Chapter 14 Clinical Judgment

A group of student nurses has been encouraged by their instructors to be intentional and deliberate about applying clinical decision-making models to their practice. A student tells a colleague, "The model that makes the most sense to me is the information-processing model, because it seems the most straightforward." How should the colleague best respond to this student?

"It is definitely a clear model, but it does not really capture all of the complexities and the human element of nursing."

The nurse is applying the Clinical Judgment Measurement Model (CJMM) to the care of a client who has been expressing anxiety. The nurse has recognized and analyzed the various cues that the client is exhibiting, has prioritized hypotheses that may explain the client's anxiety, and is now generating possible solutions. In this particular stage of the CJMM, the nurse is demonstrating which component of Rest's framework of moral reasoning?

moral judgment/reasoning

Tanner's Clinical Judgment Model in order

noticing interpreting responding reflecting

Effective Noticing

<Clear communication <Well-planned intervention/flexibility <Being skillful

Clinical Judgment Concepts (4)

>Critical thinking >Clinical reasoning >Clinical judgment >Situational awareness

Clinical Decision-Making Theories, Models, and Frameworks

>Humanistic-Intuitive Approach >Information-Processing Model >Cognitive Continuum Theory >Rest Framework go back and read page

A nurse is conscientious in applying the Quality and Safety Education for Nurses (QSEN) competencies to the provision of clinical care. To enact the value of quality improvement, the nurse should perform what action?

Advocate for changes to shift handoff so that the process is more efficient.

A community health nurse has recommended a specific, medicated wound-care product to a client with a chronic venous ulcer. A colleague has asserted that the nurse has exceeded the scope of practice. The two nurses should consult resources from what organization to resolve this dispute about the scope of practice?

American Nurses Association

A nurse has recommended a regimen of over-the-counter medications for a client who has seasonal allergies. A colleague contends that the nurse has exceeded the scope of nursing practice by recommending medications to a client. To resolve this difference of opinion, the nurses should consult resources from what organization?

American Nurses Association

Lasater Clinical Judgment Rubric #1

Based on Tanner's model; describes the development of clinical judgment >effective noticing >effective interpreting >effective responding

what is effective responding?

Calm, confident manner

A novice nurse has witnessed the value of critical thinking in planning and responding to clients. Which principle should inform the nurse's practice?

Critical thinking is a skill that can be learned and developed.

An experienced nurse has received a new client and will apply the principles of inductive reasoning in the care-planning process. What action will the nurse perform first when applying this form of clinical reasoning?

Gather objective and subjective assessment data.

The nurse is participating in a client conference for a client who has complex health needs. The client's psychiatrist, occupational therapist, and social worker are also participating in the conference. The nurse is most clearly demonstrating the values of what organization?

Interprofessional Education Collaborative

A skilled nurse is providing care for a client with mental health needs who is recovering from a stroke. The client is experiencing dysphagia (difficulty swallowing), so the nurse is working together with the speech-language pathologist (SLP) to ensure the client's cooperation with a swallowing assessment. This nurse's action best demonstrates:

Interprofessional Education Collaborative (IPEC) core competencies.

A nurse is participating on a task force that has been formed at a hospital to increase interdisciplinary collaboration. Specifically, the task force is pursuing the competencies of the Interprofessional Education Collaborative (IPEC). What goal indicates achievement of these competencies?

Members of diverse disciplines will collaborate on decision-making in an environment of mutual respect.

A nursing student is excited to begin the first semester of the program and has learned that the competencies embedded in the program include human flourishing, nursing judgment, professional identity, and spirit of inquiry. What is the source of these competencies?

National League for Nursing

Tanner's Clinical Judgment Model what are the 4 steps?

Noticing: initial grasp and perceptions of the situation that are impacted by context, the nurse's practical experience, knowledge of expected versus unexpected data, ethical perspectives, and the nurse-patient relationship Interpreting: attributing meaning to the data through multiple reasoning patterns Responding: deciding on an action (or inaction) and monitoring outcomes Reflecting: in-action and on-action

A nurse has entered a client's home and noticed the client's disheveled state and several fall risks in the home. The nurse has interpreted these data as indications of a need for increased home support for the client and responded by arranging for care. The nurse reflected on the client's response to this suggestion, as well as reflected on the course of this interaction after the fact. The nurse has most clearly exemplified what model?

Tanner's clinical judgment model

A community health nurse has a reputation that is described as "stellar" by peers and colleagues. Apart from the nurse's years of experience, the nurse's skillfulness is the attribute most described by others. According to cognitive continuum theory (CCT), what characteristic of the nurse suggests that the nurse has achieved the highest level of competence?

The nurse is able to apply intuition to complex clinical scenarios

A novice nurse has been growing in skill, largely as a result of experiential learning in the clinical setting. Within the model of experiential learning, what outcome would most clearly indicate that the nurse has achieved the stage of transformation?

The nurse integrates experience and reflections into new forms of practice.

A community health nurse has a reputation that is described as "stellar" by peers and colleagues. Apart from the nurse's years of experience, the nurse's skillfulness is the attribute most described by others. According to cognitive continuum theory (CCT), what characteristic of the nurse suggests that the nurse has achieved the highest level of competence?

The nurse is able to apply intuition to complex clinical scenarios.

For which scenario will the nurse consult resources from the American Nurses Association?

The nurse is unsure whether a particular intervention is in the nursing scope of practice.

A nurse is distraught that she failed to intervene promptly in a situation where a client's status declined sharply. The client was becoming agitated and aggressive. The nurse states, "There was just too much going on, all at once, and I basically froze and then panicked." What interpretation of this event is most accurate?

The speed and complexity of the situation overwhelmed the nurse's cognitive load.

What action by the nurse in a hospital setting best exemplifies the goals of the Interprofessional Education Collaborative (IPEC) core competencies?

coordinating with the physical therapist to amend a client's activity orders in the plan of care

A nurse is applying Tanner's clinical judgment model in the care of a postpartum client. Which action by the nurse will constitute the first step in this process?

noticing the significant aspects of the client's condition

The nurse has provided analgesia to a client who was reporting pain, and the nurse used the NCSBN Clinical Judgment Measurement Model (CJMM) to inform the process. What action by the nurse represents the final step in this model?

evaluating the client's pain 30 minutes after administering the analgesia

The nurse is describing a clinical encounter, stating, "I entered the room, gathered assessment data, and then provided the interventions specified in standard operating procedures." The nurse is applying which conceptualization of clinical decision-making?

information-processing model

A critical incident in the clinical setting that resulted in a client's death has profoundly affected the student nurse. This has prompted a self-examination of the student nurse's learning ethos. When reflecting on the learning ethos, the student nurse should consider which factor(s)? Select all that apply.

relationships, trust, and rapport that they develop

A client reported pain rated at 8/10, so the nurse administered a PRN dose of hydromorphone 30 minutes ago. In monitoring the client's status postadministration, the nurse is demonstrating what element of Tanner's Clinical Judgment Model?

responding