According to the American Nursing Association, a nurse must promote health, prevent illness, alleviate suffering, and advocate for individuals in her care. There are ten principles of nursing competence: client-centered care, interdisciplinary collaboration, evidence-based practice, quality improvement, leadership, informatics, safety, client education, professionalism, and priority setting. These principles constitute the 10 bars of the Helix of Success, a model illustrating how knowledge and critical judgment form the basis of nursing practice.
What is clinical judgment? Clinical judgment is the decision made regarding a course of action based on a critical analysis of data when nursing knowledge is applied to a clinical situation. Sound clinical judgments ensure safe, high-quality, client-centered care and validate the effectiveness of nursing interventions.
What is knowledge? Knowledge is the evidence-based acquisition of facts and the foundation of reasoned action. It can be acquired in the classroom, online, in clinical settings, or in response to other learning activities. It is reinforced when applied in laboratory and clinical situations. Nursing knowledge is critical and necessary to care for clients. It should be based exclusively on nursing research and proven practices.
Nurses need to possess a variety of different skills to make sound judgments that promote client health. They need to make appropriate nursing judgments, protect client needs and anticipate future changes. Knowledge of physiology and pathophysiology is essential to monitor, track and report client status. Pharmacology skills help administer drugs, evaluate therapeutic responses, and promote client adherence. Mathematics is also necessary for correct drug administration, to calculate nutritional needs, morbidity, and mortality rates. Studying nutrition allows them to properly screen and assess client nutrition.
Being proficient in information technology is necessary to maintain electronic medical records and connect rural clients to providers and specialists. Nurses also need to be aware of legal and ethical issues to protect their clients and adhere to nursing practice acts. Furthermore, nurses need assertive communication skills to interact with and advocate for their clients. The client is not only the patient, but their parents, spouses, and family members that need support and education.
Aspiring nurses are required to internalize massive quantities of information. Effective learning involves reinforcement, feedback, and the opportunity to process information. General strategies for success are staying organized, planning, and sticking to a certain routine. Create a calendar considering all your study obligations and family responsibilities, and make sure to schedule some time for self-care. Assess your abilities and needs objectively. Attend class daily and complete all your assignments on time. Effective preparation can cut study time in half. Furthermore, identifying your learning style and planning your study activities accordingly will allow you to maximize productivity. Generally, there are three types of learners: visual, auditory, and tactile.
Visual learners learn best by sight, from pictures, graphs and diagrams. They should sit at the front, avoid visual obstruction, and take detailed notes. During the independent study, visual learners should view videos, use charts, make flashcards, highlight important terms, and organize their notes in an outline or a PowerPoint presentation.
Auditory learners learn best by listening, and they store information by its sounds. They are easily distracted by noise and dislike working quietly. For effective study, auditory learners should always sit where they can properly hear, record lectures, read their assignments and notes aloud, create songs, and study in groups.
Tactile learners learn by touching and doing and prefer a “hands-on” approach such as participating in simulations, and role-playing. They have difficulty sitting still, prefer physical activity, and require frequent breaks. They need to apply classroom knowledge in a clinical setting, create models or concept maps, use computers, and practice with equipment.
Another important aspect of effective learning is meaningful reading. Many students read too hurriedly, passively, underline too much, or fail to question themselves about the material after. First of all, you need to orient yourself: skim the assignment and closely examine all the headings, graphs and illustrations. Now, read actively. Look for basic concepts and important information, highlight, and take notes.
Then, quiz yourself about the material and discuss it with your peers. What are the main points of the material? Convert headings into “what, who, where, why, and how” questions. Take time to reflect on what you’ve read and recite the major points from memory. Recalling information demonstrates comprehension. Finally, periodically review the material to refresh your memory and increase retention. It’s recommended you review before and after each class, not only before exams.
Taking advantage of your learning style, attending lectures, and reading your textbook all contribute to intellectual knowledge. To practice nursing, it’s necessary to combine this knowledge with foundational and critical thinking.
Foundational thinking is the ability to recall and comprehend basic nursing concepts. You remember learned information and understand the terms it is presented in. For example, checking a patient’s glucose level and determining it is too high. In clinical practice, nurses use foundational thinking to understand laboratory results, recall medication side effects, assess risk factors, or detect symptoms of an illness. To improve foundational thinking, answer practice questions and highlight keywords.
Critical thinking is used to analyze client issues. Firstly, critical thinking consists of interpreting information. Understand the meaning of written materials, communication, or empirical data. Second, analyze it and evaluate its credibility, relevance and significance. Identify knowledge gaps and draw conclusions. Then, explain your reasoning and methodology. In a clinical setting, the decision-making process consists of critically analyzing data, evaluating possible further action, and making a clinical judgment. Clinical judgment is a decision made based on a critical analysis of data when nursing knowledge is applied to a clinical situation.
Put simply, it is when you evaluate all possible actions and choose the one with the best outcome based on your nursing knowledge. For example, suppose a patient is hemodynamically unstable. In that case, he could either be experiencing increased intracranial pressure, life-threatening drug interaction or be in metabolic or respiratory acidosis or alkalosis. Several actions need to be taken simultaneously, and this is when nurses make a clinical judgment. Clinical judgment improves with experience as the steps of the clinical decision-making process begin working simultaneously. There are five stages of nursing competence: novice, advanced beginner, competent, proficient, and expert.
Clinical reasoning is the automatic mental process used when analyzing all the elements of a clinical situation and making a decision based on that analysis. It is the mechanism behind the critical analysis and clinical judgment. It guides the nurse through assessing and compiling data, selecting and discarding various bits based on relevance, considering interventions weighing potential outcomes and risk of negative consequences, and making a decision regarding client care based on nursing knowledge. This analysis is the most important cognitive skill of a nurse.