Clinical Judgement Model

ASN 110: Fundamentals of Nursing I

ozarks technial community college

Clinical Judgement Model

generate solutions

Analyze Cues

Evaluate

Recognize Cues

Prioritize hypothesis

take action

Did it work?

What does it mean?

What can I do?

What will I do?

Where do I start?

What matters most?

Recognize Cues

• Cues are found during the assessment process
• Cues are objective findings, subjective reports, heatlh history
• Filter information to identify what is important

Practice Here!

Practice Recognizing Cues

This patient is recovering following a recent abdominal surgery. Upon entering the room, what do you see that may indicate a problem?

Show Cues

Analyze Cues

Prioritize Hypothesis

Generate Solutions

• Identify expected outcomes
• SMART goals
• Consider and plan evidence-based actions that will assest client in meeting expected outcome

• Avoid potentially contraindicated actions for the indivdiual

Practice Generate Solutions

related to colectomy

Practice Generate Solutions

01

What is the problem?This is our nursing hypothesis.

Acute pain

02

What is this problem related to? This is the etiology of the problem

03

What cues told you this was a problem?This is our evidence to support the hypothesis.

as evidenced by pain rating at 7/10, facial grimacing,

04

What would show that this problem is resolved? This is our expected outcome.

Mr. Patient will have a self-reported pain rating at or below 2 out of 10 within six hours.

Are we SMART?

Mr. Patient will have a self-reported pain at surgical site rating at or below 2 out of 10 within six hours.

Who: Mr. PatientWhat: His pain Where: Surgical site Why: Pain currently at 7 out of 10

SPECIFIC WHO, WHAT, WHERE, WHY?

MEASURABLEHOW WILL I KNOW WHEN MY GOAL IS COMPLETE?

Self-reported pain rating at or below 2 out of 10.

ACHIEVABLE IS THE GOAL REASONABLE FOR THE INDIVIDUAL?

The goal is reasonable as pain interventions can assist in decreasing pain level.

RELEVANTWILL THE GOAL MEET THE CLIENTS NEEDS?

Decreasing client pain will address nursing hypothesis of acute pain.

TIME-BOUND When should this be completed? Does the deadline match the urgency of the problem?

This will be completed within six hours. This is realistic as interventions will take some time, but also provides pain relief to the client without the individual having to wait an excessive amount of time.

TAKE ACTION

• Interventions must be evidence-based
• ANA describes evidence-based nursing practice as: "providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs."

• Should help patient meet expected outcome
• Interventions should be actions that the nurse completes instead of things we want the patient to do
• We cannot make patient complete tasks
• Ex: We can encourage the patient to eat four small meals a day but we cannot force this diet change.

TAKE ACTION

Other Provider Interventions

Dependent interventions

Independent interventions

Independent Nursing Interventions

• Does not require orders, directions, or supervision from others
• Often direct care measures
• Direct care are those where the nurse has direct patient contact
• Examples:

• Basic Cares
• Hygiene, turning, etc.
• Taking vital signs and further assessment

Dependent Nursing Interventions

• Require an order from a health care provider
• Based upon proivders choices for treating/managing a medical diagnosis.
• Examples:
• Administering medications
• Invasive procedures
• Intravenous (IV) insertion, foley catheter insertion, preparing for exams
• Interprofessional collaboration
• Comples process involves people from various fields working together to achieve patient outcomes.

Other Provider Interventions

• Require combined knowledge, skills, and expertise of multiple health care providers
• Examples of different roles collaboration may occur with:
• Registered Dietitian
• Social Work
• Physical, occupational or speech therapy
• Pharmacy

• Examine the results of care by reviewing data collected. • Compare actual outcomes with expected outcomes. • Recognize errors or omissions. • Understand and reflect on patient situation. Correct errors. The continual comparison of your original assessment data with repeated assessment measures (evaluation data) obtained after an intervention informs you of a patient’s status.

Evaluate

Practice Evaluation

Expected Outcome: Mr. Patient will have a self-reported pain at surgical site rating at or below 2 out of 10 within six hours.

Nursing Interventions

Evaluate

Evaluate current pain level

Actual Outcome: Mr. Patient states that pain at surgical site is currently at 1 out of 10

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