1 Health Assessment and Clinical Judgment
Learning Objectives
After completion of this chapter, the learner will:
- relate the importance of health assessment to clinical judgment and quality of patient care
- discuss the types of health assessment
- differentiate objective from subjective data
- use techniques of physical assessment
- identify proper patient positions during physical examination
Overview of this Chapter:
This chapter will introduce the concept of clinical judgment, its significance to nursing practice, quality of care and how health assessment is an integral component of this concept. Sound clinical judgment requires nurses to be competent in several aspects of assessment such as recognition and interpretation of cues , which are prerequisites of taking actions to address the identified problems. This chapter will introduce overview of clinical judgment and health assessment, types of data, types of assessment, techniques of physical examination and positioning during physical examination.
Health Assessment and Clinical Judgment
Sound nursing clinical judgment is at the core of competent and safe client care ( Dickison et al, 2019). Clinical judgment is made up of actions and behaviors dependent on cognitive, psychomotor behaviors and affective processes. Accurate patient assessment is needed to provide appropriate intervention. Assessment includes recognizing relevant cues, not only from direct patient assessment but information from the environment, health history, laboratory values. This is an essential step of clinical judgment so that the nurse can proceed to analyze these cues, form hypothesis of the relationships of cues and prioritize problems to act on. Benner ( 2004) describes nursing practice as varied and complex and often undertermined, that good nursing practice requires that the nurse develop skillful ethical comportment and use of good clinical judgment informed by scientific evidence and technological development. Furthermore, Benner ( 2004) asserts that perceptual acuity in recognizing salient signs, symptoms and responses to therapies are required for the clinician to use good clinical judgment in particular cases. These illustrations of the necessity of clinical judgment support the need for the nurse be competent in health assessments, and that health assessment must be informed by sound clinical judgment as well.
The National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model synthesizes three established and accepted paradigms for clinical judgment that are used in educating nurses ,as a framework in the creation of test items to test clinical judgment in licensure examinations ( Dickinson, et al 2019). The NCSBN-CJM is presented in the figure below:
The nursing process includes five components of problem solving such as assessment, nursing diagnosis, planning, implementation and evaluation. It is a useful tool for beginning students as foundation for problem solving client prob