Guide for Clinical Judgment Model Reflection
This Guide for Reflection is intended to help you think about a given clinical situation you
have encountered during your clinical intensive and your nursing response to that situation.
The situation can be a specific physiological patient problem, such as an elevation in
temperature, respiratory difficulty, or electrolyte imbalance. You may choose to describe a
situation involving a patient’s family. The situation can be a description of your role in
interdisciplinary problem solving. The reflection situation may describe an ethical issue you
encountered in practice. Use the guide for reflection as a way to help you tell the story of
the situation you encountered.
The guide provides you with a way of thinking about care that supports the development of
your clinical judgment. Although there are many ways of organizing your thinking about
patient care and professional nursing practice, Tanner’s (2006) Clinical Judgment Model
provides the framework for the questions in this study guide. Your professional development is
further supported with feedback from faculty. Feedback about your reflections will be
provided using the Lasater (2007) Clinical Judgment Rubric.
You will need to type up your answers to the reflection questions below and submit to your
Clinical Instructor via email prior to your post-conference meeting.
Introduction Describe the nursing situation you encountered during this clinical rotation.
Background Describe your relationship with the patient at the time you noticed the situation (e.g., previous contact with the patient and/or family, the quality of the relationship). Consider experiences you have had that helped you provide nursing care in this situation. Describe your previous nursing experience with a similar problem, and/or personal experiences that helped guide you as you worked with the patient. Describe your beliefs about your role as a nursing working on the situation. Describe any emotions you had about the situation.
Noticing
What did you notice about the situation initially? Describe what you noticed as you spent more time with the patient and/or family.
Interpreting Describe what you thought about the situation (e.g. its causes, potential resolutions, patterns you noticed). Describe any similar situations you have encountered in practice before. Describe any similarities and differences you observed when compared with the current situation.
Guide for Clinical Judgment Model Reflection
GUIDE FOR REFLECTION USING TANNER’S (2006) CLINICAL JUDGMENT MODEL
What other information (e.g. assessment data, evidence) did you decide you needed as you considered the situation? How did you obtain this information? What help with problem solving did you get from your preceptor? What did your observations and data interpretation lead you to believe? How did they support your response to the situation?
Responding After considering the situation, what was your goal for the patient, family and/or staff? What was your nursing response, or what interventions did you do? Describe stresses you experienced as you responded to the patient or others involved in the situation.
Reflection-in- Action
What happened? How did the patient, family, and/or staff respond? What did you do next?
Refection-on- Action and Clinical Learning
Describe three ways your nurse care skills expanded during this experience. Name three things you might do differently if you encounter this kind of situation again.
What additional knowledge, information, and skills do you need
when encountering this kind of situation or a similar situation in the
future?
Describe any changes in your values or feelings as a result of this experience.
Guide for Clinical Judgment Model Reflection
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**Guide for Clinical Judgment Model Reflection**
**Introduction:**
During my clinical rotation, I encountered a situation where a patient presented with acute respiratory distress due to exacerbation of chronic obstructive pulmonary disease (COPD).
**Background:**
At the time of noticing the situation, I had developed a rapport with the patient through previous interactions during rounds and medication administration. My previous nursing experiences with COPD exacerbations helped guide my approach to caring for the patient. I believed my role as a nurse was to assess the patient’s condition, provide appropriate interventions, and collaborate with the healthcare team to optimize patient outcomes. I experienced a mix of emotions, including concern for the patient’s well-being and a sense of responsibility to provide effective care.
**Noticing:**
Initially, I noticed the patient’s increased respiratory rate and use of accessory muscles for breathing. As I spent more time with the patient, I observed worsening oxygen saturation levels and increased dyspnea during activity.
**Interpreting:**
I interpreted the situation as an acute exacerbation of COPD likely triggered by a respiratory infection or environmental factors. Similar situations encountered in practice involved managing COPD exacerbations with bronchodilators, oxygen therapy, and corticosteroids. However, I noted differences in the severity of respiratory distress and the patient’s response to interventions compared to previous cases.
**Additional Information and Help with Problem-Solving:**
I decided to gather further assessment data, including auscultation findings, arterial blood gas results, and the patient’s medical history. I obtained this information through collaboration with the healthcare team and utilization of diagnostic tests. My preceptor provided guidance on interpreting assessment findings and selecting appropriate interventions based on the patient’s condition. The observations and data interpretation supported the diagnosis of COPD exacerbation and guided the selection of pharmacological and non-pharmacological interventions.
**Responding:**
My goal for the patient was to improve respiratory status, alleviate distress, and prevent respiratory failure. I initiated oxygen therapy, administered bronchodilators and corticosteroids as ordered, and assisted with positioning for optimal breathing. I experienced stress related to the urgency of the situation and the need to act quickly to stabilize the patient.
**Reflection-in-Action:**
The patient’s respiratory distress improved following interventions, with a gradual increase in oxygen saturation and decreased dyspnea. The family expressed gratitude for the care provided, and the healthcare team collaborated effectively to ensure the patient’s needs were met.
**Reflection-on-Action and Clinical Learning:**
Through this experience, my nursing care skills expanded in areas such as rapid assessment, prioritization of interventions, and collaboration with interdisciplinary teams. If I encounter a similar situation again, I would focus on earlier recognition of respiratory distress cues and more proactive intervention. Additionally, I would seek opportunities to enhance my knowledge of advanced respiratory management techniques and refine my critical thinking skills.
**Additional Knowledge and Skills Needed:**
In future encounters with COPD exacerbations or similar respiratory emergencies, I would benefit from additional knowledge in interpreting arterial blood gas results, performing advanced respiratory assessments, and implementing evidence-based interventions to optimize patient outcomes.
**Changes in Values or Feelings:**
This experience reinforced the importance of timely and effective nursing interventions in managing acute respiratory conditions. It also deepened my appreciation for the resilience and vulnerability of patients facing chronic illnesses like COPD.
**Guide for Clinical Judgment Model Reflection**
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