casestudy 3
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InstructionssforCaseStudy.docx
CaseStudyRubicAdvanced.pdf
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InstructionssforCaseStudy.docx
What You Will Do During This Case Study
This case study is designed to help you practice the clinical judgment skills outlined in the KRNCJR. Here’s what you’ll be expected to do as you work through it:
STEP 1 — NOTICING: Identify What Clinical Data Matters Most
As you review the case information, your first task is to identify the clinical cues that are the most important or concerning.
You will do this by:
✓ Focused Observation
· Paying close attention to the patient’s assessment findings, vital signs, lab results, medications, and history.
· Distinguishing relevant information from background details.
✓ Recognizing Deviations from Expected Patterns
· Identifying what is different from what you would expect for this patient.
· Noting abnormal findings or trends that may indicate a change in condition.
· Asking yourself: “What here is concerning, and why does it matter for this patient right now?”
This step sets the foundation for your clinical reasoning.
STEP 2 — INTERPRETING: Make Sense of the Clinical Data
After you identify the key cues, your next task is to interpret what these findings mean.
You will do this by:
✓ Prioritizing Data
· Deciding which findings require immediate attention.
· Ranking clinical cues by urgency or risk.
✓ Making Sense of Data
· Connecting clinical cues to potential problems or complications.
· Considering how the patient’s condition is changing.
· Asking yourself: “What is this data telling me? What could be happening physiologically?”
This step helps you determine whether a problem is present and what the priority is.
STEP 3 — REFLECTING: Analyze Your Thinking and Decisions
At the end of the case study, you will reflect on your clinical judgment process.
You will do this by:
✓ Evaluating the Plan of Care
· Considering whether the nursing actions you identified were effective.
· Determining how the patient responded.
✓ Evaluation/SelfAnalysis
· Reflecting on the decisions you made and the reasoning behind them.
· Identifying what you did well and what you would improve.
⭐ In short, during this case study you will:
1. Notice the most important clinical cues.
2. Interpret what they mean and decide whether a problem exists.
3. Reflect on your reasoning and plan for improvement.
CaseStudyRubicAdvanced.pdf
KeithRN.com
Copyright © 2023 KeithRN, LLC, Andover, Minnesota USA. All rights reserved. Structure adapted from Lasater (2007), with permission.
KRN CLINICAL JUDGMENT RUBRIC
NOTICING Effective NOTICING Involves: Exemplary = 4 Accomplished = 3 Developing = 2 Beginning = 1
Focused Observation Recognizes majority (>90%) of relevant clinical data
Recognizes most (75–90%) of relevant clinical data
Recognizes some (50–74%) of relevant clinical data
Recognizes minimal (<50%) of relevant clinical data
Recognizing Deviations from Expected Patterns
Recognizes majority (>90%) of concerning clinical data trends
Recognizes most (75–90%) of concerning clinical data trends
Recognizes some 50–74%) of concerning clinical data trends
Recognizes minimal (<50%) of concerning clinical data trends
INTERPRETING Effective INTERPRETING Involves:
Exemplary = 4 Accomplished = 3 Developing = 2 Beginning = 1
Prioritizing Data Demonstrates thorough analysis (>90%) of clinical data to formulate the most urgent nursing priority
Demonstrates analysis of most (75–90%) clinical data to formulate a nursing priority that is relevant but may not be the most urgent
Demonstrates fundamental analysis (50–74%) of clinical data to formulate a nursing priority that is not the most urgent
Demonstrates lack of analysis (<50%) of clinical data that results in formulating incorrect nursing priority
Making Sense of Data Identifies clinical significance of the majority (>90%) of relevant clinical data
Identifies clinical significance of most (75–90%) relevant clinical data
Identifies clinical significance of some (50–74%) relevant clinical data
Able to identify clinical significance of minimal (<50%) relevant clinical data
RESPONDING Effective RESPONDING Involves:
Exemplary = 4 Accomplished = 3 Developing = 2 Beginning = 1
Well-Planned Intervention/Flexibility
Identifies majority (>90%) of nursing interventions that are relevant to this scenario
Recognizes most (75–90%) nursing interventions that are relevant to this scenario
Recognizes some relevant (50– 74%) nursing interventions that are relevant to this scenario
Recognizes minimal relevant (<50%) nursing interventions that are relevant to this scenario
Being Skillful Complete consistency between each step of the nursing process. Nursing plan of care is thorough.
Is mostly consistent between each step of the nursing process. Nursing plan of care is mostly thorough.
Little consistency between each step of the nursing process. Nursing plan of care has some thoroughness.
No consistency between each step of the nursing process. Superficial and lack of thoroughness in nursing plan of care.
CONTINUED on next page
RESPONDING continued
Effective RESPONDING Involves:
Exemplary = 4 Accomplished = 3 Developing = 2 Beginning = 1
Clear Communication
(Not able to be assessed with SKINNY or NextGen Reasoning)
Communicates concisely and effectively using SBAR by summarizing majority (>90%) of relevant clinical data and correctly interpreting current clinical status
Using SBAR, summarizes most (75–90%) of clinical data that is relevant, correctly interprets the patient’s current status
Using SBAR, summarizes some (50–74%) clinical data that is relevant, correctly interprets the patient’s current status
Using SBAR, unable to summarize (<50%) relevant clinical data, incorrectly interprets the patient’s current status.
Recognizing Patient Problems (Not able to be assessed with SKINNY or NextGen Reasoning)
Identifies all most likely and worst possible problems and recognizes majority (>90%) of expected early changes in patient’s condition
Identifies most (75–90%) potential problems and recognizes most expected early changes in patient’s condition
Identifies some (50–74%) potential problems but not the most important and recognizes some expected early changes in patient’s condition
Unable to identify (<50%) potential problems or recognize expected early changes in patient’s condition
KRN CLINICAL JUDGMENT RUBRIC KeithRN.com
REFLECTING Effective REFLECTING Involves:
Exemplary = 4 Accomplished = 3 Developing = 2 Beginning = 1
Evaluating Plan of Care Able to evaluate care by adjusting the nursing priority by recognizing majority (>90%) of relevant evaluation data
Able to evaluate care by adjusting the nursing priority by consistent- ly recognizing most (75–90%) relevant evaluation data
Able to evaluate care by recognizing some (50–74%) relevant evaluation data
Unable to evaluate care by adjusting the nursing priority by recognizing minimal (<50%) relevant evaluation data
Evaluation/Self-Analysis Evaluates performance on case by thoroughly reflecting and identifying personal strengths and weaknesses
Evaluates performance on case by reflecting with some thoroughness, identifying personal strengths and weaknesses
Evaluates performance on case by reflecting with some insight, identifying personal strengths and weaknesses
Demonstrates lack of insight on performance on case. Does not address personal strengths and weaknesses
Commitment to Improvement
Demonstrates commitment to ongoing improvement with detailed and specific plans to improve current weaknesses (identified in reflection) and apply what was learned to care for future patients
Demonstrates commitment to ongoing improvement with some clear plans to eliminate weaknesses (identified in reflection) and apply what was learned to care for future patients
Demonstrates commitment to ongoing improvement with vague plans to eliminate weaknesses (identified in reflection) and apply what was learned to care for future patients
Demonstrates lack of commitment to ongoing improvement with no clear plan to eliminate weaknesses (identified in reflection) and apply what was learned to care for future patients
Copyright © 2023 KeithRN, LLC, Andover, Minnesota USA. All rights reserved. Structure adapted from Lasater (2007), with permission.