Clinical Judgement Lecture Outline
Objectives
1. Differentiate the terms critical thinking, clinical reasoning and clinical judgment.
2. Compare and contrast Tanner’s clinical judgment model with the nursing process
3. Identify the steps of the nursing process.
Definition
Clinical judgment is “an interpretation or conclusion about a patient’s needs, concerns, or health
problems, and/or the decision to take action (or not), use or modify standard approaches, or
improvise new ones as deemed appropriate by the patient’s response.”*
Scope of Clinical Judgment
Standards-based approach
 Provides clear-cut guidance and standardized approaches to patient care – best
practices will lead to the best treatment
Evidence-based practice and clinical judgment
 Combines best available scientific evidence with best available patient and
practitioner experiential evidence – interested in optimal outcomes
Interpretivist perspective
 Understands nursing care is not linear –considers multiple complex variables for
clinical reasoning.
Critical Thinking
Definition: The deliberate nonlinear process of collecting, interpreting, analyzing, drawing
conclusions about, presenting, and evaluating information that is both factual and belief-based
(ACEN)
Application of knowledge and experience to identify patient problems and to direct clinical
judgments and actions that result in positive patient outcomes (Yoost, 2020).
Critical thinking is acquired through experience, commitment, and active curiosity.
WHY?
HOW?
Clinical reasoning and clinical judgment are key components to critical thinking in nursing
Methods for Improving Critical-Thinking Skills
o
o
o
o
o
o
o
o
o
o
Reflective Thinking
Discussion with colleagues
Emotional intelligence
Audible verbalization of thoughts
Literature review
Intentional application of knowledge
Concept maps
Simulation
Role playing
Written work
Clinical Reasoning


Clinical reasoning is the cognitive processes that nurses use to understand the significance of
patient data, to identify and diagnose actual or potential patient problems, to make clinical
judgments and clinical decisions to assist in problem resolution, and to achieve positive
patient outcomes.
Thinking process by which a nurse reaches a clinical judgement
Clinical Judgement



Refers to the result (outcome) of critical thinking or clinical reasoning-the conclusion,
decision, or opinion made. End product of the complex process of clinical decision making
Sound clinical judgment requires knowledge to assess and observe situations, identify
priority patient concerns, and implement evidence-based interventions to provide safe patient
care.
Nursing diagnosis is clinical judgment about a person or family’s situation or response to a
health concern or life process
Tanner's Clinical Judgement Model
Noticing:
• having a sense of what is happening in the patient’s situation
• may include recognition of or absence of expected significant clues from the patients
response
• includes influences of the nurse’s own health beliefs about patient situations and
expectations of the work culture
Interpreting: using logical reasoning to gain understanding about a situation and determine
appropriate action
Responding: analyzing a situation and choosing the best course of action
Reflecting:
• considering appropriateness of the assessment data obtained in the situation, actions
taken, and positive and negative outcomes for the patient
• learning from actions (done or not done)
• What did or didn’t work?
• What could have been done differently?
• What was done well?
• What necessary resources were available?
Nursing Process: ADPIE

The purpose of the nursing process is to diagnose and treat human responses to actual or
potential health problems (American Nurses Association).
 Foundation of professional nursing practice
 Framework within which nurses provide care to patients in an organized and
effective manner
 Requires critical thinking
The Steps of the Nursing Process are Dynamic and Interrelated





Assessment: collecting, validating, and communicating patient data
Diagnosis: analyzing patient data to identify patient strengths and problems
Planning: specifying patient outcomes and related nursing interventions
Implementation: carrying out the plan of care
Evaluation: measuring extent to which patient achieved outcomes
References
 Ackley, B. J. (2017). Nursing Diagnosis Handbook: An Evidence-Based Guide to
Planning Care (11th. ed.). Elsevier Inc.
 Giddens, J.F. (2017), Concepts for Nursing Practice (2nd ed.). Elsevier Inc.
 Tanner CA: Thinking like a nurse: a research-based model of clinical judgment in
nursing, J Nurs Educ 45:204-211, 2006.
 Yoost, B. L. & Crawford, L. (2020) Fundamentals of Nursing (2nd ed.). St. Louis, MO:
Elsevier