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

20
Coaching Students to Think Like a Nurse Chris Tanner

Upload: phamdieu

Post on 06-Mar-2018

225 views

Category:

Documents


3 download

TRANSCRIPT

Page 1: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

Coaching Students to Think Like a NurseChris Tanner

Page 2: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

What does “think like a nurse” mean?

Page 3: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

What does think like a nurse mean?

Clinical reasoningDiagnostic reasoningCritical thinkingNursing processEvidence-based practiceEthical ReasoningSystems thinking

Page 4: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 5: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

Typical Research QuestionsClinical reasoning processes?Role of knowledge/experience?Factors that influence judgment?

Page 6: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

How Clinicians Make Judgments

Noticing

Interpreting

Responding

Reflecting

Begin clinical encounter

Page 7: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 8: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 9: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What
Page 10: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 11: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 12: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

Developing clinical knowledge

Clinical preparation – setting up expectationsPre-conference – questioning for salienceBuilding on prior learning

Page 13: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 14: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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?

Page 15: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 16: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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

Page 17: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

Post clinical conference

Unfolding cases – students present particular clinical situations as they unfolded

Page 18: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

Discussion

What clinical teaching approaches have you used which support development of clinical judgment?

Page 19: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

Discussion

Where does nursing diagnosis fit in?Nursing care planning?

Page 20: Coaching Students to Think Like a Nurse - c.ymcdn.comc.ymcdn.com/sites/ · PDF fileCoaching Students to Think Like a Nurse Chris Tanner. What does “think like a nurse” mean? What

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