NUR4153 Clinical judgment is a Dynamic Process
ScenarioAs part of the clinical portion of your BSN Capstone course in your senior semester, you have the opportunity to attend a two-day seminar with senior nursing students from other academic institutions. The theme of this seminar is the application of clinical judgment to determine the best evidence-based solutions for nursing practice.InstructionsFor a clinical judgment roundtable with faculty and students that is sponsored by your academic institution, you must prepare one scenario based handout to promote robust discussion regarding the application of clinical judgment as an outcomes-based dynamic cycle of clinical reasoning and client needs. The handout must contain these components:Describe a clinical situation where you applied an outcome-based cycle of clinical reasoning to select what you considered the “best” client intervention based on information available.Include relevant external and internal cues and hypothesesDiscuss the outcomes based, iterative cycle of clinical reasoning you applied after the initial intervention to select the next “best” interventions appropriate for the particular situation based on client needs.Rationales and evidence based findings were included to support choices for the next “best” interventionsResourcesAPA Guide
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NUR4153 Clinical reasoning Deliv 5 Material
Debriefing provides an opportunity for a nurse to reflect on cognitive,
psychomotor and affective events after a situation concludes (Moran,
Winderlish, and Rubbelke, 2018). Dr. Patricia Benner (2018) identified
clinical debriefing as a strategy to connect complex clinical concepts and
phenomena necessary for effective clinical judgment (Benner, 2018).
The process of debriefing can be informal and intrapersonal, or formal
and collaborative.
Debriefing
The basic function of effective debriefing is reflective practice, “a process
of learning and development through examining one’s practice, including
experiences, thoughts, feelings, actions, and knowledge (Schutz and
Bulman, 2013).” Reflective practice to support purposeful clinical
judgment involves:
Self-awareness is a conscious connection with an innate system of
beliefs, values, and honest socialization to internal and external
perceptions of responses based on context. The judgment of our
thoughts and actions by self and others is difficult and requires courage
and confidence to understand the necessity for improvement in nursing
practice.
Objectively describing the context of a situation is difficult as we often
want the power of description to highlight our abilities in a positive light
with minimal judgment. However, the clear description of the context for
effective reflection must be comprehensive and include these five key
elements:
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Situational context including background
Logical details for the timing and sequence of events
Cognitive processing occurring within the context
Affective processing occurring within the context
Expected and unexpected outcomes
To reflect, you must first tell the entire story, even if parts of the story are
difficult to ponder and reveal individual weaknesses.
Critical analysis during reflection involves breaking the components of a
situation into small, manageable parts amendable to critique of strengths
and weaknesses. When analyzing a situation don’t force the reflection
into a linear process but include emotional aspects and recognize the
powerful dynamics of feelings and attitudes when making decisions.
Don’t be afraid to approach critical analysis as an organic process
growing out of the small, yet impactful small experiences. Nurses
performing critical analysis during reflection must integrate these four
essential features:
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Be honest regarding your existing knowledge relevant to the
situation
Be honest about your feelings and the influences on decisions
Challenge your decisions and be accountable for actions
Be open to alternative courses of actions
Synthesis is a higher level of reflection and involves integrating new
knowledge and perceptions with existing knowledge and perceptions in
an attempt to create a novel solution or gain confidence with a current
decision.
Evaluation is the highest and most difficult level of reflection and includes
judgment of decisions and behaviors against established criteria and
outcomes. The key to effective evaluation is to focus on the future
implications as positive changes rather than mistakes in the past as
failures.
Impact of Debriefing on Clinical Judgment
Purposeful, active debriefing as a strategy to analyze actions, examine
rationales and plan future actions has a statistically significant impact on
clinical reasoning. The reflective practice provides a method for nurses to
integrate contextual and cognitive components into new situations with
curiosity and confidence (Forneris, 2015).
Like clinical judgment, debriefing (reflective practice) is an iterative,
dynamic process improved through deliberate practice. Nurses must
commit the time and energy to think about their thinking and question
why and how they can evolve within the complexities of nursing practice.
Remember to embrace the emotional components of a situation and
consider client needs as a priority when debriefing to impact clinical
judgment. Remain open to ideas of others and recognize reflection is not
complete until the evaluation is integrated and openly accepted as
necessary feedback for positive growth within the role of a professional
nurse.
References:
Benner, P. (2018), Higher-order productive thinking in clinical teaching
and learning. Retrieved from https://www.educatingnurses.com/higherorderproductivethinkinginclinicalteachingandlearning/
Forneris, S. G. (2015). Enhancing clinical reasoning through simulation
debriefing: A multisite study. Nursing Education Perspectives (National
League for Nursing), 36(5), 304–310. doi: 10.5480/15-1672
Moran, V., Wunderlich, R., & Rubbelke, C. (2018). Simulation: Best
Practices in Nursing Education. Cham: Springer.
Schutz, S., & Bulman, C. (2013). Reflective Practice in Nursing (Vol. 5th
ed). Hoboken: Wiley- Blackwell.
Detailed Contextual Description Example
Objectively describing the context of a situation is difficult as we often
want the power of description to highlight our abilities in a positive light
with minimal judgment. However, the clear description of the context for
effective reflection must be comprehensive and include these five key
elements:
•
•
•
•
•
Situational context including background
Logical details for the timing and sequence of events
Cognitive processing occurring within the context
Affective processing occurring within the context
Expected and unexpected outcomes
Higher Level of Reflection Example
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