Application of Tanner's Model of Clinical Judgment in Simulation 3 (Tanner, 2006)

Application of Tanner's Model of Clinical Judgment in Simulation 3 (Tanner, 2006)

1. Noticing

   • Situation/ Context
     • Misses old apartment
       • Does not want to be in a home
     • Chronic pain
     • Does not want to go on like this
     • 86-year-old male
     • family ignoring his feelings
   • Background
     • TURP
     • Prostate Cancer
     • Widowed
     • Frail
   • Initial Expectations/ Grasp
     • family issues
     • Help transition to LTC facility
     • possible depression
     • Address pain
     • Family in denial
   • Vital signs
   • Factors influencing Noticing
     • vision
     • Values
     • culture
     • Complexity
     • Environment
   • Skill 6.2, Assessing Systematically and Comprehensively
     • Head-to-toe assessment
     • PQRST

2. Interpreting

   • pain
     • Assess cause
       • underlying health issue
         • Cancer
         • TURP
         • age related condition
       • Depression
   • Assess family dynamics
     • Therapeutic communication with patient & family
       • explore feelings
   • Lack of Knowledge of DNR
     • Needs DNR teaching
   • Vital signs
     • Skill 6.4, Distinguishing Normal from Abnormal/Identifying Signs and Symptoms
       • Within Defined Parameters

3. Responding

   • Action
     • DNR teaching
       • meaning
       • implications
       • how to implement
     • Family therapy
       • Call Case Manager
         • ISBAR
     • Pain Management
       • Morphine
       • Distractions
         • Tv
         • Music
         • Reading
   • Outcomes
     • Decreased pain
     • Understanding of DNR
     • Improved understanding/ support from family
     • Increased patient satisfaction

4. Reflecting

   • On action
     • reflect on situation
     • Acknowledge weaknesses
       • Too focused of physical assessment/ interventions
     • Implications for future practice
       • More therapeutic communication
       • Adequately explore client and family feelings
     • Apropriateness of actions
       • Explore non pharmacological pain management
     • Areas for improvement
       • Assessing for depression
   • In action
     • change in patient status
       • Call Case Manager
         • ISBAR
         • Notify case manager if pt deteriorates
       • Assess
         • Monitor for signs signs of overdose
           • Noloxone
         • Vitals
         • LOC
           • less responsive

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