The Dynamic Process of Clinical Judgement

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Competency

  1. Evaluate factors integral to clinical reasoning.
  2. Explain the impact of relational inquiry when recognizing and analyzing cues to action in the process of clinical reasoning.
  3. Integrate modes of inquiry to generate and evaluate hypotheses in the context of clinical reasoning.
  4. Determine appropriate responses when integrating situated cognition into clinical reasoning.
  5. Modify clinical judgement within an iterative, outcome-based cycle of clinical reasoning and client needs.

Scenario

You are a student in the last term of a BSN Program. You are preparing for an end of term exam. To help you prepare, your instructor developed three real world clinical scenarios to provide opportunities for you to apply clinical reasoning and clinical judgement. The instructor stated, “You received reports on these clients. Decide which one you need to see first and then make appropriate nursing decisions based on relevant information to promote positive client outcomes.”

The three scenarios include:

Instructions

Record your answers to these statements.

  • Rank the three scenarios provided in order of priority related to which client you will assess first, second and third.
    • Defend your selection for the three ranked scenarios.
  • Review the data below for the priority client to determine what to assess first.
    • Chest X-ray no abnormalities noted
    • Abdominal X-ray :diffuse gas throughout the small intestine
    • Hyperactive bowel sounds in all 4 quadrants and abdomen painful to touch
    • Pain level 10/10
    • Sodium (Na+) 147 mmol/L
    • Potassium (K+) 2.9 mmol/L
    • Chloride (Cl-) 100 mmol/L
    • Magnesium (Mg2+) 1.4 mg/dL
    • Calcium (Ca2+) 9.2 mg/dL
    • Phosphorus (P+) 2.3 mg/dL
    • Glucose 188 mg/dL
    • Serum albumin 3.0 g/dL
    • Amylase 185 unit/L
    • Serum Creatinine 0.5 mg/dL
    • BUN 15 mg/dL
    • Alkaline Phos. 155 unit/L • Protein 8.6 g/dL Bilirubin 3.5 mg/dL
  • Formulate three hypotheses based on cues provided
    • Select the priority hypothesis
    • Defend your selection
  • Describe an evaluation plan for the priority hypothesis based on expected client outcomes
  • Describe the next steps in the clinical judgement model including:
    • Actions if satisfied with client outcomes
    • Actions if not satisfied with client outcomes

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