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UNIT 1 How Nurses Think
(or not), use or modify standard approaches, or impro- vise new ones as deemed appropriate by the patient’s response” (p. 204). This definition emphasizes the impor- tance of understanding the disease process, pathophys- iology, diagnostic aspects, and impact of the illness experience for the client and family. ■ Benner et al. (2009) note that clinical judgment is the “ways in which nurses come to understand the prob- lems, issues, or concerns of client and patients, to attend to salient information, and to respond in con- cerned and involved ways” (p. 201). This definition includes the processes of acquiring, analyzing, and using information to address client needs. Inherent in each of these definitions is the requirement to use processes to achieve desired client outcomes. They require nurses to assess/recognize evidence of client problems, interpret the problems, prioritize a response, take action, evaluate outcomes, and modify actions to ensure the client’s needs are met. You must also consider the context of practice, which includes environmental factors in clinical activities (e.g., staffing, resources, client/family roles) and individual factors (e.g., skill level, knowledge, prior experience). WHAT ARE THE DIFFERENT KINDS OF NURSING KNOWLEDGE? Theoretical knowledge — knowing why —consists of information, facts, principles, and evidence-based theories in nursing and related disciplines (e.g., phys- iology, psychology). It includes research findings and rationally constructed explanations of phenomena. It also includes an understanding of the pathophysi- ology of the disease process, medical treatment (e.g., dietary, medications, activity), surgical treatment and perioperative care, and client and family factors. You will use it to describe your clients, understand their health status, explain your reasoning for choosing interventions, and predict client responses to interven- tions and treatments. Practical knowledge — knowing what to do and how to do it —is an aspect of nursing expertise. It consists of processes (e.g., the decision process, nursing process) and procedures (e.g., how to give an injection). Practical knowledge requires an understanding of the “how and why” of correctly performing nursing skills. Self-knowledge is self-understanding. Clinical judg- ment requires you to be aware of your beliefs, values, and cultural and religious biases. You can gain self- knowledge by developing personal awareness—by reflecting (asking yourself), “Why did I do that?” or “How did I come to think that?” Ethical knowledge is knowledge of obligation, or right and wrong. Ethical knowledge consists of infor- mation about moral principles and processes for mak- ing moral decisions. Ethical knowledge helps you to
fulfill your ethical obligations to clients and colleagues. Chapter 5 will help expand your ethical knowledge. Key Point: Sound clinical judgment requires the nurse to integrate various types of knowledge (e.g., theoreti- cal, practical, ethical, self-knowledge). Refer to the sce- nario in Explore Your Nursing Role. As you probably realize, knowledge is essential in nursing practice. Let’s examine some of the theoretical and practical knowl- edge Jan needed to identify signs of a deteriorating client condition and initiate appropriate interventions for Mr. Anderson. Foundational Knowledge Required: ■ Handoff report (SBAR) ■ Care of the general postoperative client ■ Care of postoperative client after abdominal surgery ■ IV fluids: types, infusion rates, indicators of complica- tion, size and type of access device ■ Care of client with drains (nasogastric tube, Foley, wound; type, drainage, patency) ■ Care of surgical wounds ■ Pain management ■ Diabetes and its management ■ Types and management of dementia ■ Role and responsibilities of members of the interpro- fessional team ■ Complications (potential, signs and symptoms) As you can see, the care of one client may require you to synthesize lots of areas. You will obtain this knowl- edge and more in your nursing program. You will learn how to put it all together. As you cover topics in your courses, always ask yourself, “How will I apply this knowledge to provide safe, quality care to my clients? Knowledge Check 2-1 ■ Define the term clinical judgment in your own words. ■ What is the difference between theoretical and practical knowledge? What Are Models of Clinical Judgment? A model is a set of interrelated concepts that represents a way of thinking about something—much in the same way that the shape of a lens affects what you see. For example, you would look through a telescope to view a distant star. Looking at the star through reading glasses or a magnifying glass would give a different view. You will learn more about models in Chapter 4. The clinical judgment models used throughout this book provide ways of making sense of the concept of clinical judgment. They define the processes involved in arriving at sound client care decisions. Tanner Model of Clinical Judgment This model describes the four aspects of the clinical judg- ment process used by experienced nurses. The critical- reasoning processes that nurses use to foster clinical
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