A Clinical Judgment Model to Apply the QSEN Competencies: Concept Based Learning

Educators are challenged to integrate the Quality and Safety Education for Nurses (QSEN) competencies (patient centered care, teamwork and collaboration, evidence based practice, quality improvement, safety and informatics) (Cronenwett et al, 2007) in classroom and clinical learning. The QSEN Learning Collaborative demonstrated that How we teach is as critical as What we teach if we are to change clinical behaviors to improve practice outcomes. Tanner’s (2006) clinical judgment model engages learners through systematic analysis of unfolding cases: noticing, interpreting, responding, and reflecting.  The model is based on previous findings that clinical judgments are influenced more by what the learner brings to the situation than objective data. Clinical judgments are influenced by engagement with and knowing the patient, the situated context and unit culture, reasoning patterns, and reflection on previous experiences. Learners develop a systematic way of thinking beyond learning disease taxonomies; the focus is on concepts and cues situated within the complexity of a patient situation. Critical reflection of unfolding cases helps learners explicate quality and safety concerns in a systematic way to develop a habit of the mind to apply in practice.

Reflection sits in the in-between space between what is learned and application in practice. Nurses reflect on and learn from experience, incorporating what they know, developing tacit knowledge that guides their practice. It may appear intuitive, but is based on recognizing situated cues derived from reflecting before action, during action, and after action to identify patterns that influence decisions. Using an unfolding case study, participants will work in groups with sets of questions to apply the clinical judgment model focusing on quality and safety competencies.

Reflecting on experience helps nurses own their experience to make sense of what happens; learning to deal with the complexities of practice contributes to nurse satisfaction, a healthy work environment, and retention.