Clinical Judgement Notes PDF

10/14/2024 Priority Setting Frameworks Patient Care Delivery Clinical Judgement Intervention - Priority setting is an essential skill for all nurses, as the nurse’s ability to interve...

10/14/2024 Priority Setting Frameworks Patient Care Delivery Clinical Judgement Intervention - Priority setting is an essential skill for all nurses, as the nurse’s ability to intervene on the highest risk problems first can decrease avoidable adverse client outcomes. Priority Setting - Defined as the delivery of nursing care based on the urgency or importance of client needs. - Involves the organization of client care whereby the most critical intervention or action is completed first. Maslow’s Hierarchy of Needs Illustrated as a pyramid with five levels ranging from basic needs at the base of the pyramid, psychological needs in the middle of the pyramid, and self-fulfillment at the peak of the pyramid. Physiological needs must typically be met before individuals attempt to fulfill higher levels in the pyramid. Individuals may move back and forth through the levels at diMerent times in their life. ABCDE Method The ABCDE method is an algorithm that can be used in establishing priorities for an individual or group of clients and is appropriate in any clinical crisis. A - Airway B - Breathing  C - Circulation D – Disability E - Exposure The CURE Hierarchy Nurses can use the CURE hierarchy (critical, urgent, routine, and extras) acronym to prioritize client care when managing numerous clients’ needs. Critical: Emergent, life-threatening situations. Urgent: Situations in which the client could suMer harm of discomfort if there is a delay in addressing the client's needs. Routine: Routine tasks associated with client care. Extras: Tasks that are not essential to client care but promote comfort. Triage Triage is like prioritization, although there is a distinct diMerence. Prioritization involves ranking potential nursing actions in order of importance. Triage assigns priority to what is being ranked based upon a quick initial, focused assessment followed by the assignment of an acuity level indicative of the amount of time a client can safely wait for screening and treatment. Triage Levels The 5-level triage system designates level 1 as the most urgent category with clients experiencing a life-threatening illness and level 5 as the least urgent category with clients being stable and suMering from nonemergency ailments. The most common 5-level triage system used in the United States is the Emergency Severity Index (ESI) and the Canadian Triage Acuity Scale (CTAS), which categories clients into those who need to be seen emergently versus urgently. Resource Allocation  Resource allocation is the process of assigning a portion or amount of a service. Priority setting involves the allocation of resources, as users must decide how resources will be distributed in caring for their clients. Nursing Care Delivery Models Total patient care Functional nursing Primary nursing Team nursing Modular nursing Patient Care Delivery Care Map Also called critical pathway Tool used to sequence treatment over a certain length of stay Include day-to-day expected outcomes and well as outcomes expected by discharge/end of treatment The same care map is used by the entire interdisciplinary team Case Management Coordinate care from hospital/inpatient settings to the home setting via the care manager in the hospital Leadership Manager Leader Transformational leader Autocratic  Democratic Laissez-faire Clinical Judgement The Nursing Process The nursing process was developed in 1958 by Ida Jean Orlando as a guide to direct nursing care. This process requires the nurse to use critical thinking and to make clinical decisions using both experience and evidence-based practice guidelines. Steps of the Nursing Process Assessment Analysis Planning Implementation Evaluation Steps of Clinical Judgement Recognize Cues (Assessment) Filter information from diMerent sources (e.g., signs, symptoms, health history, environment). Analyze Cues (Analysis) Link recognized cues to a client’s clinical presentation and establish probable client needs, concerns, or problems. Prioritize Hypotheses (Analysis) Establish priorities of care based on the client’s health problems (e.g., environmental factors, risk assessment, urgency, signs/symptoms, diagnostic tests, lab values). Generate Solutions (Planning)  Identify expected outcomes and related nursing interventions to ensure clients’ needs are met. Take Actions (Implementation) Implement appropriate interventions based on nursing knowledge, priorities of care, and planned outcomes to promote, maintain, or restore a client’s health. Evaluate Outcomes (Evaluation) Evaluate a client’s response to nursing interventions and reach a nursing judgment regarding the extent to which outcomes have been met. Clinical Reasoning The mental process used when analyzing all the data pertaining to a clinical situation. Clinical reasoning is a crucial part of the decision-making process: It guides the nurse through the process of assessing and compiling data, selecting and discarding various pieces of information based on their relevance, and making decisions about client care based on nursing knowledge. Critical Thinking Critical thinking requires lifelong learning and the ability to acquire relevant experiences that can be reflected on continuously to improve nursing judgment. The components of critical thinking include knowledge, experience, critical thinking competencies, attitudes, and intellectual and professional standards. Critical thinking incorporates reflection, language, and intuition, and it evolves through three distinct levels as a nurse gains knowledge and experience while maturing into a competent nursing professional. Reflection Reflection: Purposefully thinking back or recalling a situation to discover its meaning and gain insight into the event. Language Precise, clear language demonstrating focused thinking and communicating unambiguous messages and expectations to clients and other health care team members. Intuition An inner sensing that facts do not currently support something. Intuition should spark the nurse to search the data to confirm or disprove the feeling. Attitude Mindsets that aMect how a nurse approaches a problem. Attitudes of critical thinkers include: Confidence: Feels sure of abilities. Independence: Analyzes ideas for logical reasoning. Fairness: Is objective, nonjudgmental. Responsibility: Adheres to standards of practice. Risk-taking: Takes calculated chances in finding better solutions to problems. Discipline: Develops a systematic approach to thinking. Perseverance: Continues to work at a problem until there’s a resolution. Creativity: Uses imagination to find solutions to unique client problems. Curiosity: Requires more information about clients and problems. Integrity: Practices truthfully and ethically. Humility: Acknowledges weaknesses.