Fostering Clinical Judgment During Preceptorship

The role transition from student nurse to new graduate nurse commonly includes a preceptor relationship. Preceptorships are often the culminating nursing education experience for senior baccalaureate nurses and are used as well for orienting new graduates as they begin their staff nurse role in the hospital setting. The preceptee is paired with an experienced nurse who is charged with supporting, teaching, and exemplifying safe and competent patient care. In many cases preceptors are ascribed the task of independently validating the preceptee\u27s ability to exercise clinical judgment. Today\u27s health care environment requires nurses to be proficient critical thinkers. Patients need more complex care delivered in a shortened time frame in a technology-laden environment and with a frequently changing knowledge base. In addition, nursing practice continues to become increasingly autonomous. How do nursing students safely transition from task orientation to safe, competent, and independent practice

Examining the Relationship Between Clinical Judgment and Nursing Actions in Prelicensure Students

Faculty frequently use the Lasater Clinical Judgment Rubric (LCJR) to identify students’ clinical judgment; however, it is unclear whether LCJR scores relate to appropriate nursing action. In a pilot study consisting of senior-level nursing students (N = 22), participants were scored on the LCJR and anticipated nursing actions, and results were analyzed using simple linear regression. There was a statistically significant correlation (r = 0.364) between clinical judgment and nursing action. Results suggest that total LCJR scores may be an indicator of the completion of indicated nursing action

Values-Based Practice and Reflective Judgment

In this paper, I relate values-based practice (VBP) to clinical judgment more generally. I consider what claim, aside from the fundamental difference of facts and values, lies at the heart of VBP. Rather than, for example, construing values as subjective, I argue that it is more helpful to construe VBP as committed to the uncodifiability of value judgments. It is a form of particularism rather than principlism, but this need not deny the reality of values. Seen in this light, however, VBP is part of a broader conception of clinical judgment that can be compared with Kant’s conception of reflective judgment. This is a useful way of marking similarities between a number of issues raised in philosophy, which can inform a better understanding of clinical judgment

The Application of Clinical Judgment and Decision Making of Critical Care Nurses in Intensive Care Units (ICUs)

Background Intensive Care Unit (ICU) is the hospital setting in which applied specific application of clinical decision making and judgement. The critical patient conditions in ICU may drive nurses to make decision and clinical judgement in short period of time. The approach of clinical decision making which appropriate to be applied in the critical circumstances is important to be identified, thus it could become a guidance for novice and expert critical nurses. Aim The aim of this study was to explain how clinical decision making is applied in Intensive Care Unit (ICU)  Method A systematic review of 22 articles was carried out, articles were retrieved from CINAHL, MEDLINE, PUBMED and DISCOVERED databases. The articles were critically reviewed and analized to answer this study's aim. Result The critically review of the articles were categorized in themes: 1) application of Tanner's clinical judgment model  in ICU, 2) Types of decisions in ICU, 3) Theoretical approach: implementation of decision-making in ICU, 4) Case illustration of decision-making scheme in ICU, 5) Influencing factors of decision-making in ICU, 6) Supporting tools for clinical decision-making in ICU, 7) Understanding of attributes and concepts may enhance the quality of the clinical decision-making process in ICU, 8) Implications for nursing education and practice of understanding clinical decision making in ICU. Conclusions Critical care nurses usually combine different techniques in making decisions; analytical methods including the hypothetic-deductive method, pattern recognition, intuition, narrative thinking, and decision analysis theory are potentially applied. Clinical decision activities in ICU appear in many clinical situations, such as intervention decisions, communication decisions, and evaluation decisions. There are several factors influencing clinical decision-making in intensive care units, including nurses' experience, the patient's situation, the layout of the ICU, shift work, inter-professional collaboration practice, physical and personnel resources. The application of clinical decision making could be supported by systematic tools, and the nurses' knowledge about the concepts and attributes used in ICUs affect their clinical decision-making abilities.     Keywords: clicinal decision making, critical care nurse, IC

The Clinical Assessment in the Legal Field: An Empirical Study of Bias and Limitations in Forensic Expertise

According to the literature, psychological assessment in forensic contexts is one of the most controversial application areas for clinical psychology. This paper presents a review of systematic judgment errors in the forensic field. Forty-six psychological reports written by psychologists, court consultants, have been analyzed with content analysis to identify typical judgment errors related to the following areas: (a) distortions in the attribution of causality, (b) inferential errors, and (c) epistemological inconsistencies. Results indicated that systematic errors of judgment, usually referred also as "the man in the street," are widely present in the forensic evaluations of specialist consultants. Clinical and practical implications are taken into account. This article could lead to significant benefits for clinical psychologists who want to deal with this sensitive issue and are interested in improving the quality of their contribution to the justice system

Clinical Judgment Analysis

SUMMARY Judgment is central to the practice of medicine and occurs between making clinical observations and taking clinical decisions. Clinical judgment analysis has developed as a method of making statistically firm models of doctors' judgments. Computed models reveal the differential importance attached to items of clinical, social, or other data which are determinants of clinical decisions. These models can both reveal the causes of conflicts of judgment and may help resolve them in a way that unaided discussion cannot. Revealing experts' models to students speeds learning of diagnostic skills. Clinical judgment analysis offers a method of probing the judgments not just of students and doctors but also of patients who have shown systematic differences in their perceptions of risk and benefit. The power and relevance of clinical trials can be improved by the consistent application of judgment policies generated from both the trialists and those who will use their result

Development of a Self‐Management Theory‐Guided Discharge Intervention for Parents of Hospitalized Children

Background Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self‐management of their child\u27s care at home after discharge. Problem No theory‐based discharge intervention exists to guide pediatric nurses\u27 preparation of parents for discharge. Purpose To develop a theory‐based conversation guide to optimize nurses\u27 preparation of parents for discharge and self‐management of their child at home following hospitalization. Methods Two frameworks and one method influenced the development of the intervention: the Individual and Family Self‐Management Theory, Tanner\u27s Model of Clinical Judgment, and the Teach‐Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine‐domain conversation guide for use in acute care pediatric hospitals. Conclusions The theory‐based intervention operationalized self‐management concepts, added components of nursing clinical judgment, and integrated the Teach‐Back method. Clinical Relevance Development of a theory‐based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention

Incremental Clinical Utility of ADHD Assessment Measures With Latino Families

Objective: This study examined the incremental clinical utility of parent and teacher reports of ADHD symptomatology and functional impairment in Latino youth, as well as parent and teacher agreement with the final clinical judgment on a diagnostic structured interview. Method: Participants included 70 Latino youth (47 males, 23 females; M age = 8.13 years, SD = 2.51 years) and their parents and teachers; 60 participants were diagnosed with ADHD. Correlations, percent agreement, kappas, and regressions were utilized. Results: Results demonstrated that teachers agreed with the final clinical judgment more often than did parents. Results additionally demonstrated that functional impairment did not statistically significantly improve diagnostic models already including ADHD symptoms; follow-up analyses were run and are discussed. Finally, results demonstrated that teacher reports statistically significantly improved diagnostic models already including parent reports. Conclusion: The current findings suggest the importance of including both parent and teacher reports of both ADHD symptomatology and functional impairment when assessing ADHD in Latino youth