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Summary of the Article "Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing" by Christine Tanner

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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.

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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. Clinical judgment is viewed as an essential skill for virtually every health professional. Florence Nightingale (1860/1992) firmly established that observations and their interpretation were the hallmarks of trained nursing practice. In recent years, clinical judgment in nursing has become synonymous with the widely adopted nursing process model of practice. In this model, clinical judgment is viewed as a problem-solving activity, beginning with assessment and nursing diagnosis, proceeding with planning and implementing nursing interventions directed toward the resolution of the diagnosed problems, and culminating in the evaluation of the effectiveness of the interventions.

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Clinical judgment is imperative for professional nurses. Tanner defined clinical judgment as “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” ( Aiken LH, 2014). The clinical judgment model includes four phases: noticing, interpreting, responding, and reflecting. Effective clinical judgment is essential to ensure patient safety and quality nursing care. On the contrary, its absence increases the possibility of adverse events

In line with this, acquiring clinical judgment is a key teaching objective of nursing curricula. The challenge for nursing educators is to implement teaching techniques that improve students’ clinical judgment and to effectively navigate how to evaluate such techniques validly and reliably (Tanner C., 2006). The development of clinical judgment in nursing students entails simulation teaching. As nursing students have not yet acquired sufficient judgment and skills, allowing them to practice in real clinical settings can cause tremendous concerns from patients.

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Obviously, encourage and emphasize student reflection in post-conference so that every student can then learn from one another and deepen their ability to make correct clinical judgments through the experience of others. Remember that though clinical reasoning is essential to guide students to make a correct clinical judgment, reflection In action and reflection ON action can be another effective strategy to deepen and develop the ability of every student to THINK like a nurse!

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Tanner C. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006;45(6):204–211

Gerdeman JL, Lux K, Jacko J. Using concept mapping to build clinical judgment skills. Nurs Educ Pract. 2013

Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):1824–1830.

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