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