Clinical Judgment Model

The Lasater Clinical Judgement Rubric (LCJR) (Lasater, 2007) based on the Tanner Model of Clinical Judgment is an essential tool that utilizes critical thinking and clinical reasoning skills. This is necessary for a nurse to reach a conclusion and provide quality efficient nursing care. The purpose of this paper is to analyze how I used the clinical judgement model and the skills incorporated in it to provide care for Mr. Patience when presented with incontinence and being “not quite right”. The original presenting information led me to plan care for assessing a possible urinary tract infection (UTI). However, the scenario was more complicated than anticipated and new information was discovered that required me to shift my focus to potential

During debriefing, I reflected on action and analyzed my performance during the clinical simulation. I recognized that I was able to prioritize the abuse as I expected to need to alter my original care plan. However, in another situation I may have continued to push to find evidence for the outcome I anticipated. Having entered the situation with an open-mind to create alternatives to my original care plan was a strength. The distractions were a weakness that effected my actions as my colleagues who were not performing were more insightful in action. I need to work on my ability to tune out the distractions and focus on the situation at-hand. This will also help improve my prioritization skills which is something I recognize I need to work on. After the simulation, I reflected beyond action and completed the LCJR giving myself 36/44. After going through some best practices of evaluating critical thinking which included a self-assessment, performance evaluation, and a peer review I changed my score to 30/44. Although this would place me very close to the “Accomplished” category I understand that this is specific to the simulation and that as a student nurse, I am likely closer to the “Developing” category (Lasater, 2007). According to Benner’s Novice to Expert model I would categorize myself as an advanced beginner as although I do notice important information I still need to work on prioritization (Benner,

I am currently in the developing category of the LCJR and will continue to work on my skills and ability to reach the exemplary level (Lasater, 2007). In particular, I need to work on my ability to focus on multiple tasks and be able to separate actions by level of importance (Benner, 1982). Through gaining experience, I will learn to stay focused, despite distractions and which will lead me to gain proficiency in every section of the LCJR. In this scenario with Mr. Patience, the potential abuse became my only focus and when discussing the situation with the case manager I did not address the medical care that he needed. This effected the outcome of Mr. Patience care as he did not receive the medical care that he necessitated. Becoming more proficient in this clinical judgement process will enable me to provide quality care for my