Critical Thinking & Clinical Judgement

Potter & Perry Chapter 15

Clinical Decision Making

Separates professional nurses from technicians or other assistive personnel. Requires you to use your judgement in investigating and analyzing all aspects of a clinical problem and then applying scientific and nursing knowledge to choose the best course of action.

• A registered nurse observes for changes, recognizes and identifies new and potential problems, plans nursing strategies, and takes immediate action when the patient’s clinical conditions worsense.

Clinical Judgements

Arise from critical thinking and making timely decisions about when and how to act. Your actions may include the need to gather more data about a patient’s problems as they evolve, consult with other health care professionals for options, or intervene directly to manage or relieve the problem. Nurses apply critical thinking routinely when making clinical judgements needed for optimal patient outcomes

• influenced more by a nurse’s experience and knowledge than by the objective data about the situation at hand

• Sound clinical judgement partly relies on “knowing patients” and their typical patterns of responses as well as engaging with patients about their concerns

• Influenced by the context of the clinical situations ant eh culture of patient care settings

Critical Thinking

The objective analysis and evaluation of an issue in order to form a judgement

• influences clinical judgement

• becomes embedded in your everyday practic as it involves knowing as much as possible about each patient, reflecting on past experience, adapting within the environment where decisions are made, and using sound logical thinking.

Deductive Reasoning

a “top-down” logical process where a specific conclusion is reached from one or more general statements that are assumed to be true

• required for effective clinical decision making

Diagnostic Reasoning

Precedes clinical judgmeent and decision making. Involves being able to understand and think through clinical problems, gather information about the problem and individual cues (data), understandign the meaning of evidence, and know when there is enough information (pattern of data) to make an accurate diagnosis

Thoughtul comprehensive process leading to clinical judgment, the interpretation or conclusion based on reasoning. Is vital for improving evidence-based diagnosis and subsequent effective care planning.

Evidence-Based Knowledge

Knowledge based on reaserach or clinical expertise, makes nurses better informed critical thinkers. Involves the use of evidence in practice combined with a nurse’s professional judgement and a patient’s preferences.

Inductive Reasoning

Moves from reviewing specific data elements to making an inference by forming a conclusion about the related pieces of evidence. Previous experiences are also considered.

Inference

A conclusion reached on the basis of evidence and reasoning

Intuition

A problem-solving approach that relies on one’s inner sense. It is the ability to understand something immediately, without the need for conscious reasoning.

Intuitive thinking is commonly used for well-structured and familiar decision tasks, whereas analytic thinking is needed for ill-structured and unfamiliar decision tasks.

Knowing

You should know as much as possible about each patient, reflect on your past experience, adapt within the environment and use sound logical thinking. Ask a more experienced person if you do not know or are questioning something.

Nursing Process

The framework and essential core of practice that nurses use to apply critical thinking in nursing practice for making clinical decisions.

Five Steps:

1. Assessment

2. Analysis

3. Planning

4. Implementation

5. Evaluation

Six Cognitive Skills:

1. Recognize Cues

2. Analyze Cues

3. Prioritize Hypotheses

4. Generate Solutions

5. Take action

6. Evaluate Outcomes

Problem Solving

The process of finding solutions to difficult of complex issues

Reflective Practice

A purposeful act in which significant experiences are examined, allowing one to identify the contradiction between one’s vision of their performance and actual practice.