Last week we left you with the question “Can you teach nurses good clinical judgment?” We received several thoughtful responses over the week. One of these was the question ” If good clinical judgment is the product of the individual’s combined experience, knowledge, attitudes, and beliefs what are the best practices to teach nurses this essential skill?”
Take a moment to consider your nursing in-service and continuing education experiences recently. Many times these important clinical training sessions are filled with information about assessment, interventions, coordination of care and facility policy. The experience often consists of primarily one way communication from the instructor to the student. Application of the material is measured by the nurse’s ability to perform the clinical skill according to facility policy, procedure and protocol.
To develop or improve clinical judgment nurses must be engaged to actively think and apply the information. The educational experience should involve opportunities for participants to think about the material and use it through interactive dialog and probing questions. One technique we have had good success with is the use of case examples with questions designed to support nurses’ critical thinking. Questions that support critical thinking ask the nurse to describe what they were thinking and feeling about a clinical situation and how those assumptions contributed to a conclusion about what was going on with the patient. The nurse’s reasoning process is the focus of learning and development not their skill performing a procedure or accuracy in drawing the “right” conclusion.
Mind mapping is another tool that can help develop clinical judgment. It is a creative method nurses can use to display information and show how it connects together. Developing an algorhythm or decision tree that guides a nurse through a response to a problem, such as chest pain for example, is another option. The key point here is that the individual nurse develops the map or decision tree to show how they are organizing information and reflecting on the situation.
Reflective practice is another activity that encourages development of clinical judgment. Reflection on an actual clinical experience can yield a wealth of wisdom for the nurses involved. By guiding the discussion toward analysis and synthesis of information, the experience can expand both individual and group learning. Another example of reflection is to ask nurses in orientation and mentoring to keep a journal of their patient experiences and then review these entries periodically to guide discussion into deeper meanings of assessments or a better understanding of the variation and nature of the correctional healthcare setting. For more information see a previous post about reflective practice.
A final approach to development of clinical judgment is simulation. Simulation can be used to mimic common man-down situations or other presentations of important clinical events to encourage staff to think about the factors that they were aware of and that influenced the various decisions made. Simulation allows nurses to gain practice experience in a safe clinical environment.
A common thread throughout all these activities is the emphasis on thought processes, inquiry and reasoning. This can take some guidance, as nurses are more likely to focus on the “how” and “what” to do rather than the why. Redirecting questions to engage staff in truly thinking about their thinking and the reasoning behind their decisions can be difficult to sort out, but the hard work pays dividends.
SO, the good news is that correctional nursing clinical judgment CAN be taught and developed. It involves the nursing process and critical thinking. Finally, it is influenced by both the nurse’s background and the patient’s typical pattern of responses. Read more about developing nurses’ clinical judgment in Essentials of Correctional Nursing, Chapter 19: Professional Practice. Order your copy directly from the publisher at http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4 .
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