making through critical thinking.

[Caputi Method] What is it based on?

The NCSBN Clinical Judgment Model.

[Caputi Method] What does it emphasize?

Recognizing cues, analyzing information, and making timely decisions in dynamic clinical situations.

[Caputi Method] How does it relate to the nursing process?

the "how to" of the nursing process: it explains the thinking, the details.

[Caputi Method] Major purpose of using it.

To transform everyday thinking into clinical judgment (safe patient care + improved outcomes), through an organized framework and clear language for thinking skills.

How is the Caputi Method learned? (process)

Definition of each competency -> relate to everyday life -> everyday life example -> nursing example -> apply each competency in the nursing example -> use cognitive guidance tools to learn each competency.

[Caputi Steps] Name the 5 major steps in order

1) Getting the Information (Assessing)

2) Making Meaning of the Information (Problem solving/Diagnosing)

3) Determining Actions to take (Planning)

4) Taking Action (Implementing)

5) Evaluating outcomes and your thinking (Evaluating)

[Caputi Steps] Step 1 competencies

a) Determining important information to collect

b) Scanning the environment / c) Identifying signs and symptoms

d) Assessing systematically and comprehensively

e) Ensuring accurate information

[Caputi Steps] Step 2 competencies

a) Clustering related information

b) Identifying assumptions

c) Recognizing inconsistencies

d) Distinguishing relevant from irrelevant information

e) Judging how much ambiguity is acceptable

f) Comparing and contrasting

g) Predicting potential complications

h) Collaborating with healthcare team workers

i) Determining patient care needs/healthcare environment issues

[Caputi Steps] Step 3 competencies

a) Selecting interventions

b) Managing potential complications

c) Setting priorities

[Caputi Steps] Step 4 competencies

a) Determining how to implement the planned interventions

b) Assigning

c) Communicating

d) Teaching others

[Caputi Steps] Step 5 competencies

a) Evaluating data

b) Evaluating and correcting thinking

[Caputi Steps] Which step is 'Assessing'?

Step 1: Getting the Information.

[Caputi Steps] Which step is 'Diagnosing'?

Step 2: Making Meaning of the Information.

[Caputi Steps] Which step is 'Planning'?

Step 3: Determining Actions to take.

[Caputi Steps] Which step is 'Implementing'?

Step 4: Taking Action.

[Caputi Steps] Which step is 'Evaluating'?

Step 5: Evaluating outcomes and your thinking.

[Caputi Steps] Which step has 'setting priorities'?

Step 3: Determining Actions to take.

[Caputi Steps] Which step has 'clustering related information'?

Step 2: Making Meaning of the Information.

[Caputi Steps] Which step has 'scanning the environment'?

Step 1: Getting the Information.

[Caputi Steps] Which step has 'teaching others' and 'assigning'?

Step 4: Taking Action.

[Caputi Steps] Which step has 'evaluating and correcting thinking'?

Step 5: Evaluating outcomes and your thinking.

What is NCSBN-CJMM?

The clinical judgment model used for the Next Generation NCLEX.

Assessing = ? (Caputi / NCSBN-CJMM)

Caputi: Getting the Information

NCSBN-CJMM: Recognize Cues.

Diagnosing (problem solving) = ?

Caputi: Making Meaning of the Information

NCSBN-CJMM: Analyze Cues.

Planning = ?

Caputi: Determining Actions to take

NCSBN-CJMM: Prioritize Hypotheses and Generate Solutions.

Implementing = ?

Caputi: Taking Action

NCSBN-CJMM: Take Actions.

Evaluating = ?

Caputi: Evaluating Outcomes and your Thinking

NCSBN-CJMM: Evaluate Outcomes.

NCSBN-CJMM 'Recognize Cues' matches which Caputi step?

Step 1: Getting the Information.

NCSBN-CJMM 'Analyze Cues' matches which Caputi step?

Step 2: Making Meaning of the Information.

NCSBN-CJMM 'Prioritize Hypotheses' and 'Generate Solutions' match which Caputi step?

Step 3: Determining Actions to take.

What is SBAR?

A cognitive guidance tool (used to learn the competencies and to communicate).

What does SBAR stand for?

Situation, Background, Assessment, Recommendation.

[SBAR] S: Situation

Identify self, health care site, area, title, date. Briefly state the problem/issue: what is it, when it happened or started, how severe.

[SBAR] B: Background

history of problem/issue (with date/time), list of current situations, most recent occurrences, national standards, policy, regulations, standard requirements.

[SBAR] A: Assessment

What is your assessment of the situation?

[SBAR] R: Recommendation

What is your recommendation, or what do you want (say what you want done)?

3 questions to ask about a patient care need

Is it still a problem? Resolved? Problem worse?

If the need is still a problem, what do you ask?

What changes do you need to make?

4 reflection questions

1) What went well with your plan of care?

2) Were any critical cues missed or misinterpreted?

3) How could care planning or prioritization improve in the future?

4) Was the patient satisfied with the care provided?

What is Benner's theory called?

Novice to Expert Theory.

Name the 5 stages in order

1) Novice

2) Advanced beginner

3) Competent

4) Proficient

5) Expert

[Benner] Novice: characteristics

Beginners with no experience in the situations they are expected to perform; they follow rules and guidelines closely.

[Benner] Novice: example

A first-year nursing student learning basic skills and procedures.

[Benner] Advanced beginner: characteristics

Some level of experience; can recognize recurring meaningful components of a situation.

[Benner] Advanced beginner: example

A new graduate nurse who has started working and can perform tasks but still needs guidance.

[Benner] Competent: characteristics

2-3 years of experience in the same area or similar day-to-day situations; can plan and make decisions based on long-term goals.

[Benner] Competent: example

A nurse on a medicine unit for at least 2 years who can manage patient care independently and efficiently.

[Benner] Proficient: characteristics

Perceive situations as wholes rather than individual aspects; can modify plans based on the situation.

[Benner] Proficient: example

A post-op nurse recognizes patterns of internal bleeding from experience and intervenes before problems happen.

[Benner] Expert: characteristics

Extensive experience; intuitive grasp of situations; focuses on the problem without relying on rules or guidelines.

[Benner] Expert: example

An experienced nurse walks into a room, immediately senses something is wrong and acts instantly without needing to think it through.

[Benner] Which stage: follows rules and guidelines closely?

Novice.

[Benner] Which stage: recognizes recurring meaningful components?

Advanced beginner.

[Benner] Which stage: plans based on long-term goals (2-3 years)?

Competent.

[Benner] Which stage: sees situations as wholes and modifies plans?

Proficient.

[Benner] Which stage: intuitive grasp, no need for rules?

Expert.

[Benner] overall idea in the review

you get better over time.

What 3 components overlap to form clinical judgment?

Novice to Expert Theory, Steps in Clinical Judgment, and Clinical Judgment Competencies.

Clinical Judgment Development - 5 ways it develops

1) Practice & repetition

2) Feedback & coaching

3) Reflection

4) Knowledge integration

5) Clinical experiences

Practice & repetition includes

Labs, simulation, case studies and activities (cognitive guidance tools), clinical practice.

[Clinical Judgment Development] Feedback & coaching

Timely, specific feedback; instructor guidance supports decision making.

[Clinical Judgment Development] Reflection

Enhances clinical judgment: what went well, what did not, and WHY?

[Clinical Judgment Development] Knowledge integration

Combining theory, clinical experiences and patient information; connecting concepts.

[Clinical Judgment Development] Clinical experiences

Real patients help recognize patterns, manage uncertainty and adapt to changing conditions; diverse experiences build confidence/clinical judgment.

Thinking + Framework = ?

Foundations of thinking like a nurse.

Caputi Method in one line

The "how to" of the nursing process; explains the thinking and the details.