14Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 14 Clinical Judgment

A student nurse walks into a patient room, introduces themselves, and begins to complete a full head-to-toe assessment. The clinical faculty member enters the room, introduces themselves, and asks the student to step out of the room for a moment. The student meets the faculty member in the hallway and is asked to identify 15 cues or observations they noted during their initial contact with the patient and the patient's environment. Although the student is unable to reach 15 observations, the faculty guides the student to recognize the linen on the floor, old dinner tray on the windowsill, empty water pitcher, twisted oxygen tubing, the patient's pallor, and several other things requiring action. What is the value of engaging in this kind of activity with students in the clinical setting?

a. Developing situational awareness is important to risk prevention, timely implementation of interventions, and prioritizing actions

b. Managing cognitive load begins with systematically sorting mental images and immediately addressing pressing concerns

c. Nursing best practice requires that an environmental scan be completed and documented in the electronic health record (EHR)

d. Designing interventions that increase patient satisfaction is an essential focus for nurses when completing their initial assessments

A nursing program uses Tanner’s Clinical Judgment Model, a research-based model that accounts for differences in the patient, environment, and individual student nurse. What makes Tanner’s reflection step unique?

a. The emphasis is on noticing, interpreting, and responding; reflection is less important.

b. Reflection occurs both in-action (in the moment) and on-action (after the situation).

c. Reflection occurs first in the model that is focused on rapid decision making and patient outcomes.

d. Reflection is the last step in a linear model and is designed to minimize bias in the student nurse.

b. Reflection occurs both in-action (in the moment) and on-action (after the situation).

Reflection drives the clinical judgment cycle and allows for the integration of new knowledge that will inform future situations. Reflection is as important in Tanner’s model as the other elements of noticing, interpreting, and responding. The focus of the model is the development of clinical judgment, rather than rapid decision making; as clinical judgment is developed, decision making improves and may lead to better patient outcomes. Tanner’s model is cyclic, not linear; although bias may be addressed as part of the development of clinical judgment, it is not the focus.

Nursing programs prepare students for safe clinical practice. As a student nurse, why is a basic understanding of NCSBN’s Clinical Judgment Measurement Model (CJMM) important? Select all that apply.

a. Successful completion of the NCLEX is required for professional licensure in the United States.

b. Nurse educators use the CJMM model and NCLEX test plans to develop exam questions.

c. Students should be intimately familiar with theoretical models of education to answer questions.

d. Appreciation of the core principles assists students in understanding the structure and intent of nursing exams.

e. There is overlap in the core components of clinical judgment models, measurement models, and the nursing process.

a, b, d, e.

Nurses in the United States must pass NCLEX prior to being issued a license to practice as a professional nurse. To help students achieve this goal, nurse educators model course exams on the NCSBN's NCLEX test plan in terms of content and style. Understanding the why (rationale for actions) is often helpful when students are engaged in studying, working to apply the information they have learned, and developing test-taking strategies. There is overlap between the models and processes identified as foundational to nursing education, which demonstrates the importance of fundamental concepts. A deep understanding of theoretical and philosophical models is not necessary for student nurses.

Nursing students and those studying other health sciences (medicine, pharmacy, physical therapy, etc.) are often engaged in competency-based education. What is the value of competency-based education?

a. It provides comprehensive skills checklists for students to check their progress and move on to other elements.

b. It allows for student individualization based on their unique experience and preferences.

c. It provides specific guidance on the expected level of performance that integrates knowledge, skills, abilities, and judgment.

d. Like most other education models, it is a high-level way of thinking that is not related to clinical judgment.

c. It provides specific guidance on the expected level of performance that integrates knowledge, skills, abilities, and judgment.

The definition of a competency included in the Nursing: Scope and Standards of Practice (ANA, 2021) identified includes knowledge, skills, abilities, and judgment. Competency-based education is more than a checklist and often requires repeated exposure to concepts for mastery in a variety of contexts. Although the delivery of education can flex to meet the needs of students, testing is standardized to address core competencies. Competency-based education is very direct and concrete; the development of competence requires clinical judgment.

The development of clinical judgment requires intentional focus and a willingness to grow and change both personally and professionally. How can a nursing student best foster the development of clinical judgment?

a. Engaging in learning that only appeals to their preferred learning style

b. Focusing on knowledge acquisition that is straightforward and clear

c. Developing a model for learning that integrates feedback and reflection

d. Focusing inward to develop emotional intelligence and communication skills

c. Each nursing student is in charge of their learning, including integrating feedback from exams, clinical experiences, simulations, and other assignments—reflecting on what has been learned and integrating new learning. Adaptability is key.