Clinical Reasoning/Clinical Judgment Process Step 1

Step 1: Recognize Cues

Learning Objective: Student will recognize expected findings and unexpected findings. This is key to preventing “failure to rescue” (Clayton, 2017; Fontenot, 2022; Herron, 2017).

Step 1: Recognize Cues

Educator Prompts:

“What did you see?”

“What cues are relevant or irrelevant?”

“What is going on in the environment?”

“What EHR data may be important?”

List normal findings to recognize:

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List abnormal findings to recognize:

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Environment cues (setting, presence of family):

List signs and symptoms to recognize:

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Patient Observation cues:

List key facts to recognize (from H&P, PMH, SH, etc.):

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Medical Records cues:

Time Pressure cues:

Clinical Reasoning/Clinical Judgment Process Step 2

Step 2: Cluster and Analyze Cues

Learning Objective: Student will identify content needed to cluster and analyze cues.

Step 2: Cluster and Analyze Cues  

Educator Prompts:  

“What data link together?” For example: RR24, WHEEZING, PO2 93% on RA.

“Are there any patterns?” 

“Are there any inconsistencies in the data collected?” For example: the client states no pain, yet the nurse sees them tearful, and moaning when moving. The information does not “match”. Further investigation is needed.

“What data can be clustered together to assist in determining a concern?” for example: if a client has a fever, what is the WBC count? Has there been a trend upward or downward in this data?

What is/are the connection(s) between pathophysiology and client presentation? ***This is a major area of focus to help the student begin to understand the why behind the symptoms they are finding/clustering/analyzing.

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Requires knowledge of: ***If unsure, look it up!! Ask questions!! Be the safest student nurse you can be!!

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Use findings/observations to determine client needs: 

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Student to develop inquiry:

What questions need to be asked?

What are safety concerns?

What additional information might be needed to develop a hypothesis? (In other words, did a piece of data get missed?).

Clinical Reasoning/Clinical Judgment Process Step 3

Expected Behavior(s) : student will identify possible/probable causes of the cues that were found and analyzed. Students will prioritize the hypothesis in a safe and effective manner. Faculty: Use index cards with many client symptoms, have the students generate hypothesis and prioritize what should be addressed first.

Prioritize Hypothesis   

Educator Prompts:  

“Do you need more information to form a hypothesis?” 

What is the priority issue (likelihood, risk, etc.)? 

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Requires knowledge of: 

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Indicate resources: 

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Clinical Reasoning/Clinical Judgment Process Step 4

Expected Behavior(s): Student will i dentify possible solutions to the prioritized hypothesis and minimize possible complications of the actual hypothesis. Faculty: index cards for students in groups. What interventions must be done, what should be avoided? What complications could occur, and how can they be managed?

Step 4: Generate Solutions  

Educator Prompts:  

“What interventions may be possible?” 

“What solutions did the patient need? What evidence did you have for this solution?” 

“What risks are related to your solution?” 

“What are the potential risks if you do not choose this solution?” 

“What complications may arise from the given hypothesis”?

What must the nurse address?  Are there potential complications that must be accounted for?

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Requires knowledge of: What is the pathophysiology that we are trying to correct/return to homeostasis?

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What must the nurse avoid?