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CHAPTER 2 Clinical Judgment
■ Personal bias. Clients may have fixed beliefs about health and illness. ■ Personality. Individuals have unique personalities. This means every person is different; all have indi- vidual ways of responding to stress, fear, illness, and pain. Some are hardy and show an attitude of strength, endurance, and a high threshold for pain. Others are less tolerant and may outwardly express pain or other emotions associated with illness, hospi- talization, and death. ■ Previous experience. Clients are often affected by pre- vious problems with healthcare. For example, a boy who has experienced a painful injection in the past may be terrified when he sees the nurse approaching with a syringe. Nurses Apply Knowledge to Provide Holistic Care In addition to the need to individualize care for each cli- ent, there are some aspects of nursing itself that require the nurse to be a critical thinker: ■ Nursing is an applied discipline. Nurses deal with complex, ill-defined, and sometimes confusing problems—client problems may not be well defined and straightforward. Key Point: This means that you must analyze client cues and apply your knowledge and skills and not just try to memorize and regurgi- tate facts from the textbook. ■ Nursing uses knowledge from other fields. Nurses integrate knowledge from chemistry, physiology, psy- chology, social sciences, and other disciplines into the practice of nursing to identify and plan interventions for client problems. Nurses collaborate with members of the interdisciplinary healthcare team to provide a multifaceted approach to client care. ■ Nursing is fast-paced. Nurses often deal with demand- ing situations in a complex healthcare environment. A client’s condition may change from hour to hour or even minute to minute, so knowing the routine may not be adequate. You will need to respond appropri- ately and quickly under stress. ■ The scientific basis for client care changes constantly. Therefore, you must constantly update your knowl- edge and skills throughout your career. You will need to continuously expand and refine your critical-think- ing skills as well. ■ Critical thinking is linked to evidence-based prac- tice, which you will learn more about later in this book. Evidence-based practice is a research- based method for judging and choosing nursing interventions. Think Like a Nurse 2-5: Clinical Judgment in Action Write a short scenario (story) about a nurse that illustrates one of the reasons why nurses need to be critical thinkers.
A MODEL FOR CRITICAL THINKING You will recall that a model is a set of interrelated concepts that represents a way of thinking about something. The critical-thinking model used throughout this book orga- nizes critical thinking into five major categories. Box 2-1 defines each category and provides questions to help you focus your thinking during clinical reasoning. You can use some of the questions when deciding what to think about and do; you can use others when analyzing a situation after it happens (reflecting). Figure 2-2 is a simpler repre- sentation of the model, relating it to the nursing process, which is introduced later in this chapter. Use the model as a guide when faced with clinical decisions or unfamiliar situations. The questions can help you to “think about your thinking” as you apply principles and knowledge from various sources to a problem. This should help you to achieve good out- comes for your clients. Only ask yourself the questions that are relevant to the situation. The processes do not occur “sequentially,” so you may jump back and forth among them. As you advance in your nursing program, these questions will become more intuitive. Applying the Model:An Example Let’s apply the model to a situation faced by all nursing students. Soon you will begin your clinical rotations, if you have not already done so. How could you use the five points of the critical-thinking star (see Fig. 2-2) to approach your first clinical day so that you will be well prepared and able to function safely? Contextual Awareness One of the first things you need to consider is your usual response to new expe- riences. Consider several questions that will help you address the star point of contextual awareness: How do you react to change? What other tasks or assignments do you have that will dictate the timing of your preparation? What previous experiences will aid or hamper you in your preparation? What beliefs and assumptions will affect the way you prepare for your first day of client care? Using Credible Sources You need to use credible sources of data to prepare for the clinical experience. Until you gain more experience, you can: ■ Ask your instructor for guidance on how to best prepare. ■ Consult a student who has successfully completed the same course. You will also need accurate information about the clients assigned to you. Use only knowledgeable, reliable sources of information, such as the following: ■ The client’s medical records ■ Credible Internet sites—your instructor can provide guidance. ■ Nursing texts and scholarly journals
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