1. CLINICAL JUDGMENT
Concept 36

2. Goals for This Concept Presentation
Define and describe the concept.
Discuss the attributes of clinical judgment.
Identify the ways that nurses make judgments.
Discuss context to nursing and health care.

3. Define and Describe the Concept of clinical judgment

4. 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.

5. Related Terms Inference Interpretation Decision Clinical reasoning
Critical thinking

6. Discuss THE attributes of clinical judgment

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

8. Attributes of Clinical Judgment
Involves a holistic view of the patient situation.
Is a process orientation (a circular process).
Requires reasoning and the interpretation of data.

9. 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.

10. Identify the ways that nurses make judgments

11. Clinical Judgment Process
Noticing
Interpreting
Responding
Reflecting

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

13. 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.

14. 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.

15. 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.

16. 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.

17. Noticing Collaborative Learning # 2
In your learning groups, review an illustration or video of a patient care situation. Spend 1 to 2 minutes thinking about and gathering the details of what they notice.
Compare what other students have observed.
Are there differences? Why?

18. Discuss Context to nursing and health care

19. Application Clinical judgment is an aspect of nursing in all settings.
Clinical judgment is not required in all patient interactions.
What is an example of a patient interaction that does not require critical thinking?

20. Environmental Context
Environmental context or the setting of care influences what a nurse notices.
Demanding environments of care can add an increased burden on making clinical judgments and can actually interfere with competent clinical judgment.

21. 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.

22. Application of Concept
Collaborative Learning #3
In your learning groups, think about an area in which you have a great deal of expertise. (This area could be a hobby or other life experiences.)
Share what it is like to have this expertise.
What is it like observing those who do not have a high level of skill?

23. Interrelated Concepts

24. Exemplars Clinical skills Urgent and emergent situations Communication
Medication management
Management of care