Article

Thinking like a nurse: A research-based model of clinical judgment in nursing

Oregon & Health Science University, School of Nursing, Portland, Oregon 97239, USA.
Journal of Nursing Education (Impact Factor: 0.91). 07/2006; 45(6):204-11.
Source: PubMed

ABSTRACT

This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.

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    • "As such, integrative learning is foundational to developing a competent nurse who is fully capable to address multi-layered practice situations and to adapt the skills learned across practice situations (Huber & Hutchings, 2004; James, 2010). Integrative thinking is foundational to skilled clinical reasoning and clinical judgment abilities in professional nurses (Tanner, 2006), as health care situations are generally unscripted and uncertain. "

    Preview · Article · Dec 2015
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    • "The students' team actions in the HFS scenarios were analysed using the Lasater Clinical Judgement Rubric (LCJR) matrix (Lasater, 2007), based on Tanner's Clinical Judgement Model (Tanner, 2006). The LCJR was developed in order to analyse and score students' ability to notice, interpret and respond in complex care situations in grades of four development stages: beginning, developing, accomplished and exemplary. "
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    ABSTRACT: Health care educators account for variables affecting patient safety and are responsible for developing the highly complex process of education planning. Clinical judgement is a multidimensional process, which may be affected by learning styles. The aim was to explore three specific hypotheses to test correlations between nursing students’ team achievements in clinical judgement and emotional, sociological and physiological learning style preferences. METHODS: A descriptive cross-sectional study was conducted with Swedish university nursing students in 2012–2013. Convenience sampling was used with 60 teams with 173 nursing students in the final semester of a three-year Bachelor of Science in nursing programme. Data collection included questionnaires of personal characteristics, learning style preferences, determined by the Dunn and Dunn Productivity Environmental Preference Survey, and videotaped complex nursing simulation scenarios. Comparison with Lasater Clinical Judgement Rubric and Non-parametric analyses were performed. RESULTS: Three significant correlations were found between the team achievements and the students’ learning style preferences: significant negative correlation with ‘Structure’ and ‘Kinesthetic’ at the individual level, and positive correlation with the ‘Tactile’ variable. No significant correlations with students’ ‘Motivation’, ‘Persistence’, ‘Wish to learn alone’ and ‘Wish for an authoritative person present’ were seen. DISCUSSION & CONCLUSION: There were multiple complex interactions between the tested learning style preferences and the team achievements of clinical judgement in the simulation room, which provides important information for the becoming nurses. Several factors may have influenced the results that should be acknowledged when designing further research. We suggest conducting mixed methods to determine further relationships between team achievements, learning style preferences, cognitive learning outcomes and group processes.
    Full-text · Dataset · Oct 2015
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    • "Consequently, nursing education needs to facilitate the students' development of cognitive maturity and critical thinking. Discretion is conditioned by the ability to perform critical thinking and clinical judgment (Nickerson and Thurkettle, 2013; Tanner, 2006). "
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    ABSTRACT: Aim: The aim of this study is to review international scientific articles about pedagogical strategies to teach nursing students at bachelor degree evidence-based practice (EBP). Method: A literature review including peer reviewed, original, empirical articles describing pedagogical interventions aimed at teaching bachelor's degree nursing students EBP in the period 2004-2014. Theories of discretion, knowledge transfer and cognitive maturity development are used as analytical perspectives. Results: The main challenge teaching evidence based practice is that the students fail to see how research findings contribute to nursing practice. The pedagogical strategies described are student active learning methods to teach the students information literacy and research topics. Information literacy is mainly taught according to the stages of EBP. These stages focus on how to elaborate evidence from research findings for implementation into nursing practice. The articles reviewed mainly use qualitative, descriptive designs and formative evaluations of the pedagogical interventions. Conclusion: Although a considerable effort in teaching information literacy and research topics, nursing students still struggle to see the relevance evidence for nursing practice. Before being introduced to information literacy and research topics, students need insight into knowledge transfer and their own epistemic assumptions. Knowledge transfer related to clinical problems should be the learning situations prioritized when teaching EBP at bachelor level. Theoretical perspectives of cognitive maturity development, knowledge transfer and discretion in professional practice give alternative ways of designing pedagogical strategies for EBP. More research is needed to develop and test pedagogical strategies for EBP in light of these theories.
    Full-text · Article · Sep 2015 · Nurse education today
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Questions & Answers about this publication

  • Rahimi Ali added an answer in Critical Thinking:
    Can anyone recommend a tool for problem solving and critical thinking in nursing?

    We want to measure the nurses ability in problem solving.

    Rahimi Ali

    dear Ahmad

    here are relevant publications:

    http://eprints.qut.edu.au/263/

    http://www.sciencedirect.com/science/article/pii/S0029655406800059

    https://www.researchgate.net/profile/Christine_Tanner3/publication/7003793_Thinking_like_a_nurse_a_research-based_model_of_clinical_judgment_in_nursing/links/0c9605294f14427681000000.pdf

    http://windsor.scholarsportal.info/ojs/leddy/index.php/informal_logic/article/view/2254

    • Source
      [Show abstract] [Hide abstract]
      ABSTRACT: This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.
      Full-text · Article · Jul 2006 · Journal of Nursing Education
  • Mary C R Wilson added an answer in Critical Thinking:
    Does anyone know about refleve and critical thinking?

    nursing education 

    Mary C R Wilson

    Hello Beatriz

    Was it 'reflexive' you were looking into? This paper might be of help; the authors are ResearchGate members:

    Forneris, S. G., & Peden‐McAlpine, C. (2007). Evaluation of a reflective learning intervention to improve critical thinking in novice nurses. Journal of Advanced Nursing, 57(4), 410-421.

    https://www.researchgate.net/publication/6514253_Evaluation_of_a_reflective_learning_intervention_to_improve_critical_thinking_in_novice_nurses

    Likewise, the authors of the next two papers, are in ResearchGate:

    Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: a systematic review. Advances in Health Sciences Education, 14(4), 595-621.

    https://www.researchgate.net/publication/5813985_Reflection_and_reflective_practice_in_health_professions_education_a_systematic_review

    Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.

    https://www.researchgate.net/publication/7003793_Thinking_like_a_nurse_a_research-based_model_of_clinical_judgment_in_nursing

    Riddell, T. (2007). Critical assumptions: Thinking critically about critical thinking. The Journal of Nursing Education, 46(3), 121-126.

    http://www.ncbi.nlm.nih.gov/pubmed/17396551

    Profetto-McGrath, J. (2005). Critical thinking and evidence-based practice. Journal of Professional Nursing, 21(6), 364-371.

    http://www.ncbi.nlm.nih.gov/pubmed/16311232

    Ruth-Sahd, L. A. (2003). Reflective practice: A critical analysis of data-based studies and implications for nursing education. Journal of Nursing Education, 42(11), 488-497.

    http://www.coloradonursingcenter.org/documents/clinical%20scholar/Resources/Reflective%20Practice.pdf

    Mangena, A., & Chabeli, M. M. (2005). Strategies to overcome obstacles in the facilitation of critical thinking in nursing education. Nurse Education Today, 25(4), 291-298.

    http://www.ncbi.nlm.nih.gov/pubmed/15896414

    Epp, S. (2008). The value of reflective journaling in undergraduate nursing education: A literature review. International Journal of Nursing Studies, 45(9), 1379-1388.

    http://www.ncbi.nlm.nih.gov/pubmed/18325522

    Daly, W. M. (2001). The development of an alternative method in the assessment of critical thinking as an outcome of nursing education. Journal of Advanced Nursing, 36(1), 120-130.

    http://www.ncbi.nlm.nih.gov/pubmed/11555056

    Very best wishes

    Mary

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      [Show abstract] [Hide abstract]
      ABSTRACT: This paper reports a study to determine if a reflective contextual learning intervention would improve novice nurses' critical thinking skills during the first 6 months of their practice. Nursing research evaluating the development of critical thinking in novice nursing practice is limited. The continual struggle by nurse educators to improve critical thinking demonstrates the need for innovative educational interventions that assist in the development of critical thinking as novice nurses enter into practice. This small case study was conducted in the United States of America in 2004 with six student/preceptor dyads. The contextual learning intervention was the case through which the novice nurses' critical thinking were analysed using Stake's phases of data analysis. Specific questions (i.e. novice nurses' use of reflection, context, dialogue, time) guided the analysis. Repeating patterns were coded and isolated and later collapsed/enhanced as the analysis moved forward. Three main themes describe the novice nurses' development of critical thinking: (1) influence of anxiety and power on critical thinking; putting pieces together; (2) questioning as critical thinking: sequential thinking to contextual thinking; and (3) emergence of the intentional critical thinker. Used as a reflective practicum, contextual learning can be a model of clinical learning in nursing education that develops the contextual, reflective nature of critical thinking.
      Full-text · Article · Mar 2007 · Journal of Advanced Nursing

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  • Mary C R Wilson added an answer in Nursing Care:
    Nursing Care Plans Rubric?

    Hi, I'm in the process of working on my Capstone for my Master's in Nursing Education. I would like to create a standardized rubric to use across all three levels of clinical, and I need 30 research articles to support it. Does anyone know of any good resources? 

    Mary C R Wilson

    Hello Janiece

    I wonder if there is anything here of any help? They mention 'nursing rubric' but I am not sure whether they are from the aspect that you need.

    Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503.

    http://www.oclbcp.org/Documents/Simulation%20articles/lassiter.pdf

    ResearchGate member, Dr Christine Tanner cites the above paper in:

    Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, (45), 204-11.

    https://www.researchgate.net/publication/7003793_Thinking_like_a_nurse_a_research-based_model_of_clinical_judgment_in_nursing

    Dr Laura T Gantt is also in ResearchGate; see:

    Gantt, L. T. (2010). Using the Clark simulation evaluation rubric with associate degree and baccalaureate nursing students. Nursing Education Perspectives, 31(2), 101-105.

    https://www.researchgate.net/publication/44585349_Using_the_Clark_Simulation_Evaluation_Rubric_with_associate_degree_and_baccalaureate_nursing_students

    This, I don't think, relates to care plans:

    Blood-Siegfried, J. E., Short, N. M., Rapp, C. G., Hill, E., Talbert, S., Skinner, J., ... & Goodwin, L. (2008). A rubric for improving the quality of online courses. International Journal of Nursing Education Scholarship, 5(1), 1-13.

    http://www.ncbi.nlm.nih.gov/pubmed/18976231

    This is quite old now; I thought that two of the references might be applicable but they - obviously - are older:

    Hardiker, N. R., & Rector, A. L. (1998). Modeling nursing terminology using the GRAIL representation language. Journal of the American Medical Informatics Association, 5(1), 120-128.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC61281/pdf/0050120.pdf

    Have you seen this website:

    http://www.rcampus.com/rubricshellc.cfm?sid=35&

    Very best wishes with your Masters

    Mary

    • Source
      [Show abstract] [Hide abstract]
      ABSTRACT: This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.
      Full-text · Article · Jul 2006 · Journal of Nursing Education

    + 1 more attachment