Here are some ways to improve clinical judgment in the correctional setting. If you have a leadership role in your setting, you may be able to incorporate these processes into staff meetings, annual education modules, or quality improvement activities. If you have a frontline staff position, you can still benefit from incorporating some of these processes into your own professional practices.
Case review is one of the best ways to develop clinical judgment, especially with nurses new to the specialty. Although any case can be used, the best cases are actual patient situations from current practice. For example, reviewing actions, reactions, and interactions of a recent complex or emergent patient situation can provide an opportunity to learn from the experience and from each other. Much can be gained through a dialogue about clinical judgment and some reflection in a group process after a complex case concludes. Of course, this dialog must be carefully facilitated so that team members develop abilities to critically review a case without being critical of each other. This should be an empowering experience rather than a disempowering one. Careful guidance is needed until everyone develops the skills necessary to be encouraging, purposeful, and thoughtful in the case discussion.
Guided peer review is another way to develop clinical judgment skills. Similar to traditional physician peer review, nursing peer review is an analysis of written documentation of past patient care on an individual practice basis. Peer review can be done formally or informally depending on the situation.
Reflective practice is another activity that encourages development of clinical judgment. Reflection on an actual significant clinical experience such as an unexpected death or near-miss experience can yield a wealth of wisdom for the nurses involved. By guiding the discussion toward analysis and synthesis of information, the experience can expand both individual and group learning. New staff members can be asked to keep a journal of their patient experiences that is reviewed periodically with the nurse manager or a senior staff member. The journal activity helps with reflection and the documentation can guide discussion into deeper meanings of assessments or a better understanding of facility processes.
Another activity that builds clinical judgment is simulation. Simulation allows a safe practice experience while developing procedural skill and team skills in collaboration and coordination of care. Use the disaster drill and man-down simulations to encourage clinical judgment development. Debrief the simulations as you would an actual experience and truly think about why various decisions were made.
Talking through experiences is an often-neglected way to improve clinical judgment. Whether through case studies, peer review, reflections, or simulation, talking about internal thought processes with others is a practical method for identifying the ways judgments are made. This helps confirm appropriate thinking while recognizing processes that need to be eliminated.
Probing questions combine with interactive dialogue to fully engage discussion participants. When in dialogue about a difficult clinical decision, go beyond yes or no questioning. Move beyond reaction to reflection. Questions such as “What do you think would happen if……” or “Why do you think that might happen?” encourages analysis rather than merely description.
Mind mapping, also called concept mapping, is a creative method of displaying information and how it connects together. This process is used in undergraduate nursing programs to help students think about the various elements of a clinical situation. Why not use it in clinical practice? A mind map is a visual organization around a core concept. It helps to organize thinking around a particular issue or condition.
An algorithm is a decision tree that guides us through a particular situation. While a mind map is based on relationship of information, an algorithm is expressed in a linear fashion, often answering questions of yes or no and then moving on. Algorithms give order to information to assist in determining what actions need to be taken in a clinical situation.
This Clinical Judgment post is based upon The Correctional Nurse Educator class entitled Clinical Judgment for the Correctional Nurse.