🧠 Clinical Judgment in Nursing Practice

🔹 What is Clinical Judgment?

• A process that uses:
• Nursing knowledge
• Experience
• Critical thinking
• Purpose:
• Observe & assess situations.
• Identify prioritized patient concerns.
• Generate evidence-based solutions.
• Make safe decisions for patient care. (NCSBN, 2024)

👩‍⚕️ Nurses vs. Assistive Personnel (AP)

• Professional nurses (RNs) do more than provide tasks:
• Observe changes in patient condition.
• Collect & analyze data.
• Recognize new/potential problems.
• Plan nursing strategies.
• Take immediate action when condition worsens.
• Assistive personnel (AP):
• Carry out basic aspects of care as directed.
• Do not analyze clinical changes or strategies.

📖 Themes & Components of Clinical Judgment

🧠Clinical Judgment in Nursing Practice

• Clinical judgments are influenced more by a nurse’s experience and knowledge than by the objective data about the situation at hand.
• Sound clinical judgment partly relies on “knowing patients”. Recognize patterns of health care problems.
• Most patients have health care problems for which there are no clear textbook solutions. These are unique to the patient’s physical health, lifestyle, culture, social group, environment, and experiences.
• Clinical judgments are influenced by the context of clinical situations and the culture of patient care settings.
• Nurses will use problem-solving and reflection to understand patient problems and create an individualized plan of care.

Intuition→ is one problem-solving approach that relies on one’s inner sense. CAn be seen as non

Intuition is often perceived as being a form of guessing and thus inappropriate when making nursing decisions. However, intuition is also seen as a legitimate approach to making clinical judgments. Use your own experience to make sure u are doing the correct stuff.

Decision making:

When you face a problem and choose a course of action from several options, you are making a decision. Decison must be supported by evidence.

🔬 Scientific Method in Nursing

📑 Steps

1. Identify the problem
2. Collect data
3. Formulate a question or hypothesis
4. Test the question or hypothesis
5. Evaluate results of the test or study

Specific critiacl tinking

Figure out who need heart first. Decision criteria. To check how to prioritize.

You work with the one who conditon changes quiclkil

Prioritazi and delagate. Change your rutine task so u work where needed the most.

Only if you know your pt you can nothice changes on him.

You know your pt, Maslow.

Diagnostic reasoning: being a detective>

Critical thinking making: judge.

It depends on your level, there are three level: Question

1,2,3,5,6

lEVELS OF CRITICAL THINKING

1. Right or wrong to anwser to problems. Value opinions of others experts.
2. Complex: Think crticially, adapt to scenarions. To make decisions more independently, View points, solution to problems, Relies less on expert and mor on own decision.

This nurse will run extra test, to gather data and will find out other life thratening conditions.

3. Confidente and final decion no second gessing, understand deeply. when when to act right away and when to wait.

Question

B,C

Chapter 16

2 tipes of assesment

pt center Physical and mental check up.

Culture, experience values, adaptive preferences.

Periodic assesmnet ⇒ collect and compare data, quick and focus questions. Use in emergencies and follow up vicits.

Question

A, D

Chapter 16

Assesment database: Cientific⇒ evidence

Sources: Pt, family, labs, images, other nurses,

Subjective and objective data.

Present info to pt in easier way.

7items assesment est.

Eye contact, nodding smiling.

Dementia? Build trus, therapeutic communication.

Listen, show presence, organize conversation, focus on pt concerncs, active listening.

Question: A,C,D,E

Interview phases,

Orientation/agenda phase. focus pt concerns first, build report.

Working PHASE collect data. Suffer silent (cultural) Termination phase. Summary findings, let them know interview ending, give time for additional questions. .

Open ended questions, Avoid leading questiosn….10 stuff no to do.

No obstrucion object, eye contact

Question:

Breakfast time? nop, is the appropiate time, compexities. Check if appropiate environment and timming.

Nurse health history

demographic data: gender, sex, etc.

Chapter 17 Medical diagnosis vs Nurse diagnose Focus on actuall dises and causes, bu NP, Physicians not by docotrs.

nurse diagnosis: Maslow Laws/ U can’t prescribe

Meidcal (identify the diesease) vs nursing diagnosis examples (how is pt responding to the treatment and desease, to condition, cinical judgemnt, focus on potential future probelsm. Risk for falls, infections.) Nurse is holitisc.

Nursing diagnosis: Identify actual or potencial risk, give us a common language. An sosociation aproved the diagnose language???

Problem focus (3 parts: dIAGNOSTIC LABEL, RELATED FACTOR…)

…(2 PARTS)

hEALTH PROMOTION (2 PARTS)

Problem ethiology signs and simthoms Mnemonics

PES Problem ethiiology (related factors) and symptoms (evidence that you will use, pain, signs (part of symthoms))

Rules: 1 mandga aproved

2.

3.Focus on one problem

4.Base on the diagnosis.

Diagnostic velidity (for being valid)

Clinical knowledge, base on pt needs.

If u don’t folowed you will have erros.

Erros ⇒ page 251, what coudl happen if not proper data collection, clustering, analize, data and diagnostic statemtn, Make sure allways first that the information is correct.

Nursing diagnosis = Nursing problem. Assesment of the client.

skin integtrity (problem? →what is gonna be your plan)

Nurse diangosis is not based on medical diagnosis, our diagnosis will change. Example your diangose could be impared gas exchange , once he gets better will look for somethinig else, so diagnose changes, and we notice edema and we chance our focus. We change base on what’s going on with the patient.