Clinical Judgment B 260 Fundamentals of Nursing Definition

Clinical Judgment B 260: Fundamentals of Nursing

Definition Clinical judgment is “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response. ” (Tanner, 2006*)

Nursing Care Is Not Linear Unknowns Multiple factors No clear-cut answers • One must consider multiple complex variables for clinical reasoning.

Attributes of Clinical Judgment • Involves a holistic view of the patient situation. • Requires reasoning and the interpretation of data.

Unique Situation • The nurse must recognize the unique situation of the patient, including a deep understanding of both the clinical situation and the nurse’s contribution to the patient care situation. • Each patient situation and each nurse is different; so, too, is the clinical reasoning that leads to clinical judgment.

IDENTIFY THE WAYS THAT NURSES MAKE JUDGMENTS

Clinical Judgment Process • • Noticing Interpreting Responding Reflecting

Model of Clinical Judgment Clinical judgment is not a linear process.

Noticing • A nurse notices things about a patient in the context of the nurse’s background and experience, context of environment, and knowing the patient. • A nurse is looking for patterns that are consistent with previous experiences and uses that information to guide care.

Interpreting • Interpreting is the process of assembling information to make sense of it. • Types of reasoning patterns tend to vary with the experience of the nurse. – Novice nurses tend to rely on analytic reasoning. – Expert nurses draw from a variety of reasoning patterns—analytic, intuitive, and narrative.

Responding • Responding is the implementation of actions and interventions, based on patient needs. • Depending on the level of expertise, the nurse may or may not be able to judge the effectiveness of the intervention before initiating it.

Reflecting • Reflecting is the process of thinking and learning from experiences. – Reflection-in-action happens in real time while care is occurring. – Reflection-on-action happens after the patient care occurs. • Reflecting is critical for development of knowledge and improvement in reasoning.

Experience, Knowledge, Expertise • Clinical judgment requires deep clinical knowledge and several types of thinking. • Experience does matter, but it is not solely responsible for clinical judgment.