{"id":131,"date":"2021-08-26T11:34:37","date_gmt":"2021-08-26T15:34:37","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/?post_type=chapter&#038;p=131"},"modified":"2024-01-14T11:17:26","modified_gmt":"2024-01-14T16:17:26","slug":"clinical-judgment-and-nursing","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/chapter\/clinical-judgment-and-nursing\/","title":{"raw":"Clinical Judgment and Nursing","rendered":"Clinical Judgment and Nursing"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">When collecting subjective and objective data, you need to consider clinical judgment. In nursing, the purpose of health assessment is to facilitate <strong>clinical judgment<\/strong>, which is defined as:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">A determination about a client\u2019s health and illness status.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Their health concerns and needs.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">The capacity to engage in their own care.<\/span>\r\n<span style=\"color: #000000\">AND<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">The decision to intervene\/act or not \u2013 and if action is required, what action (Tanner, 2006).<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The nursing process is the foundation of clinical judgment. However, clinical judgment is more comprehensive, action-oriented, and guided by the philosophy of client safety. Thus, it is important to learn when to act to prevent <strong>clinical<\/strong> <strong>deterioration<\/strong>, a worsening clinical state related to physiological decompensation (Padilla &amp; Mayo, 2017).<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">To facilitate clinical judgment, you must determine if the collected data represent <strong>[pb_glossary id=\"232\"]normal findings[\/pb_glossary]<\/strong>\u00a0or <strong>[pb_glossary id=\"234\"]abnormal findings[\/pb_glossary]<\/strong>. When findings are abnormal, you must act on these cues as they signal a potential concern and require action. Failing to recognize abnormal findings and act on these cues can lead to negative consequences including sub-optimal health and wellness \u2013 and more importantly, <strong>clinical<\/strong> <strong>deterioration<\/strong>. Some abnormal findings are considered <strong>[pb_glossary id=\"243\"]critical findings[\/pb_glossary]<\/strong>that place the client at further risk if the nurse does not act immediately.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The process leading to clinical judgment is described as <strong>clinical<\/strong> <strong>reasoning<\/strong>. This process involves:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Thoughtfully considering all client data as a whole, whether each piece of information is relevant or irrelevant, and how each piece of information is related or not related.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Recognizing and analyzing <strong>[pb_glossary id=\"245\"]cues[\/pb_glossary]<\/strong>. Is the information collected a normal, abnormal, or critical finding? Can the information be clustered to inform your clinical judgment?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Interpreting problems. What is the priority problem and what are the factors causing it? What else do you need to assess to validate or invalidate your interpretation? What other information do you need to collect to make an accurate clinical judgment?<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Determining, implementing, and then evaluating appropriate actions (Dickison et al., 2019; Tanner, 2006).<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The clinical reasoning process is encompassed by <strong>critical thinking<\/strong>. This means that when engaging in the process of clinical reasoning, you should systematically analyze your own thinking so that the outcomes are clear, rational, creative, and objective with limited risk of judgment and error.<\/span><\/p>\r\n\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Clinical Judgement\u00a0<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">A client tells you \u201cI have a headache.\u201d As the nurse, you immediately recognize the cue: headache. However, you do not have sufficient information to analyze this cue and identify the significance. Thus, you may ask a series of subjective questions such as \u201cWhen did the headache start? What were you doing when it started? Have you ever had this type of headache before?\u201d The client\u2019s response will provide you detailed information to facilitate your critical thinking and the process of hypothesizing what is going on, and thereby helping you determine what actions to take.<\/span><\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Clinical judgement is facilitated by cognitive steps that help you determine when and how to act to prevent clinical deterioration; see <strong>Table 1.2<\/strong>. Like the nursing process, these steps should be performed in an iterative manner as per the client situation and your clinical reasoning process.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Table 1.2<\/strong>: Clinical judgment steps (developed based on NCSBN, 2020)<\/span><\/p>\r\n\r\n<table class=\"lines\" style=\"border-collapse: collapse;width: 100%;height: 270px\" border=\"0\">\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<th class=\"shaded\" style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 15px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Steps<\/strong><\/span><\/p>\r\n<\/th>\r\n<th class=\"shaded\" style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 15px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Considerations<\/strong><\/span><\/p>\r\n<\/th>\r\n<\/tr>\r\n<tr style=\"height: 45px\">\r\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 45px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Recognize cues<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 45px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Recognizing cues involves identifying findings that require action because they are abnormal. This involves what Tanner (2006) calls \u201cnoticing\u201d (i.e., recognizing when something is abnormal). You should be asking yourself what matters most?<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 45px\">\r\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 45px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Analyze cues<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 45px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Analyzing cues involves interpreting\/making sense of the collected data, what it means, and how it may relate to possible pathophysiological processes. This involves what Tanner (2006) calls \u201cinterpreting\u201d, making sense of the collected data.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 30px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Prioritize hypotheses<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 30px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Prioritizing hypotheses involves figuring out where to start and how to prioritize care. This step involves what Tanner (2006) refers to as \u201cresponding\u201d to the collected data<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 60px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Generate solutions<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 60px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Generating solutions involves identifying the various options (e.g., actions\/interventions) to address the problem or the abnormal findings\/cues. This may involve identifying which solutions are [pb_glossary id=\"2195\"]indicated\/effective[\/pb_glossary], [pb_glossary id=\"2197\"]nonessential[\/pb_glossary], [pb_glossary id=\"2199\"]unrelated[\/pb_glossary], and [pb_glossary id=\"2200\"]contraindicated[\/pb_glossary].<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 45px\">\r\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 45px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Take actions<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 45px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Taking actions involves identifying the action that should be taken. Examples of actions are specific but could be related to notifying the physician or nurse practitioner, calling for help, monitoring the client, collecting further data.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 30px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Evaluate outcomes<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 30px\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Evaluating outcomes involves determining if the action taken was effective. It may include identifying outcomes that are considered improved, unchanged, or worsened.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">[h5p id=\"6\"]<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Dickison, P., Haerling, K., &amp; Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks.\u00a0<em>Journal of Nursing Education<\/em>,\u00a0<em>58<\/em>(2), 72-78.\u00a0<\/span><a href=\"https:\/\/doi.org\/10.3928\/01484834-20190122-03\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3928\/01484834-20190122-03<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">NCSBN (2020, Spring).\u00a0<em>Next Generation NCLEX news<\/em>.\u00a0<\/span><a href=\"https:\/\/www.ncsbn.org\/NGN_Spring20_Eng_02.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncsbn.org\/NGN_Spring20_Eng_02.pdf<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Padilla, R., &amp; Mayo, A. (2017). Clinical deterioration: A concept analysis.\u00a0<em>Journal of Clinical Nursing<\/em>,\u00a0<em>27<\/em>, 1360-1368.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1111\/jocn.14238\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1111\/jocn.14238<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing.\u00a0<em>Journal of Nursing Education<\/em>,\u00a0<em>45<\/em>(6), 204-211.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.3928\/01484834-20060601-04\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3928\/01484834-20060601-04<\/a><\/p>\r\n&nbsp;","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">When collecting subjective and objective data, you need to consider clinical judgment. In nursing, the purpose of health assessment is to facilitate <strong>clinical judgment<\/strong>, which is defined as:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">A determination about a client\u2019s health and illness status.<\/span><\/li>\n<li><span style=\"color: #000000\">Their health concerns and needs.<\/span><\/li>\n<li><span style=\"color: #000000\">The capacity to engage in their own care.<\/span><br \/>\n<span style=\"color: #000000\">AND<\/span><\/li>\n<li><span style=\"color: #000000\">The decision to intervene\/act or not \u2013 and if action is required, what action (Tanner, 2006).<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The nursing process is the foundation of clinical judgment. However, clinical judgment is more comprehensive, action-oriented, and guided by the philosophy of client safety. Thus, it is important to learn when to act to prevent <strong>clinical<\/strong> <strong>deterioration<\/strong>, a worsening clinical state related to physiological decompensation (Padilla &amp; Mayo, 2017).<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">To facilitate clinical judgment, you must determine if the collected data represent <strong><button class=\"glossary-term\" aria-describedby=\"131-232\">normal findings<\/button><\/strong>\u00a0or <strong><button class=\"glossary-term\" aria-describedby=\"131-234\">abnormal findings<\/button><\/strong>. When findings are abnormal, you must act on these cues as they signal a potential concern and require action. Failing to recognize abnormal findings and act on these cues can lead to negative consequences including sub-optimal health and wellness \u2013 and more importantly, <strong>clinical<\/strong> <strong>deterioration<\/strong>. Some abnormal findings are considered <strong><button class=\"glossary-term\" aria-describedby=\"131-243\">critical findings<\/button><\/strong>that place the client at further risk if the nurse does not act immediately.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The process leading to clinical judgment is described as <strong>clinical<\/strong> <strong>reasoning<\/strong>. This process involves:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Thoughtfully considering all client data as a whole, whether each piece of information is relevant or irrelevant, and how each piece of information is related or not related.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Recognizing and analyzing <strong><button class=\"glossary-term\" aria-describedby=\"131-245\">cues<\/button><\/strong>. Is the information collected a normal, abnormal, or critical finding? Can the information be clustered to inform your clinical judgment?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Interpreting problems. What is the priority problem and what are the factors causing it? What else do you need to assess to validate or invalidate your interpretation? What other information do you need to collect to make an accurate clinical judgment?<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Determining, implementing, and then evaluating appropriate actions (Dickison et al., 2019; Tanner, 2006).<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The clinical reasoning process is encompassed by <strong>critical thinking<\/strong>. This means that when engaging in the process of clinical reasoning, you should systematically analyze your own thinking so that the outcomes are clear, rational, creative, and objective with limited risk of judgment and error.<\/span><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Clinical Judgement\u00a0<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: left\"><span style=\"color: #000000\">A client tells you \u201cI have a headache.\u201d As the nurse, you immediately recognize the cue: headache. However, you do not have sufficient information to analyze this cue and identify the significance. Thus, you may ask a series of subjective questions such as \u201cWhen did the headache start? What were you doing when it started? Have you ever had this type of headache before?\u201d The client\u2019s response will provide you detailed information to facilitate your critical thinking and the process of hypothesizing what is going on, and thereby helping you determine what actions to take.<\/span><\/p>\n<\/div>\n<\/div>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Clinical judgement is facilitated by cognitive steps that help you determine when and how to act to prevent clinical deterioration; see <strong>Table 1.2<\/strong>. Like the nursing process, these steps should be performed in an iterative manner as per the client situation and your clinical reasoning process.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Table 1.2<\/strong>: Clinical judgment steps (developed based on NCSBN, 2020)<\/span><\/p>\n<table class=\"lines\" style=\"border-collapse: collapse;width: 100%;height: 270px\">\n<tbody>\n<tr style=\"height: 15px\">\n<th class=\"shaded\" style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 15px\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Steps<\/strong><\/span><\/p>\n<\/th>\n<th class=\"shaded\" style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 15px\">\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Considerations<\/strong><\/span><\/p>\n<\/th>\n<\/tr>\n<tr style=\"height: 45px\">\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 45px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Recognize cues<\/span><\/p>\n<\/td>\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 45px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Recognizing cues involves identifying findings that require action because they are abnormal. This involves what Tanner (2006) calls \u201cnoticing\u201d (i.e., recognizing when something is abnormal). You should be asking yourself what matters most?<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 45px\">\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 45px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Analyze cues<\/span><\/p>\n<\/td>\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 45px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Analyzing cues involves interpreting\/making sense of the collected data, what it means, and how it may relate to possible pathophysiological processes. This involves what Tanner (2006) calls \u201cinterpreting\u201d, making sense of the collected data.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 30px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Prioritize hypotheses<\/span><\/p>\n<\/td>\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 30px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Prioritizing hypotheses involves figuring out where to start and how to prioritize care. This step involves what Tanner (2006) refers to as \u201cresponding\u201d to the collected data<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 60px\">\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 60px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Generate solutions<\/span><\/p>\n<\/td>\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 60px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Generating solutions involves identifying the various options (e.g., actions\/interventions) to address the problem or the abnormal findings\/cues. This may involve identifying which solutions are <button class=\"glossary-term\" aria-describedby=\"131-2195\">indicated\/effective<\/button>, <button class=\"glossary-term\" aria-describedby=\"131-2197\">nonessential<\/button>, <button class=\"glossary-term\" aria-describedby=\"131-2199\">unrelated<\/button>, and <button class=\"glossary-term\" aria-describedby=\"131-2200\">contraindicated<\/button>.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 45px\">\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 45px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Take actions<\/span><\/p>\n<\/td>\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 45px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Taking actions involves identifying the action that should be taken. Examples of actions are specific but could be related to notifying the physician or nurse practitioner, calling for help, monitoring the client, collecting further data.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"width: 34.9345%;text-align: left;vertical-align: top;height: 30px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Evaluate outcomes<\/span><\/p>\n<\/td>\n<td style=\"width: 65.0655%;text-align: left;vertical-align: top;height: 30px\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Evaluating outcomes involves determining if the action taken was effective. It may include identifying outcomes that are considered improved, unchanged, or worsened.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-6\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-6\" class=\"h5p-iframe\" data-content-id=\"6\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch.1 Clinical Judgment and Nursing\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Dickison, P., Haerling, K., &amp; Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks.\u00a0<em>Journal of Nursing Education<\/em>,\u00a0<em>58<\/em>(2), 72-78.\u00a0<\/span><a href=\"https:\/\/doi.org\/10.3928\/01484834-20190122-03\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3928\/01484834-20190122-03<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">NCSBN (2020, Spring).\u00a0<em>Next Generation NCLEX news<\/em>.\u00a0<\/span><a href=\"https:\/\/www.ncsbn.org\/NGN_Spring20_Eng_02.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncsbn.org\/NGN_Spring20_Eng_02.pdf<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Padilla, R., &amp; Mayo, A. (2017). Clinical deterioration: A concept analysis.\u00a0<em>Journal of Clinical Nursing<\/em>,\u00a0<em>27<\/em>, 1360-1368.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1111\/jocn.14238\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1111\/jocn.14238<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing.\u00a0<em>Journal of Nursing Education<\/em>,\u00a0<em>45<\/em>(6), 204-211.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.3928\/01484834-20060601-04\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3928\/01484834-20060601-04<\/a><\/p>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"131-232\" hidden><p>are findings that are not of concern and expected for a client\u2019s age, developmental stage, and sex.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-234\" hidden><p>are findings of concern because they are not normal and not consistent with a client\u2019s age, developmental stage, and sex.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-243\" hidden><p>are findings that require prompt and immediate action to prevent clinical deterioration or intervene when a client is deteriorating.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-245\" hidden><p>are a sign or symptom that prompts an action such as an abnormal finding that signals a potential concern.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-2195\" hidden><p>, in reference to solutions\/interventions, refers to solutions and interventions that are suggested as a desirable or necessary course of action.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-2197\" hidden><p>in reference to solutions\/interventions, refers to solutions and interventions that are not needed and not absolutely necessary.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-2199\" hidden><p>in reference to solutions\/interventions, refers to solutions and interventions that are not connected or related to the problem.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"131-2200\" hidden><p>in reference to solutions\/interventions, refers to solutions and interventions that should not be used because they may be harmful.<\/p>\n<\/div><\/div>","protected":false},"author":177,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-131","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/users\/177"}],"version-history":[{"count":59,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/131\/revisions"}],"predecessor-version":[{"id":2254,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/131\/revisions\/2254"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/131\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/media?parent=131"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapter-type?post=131"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/contributor?post=131"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/license?post=131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}