Sound clinical judgment in nursing: A concept analysis

Manetti, Wendy

doi:10.1111/nuf.12303

Cited by 77 publications

(74 citation statements)

References 57 publications

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“…In addition, front‐line and head nurses perceive that workload is more influenced by patient characteristics, status or progress than by activity or tasks. Understanding patient status is essential in bedside decision‐making, and it includes data collection, cues capture, critical thinking and clinical judgment, considering the probable course of the patient (Manetti, ). In this sense, the relationship between patient acuity and nurses' clinical judgment is still underexplored.…”

Section: Introductionmentioning

confidence: 99%

Predicting patient acuity according to their main problem

et al. 2019

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Aim To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step‐down units. Background Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue. Method Cross‐sectional, multi‐centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated. Results The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81–0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005). Conclusion The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected. Implications for nursing management Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision‐making, and to optimize patients, nurses and organizational outcomes.

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Section: Introductionmentioning

confidence: 99%

Predicting patient acuity according to their main problem

et al. 2019

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“…An example is the decision to postpone the exploration of the family structure when a family is obviously preoccupied with an urgent issue in the care situation. These adaptations were generally well substantiated and based on nurses’ clinical judgment . A flexible approach rather than a strict protocol in applying the components may, therefore, be argued for.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ application of the components of family nursing conversations in home health care: a qualitative content analysis

Broekema

Paans

Roodbol

et al. 2019

Scandinavian Caring Sciences

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Scand J Caring Sci; 2020; 34: 322-331 Nurses' application of the components of family nursing conversations in home health care: a qualitative content analysis.Aim: The purpose of this study was to describe how nurses apply the components of family nursing conversations in their home healthcare practice. Method: A qualitative content analysis with a deductive approach was conducted. Home healthcare nurses conducted family nursing conversations with families from their practice. Families were selected based on three nursing diagnoses: risk of caregiver role strain, caregiver role strain or interrupted family processes. Nurses audiorecorded each conversation and completed a written reflection form afterwards. Transcripts of the audiorecorded conversations were analysed in Atlas.ti 8.0 to come to descriptions of how nurses applied each component. Nurses' reflections on their application were integrated in the descriptions. Results: A total of 17 conversations were audio-recorded. The application of each component was described as well as nurses' reflections on their application. Nurses altered or omitted components due to their clinical judgment of families' needs in specific situations, due to needs for adjustment of components in the transfer from theory to practice or due to limited skill or self-confidence. Conclusion: All of the components were applied in a cohesive manner. Nurses' application of the components demonstrates that clinical judgment is important in applying them. Further training or experience may be required to optimise nurses' skill and self-confidence in applying the components. This study demonstrates the applicability of the family nursing conversations components in home health care, allowing exploration of the working mechanisms and benefits of family nursing conversations for families involved in long-term caregiving in future studies.

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“…Clinical practice enables students to apply concepts and knowledge gained in class and through other means of learning in real-life clinical situations and develop their higher-level thinking skills. In clinical practice, students learn to make carefully thought out decisions, guided by the educator or preceptor, that impact patient outcomes (Manetti 2019). Tanner (2006) viewed clinical judgment as the interpretation of a patient's needs or health problems and subsequent decisions about actions to take (or to not act).…”

Section: Application Of Knowledge and Development Of Clinical Judgmentmentioning

confidence: 99%