Clinical Judgement Model

Journal Club Article: Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education45(6), 204-211.

Model of clinical judgement is based from 191 studies and 5 conclusions which identified:

  1. “Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand.
  2. Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns.
  3. Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit.
  4. Nurses use a variety of reasoning patterns alone or in combination.
  5. Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning.”

The developed ‘Clinical Judgement Model (pg 208) consists of 4 aspects:

  1. Noticing – a grasp of the situation
  2. Interpreting – gaining sufficient understanding of a situation
  3. Responding – determining a course of action
  4. Reflecting – reviewing the outcomes


“This model provides language to describe how nurses think when they are engaged in complex, underdetermined clinical situations that require judgment. It also identifies areas in which there may be breakdowns where educators can provide feedback and coaching to help students develop insight into their own clinical thinking. The model also points to areas where specific clinical learning
activities might help promote skill in clinical judgment.”

Keywords: Clinical judgement; clinical reasoning; problem solving; critical thinking; decision making