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Novice - beginners w/o nursing experience; do actions by following rules; limited ability to act independently
Advanced Beginner - typically new graduates, have limited nursing experience, recognizing significant cues from internal cognitive processing
Competent - after 2-3 years of experience, intentional planning of care, still not able to see bigger pictures from significant cues
Proficient - can see the whole picture, formulates own rules for actions by analyzing significant cues
Expert - many years experience, intuitive practitioner, highly developed cognitive abilities
is "an interpretation 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."*
Must develop critical thinking and clinical reasoning skills in order to practice sound clinical judgment; it involves the holistic view of the patient situation.
Clinical judgment requires interpretation of data, &
is based
on evidence rather than conjecture
Tanner's conceptual model for Clinical Judgment in Nursing consists of 4 aspects of clinical judgment:
1. noticing
2. interpreting
3. responding
4. reflecting
Broader view ... have previous ++ experience to call upon; consider all the complex factors, and include knowing the patient and your own self reflection at that point. Clinical judgment is inherently complex and influenced by many factors related to the patient, and situation and
therefore requires a holistic view. Need to consider all factors involved in patient care., including characteristics of the nurse
Process orientation-clinical judgment is a circular and interactive process. Has a understanding of the patient situation, their own experiences and values. Patients and nurses are unique and bring different backgrounds to the situation. The nurse notices features of a situation based on these factors and intervenes. While the nurse observes the patient response,
they determine what the next steps are going to be. After providing care, the nurse connects the patient outcomes in a way that enhances further understanding of future patients' care, utilizing reflection.
...reasoning is the process that leads to clinical judgments. When a situation is unfamiliar [expert Or novice] the nurse tends to rely on analytic reasoning processes, considering the possibilites and finding a soultion
Data: subjective, objective
Conjecture: assumption or conclusion you come to - not good!