week 1- clinical judgment and chronic illness

what is clinical judgement

conclusion about pt needs and the decision to take action, use standard approaches or improvise new ones

what is standards-base approach

clear-cut and standardized approaches to patient care- best practice= best treatment

what is evidence based practice and clinical judgemnet

problem solving that combines best availble science +patient and practitioner experiential evidence for optimal outcome

what is interpretivist perspective

nursing care is not linear- considers multiple complex variables

what are the 4 attributes of clinical judgement

holistic view of pts situation

process orientation

reasoning and interpretation of data

ethical orientation

what is tanners model associated with

model of clinical judgemnet

what are the 4 steps of tanners model

noticing

interpreting

responding

reflecting

define noticing

what cues are most important

what pattern of signalcues a concern

what other data do i need

define interpreting (reasoning)

assembling cues to make sense of them and to establish priority

what is my best guess

define responding

determine appropriate course of action

difference of reflecting in-action and reflecting on-action

in- patients response to nursing action while care ocurs

on- considerations of the situation after care has occured

define the nursing process

a systematic and rational method of planning and providing client care centered organized around a series of phases that facilitates holistic client centered care

define critical thinking

a combination of skills and dispositions to maximize ones ability to purposefully reflect, think deeply, act purposely: a process that results in clinical judgment

define chronic disease

medical conditions or health problems with associated symptoms or disabilities that require long term managemnet over 3months

what is chronic illness

the individuals perception of the experience of living with and the individuals/fam response to chronic disease

4 descriptors of how chronic illness are present

progressive

recurrent

fluactuating

continuous

define a progressive chronic condition

your abilities to do adls gets worse overtime, regardless of whether you have a month without feeling limited

recurrent def

you have periods of a month or more without feeling limited, your ability to do adls stays the same or gets better

fluctuating def

you never have periods of a month or more without feeling limited and ability to do adls gets better or worse (up/down shifts)

continuous def

you never have periods of a month or more without feeling limitedand your ability stays same or gets better (constant)

4 areas of impacts witha chronic disease

symptoms/impairements- physical/emotional/cognitive/mental consequences

difficulties with adls- routine activities that people tend to do everyday

challenges to social inclusion- difficulties engaging with others and participating in activities

uncertainty- worried about future living with a chronic illness

what are major risk factors across the lifespan

unhealthy eating habits, decreased energy expenditure from sedentary lifestyle, aging, tobacco, alcohol, mental health disorders

direct care vs supportive care vs holistic care

d; wound care, administering meds, physcial assessment

sup- ongoing monitoring at home, teaching (pt education), referring, mobilizing resources

hol- people often respomd to illness, education and regimens differnetly than you as a nurse might

what is analytical thinking

Systematically breaking down data to categorize and label information, such as identifying a heart rate of 110 as tachycardia

what is critical thinking

Investigating why something is happening, challenging assumptions, and asking questions like, “Why is this patient’s heart rate elevated?”

what is clinical reasoing

Integrating patient data, context, and experience to interpret what’s happening and prioritize care for this specific patient.

what is clinical judgmnet

Making a decision or taking action based on your reasoning, such as administering pain medication or calling a physician.

what is Clinical Judgment Measurement Model (CJMM)

recognize and analyze cues, generate and prioritize hypotheses, take action, and evaluate outcomes.

• this was made to have a way to evaulate on nclex

what is narrative reasoning

understanding the patient’s story, their experience of illness, and what matters most to them. It’s about seeing the situation through the patient’s eyes.

This approach is essential for individualized care and for making sense of complex, human-centered situations.