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Coaching Students to Think Like a NurseChris Tanner
What does “think like a nurse” mean?
What does think like a nurse mean?
Clinical reasoningDiagnostic reasoningCritical thinkingNursing processEvidence-based practiceEthical ReasoningSystems thinking
Focus on . . .
Clinical judgment –Conclusions about patients health status
and/or Intervention/management decisionsUnder conditions of uncertainty
Clinical reasoning – processes by which these judgments are made & evaluated
Typical Research QuestionsClinical reasoning processes?Role of knowledge/experience?Factors that influence judgment?
How Clinicians Make Judgments
Noticing
Interpreting
Responding
Reflecting
Begin clinical encounter
What the Clinician Brings to the Situation
Noticing
Interpreting
Responding
Context
Reflecting
Tanner, C.A. (2006). Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211
KnowledgeExperience
Bias
Ethical Perspective
Knowing the Patient
How Clinicians Make Judgments
Noticing Interpreting Responding
Expectations
Initial Grasp
Reasoning PatternsAnalytic Intuitive
NarrativeAction
OutcomesReflection on action andClinical Learning
ContextBackgroundRelationship
ReflectingTanner, C.A. (2006). Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211
Reflection in Action
Developing Noticing Skills
Noticing Interpreting Responding
Expectations
Initial Grasp
Reasoning PatternsAnalytic Intuitive
NarrativeAction
OutcomesReflection on action andClinical Learning
KnowledgeExperienceBias/EthicsRelationship]
ReflectingTanner, C.A. (2006). Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211
Reflection in Action
Developing Clinical Knowledge
Clinical knowledge of specific populationsMaking qualitative distinctionsRecognizing patternsClinical forethought:◦ Future think◦ Clinical forethought about particular patient
populations, diagnoses or injuries◦ Anticipation of crises, risks or vulnerabilities
for particular patients
Developing clinical knowledge
Clinical preparation – setting up expectationsPre-conference – questioning for salienceBuilding on prior learning
Example of Analytic Reasoning in Clinical Judgment
Noticing
Interpreting
Responding
Reflecting
Tanner, C.A. (2006). Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211
Diagnostic Hypotheses
Analysis Focused Assessment
Teaching Clinical Interpretation
What’s going on here? Any other interpretations?How will you tell which is most likely?What additional data do you need?
Example of Non-Analytic Reasoning
NoticingInterpreting Responding
Pattern Recognition Action
OutcomesReflection in Action(Deliberative Rationality)
ReflectingTanner, C.A. (2006). Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211
Role of Reflection in Clinical Reasoning
Noticing
InterpretingResponding
Action
OutcomesReflection ON Action
ReflectingTanner, C.A. (2006). Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211
KnowledgeFrom
Experience
Post clinical conference
Unfolding cases – students present particular clinical situations as they unfolded
Discussion
What clinical teaching approaches have you used which support development of clinical judgment?
Discussion
Where does nursing diagnosis fit in?Nursing care planning?
Teaching PrinciplesDeepening understanding of and
interconnection among important conceptsQuestion for salient features, not abstract
rules/principlesBuild on prior knowledge Developing pattern recognition
Coaching for sense of saliencePromoting deliberate practice with multiple examples◦ Different contexts◦ Different patient populations
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