How Does the Clinical Judgment Model Work? Overview and FAQ
Many organizations are integrating clinical judgment models (CJMs) to ensure patient safety despite staffing challenges underscored by a retiring nurse workforce and more new graduates at the bedside. These models provide a framework for honing critical thinking skills and offer a standardized approach to decision making within complex care environments.
If you’re looking for ways to encourage this safer approach to clinical care, we’ve got you covered. In this article, we’ll provide an overview of several popular models and answer some of the most common questions about CJMs.
The Clinical Judgment Model: An Overview
At its core, clinical judgment is decision making that is guided by critical thinking. This means that every decision is weighed by a nurse’s perception, data synthesis, and personal evaluation of a situation. You may be wondering, what’s the difference between clinical judgment vs. clinical reasoning, then? It’s a matter of process. Clinical reasoning comes before, combining with critical thinking to guide effective clinical judgment.
Given the significance of decision making to nurses, a CJM is a great tool for empowering newer members of your workforce that may not have the experience necessary to navigate these processes efficiently (especially when under pressure). A model offers a helpful framework with teachable steps to assure well-reasoned decisions. The two primary CJMs are:
- Tanner’s Clinical Judgment Model (Tanner’s CJM)
- The National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (CJMM)
Use of CJMs in Healthcare: FAQ
If you’re preparing students for a high-pressure work environment, or you’re a manager looking to evolve your mentorship program, a model equips nurses with a standardized tool for guiding data management and decision processes. Here are some answers to common model-related questions to help you identify which one may suit your organizational needs.
What’s the difference between the clinical judgment model vs. the nursing process?
The nursing process follows a linear set of steps, usually summarized by the acronym, ADPIE. It stands for assessment, diagnosis, planning, implementation, and evaluation. Each aspect of ADPIE is carried out sequentially to guide care delivery. The CJM framework differs by further expanding this process and breaking it down into measurable components for use in complex care.
What makes the different CJMs unique from one another?
For a thorough examination of the differences between the Tanner and NCSBN clinical judgment models, please refer to the table below.
| Model | Overview | Steps | Application |
|---|---|---|---|
| The Tanner Clinical Judgment Model | This model focuses on the real-time clinical setting.
It purports that effective clinical care must be done by thinking like a nurse — meaning, a nurse’s systematic internal process is essential to safe, quality clinical care. |
The Tanner CJM follows four steps:
1.Noticing. A nurse must let go of expectations and truly observe presentation details. 2.Interpreting. How are those details impacting the patient and care goals? 3.Responding. The nurse determines the correct action based on those noticed and interpreted details. 4. Reflecting. This internal evaluation evolves the nursing practice so that the model becomes second nature. |
Example: The nurse notices that the patient is diaphoretic and tremulous with garbled speech.
The nurse interprets this data as the result of poor intake after receiving mealtime insulin and checks the patient’s capillary blood glucose (CBG). The nurse responds with IV dextrose, followed by a protein-rich snack and a 15-minute re-evaluation of CBG. After reflecting on the incident, the nurse advocates for a diet order with options the patient may actually eat. |
| The NCSBN Clinical Judgment Measurement Model | This model focuses on preparing nurses, usually in the educational or testing settings.
It’s used to measure a nurse’s clinical judgment and decision-making capacity. It’s meant to help prepare nurses for making safe decisions during a crisis. |
The NCSBN CJMM is divided into four layers that are characterized by six essential skills:
1.Recognize Cues. A nurse must identify details and information to inform assessments. 2. Analyze Cues. Those cues need to be analyzed effectively to develop appropriate interventions. 3.Prioritize Hypotheses. Here, a nurse must narrow possible interventions to those most important or pressing. 4.Generate Solutions. Using evidence, the nurse should come up with possible interventions to improve outcomes. 5.Take Action. The nurse must carry out the intervention, using skills like delegation where necessary. 6.Evaluate Outcomes. Assessing the effectiveness of actions and their impact gauges success and guides future care delivery. |
Example: The nurse recognizes cues, including that the patient is diaphoretic and tremulous with garbled speech.
These cues are analyzed and categorized as consistent with hypoglycemia. Though these cues could indicate low blood pressure or overheating, the nurse prioritizes the follow-up for ruling out hypoglycemia. The nurse is aware of the best practice around correcting hypoglycemia and generates a solution with policy in mind. After checking the CBG, the nurse takes action with IV dextrose along with a protein-rich snack. A 15-minute re-evaluation of the patient’s presentation and a CBG are performed to ensure hypoglycemia is resolved. |
Which model does the Next Generation NCLEX test use?
The NCLEX test is hosted by the NCSBN. After a strategic practice analysis, the NCSBN discovered that nurses are increasingly responsible for making complex clinical care decisions. Because of this, they integrated the clinical judgment measurement model into the NCLEX to encourage educators to better prepare nurses and to ensure that new nurses have the adequate decision-making skills to practice safely.
Can judgment models reduce medical errors?
Research corroborates the need for training specific to clinical judgment. There is a tendency in high-pressure environments to skip the noticing and recognizing steps and jump directly into the action portion of clinical decision-making.
Multiple studies have shown that by prompting clinicians to give real attention to the investigative process, they’re better able to spot potential errors. Therefore, CJM model usage has the capacity to not only identify errors but also prevent them.
How can healthcare leaders promote the use of CJMs?
You’ll be able to identify which CJM is best suited for the environment of your organization based on the focus of each model. Once you’ve established which works best for your team, you’ll want to harness its benefits by implementing its use in the care setting. Here are some suggestions for promoting it with your staff:
- Introduce the use of your preferred model as essential learning during orientation.
- Include its use in mentorship programs for new nurses. Ideally, your new nurse and their mentor will review clinical situations using the steps of the CJM to explore their decision-making processes.
- Consider breaking down incident examinations and nursing wins according to the steps of the CJM during routine huddles or meetings.
- Adapt electronic health record (EHR) software to integrate stopgaps that impress the imperative for applying the CJM framework before taking clinical next steps.
- Add fliers or picture references of your chosen CJM to bulletins that feature current nursing initiatives or safety measures for reinforcement of the model’s significance.
Curious About Other Healthcare Tools That Promote Safety?
Knowing which characteristics describe the clinical judgment measurement model can help inform a better mentorship program or student nursing clinical rotation. For more outcome improvement, IntelyCare’s got you covered with helpful best practice updates and facility guides.