Understanding Clinical Judgment

today's topic to think or not to think like a nurse why every nurse must possess clinical judgment to be safe in practice [Music] did you know that half of nurses will make an error in two thirds of these mistakes are because of incorrect clinical decision making this is called failure to rescue in the nursing literature and it's one of nurse fails to respond or recognize a problem in a complication progresses until it's too late and even patient death can occur nobody wants to be a villain we all want to be superheroes and scrubs in order to do that clinical judgment is the essence of safe and professional nursing practice so let's discuss what this looks like and how its defined so we can better teach it as well as understand clinical judgment this is an essential equation for practice and what it really entails is that a nurse must be able to critically think and clinically reason and clinical judgment is the outcome or the end result clinical judgment cannot be taught directly so then we look at critical thinking and reasoning what is it let's define our terms and the essence of critical thinking though there's many definitions it's the ability of the nurse to understand and act on what they know about their nursing content this is why memorizing or parroting out of your drug handbook the mechanism of action is not going to develop the critical thinking required for safe practice you as the nurse or nursing student must understand your content that's your goal when you're studying not just to pass the test understand the content to pass the test clinical reasoning is what takes place at the bedside critical thinking is what takes place in the classroom and in your nursing program make it that priority to understand your content then reason in action with it with the clinical reasoning which is in that ability of the nurse to an essence think in action and reason as a situation changes as you all know if you've been in the clinical but a clinical context patience don't stay the same they change and can change very quickly you as the nurse must be able to think on your feet and know what to do to clinically reason when that happens when you both understand essential content by critical thinking and then reason with that knowledge at the bedside you will make the outcome of a correct clinical judgment but if you fail and don't understand your content or unable to reason you will not make the correct judgment and you'll go off on a bunny trail and you may miss something that could have adverse consequences and we don't want to do that in order to really understand the essence of clinical judgment that's required for safe practice Chris Tanner published her model of clinical judgment back in 2006 and the our title of her article was thinking like a nurse a practice based model of clinical reasoning and she identified four concise steps that the nurse must be able to do to make correct clinical judgments in the essence of her model dovetails with nursing process in those five steps of add PI but if you look at the upper right hand corner you've got four steps that begin with noticing then goes to interpreting goes to responding and then to reflecting or evaluation I'm gonna briefly explain each of these four steps so that you better understand what goes behind the correct clinical judgment notice seen as much more than the assessment of Nursing process though it's part of it it's looking at that grasp of the clinical situation and really the essence of noticing is recognizing relevant clinical data do you notice what is relevant or irrelevant that can be left behind that's not that significant that's the essence of noticing interpreting a step two and that's the ability to interpret the meaning of the data that is why you must as a student or nurse in practice understand your path of physiology because it's those call queues or relevant data that usually are based in Physiology like why is my creatinine rising and my potassium going up with a patient with heart failure or their shortness of breath and their ABG's going more acidotic for example because their co2 is climbing those are all related to pathophysiology must be understood it's also important to recognize that interpreting clinical data is influenced by what's between the ears of the nurse and how they filter that patient's data so for example if you don't have caring compassion or assume that you make assumptions about your patient like their drug seeker with that increased abdominal pain post-op and they're really rare asking for too much medication they may have perf their bowel and that increasing pain is there for a reason if you make judgments or assumptions your ability to notice and then interpret is going to be off and you'll make an incorrect judgment third step responding you must be able to correctly interpret the data and then act upon it and really this is the essence of failure to recognize or failure to rescue you don't recognize a problem until it's too late and this is again the essence of making having the correct nursing priority is again part of responding what is that priority based on your what you've noticed what you've interpreted and now how you're going to respond and then finally reflection is the essence of evaluation and it's looking at the patient and making that decision in the moment of inaction and looking at what you are interpreting and then going back to then what do I notice with my evaluation or responding there's also reflection on action which is looking at when you make an incorrect judgment you need to reflect more deeply upon it and recognize what can I learn from it we're all gonna make mistakes in practice at some point in time what did you learn and how will you grow and be better that's the question so if you haven't already subscribe to my youtube channel think like a nurse and be first in line to receive fresh content for 2020 and be sure to check out the link on this video to go deeper on this topic I have a new website just for nurse educators that goes deeper with this teaching complete with contact hours and I want to thank you for watching and use this information to develop clinical judgment whether you're a student or educator to better prepare your students for practice and licensure including the upcoming next generation coming in spring 2023 thank you so much [Music]

Channel: ThinkLikeANurse

Views: 35,905

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Id: Vjtzz_J7IqY

Length: 7min 28sec (448 seconds)

Published: Mon Feb 24 2020