Developing clinical judgement skills in nursing students

Critical thinking

To develop critical thinking skills, students must engage in activities that encourage analyzing, discriminating, information-seeking and open-mindedness. Critical thinking requires a student to think clearly, precisely, and accurately and act on what they know and understand; critical thinking precedes clinical reasoning (Manetti, 2018; Potter & Perry, 2012; Alfaro-LeFevre, 2017).

Clinical Reasoning

Clinical reasoning involves a student's ability to apply knowledge, think in action, and reason as a situation changes over time (Benner, et al., 2010). the analysis of data is done through four steps:

1. noticing relevant clinical data
2. interpreting the clinical significance of data
3. responding appropriately by prioritizing responses and actions
4. reflecting on the effectiveness of the response (Tanner, 2006).

Clinical judgement

Clinical judgement is process that results in a student's conclusions after making a holistic assessment that correctly interprets clinical data to determine a best response. It is an outcome that depends on critical thinking, clinical reasoning, and intuition (Rischer, 2021). 

In nursing, for example, strong clinical judgement involves a nurse choosing the best response among alternative actions in light of expected outcomes, the using ongoing evaluative reflection to monitor a patient's response, and then modifying interventions accordingly. Reflecting on clinical decisions afterward leads to improved judgement when caring for future patients (Alfaro-LeFevre, 2017; Tanner, 2006; Manetti, 2019).

Clinical judgement models for nursing instruction

Nursing Process (American Nurses Association)

• Assessment — the nurse assesses patients on an in-depth physiological, economic, social, and lifestyle basis.
• Diagnosis and analysis — the nurse considers the physical symptoms and patient behavior and forms a diagnosis or analysis of cues to determine the current nursing priority.
• Outcomes and planning — the nurse uses their expertise to set realistic goals for the patient's recovery and monitors those objectives closely.
• Implementation — the nurse implements the plan of care and documents the patient's progress.
• Evaluation — the nurse analyzes the effectiveness of the plan of care, studies the patient response, and alters the plan of care to achieve the best patient outcomes. (ANA Standards of Critical Nursing Practice, 1988).

Tanner's Clinical Judgement Model

1. Noticing — What clinical data does the nurse recognize as important and/or significant
2. Interpreting — What is the meaning or clinical significance of relevant clinical data that was noticed?
3. Responding — How will the nurse respond with a nursing priority and plan of case based on the clinical data that was noticed and interpreted?
4. Reflecting — After responding, what is the evaluation, reflecting on clinical data noticed by the nurse? (Tanner, 2006)

Citations

• Alfaro-LeFevre, R. (2017). Critical thinking, clinical reasoning, and clinical judgement: A practical approach. (6th ed.). St. Louise, MO: Elsevier-Saudners.
• Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
• Manetti, W. (2019). Sound clinical judgement in nursing: A concept analysis: MANETTI. Nursing Forum, 54)1, 102-110.
• Rischer, K. (2021). Faculty guide to develop clinical judgment: Transforming nursing education through the use of clinical reasoning case studies.
• 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).