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Photo of two people hugging in front of a mural.
Figure 28.1 Community-based programs approach mental health treatment from a cooperative perspective. (credit: “Compassion” by Sonya Revell/flickr, Public Domain)

When nurses analyze research evidence for client care, it entails critical thinking. Critical thinking is problem-solving using the nurse’s reasoning ability. In the context of the client’s identified needs, the nurse selects the most appropriate information from analysis of the evidence. The nurse’s application of the selected information to client care is clinical judgment. Clinical judgment directs the nurse’s decisions for client care and nursing practice. Because clients have individual needs, and nursing care evolves over time with the client, critical thinking and clinical judgment are ongoing in nursing practice.

To illustrate, the psychiatric-mental health (PMH) nurse is working with a young adult client who experiences anxiety. The client is struggling to manage this condition. The nurse researches anxiety-reduction strategies (critical thinking), selects mindfulness to teach the client as a self-care technique (clinical judgment), provides the client education, and evaluates the outcome (nursing practice).

Nursing interventions are unique to the client’s situation and are based on analysis of cues recognized in nursing assessment. Some concepts are universal in the treatment setting, such as safety and collaboration, though interventions are developed specific to the client’s expressed and identified needs guided by standards of care. Nursing judgments avoid labeling and seek to plan actions that will promote mental health.

Nurses may use various models for clinical judgment to provide a structure to their reasoning in practice. Some available models include the Clinical Judgment Measurement Model (National Council of State Boards of Nursing [NCSBN], 2019a), Tanner’s Model (Tanner, 2006), and Lasater’s Clinical Judgment Rubric (Lasater, 2011). Terminology may differ in these models while the concepts remain the same:

  • data collection by nursing assessment
  • data analysis for meaning and interpretation specific to the client
  • care planning involving the client
  • nursing action (nursing interventions)
  • effect of nursing action determined through evaluation, leading to revision of the plan or addressing additional problems

Sample care plans are provided in this chapter to assist in application of clinical judgment based on these concepts.


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