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Clinical Judgement (Critical thinking requirements (Elements of critical…

- - - - specialized knowledge
      - adapting theory & experiences to various patients & workplaces
      - consolidate theoretical & clinical learning
    - - intellectual standards
        
        "is choice of care accurate, relevant, logical & adequate?"
      - professional standards
        
        following standards for RNs
        
        responsibility & accountability
        
        knowledge-based practice
        
        ethical practice
        
        service to public
        
        self-regulation
    - - trust
      - autonomy
      - impartiality
      - responsibility
      - initiative
      - discipline
      - perseverance
      - creativity
      - curiosity
      - integrity
      - prudence
    - - general
        
        problem solving
        
        decision making
      - for clinical situations
        
        diagnostic reasoning
        
        clinical inferences
        
        clinical decision making
        
        clinical skills
        
        appropriate use of language
      - in nursing
        
        nursing process
- - - - standard-based approach
        
        when not enough clinical experience, knowledge, skills or creativity to make decisions
        
        relies on decision tress, algorithms, patient care guidelines/protocols, models of care
      - evidence-based practice
        
        use of current best evidence to make decisions about patient care
      - interpretivist perspective
        
        inductive reasoning approach to data collection
        
        generalizations formed from set of facts/observations
- - - - novice
        
        no experience in situations
        
        lacks confidence
        
        requires continuous cues
        
        unable to use discretionary judgement
      - advanced beginnner
        
        marginally acceptable performance
        
        efficient & skillful in parts but still requires occasional cues
        
        knowledge is developing
      - competent
        
        been in same/similar situations for 2-3 yrs
        
        efficient, coordinated & confident in actions
        
        conscious deliberate planning
      - proficient
        
        perceives situations as a whole
        
        understands in terms of LT goals
        
        holistic approach improves decision making
        
        modify plans in response to event
        
        recognizes normal expected picture
      - expert
        
        intuitive grasp of situations
        
        deep understanding of total situation
        
        performance flexible & highly proficient
        
        highly skilled analytic ability
  - - - looking for patterns to guide care
      - sees in context
    - - assembling info to make sense of it
      - reasoning patterns vary with experience
    - - implementing interventions
    - - thinking & learning from experiences
        
        reflect-in-action (during) & reflect-on-acting (after)
      - develops knowledge
      - improves reasoning