Clinical judgment, also known as clinical reasoning or critical thinking, is the most important part of nursing practice. It is the cognitive process by which nurses assess, interpret, and make decisions based on patient data, experience, and clinical thinking. To provide safe and effective patient care, clinical judgment is important. in this blog we will study clinical judgment in nursing and tanner’s model of clinical judgment.
What is the clinical judgment model?
The clinical judgment model is a systematic approach that guides healthcare professionals, especially nurses, to make informed decisions and to provide effective patient care. This model also helps the nurses to make decisions based on evidence and patient needs. The components found in most clinical judgment models are noticing, interpreting, responding, and reflecting.
What are the key concepts in clinical judgment models?
The key concepts that are involved in clinical judgment models are as follows:
- Clinical expertise.
- Critical thinking and problem solving.
- Patient centered care.
- Evidence based practice.
- Collaboration with other healthcare workers.
Tanners model of clinical judgment
Tanners model of clinical judgment was developed by Chritine tanner in 2006. It is one of the most widely recognized models to guide clinical decision making in nursing practice. The tanner model consists of four stages which are as follows.
- Noticing (recognizing the problem)
- Interpreting (understanding the situation)
- Responding (taking action)
- Reflecting (evaluating the outcomes)
Let us discuss each of these steps with examples.
Noticing
The first stage of tanner’s model of clinical judgment is Noticing. This means that the nurse notices what is happening to the patient. Nurses gather data about the patients such as their medical history, changes in vital signs, physical assessment etc. Nurses should be observant and observe both verbale and nonverbal cues in change of patient’s health or condition.
Example: the nurse observes that the patient’s body temperature and blood pressure is increasing which is the first sign of potential complication.
Interpreting
The next step in clinical judgment model is interpreting. In this phase the nurses, after observing the signs, have to interpret the meaning of the signs and understand the situation. The nurses have to consider the possible causes and action that should be taken during the situation.
Example: The rise in temperature might indicate infection or reaction to the medication.
Responding
The third step in clinical judgment in nursing is responding, which means taking action. The action taken is based on their interpretation. This involves direct intervention or discussion with other healthcare workers.
Example: Administering antibiotics for infection or performing CPR.
Reflecting
The final stage of tanners’ clinical judgment model is reflecting which means evaluating the outcomes. This occurs during and after nursing intervention where nurses reflect on their decisions. They evaluate whether the outcomes were achieved or not and what they can do in future for better outcomes.
Example: After administering antibiotics to the patient, nurses reflect on whether the patient’s condition was improved or not. And what can they do to make it better in the future?
What are the factors that affect the tanner’s model of clinical judgment?
The factors affecting the clinical judgment process are as follows:
- Nursing experience
- Clinical knowledge
- Critical thinking and problem-solving skills.
- Cognitive bias and intuition
- Patient factors
- Environmental and situational context
- Communication skills
- Emotional intelligence
- Cultural competence
- Team collaboration
- Professional development
Examples of clinical judgment in nursing
Triage:
One of the examples of clinical judgment is triage or prioritizing patient care. This means that when several patients are admitted in the hospital or emergency care, the nurses with their experience can tell which patients need immediate medical attention. For example, the patient experiencing heart attack will receive immediate care.
Administering medications:
Nurses with strong clinical judgment know what medication will work best for the patient. They consider the factors such as allergies and other patient conditions before administering medication. They also analyze the risks and benefits of the medication before administering to the patient to ensure patient safety.
Recognizing subtle changes in patient condition:
Another example of clinical judgment is nursing is recognizing or observing changes in patient condition which can be life threatening. For example, after surgery nurses observe that the patient’s oxygen saturation has dropped. This might indicate the signs of pulmonary embolism. So, the nurse provides oxygen to the patient, informs the doctor and gets her CT scan that confirms the diagnosis. This timely decision by the nurse can save the life of the patient.
Why is clinical judgment is important in nursing?
Clinical judgment is important in nursing as it directly impacts patient’s safety and health outcomes. Some key reasons why clinical judgment is important in nursing care.
- Ensures patient safety.
- Promotes effective decision making.
- Enhanced critical thinking and problem solving.
- Optimize patient outcomes.
- Supports ethical and compassionate care.
What are the four phases of clinical judgment?
The four faces of clinical judgment in nursing are noticing, interpreting, responding, and reflecting.
In which order should nurse perform clinical judgment?
The order which nurses should use is as follows:
- Recognizing cues or problems
- Analyzing the situation
- Prioritizing
- Generating solutions
- Taking action
- Evaluating outcomes
Conclusion
Clinical judgment is an important part of nursing practice as it ensures patient safety and effective patient outcome. Clinical judgment consists of four stages such as noticing, interpreting, responding, and reflecting. It provides safe and personalized care that results in positive patients coming. Using clinical judgment nurses can identify the problems early and can intervene timely to save the patient. This also helps the nurses to respond appropriately to the situations including both routing and emergency situations.
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