B260: Fundamentals of Nursing Clinical Judgment B260: 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*) *C.A. Tanner: Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 45(6), 2006, 204–211.

Nursing Care Is Not Linear No clear-cut answers Multiple factors Unknowns 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.