Critical Thinking & Clinical Judgement in Nursing

Critical Thinking & Clinical Judgement

• Critical thinking and clinical judgment are crucial for safe and effective nursing practice.
• 23% of graduate nurses entering practice lack the clinical reasoning skills needed for complex patients.
• Nurses fail to recognize and respond appropriately to deteriorating patients, potentially leading to adverse outcomes, even death.
• Advanced critical thinking skills are essential for preventing adverse outcomes by recognizing complications early.
• Nurses use the nursing process to apply critical thinking to make clinical decisions.
• Critical thinking skills are applied daily in nursing practice to sort information, recognize changes, and make informed clinical decisions.

Clinical Judgement

• Clinical judgment is defined as the observed outcome of critical thinking and decision-making in nursing.
• It's a process that incorporates nursing knowledge, experience, and critical thinking.
• Clinical decision-making distinguishes nurses from technical staff, who may perform tests but not interpret results.
• For example, a technician may perform a blood glucose test, but the nurse makes the clinical decision to administer insulin based on the results and the patient's needs.
• Clinical judgment involves all parts of the nursing process, from assessment to evaluation.

Student Learning Outcomes

• Students will learn the relationship between critical thinking and clinical judgment in nursing practice.
• They will understand the value of utilizing a clinical judgment model.
• Students must develop the necessary attitudes and skills for critical thinking.
• Students are expected to demonstrate critical thinking when practicing safe, effective, professional nursing care.
• Students will understand how professional standards influence clinical decisions.
• Students will understand how the nursing process functions in the context of critical thinking and clinical judgment.
• Students will differentiate subjective and objective data utilizing the "patient's story."
• Students will understand the relationship between goals of care, expected outcomes, and evaluative measures.

Readings

• Key readings include chapters specifically on critical thinking and clinical judgement.
• Fundamentals of Nursing (Potter & Perry, 11th ed., Chapter 15).
• Nursing Care Plans (Gulanick, Chapter 1 - optional).
• Clinical Judgment and Test Taking Strategies (Preface and pages 2-31).

Cognitive Skills for Clinical Judgement

• Six cognitive skills are essential for making appropriate clinical judgments:
  • Recognize cues
  • Analyze cues
  • Prioritize hypotheses
  • Generate solutions
  • Take action
  • Evaluate Outcomes

Recognize Cues

• Identify relevant and important information from various sources (history, vital signs, labs, assessments).
• Consider what is urgent, relevant, and of immediate concern.

Analyze Cues

• Organize and link cues to the client's presentation.
• Identify consistent client conditions with cues from the data.
• Determine why a cue is a cause for concern.
• Compare client data with accepted norms to identify patterns.

Prioritize Hypothesis

• Evaluate and rank hypotheses according to importance.
• Consider things such as urgency, likelihood, and risk associated with unmet needs
• Problems that, if left unaddressed, put the patient at risk for harm should be prioritized first.

Generate Solutions

• Focus on managing symptoms to help the client function at their highest level.
• Determine what desirable outcomes are needed.
• Identify interventions necessary to achieve the desired outcomes.
• Clarify what, if anything, should be avoided.

Take Action

• Carry out the specific interventions agreed upon.
• Perform appropriate interventions to alleviate symptom(s).
• Always reassess your patient after taking action/initiating interventions.
• Collect new information to assess changes.
• Determine if any of the observed changes necessitate alteration of the plan of care.

Evaluate Outcomes

• Compare outcomes with expected outcomes.
• Determine the status of the patient (improving, worsening or unchanged)
• Evaluate interventions' effectiveness.
• Reflect on the plan.

Nursing Process & Skills Interaction

• Nurses apply the nursing process (assessment, diagnosis, planning, implementation, evaluation) in clinical decision-making.
• The components of clinical judgment and decision-making interact throughout the nursing process.

Additional

• Identify various levels of interventions (independent, dependent, interdependent).
• Recognize the importance of using evidence-based practice in nursing decisions and interventions.
• Consult the care plan book or relevant texts for rationales for implementing interventions.
• Access patient information through the EMR (electronic medical record).
• Understanding of the roles, responsibilities and limitations of both nurses, and other medical professionals involved in the patient's care.