Chapter 14: Clinical Judgment
The nurse has entered a client's home and has observed that the client's respiratory rate is elevated and that the client is exhaling audibly. Based on these cues, the nurse suspects that the client is either anxious or hypoxic. Which step of the Clinical Judgment Measurement Model (CJMM) has the nurse just applied? -diagnosing -prioritizing hypotheses -providing explanations -taking action
prioritizing hypotheses Explanation: The Clinical Judgment Measurement Model (CJMM) proceeds from identification and analysis of cues (data and assessment results) to prioritizing hypotheses, or considering potential explanations. The CJMM does not include steps of "diagnosing" or "providing explanations." Taking action involves providing interventions, and occurs later than prioritizing hypotheses.
The community health nurse is participating in a debrief about a critical incident that involved a physical altercation with the client in the client's home. When applying Tanner's model of clinical judgment to this situation, the debriefing exercise constitutes what component of the model? -noticing -interpreting -reflection in-action -reflection on-action
reflection on-action Explanation: Reflection on-action involves a debrief or postconference. It occurs after the situation and drives clinical learning. Reflection in-action happens in the moment. Noticing involves the perception of cues near the beginning of the interaction, and interpreting is characterized by assigning meaning to the cues that were noticed.
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 -National League for Nursing -American Association of Colleges of Nursing -National Council of State Boards of Nursing
American Nurses Association Explanation: While each of the listed organizations provides resources and information of different types, this dispute is directly related to scope of practice, which is delineated by the American Nurses Association's Nursing: Scope and Standards of Practice.
A new nursing student has been surprised to learn that reflective journaling is a component of the curriculum. The student states to a colleague, "We would be better off spending our time working on our skills than writing in a journal." What benefit(s) of reflective journaling should the colleague describe to this somewhat frustrated student? Select all that apply. -"It can help you better understand your progress toward your learning goals." -"Reflection through journaling can help you draw more learning out of your experiences." -"Journaling can bring to mind aspects of a clinical experience that escaped you in the moment." -"In many ways, journaling is more effective than hands-on experience in growing as a nurse." -"Because of its benefits, journaling is specifically mandated in our scope of practice."
"It can help you better understand your progress toward your learning goals." "Reflection through journaling can help you draw more learning out of your experiences." "Journaling can bring to mind aspects of a clinical experience that escaped you in the moment." Explanation: Reflective journaling has numerous benefits, including determination of goals, deriving new meaning from experiences, and enhancing the understanding of clinical experiences, which often unfold at a rapid pace. It is not, however, specified as a component of scope of practice, nor is it necessarily "superior" to kinesthetic skills practice; reflection and hands-on practice are both necessary for learning.
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? -"That model was dominant in nursing for decades but has recently been replaced by more nuanced models." -"Absolutely. Many of the other models are evidence-based but excessively complex." -"It is definitely a clear model, but it does not really capture all of the complexities and the human element of nursing." -"I agree. The model is elegant for its simplicity and has been clinically linked to better client outcomes."
"It is definitely a clear model, but it does not really capture all of the complexities and the human element of nursing." Explanation: The information-processing model is attractive by virtue of its simplicity and linear nature. However, there is no significant drive to apply this model to nursing practice, because nursing is psychosocially complex and cannot be reduced to a simple equation of input and output. For this reason, it has never been predominant in nursing, even in past decades. It has not been proven to achieve better client outcomes in the literature.
A nursing student observed a staff nurse change a client's IV dressing. During post-conference, the student remarked to a classmate, "The nurse did not even follow the process we learned in lab!" What is the classmate's most appropriate response? -"You should consider some of the factors that might have influenced the nurse's action." -"It is well-known that nurses begin to 'cut corners' as soon as they graduate." -"Remember that the end result is the important thing, not the way that it's done." -"It is best to ignore what you see nurses do in practice and instead focus on what we learned."
"You should consider some of the factors that might have influenced the nurse's action." Explanation: It is important to consider contextual factors and the underlying principles when reflecting on differences between what the student nurse learns and what the student nurse observes in practice. This does not entail ignoring what is seen in the clinical setting, but rather reflecting on it. It is an unfair characterization of nurses that they become sloppy after becoming licensed. Finally, the means and method by which nursing care is provided are important; the end result is not the sole consideration.
The nurse has entered a client's hospital room and noticed that the client is grimacing and reporting bladder fullness despite the presence of an indwelling urinary catheter. The nurse has collected and interpreted assessment data and believes that the catheter is occluded. When applying Tanner's model of clinical judgment, what should the nurse do next? -Choose an intervention and then evaluate the effect of the intervention. -Articulate the assessment data and conclusions to the client. -Reflect on the situation before performing any further nursing actions. -Analyze the various cues that the client is projecting.
Choose an intervention and then evaluate the effect of the intervention. Explanation: Having performed the steps of noticing and interpreting, the nurse may progress to responding with nursing actions/interventions. Analysis of cues has already taken place during the phase of interpreting. Clear communication with the client is important, but there is no need to describe each assessment datum to the client. Reflection in Tanner's model takes place during and after nursing encounters; the progression toward action does not need to pause for reflection.
When identifying and responding to a client's anxiety, the nurse has moved through the process of recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes. The nurse's actions reflect a model proposed by the: -National Council of State Boards of Nursing (NCSBN). -National League for Nursing (NLN). -American Nurses Association (ANA). -American Association of Colleges of Nursing (AACN).
National Council of State Boards of Nursing (NCSBN). Explanation: The six steps listed constitute the NCSBN's Clinical Judgment Measurement Model (CJMM). Although it is not contrary to the values or guidance of the other listed entities, this model is specifically proposed by the NCSBN.
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? -American Association of Colleges and Universities -National League for Nursing -Centers for Disease Control and Prevention -Department of Health and Human Services
National League for Nursing Explanation: The competencies identified by the National League for Nursing include human flourishing, nursing judgment, professional identity, and spirit of inquiry. None of the other listed organizations share this particular taxonomy of competencies.
A nurse has used Tanner's clinical judgment model to frame the response to a challenging clinical situation. When enacting the final step of this process, what will the nurse do? -Reflect on-action. -Advocate for change. -Evaluate outcomes. -Self-examine for bias.
Reflect on-action. Explanation: Reflection on-action is the final step in Tanner's iterative process of clinical judgment. Evaluation of outcomes takes place previously, as part of responding. Examination for bias is not an explicit component of the model but would generally take place before a clinical encounter, when possible. Client advocacy is consistent with the model but is not an explicit part of it.
A novice nurse has received feedback from a peer that describes the nurse as lacking situational awareness. What observation by the peer likely led to this conclusion? -The nurse has difficulty identifying the less obvious changes in clients' conditions. -The nurse expresses frustration with clients who are vague or indecisive in their reports. -The nurse is unaware of the specifics of the nursing scope of practice and code of ethics. -The nurse committed a medication error by administering an immediate-release opioid rather than an extended-release opioid.
The nurse has difficulty identifying the less obvious changes in clients' conditions. Explanation: Being able to identify and address rapid changes in client status (especially subtle changes) is the hallmark of situational awareness. Medication errors can happen for many reasons and not necessarily because of a lack of situational awareness. Lack of knowledge about scope and lack of patience with clients are concerning lapses, but do not necessarily stem from a lack of situational awareness.
A new graduate is working in a public health unit that is staffed by several experienced nurses. Which description demonstrates that the nurse has attained the status of "expert" according to Benner's novice-to-expert model of nurse development? -a nurse who can consistently apply intuition to complex nursing situations -a nurse who has 10 years of clinical experience -a nurse who has provided care in numerous community-based and inpatient settings over several years -a nurse who is engaged in clinical practice, teaching, and scholarship
a nurse who can consistently apply intuition to complex nursing situations Explanation: Although all of the listed nurses may potentially have attained the level of expert, a hallmark of an expert nurse in Benner's model is the ability to discern subtle cues and apply intuition to complex situations.
The home health nurse is performing a home visit to a client who has been diagnosed with postpartum depression. How can the nurse best demonstrate the Quality and Safety Education for Nurses (QSEN) competency of safety during this home visit? -suggesting online support groups for parents in similar circumstances -assessing the client's risk for suicidal ideation during the visit -weighing the infant during the visit and comparing to the most recent values -asking the client questions to establish trust and rapport
assessing the client's risk for suicidal ideation during the visit Explanation: Assessing for suicidality is a direct and tangible expression of safety. Each of the other listed actions is consistent with safety but in a less direct manner. Rapport-building and offering support are most closely aligned with client-centered care. Assessment is also related to safety but in a less direct manner than determining suicide risk.
The nurse applies Tanner's Clinical Judgment Model while providing care on a busy medical unit. Which of the nurse's actions demonstrates reflection-in-action? -debriefing with the care team following a code blue that resulted in a client's death -gauging the effectiveness of a teaching session by monitoring the client's changing body language -journaling about a client's family conflict that the nurse observed -participating in an in-service focused on building empathic listening skills
gauging the effectiveness of a teaching session by monitoring the client's changing body language Explanation: Reflection-in-action occurs when actively engaged in the situation and during ongoing monitoring and assessment; reflection-on-action, which mirrors a debrief or postconference, occurs after the situation and drives clinical learning. Journaling also exemplifies reflection-on-action. In-service learning equips the nurse to provide better care but does not have the immediacy of reflection-in-action.
The nurse has applied Rest's framework of moral reasoning to a clinical situation that is ethically complex. In navigating the situation, the nurse has applied each of the components of the model, including moral judgment/reasoning. By acting on this component, the nurse has also exemplified what step in the Clinical Judgment and Measurement Model (CJMM)? -recognize cues -generate solutions -prioritize hypotheses -evaluate outcomes
generate solutions Explanation: Moral judgment/reasoning involves the consideration of several courses of action. This closely parallels the step of "generate solutions" within the Clinical Judgment Measurement Model (CJMM). The other listed steps either precede (recognize cues; prioritize hypotheses) or follow (evaluate outcomes) this step.
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? -humanistic-intuitive approach -cognitive continuum theory -Rest framework -information-processing model
information-processing model Explanation: The rote, linear approach to addressing issues that disregard client complexities is the information-processing model. Each of the other listed models integrates the complex, human realities of nursing practice.
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 sensitivity -moral judgment/reasoning -moral motivation/focus -moral character
moral judgment/reasoning Explanation: Moral judgment/reasoning involves consideration of several courses of action to account for the potential impact on those involved. This is tantamount to generating solutions. Moral sensitivity involves awareness of ethics. Moral motivation is the cognitive process of decision-making. Moral character is the actual implementation of a plan.
The nurse is applying Tanner's Clinical Judgment Model in the care of a client. Building off the context and background information, place the components of the model in the correct sequence. Use all options.
noticing interpreting responding reflecting Explanation: Tanner's model represents an interactive process that generally follows the sequence of noticing, interpreting, responding and reflecting (both on-action and in-action).
A nurse is navigating a busy morning on a hospital unit and is struggling to finish the necessary tasks in the time available. In response, the nurse has assigned morning hygiene tasks for two clients to an unlicensed assistive personnel (UAP). What QSEN competency is this nurse exemplifying? -evidence-based practice -client-centered care -teamwork and collaboration -quality improvement -safety -informatics
teamwork and collaboration Explanation: Although this action is consistent with all the QSEN competencies, delegation is a practical example of the competency of collaboration and teamwork in the clinical setting.
A nurse is navigating a busy morning on a hospital unit and is struggling to finish the necessary tasks in the time available. In response, the nurse has assigned morning hygiene tasks for two clients to an unlicensed assistive personnel (UAP). What QSEN competency is this nurse exemplifying? -client-centered care -safety -teamwork and collaboration -informatics -quality improvement -evidence-based practice
teamwork and collaboration Explanation: Although this action is consistent with all the QSEN competencies, delegation is a practical example of the competency of collaboration and teamwork in the clinical setting.
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 -The Joint Commission -National League for Nursing -National Councili of State Boards of Nursing
Interprofessional Education Collaborative Explanation: Active collaboration between health professions is the cornerstone of the Interprofessional Education Collaborative (IPEC) competencies. The actions are wholly consistent with the values of the other listed organizations, but the interdisciplinary nature of this action is a direct and practical example of IPEC competencies.
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? -The Lasater clinical judgment rubric -Tanner's clinical judgment model -California Critical Thinking Disposition Inventory (CCTDI) -Developing Nurses' Thinking (DNT) model
Tanner's clinical judgment model Explanation: Although the nurse's actions are not inconsistent with any of the listed models, the integration of the specific steps of noticing, interpreting, responding, and reflecting demonstrates Tanner's clinical judgment model.
A hospital client who requires assistance with hygiene has expressed a preference for receiving a bed bath after lunch rather than in the morning. The nurse has consequently changed the nursing care plan. The nurse's action reflects which QSEN competency? -client-centered care -empathic care -accountability and adaptability -quality improvement
client-centered care Explanation: Adjusting a client's care in response to the client's preferences or abilities is indicative of client-centered care. Quality improvement is focused more broadly on systems and processes. Empathic care and accountability and adaptability are not QSEN competencies.
The psychiatric-mental health nurse is planning care for an adult client. Which aspect(s) of the client's circumstances does the nurse consider to be a sign or symptom? Select all that apply. -low serotonin levels -major depression -low dopamine levels -delayed responses to questions -expressions of hopelessness
delayed responses to questions expressions of hopelessness Explanation: Major depression is a diagnosis associated with an etiology of low levels of dopamine and/or serotonin. Expressions of hopelessness and delayed responses are signs and symptoms of this underlying disorder.
A novice nurse is conscientious to integrate QSEN competencies into care. What area(s) will the nurse emphasize? Select all that apply. -safety -evidence-based practice -informatics -client-centered care -quality improvement -cost control
safety evidence-based practice informatics client-centered care quality improvement Explanation: The original QSEN competencies include six areas: client-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Cost control is not an discrete area of QSEN competencies.
A novice nurse is committed to becoming skilled in clinical judgment. Before exercising sound clinical judgment, the nurse must develop: -intuition. -situational awareness. -reflection-on-action. -complete moral character.
situational awareness. Explanation: Situational awareness is generally thought of as a necessary precursor to clinical judgment. Intuition and moral character develop after many instances of exercising sound clinical judgment. Reflection-on-action is the post-event examination of clinical situations, as defined in Tanner's Clinical Judgment Model, but it is not an explicit precondition for developing clinical judgment.
A novice nurse has witnessed the value of critical thinking in planning and responding to clients. Which principle should inform the nurse's practice? -The concept of clinical judgment has superseded the concept of critical thinking. -Critical thinking is an innate skill that some nurses possess. -Reliance on intuition is inconsistent with critical thinking. -Critical thinking is a skill that can be learned and developed.
Critical thinking is a skill that can be learned and developed. Explanation: Critical thinking is a learned skill—like many other nursing skills—that can be developed with learning and practice. It is not characterized as an innate characteristic that some possess and that others do not. Critical thinking is foundational to clinical judgment, and it can include intuition as a component.
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? -Establish rapport with a pregnant client before recommending specific actions. -Advocate for changes to shift handoff so that the process is more efficient. -Notify the health care provider when a fetal heart rate declerates suddenly. -Teach a client about the rationale for cardiac telemetry and link it to the client's diagnosis.
Advocate for changes to shift handoff so that the process is more efficient. Explanation: Process improvements, such as changes to communications like handoff, are indicative of quality improvement. Rapport-building is primarily associated with client-centered care and informing the team about a threat to health (e.g., decelerations) demonstrates safety as well as teamwork and collaboration. Client teaching is consistent with all the QSEN competencies but primarily with client-centered care.
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. -Hypothesize the client's most likely diagnoses and challenges. -Identify a respected nursing theory to inform care. -Select the principles that relate most closely to the client's admitting diagnosis.
Gather objective and subjective assessment data. Explanation: Inductive reasoning requires observing, then drawing conclusions. That is, the process begins with data (such as assessment findings) and then progresses to identification of patterns or explanations. Presupposing the client's challenges or diagnoses would be contrary to this linear process. Beginning with a principle or theory is consistent with deductive reasoning.
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? -The Joint Commission -National League for Nursing -Interprofessional Education Collaborative -National Councili of State Boards of Nursing
Interprofessional Education Collaborative Explanation: Active collaboration between health professions is the cornerstone of the Interprofessional Education Collaborative (IPEC) competencies. The actions are wholly consistent with the values of the other listed organizations, but the interdisciplinary nature of this action is a direct and practical example of IPEC competencies.
The community nurse has entered a client's home and noticed that the client is agitated and exhibits restless body language. The nurse has interpreted these behaviors as a sharp departure from the client's usual behavior and has discerned that the behavior is related to a recent family conflict. Within Tannner's model of clinical judgment, what will the nurse do next? -Respond by selecting the appropriate interventions. -Reassess the client during the next visit, after ensuring the client's safety. -Continue to monitor the client throughout the home visit. -Reflect on the nature of the visit after leaving the client's home.
Respond by selecting the appropriate interventions. Explanation: The continuum of nursing actions within Tanner's model progress from noticing (perceiving the client's behavior), interpreting (making meaning of the behaviors), to responding. Responding is characterized by choosing appropriate actions. Reflection is central to the model, but passive monitoring would not be a sufficient response to the client's behavior, which warrants the nurse's input.
A junior nursing student has learned that clinical and simulation performance will be measured according to the Lasater Clinical Judgment Rubric. This student is in a curriculum that subscribes to what model of clinical judgment? -Tanner's clinical judgment model -Benner's novice-to-expert model -The Developing Nurses' Thinking (DNT) model -The California Critical Thinking Disposition Inventory (CCTDI)
Tanner's clinical judgment model Explanation: Unlike the other listed models, the Lasater Clinical Judgment Rubric is explicitly designed to measure students' achievement of Tanner's 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 readily accepts the most complex client assignments. -The nurse is highly regarded by peers and colleagues. -The nurse is able to apply intuition to complex clinical scenarios. -The nurse has been providing care for over 10 years in the same setting.
The nurse is able to apply intuition to complex clinical scenarios. Explanation: Cognitive continuum theory (CCT) acknowledges and integrates both intuitive and analytical cognitive characteristics. These values supersede years of service, reputation, or willingness to take on difficult work.
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. -Rest's model of moral reasoning. -the American Nurses Association (ANA) Nursing: Scope and Standards of Practice. -reflection-in-action.
Interprofessional Education Collaborative (IPEC) core competencies. Explanation: Interprofessional Education Collaborative (IPEC) core competencies emphasize the need for interdisciplinary teamwork and collaboration, as demonstrated by working directly with a member of another health discipline. Reflection-in-action is a form of introspection and analysis within Tanner's model of clinical judgment, but there is no obvious indication that the nurse is doing this. The nurse's action is consistent with Rest's framework but this framework focuses on moral action, which is not described in the scenario. The nurse's action is well within the ANA Scope of Practice, but the focus on collaboration and teamwork is a more clear and apparent function.
A student nurse observed an experienced nurse performing a scheduled dressing change for a client with an abdominal incision. When describing the event to the clinical group, the student nurse states, "The experienced nurse rushed and did not do anything like what we have learned in the skills and sim labs." What characteristic of the experienced nurse's action justifies using the technique as described? -The experienced nurse adhered to the core principles of medical asepsis. -The nurse has more than 15 years of nursing experience in diverse settings. -The experienced nurse minimized the time that the field and the wound were exposed to room air. -The experienced nurse explained that there are many ways of performing any particular skill.
The experienced nurse adhered to the core principles of medical asepsis. Explanation: Variances from standard practices should be evaluated in light of how well they align with the basic principles of sound nursing care—in this case, medical asepsis. Experience alone cannot justify a particular action, and speed will not independently reduce the risk of contamination or maximize client outcomes. It is true that there are many techniques for performing common nursing tasks, but stating this fact does not guarantee that the nurse's action was acceptable.
A student nurse has been challenged to apply the principles of critical thinking during laboratory simulations. What characteristic of the student nurse's actions suggests that the student nurse engaged in critical thinking? -The student nurse adopted a position of likely being wrong rather than expecting to be right. -The student nurse identified every available option before choosing an action. -The student nurse thought systematically and reflectively before deciding what to do. -The student nurse respectfully criticized the actions of student nurses who did not choose the recommended approach.
The student nurse thought systematically and reflectively before deciding what to do. Explanation: Although there are many definitions of what constitutes critical thinking, there is broad agreement that the process involves intentional, reflective thinking to inform an action. This approach does not presume that one will likely be wrong. It often leads to an examination of various options, but it is not realistic to identify every possible option. Critical thinking is not synonymous with criticizing others.
A nursing student has been providing care for several clients in both community and hospital settings. For which client will the nurse use a concept map when planning and providing care? -client who has just been admitted to the emergency department with shortness of breath -community-dwelling client with complex physical and psychosocial needs -client who requires discharge teaching related to surgical wound care -client who has presented to the clinic for a scheduled immunization
community-dwelling client with complex physical and psychosocial needs Explanation: Although concept maps can inform care in a wide variety of circumstances, they are especially helpful when planning care for clients who have longstanding, complex needs. Concept maps have less utility in time-dependent circumstances like emergencies or in clients whose needs are more finite, such as clients needing specific teaching or a single immunization.
A nursing student has drawn on resources from many organizations while learning and practicing as a student nurse. For which action will resources from the American Nurses Association be appropriate? -determining whether an advanced wound care technique is within the scope of practice -preparing for the National Council Licensure Exam (NCLEX) -identifying the conceptual framework that underlies the nursing curriculum -participating in a unionization campaign in a local health care system
determining whether an advanced wound care technique is within the scope of practice Explanation: The American Nurses Association (ANA) performs several important roles related to nursing practice. However, it is unique in producing the Nursing: Scope and Standards of Practice. The ANA does not administer the NCLEX nor does it participate directly in labor matters related to collective bargaining.
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 -establishing trust and rapport with the client -prioritizing hypotheses that may explain the client's condition -engaging in reflection
noticing the significant aspects of the client's condition Explanation: Tanner's iterative model begins with noticing; this takes place on the basis of the nurse's initial grasp of the situation and precedes hypothesizing. Reflection takes place during and after interactions but after the initial step of noticing. Trust and rapport are key aspects of care but do not represent the initial stage of Tanner's model.
The nurse is applying the NCSBN's Clinical Judgment Measurement Model during an encounter with a client. Place the steps of the Clinical Judgment Measurement Model in the correct sequence. Use all options.
recognize cues analyze cues prioritize hypotheses generate solutions take actions evaluate outcomes Explanation: NCSBN's Clinical Judgment Measurement Model is a linear model with six discrete steps: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
A nurse's assessment of the client has revealed that the client is intensely anxious, so the nurse has administered a PRN dose of a prescribed antianxiety medication. Administering this medication constitutes which phase of Tanner's clinical judgment model? -responding -intervening -acting -doing
responding Explanation: Within Tanner's model, responding denotes deciding on an action and monitoring outcomes. The active phase of the model is not characterized as "doing," "intervening" or "acting."
A nursing student is progressing through a BSN curriculum that was engineered to align with 10 specific domains of competency and their associated featured concepts. This student's nursing curriculum is directly informed by the: -American Association of Colleges of Nursing's Essentials. -NCSBN's Clinical Judgment Measurement Model. -National League for Nursing's competencies. -The Joint Commission.
American Association of Colleges of Nursing's Essentials. Explanation: The AACN's Essentials outline 10 domains and associated competencies and subcompetencies. In addition, it includes other featured concepts such as communication; compassionate care; and evidence-based practice. The other listed organizations do include this specific structure of domains and featured concepts.
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? -National Council of State Boards of Nursing -American Nurses Association -American Association of Colleges of Nursing -National League for Nursing
American Nurses Association Explanation: While each of the listed organizations provides resources and information of different types, this dispute is directly related to scope of practice, which is delineated by the American Nurses Association's Nursing: Scope and Standards of Practice.
A nursing student has set the goal of becoming more skilled and confident in clinical judgment and clinical reasoning. What action(s) will the nurse perform to acheive the goal? Select all that apply. -Reflect on mistakes as well as successes. -Perform personal reflection during and after new experiences. -Adopt a systematic framework for practicing and evaluating clinical judgment. -Learn to trust intuition, when appropriate to the complexity of the situation. -Be continually aware of ethical issues and ethical responsibilities.
Be continually aware of ethical issues and ethical responsibilities. Perform personal reflection during and after new experiences. Learn to trust intuition, when appropriate to the complexity of the situation. Adopt a systematic framework for practicing and evaluating clinical judgment. Reflect on mistakes as well as successes. Explanation: Continual reflection, both on success and failures, is essential for developing clinical judgment. Development benefits from a recognized, testing framework. A sound framework for clinical judgment acknowledges the importance of ethics and intuition.
A student nurse who is soon to graduate is completing a preceptorship with a nurse who has many years of clinical experience. The student has marveled at the nurse's ability to derive meaning from complex and rapidly changing situations, relying heavily on nurse intuition. What characteristic of this nurse does this ability demonstrate most clearly? -The nurse is an expert, according to Benner's novice-to-expert model of development. -The nurse demonstrates ethical practice according to Rest's four-component model of moral reasoning. -The nurse has developed moral sensitivity and moral judgment. -The nurse has expanded beyond the American Nurses Association scope of practice.
The nurse is an expert, according to Benner's novice-to-expert model of development. Explanation: Intuition is a marker of an "expert" in Benner's model. Rest's framework (which contains moral sensitivity and moral judgment) focuses on ethics rather than information-processing and meaning-making. Expert nurses do not practice beyond their legally defined scope.
For which scenario will the nurse consult resources from the American Nurses Association? -The nurse is unsure how to frame feedback to a preceptor student. -The nurse needs to provide updated NCLEX information to a group of students. -The nurse is seeking guidance on QSEN competencies. -The nurse is unsure whether a particular intervention is in the nursing scope of practice.
The nurse is unsure whether a particular intervention is in the nursing scope of practice. Explanation: The American Nurses Association (ANA) produces Nursing: Scope and Standards of Practice. The National Council of State Boards of Nursing (NCSBN) administers the NCLEX. Quality and Safety Education in Nursing (QSEN) competencies are not within the purview of the ANA. Various organizations provide information and guidance on working with students, but this is not specific to the ANA.
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. -The nurse applied inductive reasoning at a time when deductive reasoning would have been preferable. -The nurse's situational awareness increased throughout the event. -The nurse failed to understand the importance of clinical judgment and clinical reasoning.
The speed and complexity of the situation overwhelmed the nurse's cognitive load. Explanation: Overstimulation in this case overwhelmed the nurse's cognitive load, leading to a failure to recognize, process, and act upon information. This is unrelated to the differences between inductive and deductive reasoning. The nurse's situational awareness decreased once overwhelmed, not increased. It is unlikely that this nurse's response was related to a lack of understanding that clinical judgment and clinical reasoning are important.
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 -National League for Nursing -National Council of State Boards of Nursing -American Association of Colleges of Nursing
American Nurses Association Explanation: The American Nurses Association (ANA) produces and maintains Nursing: Scope and Standards of Practice. This resource is considered the authority on scope of practice. The other listed organizations all inform nursing education and nursing practice in different ways, but none delineate the scope of practice.
A novice nurse is being mentored by a more experienced nurse who is able to recognize small but significant client cues and process large amounts of data in a short time. What conclusion(s) should the novice nurse draw about the more experienced nurse's practice? Select all that apply. -The nurse has a high capacity for cognitive load. -The nurse has well-developed situational awareness. -The nurse is able to rely on reflection-in-action rather than reflection-on-action. -The nurse is able to rely on intuition more than critical thinking. -The nurse is able to apply the steps of the Clinical Judgment and Measurement Model (CJMM) simultaneously.
The nurse has a high capacity for cognitive load. The nurse has well-developed situational awareness. Explanation: Cognitive load refers to the amount of information a person can hold in their memory at one time; this nurse is able to hold large amounts of data and process them quickly. The ability to discern subtle cues is associated with situational awareness. The six steps of the Clinical Judgment and Measurement Model are linear, and not normally applied at a single point in time. Intuition is more developed in experienced nurses, but this is a component of critical thinking rather than an alternative to it. Reflection-in-action and reflection-on-action are both used by experienced nurses in Tanner's clinical judgment model.
A novice nurse is being mentored by a more experienced nurse who is able to recognize small but significant client cues and process large amounts of data in a short time. What conclusion(s) should the novice nurse draw about the more experienced nurse's practice? Select all that apply. -The nurse is able to rely on intuition more than critical thinking. -The nurse has well-developed situational awareness. -The nurse is able to rely on reflection-in-action rather than reflection-on-action. -The nurse has a high capacity for cognitive load. -The nurse is able to apply the steps of the Clinical Judgment and Measurement Model (CJMM) simultaneously.
The nurse has a high capacity for cognitive load. The nurse has well-developed situational awareness. Explanation: Cognitive load refers to the amount of information a person can hold in their memory at one time; this nurse is able to hold large amounts of data and process them quickly. The ability to discern subtle cues is associated with situational awareness. The six steps of the Clinical Judgment and Measurement Model are linear, and not normally applied at a single point in time. Intuition is more developed in experienced nurses, but this is a component of critical thinking rather than an alternative to it. Reflection-in-action and reflection-on-action are both used by experienced nurses in Tanner's clinical judgment model.
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 influences the ways that care is organized and provided. -The nurse's actions influence other nurses and nursing students who are less skilled. -The nurse integrates experience and reflections into new forms of practice. -The nurse's awareness of ethical and moral issues in nursing becomes heightened.
The nurse integrates experience and reflections into new forms of practice. Explanation: Transformation encompasses meaningful change that results from integrating new experiences with reflections. This may result in practice improvements, increased awareness of ethics, or influence on others, but it is the convergence of experience and reflection that most clearly indicates personal transformation.
A nursing student is moving through a curriculum that emphasizes the value of experiential learning. The nursing student is consciously linking previous experiences with new and transformative practices. How will the nursing student link experiences with transformative behaviors? -by engaging in frequent and thoughtful reflection -by gaining the widest possible variety of learning experiences -by eliciting input from a trusted professional mentor -by reducing the amount of time elapsed from previous experiences to new experiences
by engaging in frequent and thoughtful reflection Explanation: In experiential learning, there is a progression from experiences to reflection to transformation. Without reflection, new learning cannot be gleaned from experiences and used to inform future actions. Simply increasing the pace or quantity of learning is not sufficient, nor can a mentor's guidance replace this vital step.
What action by the nurse in a hospital setting best exemplifies the goals of the Interprofessional Education Collaborative (IPEC) core competencies? -taking a course about intimate partner violence that was created by a social worker -coordinating with the physical therapist to amend a client's activity orders in the plan of care -administering a medication that was just prescribed by a health care provider -reporting a sudden decline in a client's status to the health care provider
coordinating with the physical therapist to amend a client's activity orders in the plan of care Explanation: Interprofessional Education Collaborative (IPEC) competencies go beyond carrying out orders from another profession, reporting to a member of another profession, or one-way learning from another profession. Active collaboration on client care, such as working together on activity orders, demonstrates the participatory nature of the competencies.
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 -modifying the nursing care plan to prioritize the client's risk for pain -documenting the administration of the analgesia -reflecting on the decision-making process
evaluating the client's pain 30 minutes after administering the analgesia Explanation: Evaluating outcomes is the final step in the CJMM. All of the actions listed are appropriate, but evaluation is the most direct indication of this sixth and final step.
A nursing student is providing care on a subacute step-down unit. The nursing student has received feedback that they are excessively tied to the rigid, stepwise performance of clinical tasks and fail to notice and accommodate the many contextual factors in client interactions. The nursing student is at what stage of Benner's humanistic-intuitive model of clinical judgment? -novice -advanced beginner -orientee -precompetent
novice Explanation: Reliance on rote procedures and unawareness of contextual factors are the hallmarks of a novice. Advanced beginners have started to move away from this concrete thinking and performing. Benner's model does not include categories of precompetent or orientee.
