Tanner's Model of Clinical Judgment

​Tanner's Model of Clinical Judgment

NURS 321 J. Stewart, MSN, RN

Multiple Choice

What is the first step in Tanner's Model of Clinical Judgment?

• Reflecting

• Noticing

• Interpreting

• Responding

Scenario 1

Mr. Henderson (72 y/o) is 24 hours post-op from a hip replacement. He has been on bedrest and is now cleared to sit in the chair for lunch.
When the student assists him to dangle his legs at the bedside, Mr. Henderson becomes pale and says, "I feel a bit lightheaded and see spots."

Open Ended

What do you notice?

 Noticing: You should have noticed the skin color change (pallor) and the subjective report of dizziness.

Open Ended

What can you interpret?

Interpreting: Is this a pulmonary embolism or just orthostatic hypotension?
Given the transition from lying to sitting, it’s likely a drop in blood pressure.

Open Ended

How do you respond?

Responding: Should you continue to the chair or lay him back down? (The safe response is to assist him back to a supine position).

Scenario 2

Mrs. Garcia (55 y/o) was admitted with viral pneumonia. She is receiving 2L of oxygen via nasal cannula.
During the morning assessment, the student finds Mrs. Garcia leaning forward on her over-bed table (tripod position). She is breathing at 26 breaths per minute. She is answering questions with one-word answers.

Open Ended

What do you notice?

Noticing: You should "notice" the tripod positioning and the inability to speak in full sentences, even if the pulse oximeter still reads 92%.

Open Ended

What can you interpret?

Interpreting: You should interpret that the "work of breathing" has increased significantly.

Open Ended

How do you respond?

Responding: Checking the O2 tubing for kinks, raising the head of the bed, and notifying the primary nurse/instructor.

Scenario 3

Mr. Wu is scheduled to receive his morning dose of Metoprolol (a beta-blocker).
The student takes his vitals: Blood Pressure is 116/70 mmHg, but his Heart Rate is 52 bpm. The medication administration record (MAR) says: "Hold if HR < 60."

Open Ended

What do you notice?

Noticing: You should notice the discrepancy between the patient's current heart rate and the parameters on the MAR.

Open Ended

What can you interpret?

You would understand that giving this medication could lead to symptomatic bradycardia or fainting.
Without knowing about the medication, you would interpret that the pulse (HR) is outside of ordered parameters.

Open Ended

How do you respond?

You would withhold the medication, document the reason, and communicate the finding to the clinical instructor.

Professional Communication

Answer this on the next slide:

Using the SBAR format (Situation, Background, Assessment, Recommendation), pick one of the scenarios.
How would you report this change to your clinical instructor or the primary nurse?

Open Ended

Using the SBAR format (Situation, Background, Assessment, Recommendation), pick one of the scenarios.
How would you report this change to your clinical instructor or the primary nurse?