Clinical Judgment

Clinical Judgment

• The National Council of State Boards of Nursing (NCSBN, 2019) acknowledges that clinical judgment integrates critical thinking and decision making

• To observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care

Tanner Model of Clinical Judgment

• Four aspects of clinical judgment process used by experienced nurses

  • Noticing

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

  • Interpreting

    • Reasoning processes nurses use to make sense of the initial clinical situation

  • Responding

    • Course of action taken by nurse

  • Reflecting

    • Examining the actions implemented for validation or modification

Clinical Judgment

Who Uses Critical Thinking

• Need critical thinking for critical reasoning

• “Critical thinking is the ability to apply higher-order cognitive skills (conceptualization, analysis, evaluation) and the disposition to be deliberate about thinking (being open-minded or intellectually honest) that lead to action that is logical and appropriate”

• Needs to link to evidence-based practice

• Need to be flexible, nonjudgmental, inquisitive, honest, and interested in seeking the truth

Clinical Reasoning

• Clinical reasoning is the 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

How to use in Practice

• Clients are different

  • Individual differences

  • Different beliefs

  • Different roles

  • Different experiences

  • Different bias (fixed belief of health and illness)

Nursing Process

Assessment - start here

• The systematic gathering of information related to the physiological, psychological, sociocultural, developmental, and spiritual status of an individual, group, or community

• Provides contextual information that becomes a part of the patient database

• Supplies the data necessary for diagnosis

• Reveals information about motivation and resources that help formulate outcomes

• Helps guide the choice of effective interventions and how to best implement them

• Acts as a guidepost for reassessment in the evaluation step that may determine changes in the care plan