nurs 113: clinical decision making

clinical decision making

a process nurses use to evaluate and select the best actions to meet desired goals

critical thinking

the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based

independence

does own thinking, objectively and honestly, looks for facts, not easily swayed by opinions

fair-mindedness

has neutral judgment without bias/is open to new ideas and way of doing things

aware of self-limits

knows limits of intellect and experience/expresses a willingness to self-reflect on own beliefs and ideas

integrity

challenge own ideas and methods of doing nursing care/choose the right thing to do over the popular thing to do

perseverance

has a stick with it motivation to find the best solution

confidence

knows the extent and limitations of existing knowledge base

intellect

ability to think, understand, and reason

creativity

allows a nurse to find unique solutions to a unique problem when traditional interventions are not effective

inquiry

a form of research, a search for knowledge

reasoning

the ability to walk into a patient’s room and immediately observe significant data, come to a conclusion about the patient and begin appropriate actions

reflection

the action of retrospectively making sense of occurrences, experiences, situations, or decisions and consequently learning from them

intuition

the gut feeling something’s wrong when working with a patient

clinical judgment

a cognitive process through which nurses solve problems by applying clinical reasoning, critical thinking, and decision making skills

nursing process

functions as a systematic guide to client-centered care with five sequential steps

assessment, diagnosis, planning, intervention, evaluation

ADPIE

nursing diagnosis

refers to condition that nurses are licensed to treat

nursing diagnosis

describes patient’s physical, sociocultural, psychological, and spiritual responses to illness or health condition

nursing diagnosis

change as patient’s response changes

medical diagnosis

made by a licensed provider; refers to disease process

diagnostic label

focus or subject of the problem

diagnostic label

describes patient’s health status clearly in a few words

diagnostic label

identifies topic directing formation of patient goal, desired outcomes

diagnostic label

may suggest some nursing interventions

etiology

related factors and risks

etiology

identifies one or more probable causes of health problem

etiology

differentiating among probable causes is essential

problem, etiology

parts of a nursing diagnostic two-part statement

problem, etiology, signs and symptoms

basic three-part nursing diagnosis statement

NANDA label only

basic one-part statement

circulation, airway, breathing

CAB acronym; always comes first when prioritizing nursing diagnosis

vital signs concerns, lab values that are life threatening

VL acronym; always comes first when prioritizing nursing diagnosis

goals

become basis for nursing interventions

goals

different from outcomes

goals

observable patient responses that nurse hopes to achieve

outcomes

specific observable criteria used to evaluate whether goals met

deliberate, systematic phase

nurse refers to assessment data, nursing diagnoses for direction in formulating patient goals

short-term goals

useful in acute care settings; achievable in range of a few hours to few days

long-term goals

often used for patients at home, in nursing homes, or other long-term facilities

long-term goals

apply to patients with chronic health problems

long-term goals

patients in acute care settings need them to guide discharge planning

long-term goals

achievable in range of one week to several months

planning

developing a goal

single specific action, measurable, attainable, relevant, time-limited

SMART acronym

action phase of nursing process

identifying best priority intervention, implementing these interventions

nursing interventions

include actions, delegation of task, documentation completed to help patient achieve goal based on nursing diagnosis

nursing intervention

patient-centered, specific, concise action, detailed information, realistic to individual patient, relevant to helping patient reach goal

continued, modified, terminated

nursing care plan on basis of evaluation is…

evaluation

continues until goals achieved or patient discharges

evaluation

at discharge includes status of goal achievement, self-care abilities with regard to follow-up

time management

helps nurses meet the demands of their job

evidence-based nursing practice

the practice of nursing in which the nurse makes clinical decisions on the basis of the best available, current research evidence, their own clinical expertise, and the needs and preferences of the patient

activity intolerance

nursing diagnosis for cerebrovascular accident

ineffective breathing pattern

nursing diagnosis for chronic obstructive pulmonary disease

acute pain

nursing diagnosis for femur fracture

body image disturbance

nursing diagnosis for amputation

risk for altered body temperature

nursing diagnosis for strep throat

fluid volume deficient

nursing diagnosis for dehydration

decreased cardiac output

nursing diagnosis for congestive heart failure

risk for trauma

nursing diagnosis for seizures

defining characteristics

cluster of signs, symptoms that indicate the presence of a particular diagnostic label

defining characteristics

may differ according to type of nursing diagnosis

subject, verb, goal, time limit

goal statement in form of…

goal was met

patient response same as desired outcome

goal was partially met

short-term goal achieved but long-term goal not achieved or desired outcome only partially attained

goal was not met

within time frame

date, time, goal met, evidence

format for writing evaluation after choosing best priority nursing interventions

theoretical knowledge

consists of information, facts, principles, and evidence-based theories in nursing and related disciplines

practical knowledge

consists of processes and procedures

self-knowledge

awareness of beliefs, values, and cultural and religious biases

ethical knowledge

consists of information about moral principles and processes for making moral decisions

model

set of interrelated concepts that represents a way of thinking about something

tanner model of clinical judgment

describes the four aspects of clinical judgment process used by experienced nurses

noticing

entails forming an impression of the client situation based on the nurse’s expectations, knowledge of the client, past experiences with similar clients, theoretical or textbook knowledge, and work environment

interpreting

the reasoning processes nurses use to make sense of the initial clinical situation

analytical reasoning

used by a new nurse who relies heavily on textbook information and limited client encounters

intuitive reasoning

used by experienced nurses and is based on their in-depth knowledge to grasp the situation and respond

narrative reasoning

helps the nurse to use the information obtained to understand the meaning of the client’s illness, experience, coping abilities, and vision of the future to develop person-centered plans of care

responding

the course of action taken by the nurse

reflection

powerful tool that involves examining the actions implemented for validation or modification, and it can foster personal and professional growth

reflection-in-action

used during implementation process to evaluate results and determine whether a different course of action is needed

reflection-on-action

involves a self-evaluation process to learn and refocus actions in future situations

lasater clinical judgment rubric

identifies 11 dimensions that are used to measure each of the four aspects of tanner’s clinical judgment model

lasater clinical judgment rubric

LCJR

focused observation

a perceptual understanding of the situation

manner of response

expectation of a calm, rational, purposeful, confident response

layer 4

the context layer

layer 4

identifies the individual and environmental factors that can affect the nurse’s reasoning or cognitive processes

layer 3

requires you to have a solid knowledge base to recognize patterns, understand connections between cures, examine pathophysiological processes, organize data, and relate data back to the client’s problems

layer 2

involves forming, refining, prioritizing, and evaluating hypotheses to achieve the desired outcomes

layer 1

comprises the outcome, which is clinical judgment

layer 0

clinical decisions made by the nurse to address the client’s needs

CJM model

has five layers, 0-4, with the formulation of clinical decisions to meet the client’s needs as layer 0

clinical reasoning

process of synthesizing knowledge and information from numerous sources and incorporating experience to develop a plan of care for a particular client or case scenario

critical thinking

linked to evidence-based practice

skills

refer to the cognitive processes used in complex thinking operations such as problem-solving and decision making

attitudes

consist of beliefs, feelings, and views toward something or someone

comorbidities

more than one health problem occurring at the same time

caring

involves personal concern for people, events, projects, and things