Critical Thinking & Clinical Judgment in Nursing

Critical Thinking & Clinical Judgment

• A significant percentage (23%) of graduating nurses lack adequate clinical reasoning skills, leading to incorrect clinical judgments. This poses challenges in caring for complex, acutely ill patients.
• Patients do not always remain stable; they can improve or deteriorate when complications arise.
• Nurses sometimes fail to recognize critical data related to complications and then appropriately respond.
• Adverse outcomes, potentially including death, can be prevented by correct clinical judgment in recognizing and responding appropriately to complications.
• Critical thinking is a daily activity in nursing, becoming embedded in practice through sorting information, recognizing changes and making appropriate clinical decisions.

Clinical Judgment

• Clinical judgment is the observed outcome of critical thinking and decision-making.
• It's a process that uses nursing knowledge, experience, and critical thinking skills.
• Clinical judgment distinguishes nurses from technicians because nurses actively make clinical decisions, such as those related to blood glucose testing (determining insulin needs based on results)

Student Learning Outcomes

• Understand the relationship between critical thinking and clinical judgment in nursing practice.
• Recognize the value of applying a clinical judgment model.
• Understand the attitudes and skills needed to develop critical thinking.
• Demonstrate critical thinking skills in order to practice safe, effective, professional nursing care.
• Understand the Clinical Judgment Model and its relevance to diverse healthcare settings.
• Understand how professional standards influence a nurse's clinical decisions.
• Understand the relationship between the nursing process and critical thinking.
• Distinguish between subjective and objective data utilizing patient information.
• Understand the relationship between goals of care, expected outcomes, and evaluating measures in nursing care.

Readings

• Fundamentals of Nursing, Potter & Perry, 11th edition, Chapter 15
• Nursing Care Plans, Gulanick, Chapter 1 (optional)
• Clinical Judgement and Test Taking Strategies, Preface and pages 2-31

Components of Critical Thinking

• Competence: Knowledge, skills and experience.
• Knowledge: Basic science (anatomy, physiology, microbiology), underlying disease processes, nursing theories supporting health and wellbeing.
• Experience: Personal and clinical experience, skill competence.
• Environment: Time pressure, setting, task complexity, interruptions.
• Attitudes: Perseverance, fairness, confidence, conciseness.
• Standards: Intellectual standards in measurement, evidence-based criteria for evaluation, professional standards.

Cognitive Skills for Clinical Judgment

• Recognize cues (identifying relevant information from various sources).
• Analyze cues (linking recognized cues to the client's clinical presentation: Are client conditions consistent with cues?).
• Prioritize hypotheses/problems (evaluate & rank according to priority; prioritize problems causing harm to the client).
• Generate solutions (setting priorities, identifying expected outcomes/goals, desirable outcomes, interventions, what should be avoided).
• Take action (carrying out specific, individualized, jointly agreed-on interventions in care plan; manage symptoms; ensure client functions at highest level).
• Evaluate outcomes (compare observed outcomes with expected outcomes; evaluate if improving, declining or unchanged; determine if other interventions would have been more effective).

Nursing Process

• Nurses utilize the nursing process in clinical decision-making.
• Cognitive skills in the nursing process interact.

Clinical Judgement Model

• The NCSBN Clinical Judgment Model has multiple layers: from patient needs, to clinical judgment and clinical decisions.
• Layers include: Recognize cues, Analyze cues, Prioritize hypotheses and then take action, evaluate outcomes, as well as environmental considerations, as well as competency, knowledge, experience.

Problem Solving

• Obtain information.
• Suggest possible solutions.
• Try solutions over time.
• Evaluate solutions.

Specific Critical Thinking

• Diagnostic reasoning involves understanding clinical problems, gathering information, analyzing cues, making accurate diagnoses, and deciding on interventions to meet client needs.
• Accurate problem recognition is vital before choosing and implementing solutions.
• Inductive (general) and deductive (specific) reasoning are used. Spending dedicated time with the patient/client to better identify trends and patterns is crucial.

This quiz explores the vital role of critical thinking and clinical judgment in nursing practice. It addresses the challenges faced by nurses in recognizing and responding to patient complications and highlights the importance of adequate clinical reasoning to prevent adverse outcomes. Test your knowledge on how critical thinking is applied in clinical scenarios.