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UNIT 1 How Nurses Think
Client Needs
Clinical Decisions
Layer 0
Clinical Judgment
Satisfied
Layer 1
Not Satisfied
Refine Hypotheses
Evaluation
Form Hypotheses
Layer 2
Analyze Cues
Prioritize Hypotheses
Generate Solutions
Take Actions
Evaluate Outcomes
Recognize Cues
Layer 3
Patient Observation
Patient Observation
Environment
Knowledge
Resources
Knowledge
Skills
Knowledge
Skills
Time Pressure
Candidate Characteristics
Task Complexity
Medical Records
Time Pressure
Specialty
Experience
Experience
Experience
Consequences & Risks
Cultural Considerations
Layer 4
FIGURE 2-1 National Council of State Boards of Nursing (NCSBN) clinical judgment model.
do not possess the competencies necessary for entry- level practice in complex healthcare environments. They do not have the high level of clinical judgment that characterizes more experienced nurses, who use their experience to readily anticipate a client’s needs. Less experienced nurses are unable to detect the subtle changes in client cues that indicate a change in condi- tion. Your program of study will include activities (e.g., critical-thinking activities, simulation, direct client care, testing) that are designed to foster your development of clinical judgment. The NCSBN CJM model measures whether a test- taker has the established degree of clinical judgment and decision-making abilities to be a safe practitioner. The model helps you to recognize, analyze, organize, prioritize, and use your knowledge to make safe client care decisions. This process will be important in prepa- ration for the licensure examination (NCLEX) to become a registered nurse after graduation. Using this process now and throughout your nursing program of study will facilitate your readiness for the examination. The
NCLEX assesses and measures your abilities to be a safe practitioner. Key Point: To make sound clinical nursing judgment, nurses need the theoretical knowledge and practical competencies to recognize and analyze cues, formulate hypotheses, generate solutions, implement interven- tions, and appropriately evaluate client outcomes. In addition, the context (environmental and individual fac- tors, e.g., time constraints, resources, risks, support) of the situation or scenario should be considered. The CJM model defines and assesses clinical judgment. Therefore, you should be familiar with the framework for how you should develop and use your nursing knowledge. The CJM model has five layers, 0 to 4, with the formu- lation of clinical decisions to meet the client’s needs as layer 0 (Dickison et al., 2018): ■ Layer 4 , the context layer, identifies the individual and environmental factors that can affect the nurse’s reasoning or cognitive processes. Examples of indi- vidual factors include one’s knowledge base, skill
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