INTRO TO CJMM
CJMM
Clinical judgement is defined as the observed outcome of which processes?
- Critical thinking
- Decision making
Match the type of contextual factors influencing clinical judgement w/ appropriate
examples.
Education, Experience, Knowledge - internal contextual factors
Distractions, time pressures, time complexity - external contextual factors
Match the layers of the Clinical Judgment Measurement Model with the concept
addressed in each layer.
Observation: layer 0
Hypotheses: layer 2 & 3
Clinical Judgement: layer 1
Contextual Factors: layer 4
Layer 0: Observable Components
Clinical Needs:
Identification of patient needs initiates the process of clinical judgment.
Clinical decisions made at the completion of the clinical judgment process affect patient
needs.
Definition of patient needs: what is needed or desired to improve overall health.
Examples of patient needs: personal care/hygiene needs, symptom/disease
management, emergent care, emotional support, spiritual needs, cultural needs, health
promotion, infection control, medication management, and pain relief.
Clinical Decisions:
Clinical decisions conclude the clinical judgment process.
Clinical decisions are influenced by the entire clinical judgment process.
Layer 1: Clinical Judgement
Defined by the observable outcome of critical thinking and decision making depicted in
layer 0 and the unobservable cognitive operations depicted in layers 2 and 3
Clinical judgment is an essential component of nursing practice as it allows nurses to
observe changes in patient status, recognize potential problems, and take immediate
action when needed. Initially, the nurse might not have a clear or accurate
understanding of a patient's needs and the appropriate actions to take. The nurse
should question and explore different perspectives and interpretations to find the best
solution for the patient, and the CJMM provides a framework for the nurse to apply
these clinical judgment skills.
Which characteristic describes patient needs as they relate to layer 0 of the
Clinical Judgment Measurement Model?
Are influenced by clinical decisions.
Clinical decisions made at the completion of the clinical judgment process affect patient
needs.
Which activities would the nurse perform when a clinical situation occurs
according to layer 1 of the Clinical Judgment Measurement Model?
, - Seek new knowledge
The nurse seeks new knowledge, recognizing that there are seldom clear, "one size fits
all" solutions.
-Respond appropriately
-The nurse should be flexible and respond timely, as appropriate for the unique
situation.
-Consider influencing factors
The nurse considers all factors that might influence the particular patient’s
circumstances.
-Recognize what is happening
The nurse must clearly understand what is happening with the patient to respond
appropriately.
-Interpret the meaning of the situation
Clinical judgment is complex, and every patient experiences unique health problems.
The nurse must accurately interpret the meaning of the situation to provide safe,
competent care.
Which components are addressed by layer 1 of the Clinical Judgment
Measurement Model (CJMM)?
- Unobservable cognitive operations
Layer 1 is a cognitive layer of the CJMM that includes unobservable cognitive
operations.
-Observable outcome of critical thinking
3 Functions of Layer 2:
- Form Hypotheses
- Refine Hypotheses
- Evaluation
Layer 2: Form Hypotheses - Refine Hypotheses - Evaluation
Layer 2 of the CJMM represents a cyclical, or recurring, process of three cognitive
operations: forming hypotheses, refining hypotheses, and evaluating outcomes.
Layer 2: Refining Hypotheses
Once the hypotheses are developed, the nurse refines them to ensure that the patient's
priority needs are met in the most appropriate manner. It is important to remember that
patients who present with similar disease processes or injuries may not actually have
the same plan of care. The hypotheses are prioritized and solutions are generated
based on the priority concerns to develop a plan of care to meet the unique needs of
each individual patient.
Evaluating Outcomes
Questions the nurse can ask to evaluate actual or observed outcomes against
expected outcomes are as follows:
-What signs would indicate improvement or a positive outcome?
-What signs would indicate a decline or a negative outcome?
-What signs would suggest that the patient’s status has not changed?
-Were the solutions/interventions effective?
-What other solutions/interventions might have been more effective?
-Should the nurse revise any components of the plan of care to best meet the patient’s
needs?
CJMM
Clinical judgement is defined as the observed outcome of which processes?
- Critical thinking
- Decision making
Match the type of contextual factors influencing clinical judgement w/ appropriate
examples.
Education, Experience, Knowledge - internal contextual factors
Distractions, time pressures, time complexity - external contextual factors
Match the layers of the Clinical Judgment Measurement Model with the concept
addressed in each layer.
Observation: layer 0
Hypotheses: layer 2 & 3
Clinical Judgement: layer 1
Contextual Factors: layer 4
Layer 0: Observable Components
Clinical Needs:
Identification of patient needs initiates the process of clinical judgment.
Clinical decisions made at the completion of the clinical judgment process affect patient
needs.
Definition of patient needs: what is needed or desired to improve overall health.
Examples of patient needs: personal care/hygiene needs, symptom/disease
management, emergent care, emotional support, spiritual needs, cultural needs, health
promotion, infection control, medication management, and pain relief.
Clinical Decisions:
Clinical decisions conclude the clinical judgment process.
Clinical decisions are influenced by the entire clinical judgment process.
Layer 1: Clinical Judgement
Defined by the observable outcome of critical thinking and decision making depicted in
layer 0 and the unobservable cognitive operations depicted in layers 2 and 3
Clinical judgment is an essential component of nursing practice as it allows nurses to
observe changes in patient status, recognize potential problems, and take immediate
action when needed. Initially, the nurse might not have a clear or accurate
understanding of a patient's needs and the appropriate actions to take. The nurse
should question and explore different perspectives and interpretations to find the best
solution for the patient, and the CJMM provides a framework for the nurse to apply
these clinical judgment skills.
Which characteristic describes patient needs as they relate to layer 0 of the
Clinical Judgment Measurement Model?
Are influenced by clinical decisions.
Clinical decisions made at the completion of the clinical judgment process affect patient
needs.
Which activities would the nurse perform when a clinical situation occurs
according to layer 1 of the Clinical Judgment Measurement Model?
, - Seek new knowledge
The nurse seeks new knowledge, recognizing that there are seldom clear, "one size fits
all" solutions.
-Respond appropriately
-The nurse should be flexible and respond timely, as appropriate for the unique
situation.
-Consider influencing factors
The nurse considers all factors that might influence the particular patient’s
circumstances.
-Recognize what is happening
The nurse must clearly understand what is happening with the patient to respond
appropriately.
-Interpret the meaning of the situation
Clinical judgment is complex, and every patient experiences unique health problems.
The nurse must accurately interpret the meaning of the situation to provide safe,
competent care.
Which components are addressed by layer 1 of the Clinical Judgment
Measurement Model (CJMM)?
- Unobservable cognitive operations
Layer 1 is a cognitive layer of the CJMM that includes unobservable cognitive
operations.
-Observable outcome of critical thinking
3 Functions of Layer 2:
- Form Hypotheses
- Refine Hypotheses
- Evaluation
Layer 2: Form Hypotheses - Refine Hypotheses - Evaluation
Layer 2 of the CJMM represents a cyclical, or recurring, process of three cognitive
operations: forming hypotheses, refining hypotheses, and evaluating outcomes.
Layer 2: Refining Hypotheses
Once the hypotheses are developed, the nurse refines them to ensure that the patient's
priority needs are met in the most appropriate manner. It is important to remember that
patients who present with similar disease processes or injuries may not actually have
the same plan of care. The hypotheses are prioritized and solutions are generated
based on the priority concerns to develop a plan of care to meet the unique needs of
each individual patient.
Evaluating Outcomes
Questions the nurse can ask to evaluate actual or observed outcomes against
expected outcomes are as follows:
-What signs would indicate improvement or a positive outcome?
-What signs would indicate a decline or a negative outcome?
-What signs would suggest that the patient’s status has not changed?
-Were the solutions/interventions effective?
-What other solutions/interventions might have been more effective?
-Should the nurse revise any components of the plan of care to best meet the patient’s
needs?
