Question

How does compassionate client-centered care relate to Tanner's Clinical Judgement Model?

Answer 1

INTRODUCTION

Clinical Judgement is defined as 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.

Nurses must deal with a broad range of issues related to the condition of each patient, including complications and improvements, as well as annotations to clinical records and communications with physicians. As such, the nurse’s judgement is at the heart of care delivery.

Judgement guides action and decisions, not only of the nurse, but also of physicians and other care providers. It is therefore essential for the nurse to have observational and reasoning skills in order to make sound, reliable clinical judgements.

Clinical judgement is the conclusion or enlightened opinion at which a nurse arrives following a process of observation, reflexion and analysis of observable or available information or data.

How compassionate client centered care relate to Tanner's Clinical Judgment model:

Tanner's Clinical Judgement Model(2006) is based on over 200 research studies investigating the way nurses think in practice.The processes of clinical judgment include noticing, interpreting, responding, and reflecting.

1.Noticing:

Noticing is the process of perceiving important or salient aspects of the situation.

It is the ability to identify signs and symptoms and ability to recognize that a situation is different, changed, or not normal.

Noticing also includes,

gathering complete and accurate data

collecting data from all available sources.

assessing systematically and comprehensively

organized manner to collect data to make sure nothing is omitted or forgotten.

predicting (and managing) potential complications.

noticing the nurse's predicting complications and identifying possible problems. arriving at a conclusion without supporting evidence.

2.Interpreting:

Interpreting means grouping together information with a common theme; a method of organizing data so as to put related things together in order to better understand a situation.

Interpreting includes,

recognizing inconsistencies

identifying missed matched data; seeing subjective data and objective data support each other.

checking accuracy and reliability

realizing something doesn't seem right; taking action to determine if it is accurate or not.

distinguishing relevant from irrelevant

deciding which information is pertinent or connects with the matter at hand (i.e. whats going on with the patient)

determining the importance of information

  

For example, Nurses must be able to sort through clinical knowledge, act on important information and disregard what is not important; evaluate information to identify a possible new issue or problem that was not previously identified. (figure out what is new or what is changed.)

comparing and contrasting(looking at 2 similar cases and identifying the subtle differences).

predicting and managing potential complications

looking at the big picture to consider possible complications of an individual patient.

judging how much ambiguity is acceptable.

using legal ethical and professional guidelines. (nurses must consider legal, ethical, and professional guidelines when providing care. nurses must work within the legal guidelines of the nurse state practice act)

3 .Responding:

Once the patient data have been sorted and interpreted, the nurse uses her interpretation to respond to the particular patient issue through one or more nursing interventions.

4.Interpreting:

Using the particular patient data as well as germane theoretical and experiential knowledge, the nurse begins to assemble all the information to make sense of it.

Reflection-in-action

Reflection-in-action refers to the nurse's understanding of patient responses to nursing actions while care is occurring.

Reflection-on-action

Reflection-on-action is consideration of the situation after the patient care occurs. In reflection-on-action, the nurse contemplates a situation and considers what was successful and what was unsuccessful.

Example of Reflection-in-action

The nurse chooses a pain medication dose based on many factors; while administering the medication intravenously, the nurse is continually assessing and reflecting on the patient's response to medication. This is an example of reflecting-in-action. If the desired response is not achieved, the nurse may need to return to interpreting the data in order to respond with a different intervention.

Example of Reflection-on-action

The nurse may take some time at the end of his or her shift to analyze why she intervened in a specific way for this particular patient and to consider whether the intervention was successful. Reflection-on-action is when significant learning from practice occurs and it is important to the development of increasing skillfulness as a nurse.

Thus all the above aspects of Tanner's Clinical judgement model focus and relate to compassionate client centered care.