coaching students to think like a nurse - c.ymcdn.comc.ymcdn.com/sites/ · pdf filecoaching...

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