The new Fundamentals of Nursing 11th edition has incorporated a clinical judgment model for nursing students to apply in their practices with the goal of better preparing them to become expert clinicians. Clinical judgment is a conclusion about a patient's needs or health problems that leads to taking or avoiding action, using or modifying standard approaches, or creating new approaches. based on a patient's response to care. The process uses nursing knowledge, experience, environmental factors, and critical thinking standards to assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions to make the decisions needed to deliver safe patient care. The model demonstrates how clinical judgment evolves from the nurse's application of the nursing process and critical thinking.
Even though beginning nursing students are linear learners, the model will promote development of cognitive skills students need to become competent in their practices and improve their ability to make sound clinical judgments. To understand the nursing process, you need to understand how a nurse begins a patient encounter. An expert nurse assumes a patient's care by first reviewing factors in the medical record that are known. Example, an actual or tentative diagnosis, a list of medications prior to medical treatment, medical history. These factors trigger a nurse to consider existing knowledge about the diagnosis and its symptoms, the expected effects of the medications and treatments, and any experience, classroom or real, that adds to that knowledge.
Armed with such knowledge, the nurse approaches a patient and performs an assessment. What is known previously and what a nurse learns while conducting the assessment drives a myriad of questions and observations. all aimed at collecting as much information about the individual patient as possible. With each new piece of information, the nurse considers if more data is needed or refined. While assessing the patient's condition, the patient, the nurse applies critical thinking.
Knowledge about a patient's symptom, for example pain, directs the nurse to be thorough in understanding the source and nature of the symptom. Previous experience may help the nurse consider a unique way to assess the patient's pain, for example have the patient cough or turn onto side. The nurse considers if conditions in the environment alter how the patient is repressed.
information, for example the comfort of the room. Critical thinking attitudes and standards ensure a thorough coverage of data needed. The nurse will analyze the data from assessment and name the problem.
In the form of a nursing diagnosis, a clinical judgment made by a registered nurse to describe a patient's response or vulnerability to health conditions that the nurse is licensed and competent to treat, for example, pain, lack of knowledge regarding surgery, or anxiety. The identification of nursing diagnosis alerts other nurses and healthcare professionals to the patient's nursing care problems, improving communication and consistency in care. Once nursing diagnoses are made, the nurse plans care by prioritizing the diagnoses and planning the interventions and care approaches.
Part of planning is also setting expected outcomes. for each nursing diagnosis. For example, if a diagnosis is fall risk, an expected and measurable outcome for the patient is, patient will not incur a fall during hospitalization. Here again, critical thinking is applied to the planning step with the nurse, for example, including any standards of care that are designed to prevent falls. After a plan of care is made, the nurse delivers interventions chosen to minimize or eliminate the patient's nursing diagnoses.
In the example of safety, the nurse works in collaboration with a nurse assistant to initiate universal fall precautions, explains to the patient the risks the patient has for falling, and reasons for the precautions. Family members are included to reinforce safety needs. The nurse continually applies critical thinking to individualize any interventions. For example, does a patient require a physical therapy referral for a cane to walk safely?
Clinical judgment requires thoughtful reflection about the selection and timing of interventions, frequency, and combinations of interventions most effective. A critical step in the nursing process is evaluation. The determination as to whether a nursing intervention was successful, did a patient's condition change, improve, or worsen.
When the nurse assesses, When the patient first assesses a patient initially, data collected provides a baseline of the patient's clinical condition. During evaluation, the nurse conducts similar assessment measures, for example, reviews fall risks, questions patient's knowledge. After comparing assessment data with evaluation findings, the nurse decides if interventions had an impact.
Evaluation determines if nursing diagnoses have resolved or if problems continue and require revision to the plan of care.