4.1 Critical Thinking and the Nursing Process

The nursing process is a five-step process that serves as the foundation of nursing practice.
The nursing process consists of assessment, diagnosis, planning, implementation, and evaluation.
The nursing process typically moves in a forward direction, but at times the nurse must circle back to previous steps to gather more patient data or perform additional interventions.
This is a continuous process that allows the nurse to provide and evaluate care to promote optimal patient outcomes.
The Clinical Judgment Measurement Model (CJMM) was developed to help nursing students learn, practice, and demonstrate clinical judgment skills.

4.2 Clinical Judgment Measurement Model Overview

Historically, nursing was often viewed as a task-oriented career, but in recent years the profession has grown in terms of autonomy and clinical judgment.
The CJMM, a tool designed to measure critical thinking and clinical judgment in nursing students, was developed to allow educators to assess the development of nursing student’s critical thinking skills to help ensure that they are ready to practice as a nurse after graduation.
The CJMM involves several steps that have expanded upon the traditional nursing process model, making it an excellent framework to guide new nurses in making clinical judgment calls in practice.

Nurses use diverse sources and methods to gather critical subjective and objective data during patient assessments.
Patient data collected by the nurse are analyzed and prioritized based on the patient’s specific situation and current needs.
By prioritizing throughout the nursing process, nurses ensure that immediate, life-threatening conditions are addressed, while also considering each patient's overall well-being and long-term health needs.
Analyzing the data involves identifying clues and making inferences, recognizing patterns, and applying inductive and deductive reasoning.

After recognizing and analyzing patient cues, the next steps of the CJMM are prioritizing hypotheses, generating solutions, and taking action.
The nurse uses the cues from the previous steps to develop hypotheses, or educated guesses, about what is causing the patient’s health problems.
The nurse works closely with the patient to develop outcomes, or goals, of care and to generate solutions that aim to achieve those goals.
Taking action involves implementing appropriate nursing interventions in an effort to achieve desired patient outcomes.

After implementing interventions, the nurse evaluates their effectiveness to determine whether care goals have been met.
Based on these findings, the nurse can revise the plan of care and implement different nursing interventions as necessary.
The evaluation phase technically marks the end of the CJMM cycle; however, CJMM is a continuous process that nurses move through when providing nursing care.