Reflective essay from my previous failed assessment

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Models of Clinical Reasoning and Judgment in Nursing


Clinical reasoning and clinical judgement in nursing are one of the most critical nursing skills in caring for patients especially those that are critically ill (Callister, 2012). Nursing significant clinical judgement is dependent on nurse’s critical thinking skills, and knowledge learned from nursing literature (Alfalo 2013). The clinical judgement is influenced by person’s philosophical perspective, attitudes, and preconceptions and it is an ongoing process that is used in solving different cases in ongoing clinical encounters (Audry, 2014). In my previous assessment items, there are various areas I failed to apply and demonstrate full concepts of clinical reasoning and judgment in preparation and presentation of my case study from the comments of my teacher.
In that case, I have identified three areas of learning that I will focus and prepare myself for improvement of the future case studies includes the following;

  1. Learn on how to create a comprehensive clinical handover in development and preparation of a detailed case study.

  2. Review on how to demonstrate clinical reasoning skills by giving accurate and well-justified answers.

  3. I will also improve my ability to identify and address priority clinical problems and apply nursing and corroborative interventions to manage these priorities.

The Information Processing Model

The information processing model is used in clinical reasoning and decision making. In nursing practice nurses adopted this hypothetical-deductive approach to be used in clinical decision making to assess outcomes numerically and analytically using decision trees (Daniel, 2012). Nurse’s uses these analytical models to diagnose reasonably which assumes that individual thought process follows the rational logic that can be analysed until a decision has been made. The ability to recognize clinical situation and experience clinical reasoning process also are the key component in the analytical model (Joy, 2013).

The hypothetic-deductive approach in clinical reasoning involves various levels. Cue cognition stage is the initial stage where nurse collects patient information. In collecting patient information, I did not compare and contrast with the previously recorded data. I only took the current data provided without taking consideration of previous reports which could have an impact in selecting priority data (Rassol, 2013).By skipping this stage, I was unable to come up with the final decision since I just jump to final intervention without considering the most relevant. The second strange is hypothesis generation where a nurse comes up to tentative decisions specific to information generated of which I skipped this stage up to the third stage. This is followed by cue interpretation where cues generated from the original encounter will be used in interpretation and will significantly contribute to the original hypothesis or denies cues that are not related (Callister, 2012). The final stage the cues provided will be evaluated to its possible contribution to confirmation of advantages and disadvantages of the last hypothesis (Mike, 2012).

The nurse reviews the current information provided, then gather new information through assessment of patient data and finally recall the relevant knowledge required in patient care (Mitchem, 2013). I did not remember in detail the knowledge on how opioids and other medication used in palliative care were necessary, their specific indications, adverse effects, and contraindication. Information processing enables the nurse to analyses data so as to come to an understanding of signs and symptoms (Karen, 2012). This helps to distinguish irrelevant from relevant information by narrowing down the clues to the most significant of which I failed to come up with the data concerned and what I thought was missing since I never expand on looking for new information needed to develop a sound clinical judgement. I only used the provided information only (Audry, 2014).

The nurse is also able to relate patterns and new relationships between original data and data collected and make deduction opinions that follow logically considering alternatives and consequences the hypothetical deductive also enables me to match the current situation from the past, and I can predict outcomes (Thomas, 2014). From my presentation, I did not relate any patterns because I only had one source of data that limited me from considering alternatives (Joy, 2013). I did little to expand the knowledge provide with the knowledge I had to learn for example I was unable to indicate and realise that GCS of 14 is below 15 and that showed abnormality which needed intervention. I took it as nearer to normal but not abnormal as it was (Karen, 2012).

In clinical decision-making strategies the nurse usually corroborates with colleagues particular the experts to interpret cues and events that are no clear to enhance collegial verification (Feldman, 2012). In planning my interventions, I did not include any collaborative measures which led to unverified mistakes leading to poor outcomes and nursing evaluations (Joy, 2012).

The Intuitive Humanistic Model

This clinical model focuses on the relationship between nursing experiences and education gained from it and how it helps in the clinical decision-making
process as the nurse develops in solving a clinical problem (Joy, 2013). The model does not use hypothesis testing but the use of learned procedures and guidelines in decision making by understanding the concept deeply. (Rassol, 2013) In item three I did not fully understand the concepts of identifying priorities for intervention; instead, I discussed information presentation. (Karen, 2012) The application of knowledge that is evident or immediate which follow clinical situations that have rationales by correlating possibility, meanings and outcomes by use of intuitions (Joy, 2013). Intuition in this concept will be described as an act of synthesizing ethical, empirical, aesthetic and personal knowledge. (Karen, 2012) I failed to use my knowledge learned in class to apply in the planning of intervention and case presentation. Intuitive judgement is to act on immediate awareness of education that is related to early experience perceived as a whole. The connection with the first presentation of case study does not link with the third completely as I do not discuss the priorities intervention simultaneously it is like I am starting another new, different presentation (Karen, 2012).

In addition intuition involves making nurse-patient connections and applying the principle of empathy in nursing care (Power, 2012). This helps in developing best strategies in making an excellent clinical reasoning and forecasting on outcomes that may result. I fail to create connections with the patient since I did not take the deeper assessment and have no enough experience (Banning, 2013). Despite
that, I fail to console experts to assist in decision making in my clinical reasoning. I did not examine previous unique clinical situations to determine how they were solved. The model further describes intuition as experimental learning. The quality of analysis of a decision making in clinical reasoning improves as nurses stay with the patient to gain experience (Thomas, 2014). This enhances ease in decision-making since you will quickly find findings that occur in the already reported health history and approve on priorities highlighted (Daniel, 2012). Staying with the patient for a given period will provide a greater insight of the evidence presented and knowledge you have to support nursing practice and clinical decisions of which I did not give myself a good time to stay with patient or analyses profoundly patient report (Mitchem, 2013).

There are Seven factors characterised intuition concepts. One of these factors is an emotional awareness that is accompanied by pre-emotions. I did not have emotional awareness since I only did the case more physically and not psychologically. None of my intervention appreciated the spiritual
awareness of my client. The second factor is physical sensation such as feeling, reassuring the feelings brought by anxiety, spiritual connection, reading and sensing energy and cues which enforce making connections. The key component in dealing with a client understands his or her psychology of which I did not work on it too much as required.

There are various characteristics related to the intuition that enforces clinical decision making and judgement (Feldman, 2012). These factors include, willing to take risks in a clinical area. This involves making a tentative decision first before making any hasty final decision (Daniel, 2012). The other is acknowledging intuition in clinical practice which includes allowing your free mind to solve decisions with preference to education and already information you possess. In solving my clinical case I never fully demonstrate the level of my educational understanding in pathophysiology and discussion of terms such as palliative care in detail rather I just give definitions (Callister, 2012). Others include takes action based on intuitions, rigidity and cautions plus being creative and self-awareness (Joy, 2013).

For one to learn, this model of intuition insists that one has to search contributions fully from experienced or seek advice and support putting an excellent clarity of the roles (Mike, 2012). This enables one to focus on responsibilities and relevant roles in nursing care. In the process of identifying new strategies from experienced nurses, one will identify new cues from the case of which I was unable to determine new signals since I did little in corroboration with other nurses (Karen, 2012). The process of cues recognition is referred to as pattern recognition which involves cues identification from patient knowledge and nurse education and looking similarities from the previous similar condition of the same patient or different patient (Thomas, 2014). The ability to have good pattern recognition develops as one go deeper to the patient condition (Rassol, 2013).

Clinical Decision Making Model

This is a multi-directional model that develops from both pattern recognition and hypothetical model as a basis for clinical decision making and reasoning (Joy, 2013). The key features of this model include controlling and anticipating risk, investigating pre-encounter data, standard nursing care provision, situational and patient modification and hypothesis generation triggers followed by nurse actions (Banning, 2013).

Pre-encounter data is patient information a nurse have before the first contact with the patient. This information includes patient records and flow sheets plus information gotten from communication with the health team of which I did little about in my presentation. (Karen, 2012) Assumptions, beliefs textbook information, experiences, and interests that affect nurse patterns are noted (Karen, 2012).In my case presentation, I did not first review anatomy and physiology, pathophysiology and specific nursing care of the disease in my learning in class and textbooks so as to have a clear insight in the management of my patient in the clinical area (Gerberson, 2014).The role of this data is to help a nurse to predict the occurrence of health problem the client may develop. Anticipating and controlling risk involves nurse’s consideration and extent of each actual and potential health issue then ranking it accordingly of which I never ranked my client’s problems accordingly since I did random selecting of priority problems (Mooi, 2012). This is now followed by taking appropriate nursing intervention on priority risks to reduce most threatening risk and support the health of a client.

The learned nursing procedures as practised by the institutional hospital should be employed fully. The hospitals protocols and exacts benefiting habits of the institution should also be followed to ensure uniformity of care (Mooi, 2012). The standard of care
is directed toward the achievement of pre-encounter
data, and the clinical decision might be tentative since the condition may change in time (Power, 2012). This therefore provides a basis to develop immediate plans and also plans. In my presentation, I have immediate plans, and I did not put into consideration of the plans
for palliative care. (Thomas, 2014)

The next component of clinical decision making and reasoning is situational, and client modification that takes place in the central client focused crisis that always involves more than one repeated time visits which are constantly interrupted (Callister, 2012). The factors that influence the condition of the
client are made including the information that one receive from the corroborative staff comments of the same client or different with the same condition of which I did little on this (Power, 2012). These quality skills that a nurse gets from the visits include understanding the patient psychological and physiological functions midst to management of the client condition (Alfalo, 2013).

Hypothesis generation is the final aspect of a clinical
decision-making model. This involves testing theory
about any potential change in patient’s status; pre-encounters information availability and important clues to the client’s current situation by
synthesising interferences and facts to make a correct diagnosis for the patient problem, and also selecting some actions between different alternatives available (Karen, 2012).In my case study, I only focused on one line of intervention without considering alternatives which hindered me in making a variety of clinical judgements so as to determine which fits most (Mike 2012). The professional and social context of the problem should also be considered plus reviewing substantial improvements and deterioration of the patient condition. At this time the nurse will gain experience of homoeostasis assessment of client state (Power, 2012). The more the nurse gain experience, the more she will be able to develop abilities in recognition patterns (Power, 2012).


The three models explain how to handle the clinical situation in a more comprehensive manner so as to entirely solve patient’s problems. In information processing, a bright nurse will collect patient information from all available sources that are, patient reports, information from other health providers and family, previous handover report, similar information from the different patient and review knowledge from textbooks. The nurse should also use available learned knowledge from class and books or from experience to solve clinically critical problems. Identifying pre-encounter data, modification of patient situation, practising standard nursing care and generating hypothesis for the nurse actions are among the key features in good clinical reasoning and judgement.

Implications of this Learning Experience for Future Nursing Practice

I have learned that for proper identification of relevant and priority data for the patient care I have to deep into details. In this, I will be gathering information from all available sources and compare and contrast them. For me to be able to process and understand information of the patient well, I have to interpret the available information, distinguish relevant from irrelevant, relate new relationships and patterns, make a deduction from opinions, match current situations with the past and predict outcomes (Joy, 2013).

In addition, I have learned that for proper solving of clinical problems I have to learn from experience through practising by trying to solve day to day different patient cases. I have also to utilise my knowledge learned and before solving a problem it will always be good I review clinical procedures, anatomy and physiology, pathophysiology and many nursing cares of the underlying condition at hand. This will help me to demonstrate my understanding of the status of the patient and also help me identify factors for improvement and those that show deterioration (Mike, 2012).

I have also understood the need in corroborating and seeking information from the experience and expert nurses so as to have guidance and add skills in patient care. In
future, I will always console my colleagues and superiors about what am not sure so as to be able to identify specific priorities for nursing care in a given condition. I will always check and understand in details the explanation of terms and disease processes so as to enable me to dig in detail the needs at hand (Daniel, 2012).

The other learning I have learned is the need to build my knowledge in clinical [practice by performing and solving more cases. In future I will always check my patient time to time so as to review the progress and also try to connect spiritually and emotionally will always investigate pre-encounter data of a patient thoroughly and practice standard nursing care in developing and solving hypothesis (Audry, 2014).


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