Page 93 - Encyclopedia of Nursing Research

60 n CLInICAL JUDGMEnT

experience are significantly more likely to concerned and involved ways. Clinical judg-
prefer an active role in clinical decision mak- ment occurs within a framework of clinical,
C ing (Florin, Ehrenberg, & Ehnfors, 2008). It legal, ethical, and regulatory standards and
is also crucial for nurses to have knowledge is closely aligned with phenomena such as
of ethical issues related to clinical decision critical thinking, decision making, problem
making. This is particularly important when solving, and the nursing process (Benner,
the decision process is regarding end-of-life Tanner, & Chesla, 1996).
care (Mahon, 2010). Expert clinical judgment is held in high
nurses’ decision making has been regard by nurses as it is generally viewed as
shown to be affected by the sociodemograph- essential for provision of safe, effective nurs-
ics of the patient. Age, sex, race, religion, and ing care and the promotion of desired out-
socioeconomic status can impact on decision comes. nursing research has been conducted
making. Racial disparities in health care may on the processes of clinical judgment with
be due to racial biases when formulating the intent to better understand how nurses
clinical decisions. Interviews with African identify relevant information from the vast
American patients with diabetes revealed amounts of information available and then
that they believed that shared decision mak- use that information to make inferences about
ing was offered more often to White patients patient status and appropriate interventions.
(Peek et al., 2010). non-White patients pre- The complexity of the clinical judgment pro-
senting to the emergency department with cess has brought about collaboration of nurse
chest pain are hospitalized less frequently researchers with multidisciplinary experts
than White patients (Pope et al., 2000). There from a broad array of scientific backgrounds
was a significant difference in reports of sus- including cognitive psychology, informatics,
pected abuse after the evaluation of fractures phenomenology, and statistics.
between minority and nonminority children The body of research on clinical judg-
(Lane, Rubin, Monteith, & Christian, 2002). ment generated by interdisciplinary collabo-
Competent clinical decision making by ration has been categorized into two distinct
nurses requires being cognizant of potential theoretical classifications: the “rationalistic”
biases. Decision making is critical to nurs- and the “phenomenological” perspectives. In
ing practice. Gathering, organizing, and pri- this context, the term “rationalistic” describes
oritizing data are major components of the scientific inquiry into the deliberate, con-
process. Continued research in this area can scious, and analytic aspects of clinical judg-
foster the development of decision-making ment (Benner et al., 1996). Examples include
skills in novice nurses and cultivate high research on the role of information process-
clinical decision-making ability in expert ing, diagnostic reasoning (Tanner, Padrick,
nurses. Westfall, & Putzier, 1987), and decision
analysis (Schwartz, Gorry, Kassirer, & Essig,
Terri H. Lipman 1973) in the clinical judgment process. The
term “phenomenological” refers to research
on the skill-acquisition component of clinical
judgment as advanced by Benner and Tanner
CliniCal JudgMent (1987) and Benner et al. (1996) in the novice
to Expert Model.
Information processing theory and diag-
Clinical judgment has been defined as the nostic reasoning are based on the work of
process by which nurses come to understand Elstein, Shulman, and Sprafka (1978) and
problems, issues, or concerns of patients, newell and Simon (1972) and collectively
attend to salient information, and respond in describe problem-solving behavior and the