Clinical judgement in nursing – An evolutionary concept analysis

Connor, Justine; Flenady, Tracy; Massey, Debbie; Dwyer, Trudy

doi:10.1111/jocn.16469

Cited by 32 publications

(28 citation statements)

References 93 publications

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“…Direct care delivery encompasses making informed decisions in response to patient needs using critical thinking skills and knowledge gained from education and experience (Modic, 2013). Clinical decision-making is a reflective reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in appropriate responses to patient needs and care delivery (Connor et al, 2022). Several studies have shed light on the various factors that influence the development of competence and clinical decision-making among newly graduated nurses.…”

Section: Backg Rou N Dmentioning

confidence: 99%

New graduate nurses' delivery of patient care: A focused ethnography

Kaldal

Feo

Conroy

et al. 2023

Journal of Clinical Nursing

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AimTo explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings.DesignQualitative study using focused ethnography.MethodsDuring the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi‐structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis.ResultsThree main structures were developed from the data: ‘Contrasting Intentions and Actions for care delivery’, ‘Organizational Constraints Block Interpersonal Aspects of Nursing Care’ and ‘Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions’.ConclusionNewly graduated nurses were committed to delivering high‐quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally.Relevance to Clinical PracticeEstablishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high‐quality patient care.Reporting MethodThe reporting adhered to the COREQ guidelines.Patient or Public Contribution‘No Patient or Public Contribution’.

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Section: Backg Rou N Dmentioning

confidence: 99%

New graduate nurses' delivery of patient care: A focused ethnography

Kaldal

Feo

Conroy

et al. 2023

Journal of Clinical Nursing

View full text Add to dashboard Cite

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“…8 This approach is particularly well-suited to psychological and sociological concepts and is often used in evaluating clinical concepts. [22][23][24][25]…”

Section: The Evolutionary Methodsmentioning

confidence: 99%

“…The inclusion of data analysis ensures consideration of quantitative aspects of the concept along with sociocultural or language‐based examination 8 . This approach is particularly well‐suited to psychological and sociological concepts and is often used in evaluating clinical concepts 22–25 …”

Section: Approaches To Camentioning

confidence: 99%

A guide to the selection and application of concept analysis

et al. 2022

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The purpose of this article is to provide practical guidance in the process of choosing a method to use for concept analysis (CA), a commonly used method for defining and exploring concepts in nursing. Best outcomes are achieved when there is close alignment between the concept, the purpose of the analysis, and the CA method utilized. This process has become complicated by the number of approaches developed in recent decades, with varying purposes and theoretical underpinnings.Other variables include the specific type of concept chosen and the purpose of the analysis, which may vary from clinical care to theory development to research design. The net result is a process that can be confusing for experienced and inexperienced scholars alike. An overview of the most common CA methods used in recent years, including theoretical underpinnings, intended uses, steps involved in the process, and recommended applications, is followed by detailed guidance in selecting a method to use for the specific concept to be analyzed. Also provided is a discussion of the factors to consider in choosing a concept for analysis. The desired outcome is the promotion of high-quality CA that advance the scholarship of nursing.

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“…Clinical judgement is recognised as both a complex process and an outcome, drawing on RNs' experience, understanding of patients' reaction patterns, consideration of patient concerns and awareness of the contextual and cultural factors in the care unit (Tanner, 2006). Concept analysis has determined that clinical judgement is a ‘reflective and reasoning process’ that uses all available data, relying on an ‘extensive knowledge base’, and results in a ‘clinical conclusion’ (Connor et al., 2022). This definition includes both a process and an outcome compatible with Tanner (2006), but it differs by describing the increased importance of a ‘knowing landscape’ as a ‘fundamental basis’ in nursing (Connor et al., 2022, p. 3336).…”

Section: Introductionmentioning

confidence: 99%

Thinking strategies used by registered nurses during drug administration in nursing homes—An observational study

Solberg,

Devik,

Bell

et al. 2023

Journal of Clinical Nursing

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AimTo explore registered nurses' thinking strategies during the drug administration process in nursing homes.DesignAn exploratory qualitative design.MethodsEight registered nurses, one male and seven female, in five nursing home wards in Mid‐Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow‐up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data.ResultsThe registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were ‘providing explanations’, ‘setting priorities’ and ‘drawing conclusions’. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled ‘controlling’ and ‘interacting’. Among all strategies, ‘controlling’ was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing.ConclusionThe study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well‐being and upholding medication safety standards in healthcare settings.Relevance to Clinical PracticeUnderstanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice.Patient or Public ContributionPatients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients.Reporting MethodThe reporting of this study adhered to the COREQ checklist.

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Clinical judgement in nursing – An evolutionary concept analysis

Cited by 32 publications

References 93 publications

New graduate nurses' delivery of patient care: A focused ethnography

New graduate nurses' delivery of patient care: A focused ethnography

A guide to the selection and application of concept analysis

Thinking strategies used by registered nurses during drug administration in nursing homes—An observational study

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