NUR 215 Chapter 2 - Clinical Judgement PDF

NUR 215 Chapter 2- Clinical Judgement  Thinking Doing What does Nursing Involve Caring  NCSBN (2019) Tanner (2006) Benner, Tanner & Chesla (2009) Common factors What is Clinical Requirement of nu...

NUR 215 Chapter 2- Clinical Judgement  Thinking Doing What does Nursing Involve Caring  NCSBN (2019) Tanner (2006) Benner, Tanner & Chesla (2009) Common factors What is Clinical Requirement of nurses Judgement? Recognize and interpret Prioritize Take action Evaluate outcomes Modify as needed Different Kinds of Nursing Knowledge  Theoretical  Practical  Self  Ethical Knowledge Check Which type of nursing knowledge requires an understanding of the pathophysiology of the disease process, medical treatment, and client and family factors? A. Practical knowledge B. Self knowledge C. Ethical knowledge D. Theoretical knowledge  Correct answer: D Theoretical knowledge is understanding the “why” to gain a strong foundation for analysis and synthesis of data. Knowledge It consists of information, facts, principles, and Check evidence-based theories in nursing and related disciplines (e.g., physiology, psychology) It is book knowledge.  Tanner model of clinical judgement Contains four aspects Models of Clinical Judgement Noticing Interpreting Responding Reflections  Identifies 11 dimensions that are used to measure each of the four aspects of Tanner’s clinical judgment model Lasater Clinical It categorizes the progressive development Judgment of clinical judgment in each dimension Rubric Beginning Developing Accomplished exemplary  Measures whether a test-taker has the established degree of clinical judgment and decision-making abilities to be a safe practitioner Helps nurse recognize, analyze, organize, prioritize, and use NCSBN knowledge to make safe client care decisions Clinical Judgment Important in preparation of the Model licensure examination (NCLEX) to become a registered nurse after graduation Layers of the NCSBN Clinical Judgment Model Layer 0- clinical decisions Layer 1- comprises the outcome (clinical judgment) Layer 2- form, refine hypotheses; evaluation Layer 3- contains the clinical judgment tasks (recognized cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes) Layer 4- context individual and environmental factors) Knowledge Check What is the process of noticing? A. Developing an impression of the client situation based on the nurse’s expectation, knowledge, and past experiences B. The course of action taken by the nurse C. The process of examining the actions implemented D. The reasoning process nurses use to make sense of the initial clinical situation Knowledge Check Correct Answer: A Noticing entails performing an impression of the client situation based on the nurse’s expectation, knowledge of the client, past experiences with similar clients, theoretical or textbook knowledge, and the work environment (e.g., unit culture, patterns of care). Clinical Reasoning The process of synthesizing Requires a reliance on your knowledge and information knowledge and experience from numerous sources and to form a conceptual incorporating experience to image of a client’s problem develop a plan of care for a and its effective particular client or case management scenario  Importance of Clinical Reasoning It is an essential component of The practice of professional nursing Ineffective clinical reasoning skills is a developing clinical judgment and requires strong clinical reasoning skills major factor in the failure of nurses to practicing safe care. due to a rapidly changing complex respond appropriately to deteriorating healthcare environment. client conditions.   A combination of  Reasoned thinking  Openness to alternatives What Is  Ability to reflect Critical  A desire to seek truth Thinking? Knowledge Check The most correct definition of critical thinking is: A. A problem-solving process that enables one to show others they are wrong B. An examination of one’s own beliefs in order to defend them intelligently C. Purposeful, analytical thinking that results in a reasoned decision D. Rational thinking that results in obtaining the one correct answer Knowledge Check Correct Answer: C Most definitions of critical thinking include the concept of it being purposeful and deliberate. It is more than just problem-solving and is not used exclusively to defend one’s beliefs. Critical thinking enables a person to see that there may be more than one correct answer.  Objectively gathering information on a problem or issue Recognizing the need for more information Evaluating the credibility and usefulness of sources of information What Are Recognizing gaps in one’s own knowledge Critical- Thinking Listening carefully; reading thoughtfully Skills? Separating relevant from irrelevant data and important from unimportant data  What Are Critical-Thinking Skills? (continued_1) Organizing or Organizing or grouping information in meaningful ways grouping Making Making inferences (tentative conclusions) about the meaning of the information Visualizing Visualizing potential solutions to a problem Exploring Exploring the advantages, disadvantages, and consequences of each potential action Evaluating Evaluating the credibility and usefulness of sources of information What Are Critical-Thinking Skills? (continued_2) Recognizing differences and Prioritizing or ranking data as needed similarities among things or situations  Intellectual autonomy Intellectual curiosity Intellectual humility Intellectual empathy What Are Intellectual courage Critical- Thinking Intellectual perseverance Attitudes? Fair-mindedness Confidence in reasoning  Nurses are faced with complex situations. Each client is unique. Nurses apply knowledge to provide holistic care. Why Is Nursing is an applied discipline. Critical Thinking Nursing uses knowledge from other fields. Important for Nurses? Nursing is fast-paced.  The scientific basis for client care changes constantly. Why Is Critical Thinking Important for Critical thinking is linked to Nurses? evidence-based practice. (continued_1) Knowledge Check A nurse who is newly employed at a hospital questions a standard of client care that does not seem to follow evidence-based practice. Which critical thinking attitude is the nurse demonstrating? A. Intellectual autonomy B. Intellectual humility C. Intellectual courage D. Fair-mindedness Knowledge Check Correct Answer: A Critical thinkers are not afraid to question things. They do not proceed with a questionable action simply because “that’s the way it’s always been done.”   Five step/category process  Contextual awareness  Inquiry Critical-  Considering alternatives  Analyzing assumptions Thinking  Reflecting skeptically and deciding what to Model do How Is the Nursing Process Related to Critical Thinking?  Critical thinking and the nursing process are interrelated but not identical.  Nursing decisions that require critical thinking may not be related to the nursing process.  Some nursing activities do not require reflective critical thinking, although they must be done skillfully.  Nursing process is a problem-solving process.  The nursing process correlates and overlaps with those of clinical judgment. The nursing process facilitates How is the clinical decision making. Nursing Process The nursing process guides clinical Related to reasoning to provide a solid Clinical foundation to develop clinical judgment. Judgment?  Caring is always specific and relational for each nurse– person encounter. Caring is not an abstraction. What Is Caring? Caring involves thinking and acting in ways that preserve human dignity and humanity.  Knowing Being with Doing for Components of Caring Enabling Maintaining belief  Definition A unique blend of thinking, doing, and caring for the purpose of affecting good outcomes from a client situation What Is Full- What are the model concepts? Spectrum Nursing? Thinking Doing Caring Client situation Full-Spectrum Nursing Model How Does the Model Work? Thinking Doing Critical thinking Practical knowledge Theoretical knowledge Nursing process How Does the Model Work? (continued_1) Caring Client situation Self-knowledge Client data Ethical knowledge Client preferences Context Knowledge Check College courses, such as microbiology and human growth and development, present content that is considered part of theoretical nursing knowledge. A. True B. False Knowledge Check Correct Answer: A Knowledge gained in these courses helps the nurse develop a more holistic and complete plan of client care.  It is a pleasant Saturday afternoon and you are meeting with an old friend whom you have not seen in 2 years. She says, “I hear you’ve decided to be a nurse. Critical What made you choose that?” How would you reply to Thinking her question?  The term “critical thinking” seems to suggest that good thinking is an intellectual activity rather than involving Safe, feeling and emotion. How do you think a nurse can use critical thinking to practice in a caring manner? Effective Care: Thinking, Doing, Caring  As a client, which safe, effective care competence would you choose for your nurse to have if the nurse Socratic could be expert in only one of the skills?  Thinking (knowledge, problem-solving) Reasoning  Doing (skills)  Caring (self-knowledge, ethical knowledge, affective and interpersonal skills)  Clinical Judgement  Questions  REFERENCE Treas, L. S., Barnett, K. L., & Smith, M. H. (2022). Davis Advantage for Basic Nursing: Thinking, Doing and Caring.(3rd. ed.). F.A. Davis Company. ISBN: 9781719642071