Critical Thinking, Clinical Reasoning, and Judgement – Flashcards
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Critical Thinking
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Disciplined thinking that is clear, rational, open-minded, and informed by evidence. A group of interconnected skills to analyze, creatively integrate and evaluate what you read, hear or observe.
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Critical thinking is...
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first step toward developing clinical reasoning necessary skill for a college graduate and a healthcare professional cornerstone of the Nursing Program
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Students graduating with a B.S. in Nursing from CSUEB will be able to
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Synthesize knowledge from the natural sciences, behavioral sciences and the humanities with current nursing knowledge and theory to deliver nursing care; Use critical thinking and communication skills to develop partnerships with clients and other healthcare professionals
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Clinical Judgment
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The interpretation or conclusion about whether or not to take an action based on clinical reasoning.
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Clinical Judgment: A complex process that includes
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Evaluating evidence Generating alternatives Weighing advantages and disadvantages Choosing the most appropriate action
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Tanner's model of Clinical Judgement in Nursing
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Judgement is influenced by what nurse brings to situation, influenced by context of situation, depends on knowing pts and patterns, variety of reasoning patterns, reflextion
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Reflecting on practice often happens when there is
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an error in clinical judgment. This reflection is vital for developing clinical knowledge and improving clinical reasoning
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Tanner's Model of Clinical Judgment
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Model depicts constant change, inter relations, and feedback loops. Begins with understanding that the nurse's background and the context of the situation will influence everything else.
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Clinical Judgement vs Nursing Process
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Noticing = Assessment Interpreting = Diagnosis Responding = Plan/intervention Reflection = Evaluation
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What promotes the development of clinical judgment?
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SIM, understanding own background and biases, comparing generic info to actual cases, reflect on own actions, evaluate outcomes
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How do we measure improvements in clinical judgment?
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Instructors observe clinical behaviors and give feedback Students self-reflection assignments
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ways to measure clinical judgement
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Reflective assignments in courses De-briefing in a group or individually with an instructor Dr. Lasater's Clinical Judgment Rubric
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Rubrics
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A rating tool that: Clarifies expectations Facilitates communication Fosters critical thinking Provides feedback
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4 phases of clinical judgement
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1. Noticing 2. Interpreting 3. Responding 4. Reflection
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Noticing
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Focused observation on objective and subjective data Recognizing deviations from expected patterns Info seeking
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Interpreting
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prioritize data Make sense of data and compare to known data
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Responding
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calm & confident manner assumes responsibility clear communication well planned intervention / flexibility interventions tailored to pt being skillful: mastery of skills
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Reflecting
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Evaluating self analysis Commitment to improvment
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Evaluate Performance Ratings
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Beginning Developing Accomplished Exemplary
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LCJR
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Provides framework for self-assessment and formal evaluation of clinical judgement development
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The 5 assumptions of clinical judgement take into account...
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Knowledge Application Affective aspects of caregiver and environment
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Development of clinical judgement within the 4 phases can be evaluated using the...
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LCJR in the SIM environment
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Application of cognitive meta cognitive, psycho motor, and affective proceses
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leads to sound and competent nursing practices
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Clinical Judgement can only be evaluated when...
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there are observable behaviors that allow for the evaluation of the level of mastery in cognitive domains, psycho motor domains, and affective domains. Observable behaviors and self-reflection
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The purpose of reflective assignments...
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is in developing clinical knowledge and improving clinical reasoning
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Cognitive and metacognitive processes of clinical reasoning can be developed withi the practice of nursing through the use of
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reflective assignments
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Engaging in Reflection enhances
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learning from experience
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Reflection-In-Action
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the nurse's ability to read the patient; how the patient is responding to nursing interventions AND adjust interventions if needed
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Reflection-On-Action
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completes the cycle shows what nurses gain from their experience contributes to their ongoing clinical knowledge development and their capacity for clinical judgement in the future
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Critical Thinking breakdown
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*The cognitive process used for analyzing knowledge uses cognition a way of imposing intellectual standards cognitive process used to analyze empirics knowledge based not dependent on current situation based on evidence and science *Critical thinking is one of the key factors of clinical reasoning
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Clinical Reasoning beakdown
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*The cognitive and metacognitive processes used for analyzing knowledge relative to a clinical situation or a specific patient uses cognition to connect to a pt or situation application of critical thinking to the clinical situation knowledge and experience as well as engagement in clinical situation Requires backgrounds of scientific knowledge and a general case in which to apply knowledge Set of cognitive processes use to discern the relevance of the evidence and science as it applies
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Clinical Judgement breakdown
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*Cognitive psychomotor and affective processes demonstrated through action and behaviors Application of clinical thinking in clinical practice n interpretation or conclusion about a pts needs and the decision to take action Can only be evaluated when there are observable behaviors that allow for the evaluation of level of master in: cognitive, psycomotor, and affective specific to individual
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4 Aspects of Clinical Judgement
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noticing interpreting responding reflective
