Preceptors’ Level of Performance

The Nursing Clinical Judgment Template

Noticing	Interpreting	Responding	Reflecting
What happened?	What does this mean to you as a nurse?   What does this mean to the healthcare team?   What does this mean to the patient and family?   What does this mean to the community?	What can nurses do?   What can the healthcare team do?   What can the family do?   What can other organizations/government do?   How should the plan be prioritized?	How would the nurse know the issue/problem is improving?   How would the nurse know the issue/problem is NOT improving?

As a new nurse on a busy medical surgical floor, you have been assigned a preceptor to shadow during the first few months of employment. During your observation, you note the following qualities of the nursing care provided: The preceptor focuses on each component of the assessment one at a time, focuses on the most obvious data during observation of her patients, makes an effort to prioritize data but also attends to less relevant or useful data, interprets the patient’s data patterns and compares with known patterns to develop an intervention plan, and generally displays leadership and confidence, being able to control or calm most situations. She communicates effectively, explaining interventions while calming and reassuring the patients and their families. She shows mastery of all necessary nursing skills.

1. What core elements of Tanner’s clinical judgment model are being demonstrated by your preceptor during your observation?
2. Using Lasater’s clinical judgment rubric, how would you describe your preceptors’ level of performance related to effective noticing?
3. How would you describe your preceptors’ level of performance related to effective interpreting?
4. How would you describe your preceptors’ level of performance related to effective responding?
5. As a preceptor, what skills would you expect to identify if exemplary performance were required?

To analyze the situation described, it’s essential to consider both Tanner’s Clinical Judgment Model and Lasater’s Clinical Judgment Rubric, which are fundamental in assessing and enhancing clinical judgment in nursing.

Tanner’s Clinical Judgment Model

This model is structured around four main processes: Noticing, Interpreting, Responding, and Reflecting.

1. Noticing: Recognizing cues and setting priorities.
2. Interpreting: Processing information to understand the patient’s condition.
3. Responding: Acting on decisions in a timely and effective manner.
4. Reflecting: Evaluating the outcomes and personal performance.

Observations of the Preceptor Based on Tanner’s Model

Noticing

Your preceptor focuses on each component of the assessment one at a time and focuses on the most obvious data, suggesting a methodical and structured approach. This demonstrates a competent level of noticing, where relevant cues are identified systematically.

Interpreting

The preceptor interprets the patient’s data patterns and compares them with known patterns to develop an intervention plan. This is a clear demonstration of effective interpreting, as it involves synthesizing information to form an accurate understanding of the patient’s condition.

Responding

The preceptor’s ability to control or calm most situations, alongside effectively communicating and reassuring patients and their families, reflects a high competence in responding. This shows that the preceptor can implement planned interventions effectively and adjust actions as needed.

Reflecting

While the scenario doesn’t explicitly mention reflecting post-care, the preceptor’s general display of leadership and confidence might suggest an implicit evaluation of actions and outcomes, which is a part of reflecting.

Lasater’s Clinical Judgment Rubric

This rubric expands on Tanner’s model by providing specific criteria to assess performance across four levels: Beginning, Developing, Accomplished, and Exemplary.

Effective Noticing

• Level of Performance: The preceptor, focusing on both significant and less relevant data, might fall between Developing and Accomplished. In an Exemplary level, the focus would likely be more refined to most pertinent data only.

Effective Interpreting

• Level of Performance: Given the preceptor’s ability to compare patient data with known patterns to formulate care plans, this suggests an Accomplished level. An Exemplary performance would perhaps involve more nuanced interpretation and integration of subtle data cues.

Effective Responding

• Level of Performance: The preceptor seems to demonstrate an Accomplished or even Exemplary level in responding, given the effective communication and control over situations, showing adaptability and precision in interventions.

Skills for Exemplary Performance

For a preceptor to be considered exemplary, they would typically demonstrate:

• Advanced critical thinking and problem-solving skills.
• Exceptional communication abilities, both in clarity and empathy.
• High proficiency in technical nursing skills.
• The ability to prioritize care based on acute assessments and patient needs.
• Reflective practice that consistently improves and adapts patient care based on outcomes and feedback.

These frameworks help outline a clear path for assessing and enhancing clinical judgment, which is crucial for effective nursing practice, especially in dynamic environments like a medical-surgical floor.