• Discuss three potential barriers that you would anticipate when providing care to Jose based on his age and culture.
• Provide an example of how you would overcome each of the three barriers through the implementation of multidimensional care strategies.
The clinical judgment measurement model from the National Council of State Boards of Nursing (NCSBN) is a tool that helps nurses think critically and come up with solutions. Nurses who are good at their jobs use this way of thinking when analyzing data, ranking hypotheses, coming up with solutions, and judging the results. I was a certified nursing Helpant working with a client in an Helped living facility when I used the steps in this model. In this situation, a coworker and I saw a client with type 2 diabetes mellitus who was sweating, shaky, confused, pale, and had a fast heart rate. I knew that we had to act quickly and effectively because these symptoms were scary, especially since the person had been diagnosed with diabetes.
The first step in the clinical judgment model is to notice clues. We can’t say enough about how important the “cue collection” step is to clinical reasoning and judgment. If early, subtle signs aren’t noticed, it can be bad for the patient (Levett-Jones, 2018). In this case, I noticed that the client was sweating a lot, shaking, confused, pale, and had a fast heart rate. I used the ABC pneumonic to figure out what order these observations should be in: (A) airway, (B) breathing, and (C) circulation (Ignatavicius, et al., 2021). Using this method to rank cues, I would put them in the following order: 1. Fast heart rate, 2. Pale skin, 3. Sweating, 4. Shaking, and 5. Confusion.
Step 2 of the clinical judgment model is to make hypotheses and rank them in order of importance. I came up with three ideas based on my analysis of the clues. Since he had type 2 diabetes, my first thought was that this client’s tachycardia, paleness, sweating, shaking, and confusion were caused by low blood sugar. The second idea I came up with was that the client with a fast heart rate, pale skin, sweating, shaking, and confusion was anxious. The third idea I came up with was that this client’s tachycardia, pallor, diaphoresis, shaking, and confusion were all signs of dementia, since he was 80 years old and had a history of dementia and Parkinson’s disease in his family.
In the third step of the clinical judgment model, hypotheses are put in order of importance. I chose hypoglycemia and anxiety as the two most important ideas for this patient. I put the first hypothesis at the top of the list because identifying a hypoglycemic patient is so important because it could lead to coma or even death (Matthew, et al., 2022). I chose anxiety over dementia because anxiety causes cortisol levels to be high. In small amounts, cortisol can be good for you because it makes our central nervous system send out the “fight or flight” signal. But when the body is exposed to high levels of cortisol for a long time, such as when someone has anxiety, this can cause fatigue, high blood pressure, headaches, depression, trouble sleeping, and other problems (Premier Health, 2017).
In the fourth step of the clinical judgment model, solutions are made. At this stage, it’s important to know what changes need to be made to the plan of care and priority interventions based on the priorities. The most important thing to do for this patient was to call the on-call registered nurse, give them fruit juice or another source of easily absorbed carbs, and call emergency medical services or 911. Intravenous (IV) dextrose and then an infusion of glucose can be used to treat severe hypoglycemia. Patients who are awake and able to take oral medications should be given carbohydrate sources that are easy to absorb, like fruit juice (Matthew, et al., 2022). The plan of care for this patient should include regular blood sugar checks and regular wellness checks. Before this happened, they weren’t checked on very often. After that, staff checked on them every hour.
Assessment of outcomes is the last step of the clinical judgment model. What worked well about this situation was how quickly my coworker and I reacted. We were able to connect the client’s symptoms to the fact that he was diabetic. We checked his blood sugar because we knew these were signs of hypoglycemia. It was about 62 mg/dL. We gave him cranberry juice from his refrigerator and called 911. We came to the right conclusion by using the clinical judgment model, which could have saved this client’s life. When it comes to critical thinking and getting the best results for patients, it’s important to know how this model works.
