Clinical judgement

Skills

Information Seeking Discrimination Analyzing Transforming Knowledge Predicting Applying Standards Logical Reasoning

Explain what standard-based judgment is and give an example.

Based on set of rules for a situation. Example: protocols like handwashing

Why is clinical judgment essential in healthcare?

Help nurses create a care plan specifically for patients' needs

Habits of the mind

Perseverance Open-mindedness Flexibility Confidence Creativity Inquisitiveness Reflection Intellectual Integrity Intuition Contextual Perspective

What does the acronym SMART stand for?

Specific, measurable, attainable, realistic, timeframe

A nursing instructor is explaining how clinical judgment is different than clinical reasoning and critical thinking. Which statements should the instructor include in the explanation? (Select all that apply.) a. Clinical judgment is the interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision whether or not to take action. b. Critical thinking is a cognitive process that is knowledge based and used for analysis of an issue or problem but is not situated or specific to a given patient. c. Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. d. Clinical judgment is an iterative process of noticing, interpreting, and responding. e. Clinical judgment requires the nurse to apply knowledge to the unique patient situation to make sense of it and respond appropriately in the specific context.

a,b,c,e a. Clinical judgment is the interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision whether or not to take action. b. Critical thinking is a cognitive process that is knowledge based and used for analysis of an issue or problem but is not situated or specific to a given patient. c. Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. e. Clinical judgment requires the nurse to apply knowledge to the unique patient situation to make sense of it and respond appropriately in the specific context.

The nurse uses critical thinking to interpret data. Which of the following data sources are objective? (Select all that apply.) a. Patient interview b. Laboratory values c. Body language d. X-ray results e. Vital signs f. Breath sounds

b. Laboratory values d. X-ray results e. Vital signs f. Breath sounds -Objective data is observable data that is assessed through vision, hearing, smell, and touch. Subjective data includes patient history and nonverbal data such as body language, facial expressions, etc.

The nurse administers an IV pain medication that has an onset of 5 minutes to a patient who is reporting a pain level of 9/10. When the patient does not begin to get relief after the 5-minute time frame, the nurse immediately looks for interventions to help reduce the pain level. This response is an example of what aspect of Tanner's Clinical Judgment Model? a. Reflection-on-action b. Reflection-in-action c. Analysis of cues d. Information seeking

b. Reflection-in-action -When the nurse recognizes an issue during an action and then acts on that issue, that is reflection-in-action. Reflection-on-action takes place after the fact or retrospectively. Analysis of cues and information seeking are not steps in Tanner's Clinical Judgment Model.

Which statement best describes clinical reasoning? a. The mathematical calculation process by which a nurse verifies a medication dosage. b. The process of a nurse using experiential knowledge to put everything together to make sense of it. c. An iterative process of noticing, interpreting, and responding to the patient and how the patient responds to the nurse's actions d. An inherently complex process influenced by many factors related to the particular patient and caregiving situation.

c. An iterative process of noticing, interpreting, and responding to the patient and how the patient responds to the nurse's actions - Clinical reasoning is an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions. Process orientation utilizes experimental knowledge. The holistic view is influenced by complex factors surrounding the patient and caregiving situation. A dosage calculation is a knowledge-based skill.

The nurse is completing a patient assignment and will use information gathered to identify problems and work to prevent complications. In the National Council of State Boards of Nursing-Clinical Judgment Measurement Model (NCSBN-CJMM), this activity occurs in which step? a. Take action b. Outcome evaluation c. Recognize cues d. Analyze signs

c. Recognize cues -Identify relevant and important information from different sources (e.g., medical history, vital signs), assessing what information is relevant/irrelevant and most important as well as what information is most important are all components of recognizing cues in the NCSBN-CJMM. Taking action and analysis of signs (cues) are other steps in the NCSBN-CJMM. Evaluation is the final step in the Nursing Process and the NGN Clinical Judgment Process.

Which one is not a part of the nursing process? a. Assessment b. Evaluation c. Implementation d. Education

d. Education

What component of the nursing process carries out a plan to promote health and a safe environment. a. Assessment b. Diagnosis c. Planning d. Intervention/Implementation e. Evaluation

d. Intervention/Implementation

A type of problem-solving that involves working through a set of rules that govern a scenario. Which of the following critical thinking skills does this describe? a. Information seeking b. Contextual perspective c. Intellectual integrity d. Logical Reasoning e. Predicting

d. Logical Reasoning

The nurse categorizes which nursing action as an example of professional autonomy? a. The nurse working on a medical unit contacts the respiratory therapist to draw arterial blood gases (ABGs) for a patient with acute asthma. b. The novice nurse seeks out an experienced colleague for guidance when preparing to administer blood. c. The nurse contacts the PCP for clarification of a medication order. d. The experienced nurse who works in the intensive care unit draws ABGs for an assigned ICU patient.

d. The experienced nurse who works in the intensive care unit draws ABGs for an assigned ICU patient. -Professional autonomy implies self-sufficiency and independence. Often, each nursing unit within a medical center or hospital has different rules about what interventions nurses practicing on that unit are permitted to perform. For instance, a nurse practicing in the intensive care unit may be required to draw arterial blood gases (ABGs) on assigned patients. However, the same nurse may be required to call a respiratory therapist to draw ABGs when working on a medical surgical unit. The other choices indicate application of critical thinking skills at varying levels but do not indicate professional autonomy.

A new graduate nurse is working with a nurse who has been out of school for 10 years. The experienced nurse states, "I don't see the difference between this clinical reasoning and the nursing process." Which statements by the graduate nurse are appropriate? (Select all that apply.) a. Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. b. Clinical reasoning is limited to assessing, evaluating, and treating the nursing diagnosis. c. Clinical reasoning involves reflecting on interventions and reevaluating the plan of care based on the results of reflection. d. Clinical reasoning involves assessing, diagnosing, and planning and using interventions based on assessments. e. Clinical reasoning is an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions.

a,c,e a. Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. c. Clinical reasoning involves reflecting on interventions and reevaluating the plan of care based on the results of reflection. e. Clinical reasoning is an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions.

The nurse identifies that confidence is one of the attributes of successful clinical judgment. Which statements by the nurse are accurate regarding this attribute? (Select all that apply.) a. "Nurses who are confident are more assertive." b. "Overconfidence occurs with increased experience." c. "Legitimate confidence results from knowledge and willingness to seek guidance from expert practitioners." d. "Overconfidence may lead to negative patient outcomes." e. "Confidence in actions is simply reacting to problems."

a. "Nurses who are confident are more assertive." c. "Legitimate confidence results from knowledge and willingness to seek guidance from expert practitioners." d. "Overconfidence may lead to negative patient outcomes." -Confidence is demonstrated by nurses who are more assertive, seek knowledge and guidance from experts, and recognize that overconfidence may lead to poor patient outcomes. B is not true, as overconfidence in nursing may lead to unsafe care. E is not accurate, as confidence is taking preventive actions rather than simply reacting to problems.

The nurse obtains a lower-than-normal (88% on room air) pulse oximetry reading on a patient. Which actions by the nurse result from accurately employing the critical-thinking skill of analysis in the nursing process? (Select all that apply. ) a. Assessing the patient for symptoms of hypoxia b. Providing oxygen according to standing orders c. Elevating the head of the bed, if not contraindicated d. Allowing the patient to be alone to rest more comfortably e. Discussing adaptations needed for daily activities with the patient

a. Assessing the patient for symptoms of hypoxia b. Providing oxygen according to standing orders c. Elevating the head of the bed, if not contraindicated -Analysis involves assessing a situation and determining what should be done based on an appropriate rationale. In this case, assessing the patient for symptoms of hypoxia, providing oxygen as ordered, and elevating the head of the bed help determine the extent of air hunger, promote increased gas exchange, and ease the effort of breathing. Leaving a patient who has a low pulse oximetry reading alone is potentially dangerous. Discussing nonemergent information with a patient experiencing air hunger requires increased oxygen consumption and is inappropriate.

The nurse obtains a lower-than-normal (88% on room air) pulse oximetry reading on a patient. Which actions by the nurse result from accurately employing the clinical judgment attribute of early problem recognition? (Select all that apply.) a. Assessing the patient for symptoms of hypoxia b. Providing oxygen according to standing orders c. Elevating the head of the bed, if not contraindicated d. Allowing the patient to be alone to rest more comfortably e. Discussing adaptations needed for daily activities with the patient

a. Assessing the patient for symptoms of hypoxia b. Providing oxygen according to standing orders c. Elevating the head of the bed, if not contraindicated -Early problem recognition is critical to safe patient care. Noticing slight or dramatic changes in a condition and preventing complications is expected of all nurses. Accurate and ongoing assessment is essential throughout nurse-patient interaction. In this case, early problem identification includes assessing the patient for symptoms of hypoxia (to determine the extent of air hunger), providing oxygen as ordered (which promotes increased gas exchange), and elevating the head of the bed (which helps ease the effort of breathing). Leaving a patient who has a low pulse oximetry reading alone is potentially dangerous and not early problem identification. Discussing nonemergent information with a patient experiencing air hunger requires increased oxygen consumption. This is inappropriate and, again, is not early identification of problems.

During the assessment of a patient admitted for a total hip replacement, the nurse asks the patient to explain prior hospital experiences and, more specifically, any operative experiences. These questions reflect the nurse's use of which intellectual standard of critical thinking? a. Clarity b. Logic c. Precision d. Significance

a. Clarity -Patient information must first meet the intellectual standard of clarity before it is evaluated for precision, logic, or significance.

In providing care to a patient admitted to rule out human immunodeficiency virus (HIV) infection, wearing gloves during which activity may be an indication of bias? a. Collecting the patient's medical history b. Administering IV medications c. Performing oral care d. Completing a bed bath

a. Collecting the patient's medical history -Donning gloves every time the nurse enters the patient's room may reflect bias related to the care of a patient with HIV infection and may interfere with the development of a therapeutic relationship with the patient. The patient with HIV is on standard precautions unless there are complications that put the nurse at risk of blood or body fluid exposure. It would be appropriate for the nurse to wear gloves during the other activities

The nurse recognizes which environmental factors that influence clinical judgment skills? (Select all that apply.) a. Cultural values b. Literature review c. Cue analysis d. Complexity of tasks e. Interruptions

a. Cultural values d. Complexity of tasks e. Interruptions -A, D and E are all environmental factors that can impact clinical judgment skills. Cue analysis is a component of the NCSBN-CJMM. Literature review is a strategy to develop strong clinical judgment skills.

In preparing for a certification examination, the nurse chooses to develop a concept map to help understand the content. This strategy is based upon which characteristics of concept maps? (Select all that apply.) a. Facilitates note taking b. Requires thinking aloud c. Fosters making correlations between concepts d. Validates content with an expert e. Organizes visual data

a. Facilitates note taking c. Fosters making correlations between concepts e. Organizes visual data -Concept maps are a method to organize and visualize data in order to identify relationships and solve problems. Concept maps can be used for note taking, mapping nursing care plans, and preparing for exams. Through visual representations, the student can make correlations between related concepts.

Which of the following are the components of Carper's ways of knowing? (SATA) a. Factual knowledge from science b. Self-awareness and empathy c. Ethical framework/ moral attitude d. Skilled in action e. Education on health promotion

a. Factual knowledge from science b. Self-awareness and empathy c. Ethical framework/ moral attitude d. Skilled in action

Which step of Tanner's Clinical Judgement process coincides with the diagnosis/planning stage of the nursing process a. Interpreting b. Noticing c. Reflecting d. Responding

a. Interpreting

During the postoperative assessment on a patient, the nurse has a "hunch" that the patient has a postoperative complication based upon a. intuition. b. interpretation. c. information processing. d. inference.

a. Intuition -Knowing or feeling that you know something without specific evidence is one explanation of intuition. Intuition is a valid characteristic of expert clinical judgment acquired through knowledge, practice, and experience. It is described as how expert nurses use intuition to facilitate problem solving because this "hunch" (most likely intuition) is based upon experiential knowledge.

In preparing to administer medications to a patient, the nurse notes a medication that she has never administered. If the nurse administers the medication without researching the medication, this represents which error in critical thinking? a. Lack of information b. Illogical thinking c. Close-mindedness d. Erroneous assumptions

a. Lack of information -The nurse cannot critically think about something he or she does not know. As a result, knowledge deficit can cause errors in thinking. The nurse in practice must continue to build his or her knowledge base in order to provide safe and appropriate care. This is particularly relevant to the increased numbers of medications that nurses administer, and the possible interactions with other medications and foods. The nurse can make a medication error if new or unfamiliar medications are not researched prior to administering to patients.

In providing care to a newly admitted patient, the nurse's inferences are more accurate if based upon which of the following? a. Objective data b. Assumptions c. Intuition d. Experience

a. Objective data -Because objective data is based upon observable data that can usually be replicated by another provider, it is the more valid basis for inferences. The accuracy of the inferences is directly related to the accuracy of what the inference is based upon. Assumptions are beliefs that are taken for granted and "assumed" true. Knowing or feeling that you know something without specific evidence is one explanation of intuition. Explanation is a way of describing a conclusion, not data.

The student nurse is preparing for the first clinical day of patient care. Which strategy of critical thinking would be an example of thinking ahead? a. Researching evidence-based care strategies b. Assessing the patient's physical status c. Identifying and preventing patient risk d. Deciding what component of care could be improved

a. Researching evidence-based care strategies -Thinking ahead requires being prepared, anticipating potential challenges, and identifying necessary resources that can provide helpful information. Thinking ahead is especially important for students and novice nurses. Ways in which student nurses can think ahead include reading textbooks, researching evidence-based care strategies, and becoming aware of resource people within the clinical setting. B and C are examples of thinking in action and D is an example of thinking back or reflecting.

The nurse can facilitate critical thinking through the use of which interpersonal skills? (Select all that apply.) a. Teamwork b. Intuition c. Judgment d. Conflict management e. Advocacy f. Reasoning

a. Teamwork d. Intuition e. Advocacy -Interpersonal skills such as teamwork, conflict management, and advocacy engage others in the process of critical thinking. Intuition, judgment, and reasoning are intrapersonal aspects of critical thinking that the nurse may use personally to better understand a situation.

The nurse recognizes that in Tanner's Clinical Judgment Model, which statement best explains the step of interpreting? a. The nurse engages in clinical reasoning to analyze what is occurring and to form a hypothesis. b. After actions are considered for care, the nurse weighs the potential outcomes of those interventions. c. The nurse gets the initial grasp of the patient's situation. d. The nurse "reads" the patient and adjusts interventions based on this assessment

a. The nurse engages in clinical reasoning to analyze what is occurring and to form a hypothesis -When the nurse uses clinical reasoning to analyze what is occurring and to form a hypothesis, this is the step of interpreting in the Tanner Clinical Judgment Model. It is responding when, after actions are considered for care, the nurse weighs the potential outcomes of those interventions. Noticing is when the nurse gets the initial grasp of the patient's situation. Reflection-in-action is when the nurse reads the patient and adjusts interventions based on this assessment.

Discuss the application of the interpretivist perspective in clinical situations. In which of these circumstances would the interpretivist perspective be used? (select all that apply) a. There is no clear-cut answer b. In a critical situation c. By a nurse with lots of experience d. By a student nurse e. When a strict protocol is required to be followed

a. There is no clear-cut answer c. By a nurse with lots of experience

Which educational activities will promote the development of clinical judgment skills in nurses and student nurses? (Select all that apply.) a. Unfolding case studies b. Clinical assignments c. Simulation of clinical scenarios d. Answering true/false test questions e. Concept mapping f. Completing math calculations

a. Unfolding case studies b. Clinical assignments c. Simulation of clinical scenarios e. Concept mapping -Strategies to develop strong clinical judgment skills include utilization of unfolding case studies, application of skills in appropriate clinical assignments, use of simulation incorporating clinical scenarios, and concept mapping. Answering true/false test questions and completing math calculations do not enhance clinical judgment.

Which of the following actions reflects inductive reasoning? a. Using subjective and objective data to confirm a diagnosis b. Assessing for specific clinical presentations based on a disease process c. Correlating elevated blood pressure to pathophysiology d. Validating an automatic blood pressure cuff reading with a manual measurement

a. Using subjective and objective data to confirm a diagnosis -Inductive reasoning uses specific facts or details to make conclusions and generalizations (i.e., going from specific to general). Using assessment data (specific data) to arrive at a conclusion (diagnosis) is an example of induction. Deductive reasoning involves generating facts or details from a major theory, generalization, or premise (i.e., from general to specific). The validation of a disease process (general) by specific assessment parameters (signs and symptoms, diagnostic study results, etc.) is an example of a deduction.

In approaching a new clinical situation, the nurse uses which question to facilitate precision in critical thinking? a. "What do I know about this situation?" b. "What additional details do I need to gather?" c. "Does the clinical presentation correlate with the diagnosis?" d. "Are the treatments appropriate for the diagnosis?"

b. "What additional details do I need to gather?" -Precision relates to providing sufficient detail to lead to an exact understanding of the situation. What do I know about this situation? is focused on self-reflection about what is known about the situation. Does the clinical presentation correlate with the diagnosis? relates to relevance. Are the treatments appropriate for the diagnosis? relates to logic.

The nurse receives change of shift report on the five assigned patients and reviews prescriptions, treatments, and medications scheduled for the shift. Based on analysis of this information, the nurse chooses which patient to assess first. Which process of critical thinking best describes the nurse's action? a. Problem b. Decision making c. Judgment d. Reasoning

b. Decision making -The nurse used decision making to guide which patient to see first, based on an analysis of patient data and care needs. Problem solving is used when the nurse is faced with a situation that requires analysis and a solution. Judgment is used in the decision-making process but does not result in the actual decision. Reasoning is logical thinking that may be used in decision making but, again, is not the actual result. Decision making culminates in a definitive action.

The nurse is completing an assessment on a patient with sudden onset of abdominal pain. During the assessment, the nurse considers similar presentations and the underlying pathophysiology related to the patient's clinical manifestations. Which critical-thinking skill should the nurse use first to determine the cause of the patient's abdominal pain? a. Evaluation b. Interpretation c. Reflection d. Inference

b. Interpretation -Nurses use interpretation to understand and explain the meaning of data. In this case, the nurse must first interpret the assessment data before reflecting on its meaning, evaluating its reliability or credibility, and making inferences that will have an impact on treatment options

A nurse wishes to obtain data about a patient's self-esteem. What is the best assessment technique for the nurse to use to obtain this data? a. Conducting a structured interview with direct questions b. Interviewing the patient in an unstructured format c. Disregard any nonverbal clues from the patient d. Completing an entire head-to-toe assessment first

b. Interviewing the patient in an unstructured format -An unstructured interview format allows the nurse to establish rapport and get insight into the patient's perspective. Combined with observation, this would yield the best information. Observation often results in gathering a depth of data that is difficult to gain by other methods. Combined with an unstructured interview to gain the patient's trust, this technique would be very valuable. A head-to-toe assessment would not yield information about self-esteem. A structured interview is often used to gather specific information, but since this nurse has not yet had time to develop rapport, focusing questions on a sensitive issue such as self-esteem would probably not elicit accurate information. Also, structured interviews are most often used in emergency situations, and this does not qualify as an emergency.

The nurse uses a case study presentation to present an educational offering to the staff on the unit. This strategy improves the staff nurses' critical thinking through which of the following? a. Reviewing the literature b. Practicing application of knowledge c. Discussing with colleagues d. Role playing

b. Practicing application of knowledge -While the nurse may review the literature and discuss the presentation with colleagues in the preparation of the educational offering, the integration of a case study facilitates the critical thinking of the nurses attending through the application of knowledge. Role playing involves participants being involved in a "playing out" the content.

Which of the following is the best behavioral objective? upon completion of this class, the student will be able to: a. know when to use a reflective journal b. list 3 components of a reflective journal c. understand how to write a reflective journal d. write an appropriate reflective journal

b. list 3 components of a reflective journal

A new graduate nurse explains a new approach in the positioning of patients with chronic low back pain. The nurse preceptor responds, "That is not the way we do it here." The preceptor's response illustrates which error in critical thinking? a. Lack of information b. Erroneous assumptions c. Illogical thinking d. Bias

c. Illogical thinking -Illogical thinking is often characterized by hasty generalizations and assumptions that do not consider the evidence. Another trait associated with this type of thinking is related to following tradition and uses the argument that "we have always done it this way." When illogical thinking is used, creativity in thinking can be limited, and new ideas and approaches do not evolve. In nursing, illogical thinking can occur if nurses do not stay current, and care can be compromised.

A nursing instructor assigns the clinical group the task of writing a journal depicting the student's clinical day. What is the most likely rationale for this assignment? a. Journaling teaches open-mindedness, a critical thinking disposition. b. Journaling is a way to organize your thoughts about your experiences. c. Journaling allows reflection, an important critical thinking skill. d. Journaling gives you time to review what happened in your clinical.

c. Journaling allows reflection, an important critical thinking skill. -Critical thinking requires reflection on what occurred, how data were processed, and how decisions were made. Journaling is one method of developing critical thinking skills. Journaling does give nurses time to review what happened in their clinical, but this statement does not go far enough in explaining the importance of the journal-writing process. Journaling may be a way to organize thoughts about one's experiences, but this statement is too narrow an explanation and does not account for the critical aspect of reflection. Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views. Journaling can assist with developing this disposition, but only if what is written reflects that specific topic.

The nurse is assigned to develop a plan of care for a patient with a medical diagnosis that is unknown to the nurse. Guided by critical thinking, which action should the nurse take first? a. Ask the patient to describe the chief complaint b. Request that another nurse be assigned to this patient c. Review data about the medical diagnosis and routine management d. Complete a physical assessment of the patient

c. Review data about the medical diagnosis and routine management -The priority action is to find the necessary information/data needed to guide the nursing care. The nurse cannot apply critical thinking about something that is unknown. If the nurse asks the patient to describe the chief complaint or completes the physical assessment with limited knowledge of the disease process, the nurse has nothing to corroborate or compare. Requesting another nurse to care for the patient does not address the lack of knowledge.

Which question would be most appropriate for the nurse to ask while evaluating the relevance of patient data? a. Do these findings make sense? b. How can this information be verified? c. What are the most significant factors in the problem? d. What is the relationship of this information to other data?

c. What are the most significant factors in the problem? -Determining relationships is effective in establishing the relevance of data. Verification of information is related to accuracy, making "sense" relates to logic, and significance more closely relates to depth. The routine use of the intellectual standards helps improve critical thinking.

A nurse is talking to a woman who recently lost her husband. the nurse has never experienced the loss of a family member. In this situation, the nurse would most likely employ a. ethical knowing b. esthetic knowing c. empirical knowing d. personal knowing

c. empirical knowing

A nursing student observes an experienced nurse perform a complicated medical procedure while talking to the patient about discharge plans. afterwards, the nurse asks if the student noticed that the patient was short of breathe. The nurse was demonstrating a. personal knowing b. unknowing c. esthetic knowing d. empirical knowing

c. esthetic knowing -experience

Which of the following is an example of a standards based approach to clinical judgment? a. planning patient care b. meeting with the patient's family c. initiating CPR d. patient teaching

c. initiating CPR

From an interpretivist perspective, which of the following factors will a nurse consider while caring for a patient? (Select all that apply.) a. Information from significant others and friends b. The nurse's previous experiences, values, and emotions c. Context of care d. What the nurse personally brings to the caring encounter e. The information from the chart

All of them a. Information from significant others and friends b. The nurse's previous experiences, values, and emotions c. Context of care d. What the nurse personally brings to the caring encounter e. The information from the chart

A nursing student completes a reflective journal about a clinical experience. The student is reflecting a. after action b. beyond action c. on action d. about action

a. after action

What is the reason for the Carper's theory? a. Expressing the lack of nursing knowledge b. Providing a base for self reflection c. Creates an effective nursing practice d. Educates others on how to provide only personal care

c. Creates an effective nursing practice

In using intuition to address a clinical problem, the expert nurse bases his or her approach upon which of the following? a. Judgment b. Data collection c. Experiential knowledge d. Logical deduction

c. Experiential knowledge -Alfaro-LeFevre (2009) describes how expert nurses use intuition to facilitate problem solving because this "hunch" (most likely intuition) is based upon experiential knowledge. Less experienced nurses rely more on logic and a step-by-step approach when encountering the same issue. In either situation, intuition based upon critical thinking requires analysis and evidence to support actions.

The nurse facilitates the use of the intellectual standard of critical thinking of significance by posing which question to determine the patient's understanding of his or her new diagnosis of type 1 diabetes mellitus on his or her lifestyle? a. "What information do I need to provide to teach the patient?" b. "Do you understand how to administer your insulin?" c. "What are the signs of low blood glucose?" d. "How will this diagnosis impact your career?"

d. "How will this diagnosis impact your career?" -Significance focuses on how important the information (diagnosis of diabetes mellitus) is to the issue being addressed. Because the nurse is attempting to determine the understanding of the new diagnosis, a focus on how the disease will affect the person's lifestyle focuses on the significance to the patient. The other questions address content, knowledge about DM, not on its effect on the patient's lifestyle/adjustment.