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CHAPTER 2 Clinical Judgment
Critical Thinking and Clinical Judgment 1. At the end of your first nursing class, your instructor gives an overview of a long-term assignment. She informs you that, for each semester of the program, the class is required to complete a project that provides some type of service to the college community or the local community and that demonstrates the role or importance of nursing. The instructor asks you to begin discussing potential projects and come to class next week prepared to discuss several proposals for your community and the potential benefits of each option. You and several friends gather to talk about the class. “What an odd assignment!” you tell your friends. “How can we possibly do this now? We are not nurses. We do not have any skills. What could we possibly do?” Your friends echo similar views. This exercise will help you work through the imaginary assignment you have just read. Use the critical-thinking model shown in Figure 2-2 in Volume 1 and the sample questions in Box 2-1 of Volume 1 to complete the assignment. Go to Volume 1, Chapter 2: Clinical Judgment. a. Contextual awareness is one concept in the critical-thinking model. Consider the context in which the assignment was given. ■ What exactly is this assignment? ■ Your instructor is perfectly aware of your knowledge and skill levels. Why do you think she would ask students to complete such an assignment so early in their nursing studies? To complete this assignment, you would need to gather information to find ways to answer the following ques- tions. You would also need to use credible sources (another task of critical thinking) to address these questions.
b. What sources might you use to answer the following two questions? ■ What will I learn this semester? ■ What skills will I have by the time this assignment is due? c. What are some ways in which you could answer the following two questions? ■ What do nurses do? ■ How do nurses interact with the community?
d. List some ways in which you could obtain information to answer this question: What does my community need?
e. If you had gathered the preceding information, you would then need to consider possible solutions. One way would be to develop a list of community needs, a list of activities that nurses engage in, and a list of skills and knowledge that you will have at the end of the term. Then look at the overlap between the lists. This should help you to get some ideas for projects. Imagine now that you have a list of possible projects similar to the following: ■ Take blood pressures at a neighborhood grocery store for a day. ■ Hold a health fair at a neighborhood shopping center. ■ Create some materials for teaching about a healthy diet and distribute them at a community event. Now think critically about this list of projects (this involves reflective skepticism and exploring and imagining alter- natives ). What questions could you ask about each project to help you decide which to actually do? 2. Review the following scenarios. Is critical thinking occurring? If so, which part of the critical-thinking model is the student using, or which critical-thinking skill or attitude from Chapter 2 in Volume 1? If there is no evidence of critical thinking, revise the scenario to include it. a. Juan is a first-year nursing student. His clinical rotation is at a skilled nursing facility (SNF). He arrives at the unit at 7 a.m. for the start of the day shift. After hearing the shift change report, he prepares to give his client a bed bath per unit policy. b. Lily is teaching her patient, Mr. Johannsen, about the medications he will be taking when discharged from the hospital. When Lily reviews the list with him, he says, “That’s too many medicines. It’s too confusing.” Lily devises a schedule and information sheet about the medications that she gives to her client. She reviews the medications and their schedules with Mr. Johannsen and his wife before discharge.
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