NUR 130 Exam 1 Clinical reasoning Answer- -Thinking process by which a nurse reaches a clinical judgement and or decision - Fine attunement Answer- How someone reacts and paying close attention Critical thinking Answer- -Cognitive process used for the analysis of an issue or problem -Knowledge-based -How we think through a situation, prioritize what needs to be done first, and think about patients' outcomes Clinical judgement Answer- -Interpretation and conclusion about a patient's needs, concerns, or health problems -To either take action, improvise new ones, using or modify standard approaches deemed appropriate for the patient Environmental factors IMPORTANT Nursing knowledge is NOT an environmental factor IMPORTANT Answer- -Limited staff and equipment -Stat med vs routine med Increased respiratory rate Answer- First sign of sepsis Defining attributes of clinical judgement Answer- -Holistic view of the client situation -Process orientation -Reasoning and interpretation -Ethical comportment Holistic view of client Answer- Looking at the whole person, mind, body and spirit Process orientation Answer- -Asking the patient questions to lead to an answer -Ability to reflect on something after it is done -Having goals during the shift Reasoning and interpretation Answer- Help to get to the decision Ethical comportment Answer- -What is right and what is wrong Morals Answer- - Own values and beliefs -The culture that one grew up in 1 / 2
Evidence based practice Answer- A problem solving approach to clinical decision making that combines the best available scientific evidence with best available patient and practitioner experiential evidence toward optimal healthcare outcomes -Best evidence to inform practice Nursing process IMPORTANT Answer- ADPIE Assessment (see, hear, feel) (what meds do you take? why are you here? Did anything happen in the past couple
of days) (ex: headache just developed after a car accident)
Diagnosis (analysis) (ex: head injury)
Planning (Telling the doctor the patient may need a CT scan) Implementation (Start IV and get ready for CT) (Taking action) Evaluation (Gets CT and gives medicine to have less of a headache) Reflection in action Answer- Happens during the care of the patient -Observing a patients reaction and deciding if that action has helped with the primary concern Tanner clinical judgement model Answer- 1. Nurse's knowledge. experience, ethical perspective, and knowing the patient
- Noticing (assessment) *do not use your family or your symptoms as a basis*
- Interpreting (analyzing and planning)
- Responding (implementation)
- Reflecting (evaluation)
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Reflection on action Answer- Happens after the patient care occurs -To see what went well or what could be better after the fact -Usually with other people and usually about performance improvement Clinical judgement measurement model Answer- -Layer 0 through 2 is the basis of how the clinical judgment is made -Layer 3 and 4 is what one expects from a nurse during study or in the room Clinical judgement environmental factors Answer- -Environment around them -Client oberservation -Consequences and risks -Time pressure -Task complexity -Cultural consideration -Medical records -Resources Clinical judgment individual factors Answer- -Knowledge -Skill -Specialty -Prior experience -Level of experience -Candidate characteristics