1
Fundamentals
Unit 3: Chapters 15 - 20 : Clinical Judgment in Nursing Practice :
★ Critical Thinking and Clinical Judgment (209)
★ Nursing Assessment (225)
★ Analysis and Nursing Diagnosis (243)
★ Planning and Outcomes Identification in Nursing (258)
★ Implementing Nursing Care (276)
★ Evaluation (292)
Chapter 15: Critical Thinking and Clinical Judgment
Thinking about past experience, reflecting on knowledge about problems = factors and more
involves critical thinking to make judgment and decide.
Nurses roles:
★ Recognize patients health records needs
★ Form clinical judgments, use critical thinking to make timely decisions
★ Gather data information about patients problems
Critical Thinking as a Nurse involves:
- Knowing as much as possible about your patients
- Sorting out information into patterns to identify problems and make appropriate clinical
care decisions
- Recognizing changes
- Helping you become open minded, confidence, process in mastering through
commitment and active learning
Clinical Judgment: observed outcome of critical thinking and decision making.
Conclusion about patients needs or problems, taking or avoiding action, modify or making new
approaches but using knowledge and experience. Also includes engaging with patients,
influenced by clinical situations, problem solving and reflecting.
Clinical Decision: Making: using judgment in investing and analyzing aspects of clinical
problems to choose the best action.
, 2
Clinical Judgment = Nursing Process = Patients needs and clinical decisions
Assessment- recognize cues
Diagnosis- analyze cues
Planning- prioritizing hypothesis and generate solutions
Implement or Intervention- take action
Evaluate- evaluate outcomes
=
Critical Thinking Competency
- Knowledge Base
● Basic nursing science
● Nursing and health care theory
● Patient data
- Experience
● Personal, clinical practice and skills
- Environment
● Time pressure and setting
● Task complexity
● Interruptions
- Attitudes
● Intellectual and professional
Critical Thinking: ability to think systematic and logic with openness to questions and
reflect on reasoning process
Nursing Process: framework nurses us to apply critical thinking in Nursing Practice for
making clinical decisions. The purpose of the Nursing Process is to diagnose and treat human
responses. Format of the Nursing Process is unique to the discipline of nursing and provides a
common language and process.
General critical thinking:
➔ Identify problem
➔ Collect data
➔ Formulate question of hypothesis
➔ Test question or hypothesis
➔ Evaluate results of test or study
, 3
Problem Solving: obtaining information to clarify the nature of the problem. Try
solutions and evaluate and try different options if the problem arises.
Intuition: problem solving that relies on one's sense. Usually well structured and familiar
decision tasks, forming guesses when making nursing decisions. Experienced nurses can sense
“red flags” , they know how to anticipate a problem.
Diagnostic Reasoning: form of decision making that involves being able to understand
and think through clinical problems. Analyzing cues, meaning of evidence and deciding on an
intervention. When uncertain of a diagnosis, continue to collect data until you determine a
patient's unique situation.
After decision making questions you form inferences.
- Objective clinical findings
- Diagnostic test results
- Observations about patients
- Performing inductive reasonings
Inductive reasoning: reviewing specific data elements to make inferences by forming a
conclusion about related pieces of evidence.
Deductive reasoning: moves from general to specific. Nurses will analyze facts and
observations from a conceptual viewpoint like prioritization of needs.
Knowing the patient offers the nurse a bigger picture. Forming relationships builds your ability
to make clinical decisions and enhance your ability to know your patients.
★ Spend enough follow up assessments to observe patients behavior to improve knowledge
of your patients. Know your patients conditions and identify changes
★ Check on patients and access + monitor problems to help you identify clinical changes
overtime
★ Engage in patients conversations and being able to care for them
Clinical decision making for groups of patients:
- Identify and collaborate the problem of each patient. Analyze the problems and which
one is more urgent based on basic needs.
- Consider the time it takes to care for patients whose problem are high priority
- Resources to manage each problem, assistance working with you
- Patients and family decisions , deciding and nursing care procedures
Fundamentals
Unit 3: Chapters 15 - 20 : Clinical Judgment in Nursing Practice :
★ Critical Thinking and Clinical Judgment (209)
★ Nursing Assessment (225)
★ Analysis and Nursing Diagnosis (243)
★ Planning and Outcomes Identification in Nursing (258)
★ Implementing Nursing Care (276)
★ Evaluation (292)
Chapter 15: Critical Thinking and Clinical Judgment
Thinking about past experience, reflecting on knowledge about problems = factors and more
involves critical thinking to make judgment and decide.
Nurses roles:
★ Recognize patients health records needs
★ Form clinical judgments, use critical thinking to make timely decisions
★ Gather data information about patients problems
Critical Thinking as a Nurse involves:
- Knowing as much as possible about your patients
- Sorting out information into patterns to identify problems and make appropriate clinical
care decisions
- Recognizing changes
- Helping you become open minded, confidence, process in mastering through
commitment and active learning
Clinical Judgment: observed outcome of critical thinking and decision making.
Conclusion about patients needs or problems, taking or avoiding action, modify or making new
approaches but using knowledge and experience. Also includes engaging with patients,
influenced by clinical situations, problem solving and reflecting.
Clinical Decision: Making: using judgment in investing and analyzing aspects of clinical
problems to choose the best action.
, 2
Clinical Judgment = Nursing Process = Patients needs and clinical decisions
Assessment- recognize cues
Diagnosis- analyze cues
Planning- prioritizing hypothesis and generate solutions
Implement or Intervention- take action
Evaluate- evaluate outcomes
=
Critical Thinking Competency
- Knowledge Base
● Basic nursing science
● Nursing and health care theory
● Patient data
- Experience
● Personal, clinical practice and skills
- Environment
● Time pressure and setting
● Task complexity
● Interruptions
- Attitudes
● Intellectual and professional
Critical Thinking: ability to think systematic and logic with openness to questions and
reflect on reasoning process
Nursing Process: framework nurses us to apply critical thinking in Nursing Practice for
making clinical decisions. The purpose of the Nursing Process is to diagnose and treat human
responses. Format of the Nursing Process is unique to the discipline of nursing and provides a
common language and process.
General critical thinking:
➔ Identify problem
➔ Collect data
➔ Formulate question of hypothesis
➔ Test question or hypothesis
➔ Evaluate results of test or study
, 3
Problem Solving: obtaining information to clarify the nature of the problem. Try
solutions and evaluate and try different options if the problem arises.
Intuition: problem solving that relies on one's sense. Usually well structured and familiar
decision tasks, forming guesses when making nursing decisions. Experienced nurses can sense
“red flags” , they know how to anticipate a problem.
Diagnostic Reasoning: form of decision making that involves being able to understand
and think through clinical problems. Analyzing cues, meaning of evidence and deciding on an
intervention. When uncertain of a diagnosis, continue to collect data until you determine a
patient's unique situation.
After decision making questions you form inferences.
- Objective clinical findings
- Diagnostic test results
- Observations about patients
- Performing inductive reasonings
Inductive reasoning: reviewing specific data elements to make inferences by forming a
conclusion about related pieces of evidence.
Deductive reasoning: moves from general to specific. Nurses will analyze facts and
observations from a conceptual viewpoint like prioritization of needs.
Knowing the patient offers the nurse a bigger picture. Forming relationships builds your ability
to make clinical decisions and enhance your ability to know your patients.
★ Spend enough follow up assessments to observe patients behavior to improve knowledge
of your patients. Know your patients conditions and identify changes
★ Check on patients and access + monitor problems to help you identify clinical changes
overtime
★ Engage in patients conversations and being able to care for them
Clinical decision making for groups of patients:
- Identify and collaborate the problem of each patient. Analyze the problems and which
one is more urgent based on basic needs.
- Consider the time it takes to care for patients whose problem are high priority
- Resources to manage each problem, assistance working with you
- Patients and family decisions , deciding and nursing care procedures
