Clinical Judgment Notes


Introduction to Healthcare

  • Healthcare, like the airline industry, is highly complex and rapidly changing.

  • Both face demands in staffing and reimbursement procedures.

  • Both can have catastrophic consequences if errors occur.

Clinical Judgment Definition

  • Requires the nurse to apply knowledge to a unique client situation to make sense of it and respond appropriately in context.

  • Recognizes that diverse patients mean there is not one correct answer.

Clinical Reasoning

  • The thinking process by which a nurse reaches a clinical judgment.

  • Involves noticing, interpreting, responding, and reflecting.

  • Reasoning is based on the patient's response.

Critical Thinking

  • A cognitive process used for the analysis of a problem.

  • Knowledge-based and consistent across all situations.

  • Context is unimportant.

How Nurses Make Judgments: Tanner's Model

  • A thinking process involving inferences and interpretations that influence actions.

  • Tasks are constantly "restacked" in a dynamic, ever-changing process.

  • Influenced by the nurse's knowledge, experience, ethics, and the patient's background.

  • Components:

    • Noticing

    • Interpreting

    • Responding

    • Reflecting

Tanner Clinical Judgment Model

  • Background/Context →\rightarrow Noticing (labs, VS, patient demeanor).

  • Reasoning/Data Gathering/Conferring →\rightarrow Interpreting.

  • Interpretation leads to Actions →\rightarrow Responding.

  • Patient Response to Action Determines next Action →\rightarrow Reflection.

  • Using patterns & cues to find information.

  • Make hypotheses & test.

  • Respond using 1 or more actions.

  • Determine patient status and adjust.

Approaches to Clinical Judgment

  • Standards-Based:

    • Uses tools, trees, algorithms.

    • Rules decide actions.

    • Suitable for emergencies where no clinical judgment is required.

    • Good for new nurses.

  • Evidence-Based:

    • Based on best evidence and research.

    • Uses clinical judgment, incorporating clinician and patient experiences.

    • Requires practical knowledge.

Nursing Process

  • Nursing profession structure.

  • ADPIE (Assessment, Diagnosis/Analysis, Planning, Implementation, Evaluation).

  • Different from clinical judgment, as it is linear and static.

Comparison of Models

  • Nursing Process (ADPIE/AAPIE):

    • Assessment

    • Diagnosis/Analysis

    • Planning

    • Implementation

    • Evaluation

  • Tanner's CJ Model:

    • Noticing: Recognize Cues

    • Interpreting: Analyze Cues

    • Responding: Generate Solutions

    • Reflecting: Evaluate Outcomes

  • NCJMM:

    • Recognize Cues

    • Analyze Cues

    • Prioritize Hypotheses

    • Generate Solutions

    • Take Action

    • Evaluate Outcomes

NCSBN Clinical Judgment Model

  • The National Council of State Boards of Nursing developed a model of clinical judgment that expands the nursing process.

  • Steps:

    • Recognize cues

    • Analyze cues

    • Prioritize hypotheses

    • Generate solutions

    • Take action

    • Evaluate outcomes

Wrap Up

  • The Clinical Judgment Measurement Model (CJMM) measures foundational knowledge and skills.

  • The 6 steps are repetitious and not linear.

  • Consistent clinical judgment leads to safe and effective nursing.