Read the article “Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing” by Christine Tanner, which is linked below:
Link to article http://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=106314107&S=R&D=rzh&EbscoContent=dGJyMNHX8kSeprI4y9f3OLCmr1GeprdSsKa4Sq%2BWxWXS&ContentCustomer=dGJyMPGvrk%2B0prBLuePfgeyx43zx
In at least three pages, answer the following questions:
- What do you feel are the greatest influences on clinical judgment? Is it experience, knowledge, or a combination of those things?
- In your opinion, what part does intuition play in clinical judgment? How do you think you’ll be able to develop nursing intuition?
Additional sources are not required but if they are used, please cite them in APA format.
Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing
Christine A. Tanner, PhD, RN
This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judg- ments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combina- tion; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the de- velopment of clinical knowledge and improvement in clini- cal reasoning. A model based on these general conclusions emphasizes the role of nurses’ background, the context of the situation, and nurses’ relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.
Clinical judgment is viewed as an essential skill for virtually every health professional. Florence Nightingale (1860/1992) firmly established that observations and their interpretation were the hallmarks of trained nursing practice. In recent years, clinical judg-
Dr.Tanner is A.B.Youmans-Spaulding Distinguished Professor, Ore- gon & Health Science University, School of Nursing, Portland, Oregon.
Address correspondence to Christine A. Tanner, PhD, RN, A.B. Youmans-Spaulding Distinguished Professor, Oregon & Health Sci- ence University, School of Nursing, 3455 SW U.S. Veterans Hospital Road, Portland, OR 97239; e-mail: firstname.lastname@example.org.
ment in nursing has become synonymous with the widely adopted nursing process model of practice. In this model, clinical judgment is viewed as a problem-solving activity, beginning with assessment and nursing diagnosis, pro- ceeding with planning and implementing nursing inter- ventions directed toward the resolution of the diagnosed problems, and culminating in the evaluation of the effec- tiveness of the interventions. While this model may be useful in teaching beginning nursing students one type of systematic problem solving, studies have shown that it fails to adequately describe the processes of nursing judgment used by either beginning or experienced nurses (Fonteyn, 1991; Tanner, 1998). In addition, because this model fails to account for the complexity of clinical judg- ment and the many factors that influence it, complete reli- ance on this single model to guide instruction may do a significant disservice to nursing students. The purposes of this article are to broadly review the growing body of re- search on clinical judgment in nursing, summarizing the conclusions that can be drawn from this literature, and to present an alternative model of clinical judgment that captures much of the published descriptive research and that may be a useful framework for instruction.
DefiNiTioN of TeRMs
In the nursing literature, the terms “clinical judg- ment,” “problem solving,” “decision making,” and “critical thinking” tend to be used interchangeably. In this article, I will use the term “clinical judgment” to mean an inter- pretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response. “Clinical reasoning” is the term I will use to refer to the processes by which nurses and other clinicians make their judgments, and includes both the deliberate process of