Clinical decision making

Question 1

Facts

Answer 1

can be verified through investigation

Question 2

Inferences

Answer 2

Conclusions drawn from facts; going beyond facts to make a statement about something not currently known

Question 3

Judgments

Answer 3

Evaluation of facts or info that reflect values or other criteria
A type of opinion

Question 4

Opinions

Answer 4

Beliefs formed over time

May include judgements that may fit facts or be in error

Question 5

Bandwagon reasoning

Answer 5

Doing something because everyone else is doing it

Question 6

Circular reasoning

Answer 6

Supporting an opinion by restating it using different words

Question 7

Cause-and-effect fallacy

Answer 7

Linking something that happens to something that occurs before it happens

Question 8

Either-or fallacy

Answer 8

Assuming a detailed question only has a couple of responses

Question 9

Overgeneralizations

Answer 9

Not enough evidence to come to a conclusion

Question 10

Assessment

Answer 10

gathering info to determine what the problem is.

Question 11

Nursing diagnosis

Answer 11

stating the specific problem to solve based on the assessment data obtained

Question 12

Planning

Answer 12

Stating how to know when the problem is resolved

Question 13

Implementation

Answer 13

Giving solutions to resolve the problem

Question 14

Evaluation

Answer 14

Evaluating if the problem has been resolved

Question 15

Benner’s skill acquisition model

Answer 15

Five levels of proficiency that a nurse will progress through as she gains additional clinical experience.
Novice, advanced beginner, competent, proficient, and expert

Question 16

Benner’s 5 levels of clinical competence: Novice

Answer 16

Beginners without nursing experience
Do actions by following rules
Limited ability to act independent of being told what to, when to, and how to do nursing actions

Question 17

Benner’s 5 levels of clinical competence: Advanced beginner

Answer 17

Typically new grads
Have limited nursing experience
Beginning to recognize significant cues from internal cognitive processing

Question 18

Benner’s 5 levels of clinical competence: Competent

Answer 18

After 2-3 years experience
Intentional planning of care
Still not able to see bigger picture from significant cues

Question 19

Benner’s 5 levels of clinical competence: Proficient

Answer 19

Can see the whole picture

Formulates own rules for actions by analyzing significant cues

Question 20

Benner’s 5 levels of clinical competence: Expert

Answer 20

Many years experience
Intuitive practitioner
Highly developed cognitive abilities

Question 21

Lasater’s Clinical Judgement Rubric

Answer 21

Developed to measure and evaluate clinical judgment using simulation

Question 22

Features of the Tanner Clinical Judgment Model: Noticing

Answer 22

Having sense about what is happening in client situation
May include recognition of or absence of expected sig. cues from client’s responses to illness or medical condition.
Includes influences of the nurse’s own health beliefs about client situations and expectations of the work culture for client care.

Question 23

Features of the Tanner Clinical Judgment Model: Interpreting

Answer 23

Using logical reasoning to gain understanding about a situation and determine appropriate actions

Question 24

Features of the Tanner Clinical Judgment Model: Responding

Answer 24

Analyzing sit. and choosing best course of action
Intuitive “knowing” from past similar experiences
Using past similar experiences to make sense of a present sit.
Responsive actions by nurse

Question 25

Features of the Tanner Clinical Judgment Model: Reflecting

Answer 25

Cognitively reviewing clinical situation Considering appropriateness of assessment data, actions taken, and +/- outcomes for client Making mental response adjustments to be done in future similar situations Learning from actions

Question 26

Lasater's Clinical Judgement Rubric

Answer 26

Based on Tanner's clinical judgment model. | Developed to measure and evaluate clinical judgment using simulation

Question 27

Lasater's levels of clinical development: Noticing

Answer 27

Focus on significant cues Recognize differences Look for cues

Question 28

Lasater's levels of clinical development: Interpreting

Answer 28

Prioritize data | Make sense of data

Question 29

Lasater's levels of clinical development: Responding

Answer 29

Calm and confident Clear communication Do planned actions Skill abilities

Question 30

Lasater's levels of clinical development: Reflecting

Answer 30

Evaluate/analyze self | Desire to be better

Question 31

Intellect

Answer 31

Ability to learn, understand knowledge Capacity for thinking, reasoning intelligently Salient cues

Question 32

Creativity

Answer 32

``` Outlet for imagination Finding unique solutions to unique problems when traditional interventions ineffective Thinking out of the box Increases number of alternatives Requires knowledge of the problem ```

Question 33

Inquiry

Answer 33

Search for knowledge, facts. To gain clarification, find solutions to problems Differs from query

Question 34

Reasoning

Answer 34

``` Deductive reasoning (top down) Inductive reasoning (Bottom up) Clinical reasoning ```

Question 35

Reflection

Answer 35

Action of making sense of occurrences, situations, or decisions by carefully considering totality of experience Debriefing (reflective thinking)

Question 36

Intuition

Answer 36

"Gut reaction" Use of nursing knowledge, experience, expertise for understanding without conscious use of reasoning. Process of continual analyzing Not recommended for new nurses, students

Question 37

Types of decisions made during process of solving problems

Answer 37

Value decisions Time management decisions Scheduling decisions Priority decisions

Question 38

Nursing process

Answer 38

Used to identify a client's health status and actual or potential healthcare problems or needs, to establish plans to meet the identified needs, to deliver specific nursing interventions to meet those needs, and to evaluate the success of those interventions

Question 39

What are the five phases of the nursing process?

Answer 39

``` Assessment Diagnosis Planning Implementation Evaluation ```

Question 40

Nursing process: Assessment

Answer 40

Collect Data Organize Data Validate data

Question 41

Nursing process: Diagnosis

Answer 41

Analyze data Identify health problems, risks and strengths Formulate diagnostic statements

Question 42

Nursing process: Planning

Answer 42

Prioritize problems/diagnoses Formulate goals/desired outcomes Select nursing interventions Write nursing interventions

Question 43

Nursing process: Implementation

Answer 43

``` Reassess the pt Determine the nurse's need for assistance Implement the nursing interventions Supervise delegated care Document nursing activities ```

Question 44

Nursing process: Evaluation

Answer 44

Collect data related to outcomes Compare data with outcomes Relate nursing actions to client goals/outcomes Draw conclusions about problem status Continue, modify or terminate the pt's care plan

Question 45

Purpose of assessment

Answer 45

To establish a database about the pt's response to health concerns or illness and the ability to manage healthcare needs

Question 46

Purpose of nursing diagnosis

Answer 46

Identify pt strengths and health problems that can be prevented or resolved by collaborative and nursing interventions. Develop a list of nursing and collaborative problems

Question 47

Purpose of planning

Answer 47

Develop an individualized plan of care that specifies pt goals/outcomes Promote wellness Prevent illness and disease Restore health Facilitate coping and altered functioning

Question 48

Purpose of evaluation

Answer 48

Determine whether to continue, modify or terminate the plan of care