Guide for Reflection Using Tanner’s (2006) Clinical Judgment Model

Instructions

This Guide for Reflection is intended to help you think about a given clinical situation you have encountered during the past week and your nursing response to that situation. The situation can be a specific physiological patient problem, such as an elevation in temperature, respiratory difficulty, or electrolyte imbalance. You may choose to describe a situation involving a patient’s family. The situation can be a description of your role in interdisciplinary problem solving. The reflection situation may describe an ethical issue you encountered in practice. Use the guide for reflection as a way to tell the story of the situation you encountered. The guide provides you with a way of thinking about care that supports the development of your clinical judgment. Although there are many ways of organizing your thinking about patient care and professional nursing practice, Tanner’s (2006) Clinical Judgment Model provides the framework for the questions in this guide. Introduction Describe a nursing situation you encountered this week (see the instructions above). Background • Describe your relationship to the patient at the time you noticed the situation (e.g., previous contact with patient and/or

family, the quality of your relationship). • Consider experiences you have had that helped you provide nursing care in the situation. Describe your formal knowledge

(e.g. physiology, psychology, communication skills), previous nursing experiences with a similar problem, and/or personal experiences that helped guide you as you worked with the patient.

• Describe your beliefs about your role as the nurse in working on the situation. • Describe any emotions you had about the situation.

Noticing • What did you notice about the situation initially? • Describe what you noticed as you spent more time with the patient and/or family.

Interpreting • Describe what you thought about the situation (e.g. its cause, potential resolutions, patterns you noticed). • Describe any similar situations you have encountered in practice before. Describe any similarities and differences you

observed when compared with the current situation. • What other information (e.g. assessment data, evidence) did you decide you needed as you considered the situation? How

did you obtain this information? What help with the problem did you get from your preceptor? Your conclusion: What did your observations and data interpretation lead you to believe? How did they support your response to the situation? Include pertinent pathophysiology and/or psychopathology. Responding • After considering the situation, what was your goal for the patient, family and/or staff? What was your nursing response, or

what interventions did you do? List all actions that you took. • Describe stresses you experienced as you responded to the patient or others involved in the situation.

Reflection-in-Action • What happened? How did the patient, family, and/or staff respond? What did you do next?

Reflection-on-Action and Clinical Learning • Describe three ways your nursing care skills expanded during this experience. • Name three things you might do differently if you encounter this kind of situation again. • What additional knowledge, information, and skills do you need when encountering this kind of similar situation in the

future? • Describe any changes in your values or feelings as a result of this experience. Nielsen, A. et al. (2007). Gudie for Refelction Using the Clinical Judgment Model. Journal of Nursing Education, Vol.46, No.11

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