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Clinical Judgment and Nursing Diagnoses in Nursing Administration. Chapter Six Part Two. Clinical Judgment and Nursing Diagnoses in Nursing Administration. Contributors T. Heather Herdman Marcelo Chanes. Reality of the Nurse Administrator Role. ( Chanes and Leite 2008).

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clinical judgment and nursing diagnoses in nursing administration
Clinical Judgment and Nursing Diagnoses in Nursing Administration

Chapter SixPart Two

clinical judgment and nursing diagnoses in nursing administration1
Clinical Judgment and Nursing Diagnoses in Nursing Administration

ContributorsT. Heather HerdmanMarcelo Chanes


Research Priorities for Administrators

  • Patient Safety
  • Outcomes of Care Delivery
  • Implementing Nursing Knowledge in Clinical Practice and Evaluating the Benefit to the Patient
  • Nursing Input into Health Policy and Decision Making
  • Staffing Issues
  • Communication in Clinical Practice
  • Determining Means to Evaluate the Relationship Between:
    • Supervision of Nurses and Quality Improvement
    • The Effect of Decision Making
    • The Nurse:Patient Ratio and Its Effect on Patient Outcomes/Safety

Nursing’s Role in Patient Safety

Principles of Best Practice

  • Evidence-Based Practice
  • Patient-Centered Processes
  • Communication
  • Lifelong Learning

Leaders Must Acknowledge that the Healthcare Environment is High Risk


Nurse Administrator Role

  • Nurse Administrators have a Strategic Role in the Implementation of a Working Process for the Nursing Department
  • This Role Should be Based on:
    • Concept of Nursing Process
    • Concept of Nursing Autonomy
    • Concept of Nursing Quality
    • Use of Evidence-Based Nursing Taxonomies

Model of Desire for Working with NDx

Morgan (2006) Says that Management Creates:

A Holographic Model in Which Beliefs of the Whole Organization are Built On Every Single Organizational Cell, Beyond Demonstrations of the Leader’s Beliefs


Model of Belief Creation

(Chanes and Leite 2008)


Take Note

Administrators Create Beliefs with Their Attitudes


Importance of Beliefs

  • Help Others to Act Inside a Model
  • Help Others to Deal with Resistance
  • Help Nurse Managers to Identify Multipliers and Leaders

Beliefs Are Very Important


Multipliers Can Be…

  • Nurses for a Pilot Project to Implement NDx in Your Practice
    • Help Them to Collect Nursing-Sensitive Indicators
    • Help Them to Deal with Barriers
    • Help Them to Gain Respect/be Seen as a Positive Influence within Your Institution
    • Help Them to Show That …
Nursing Diagnosis is Not “One More Task” It is “the Task” (the Knowledge) that is the Basis of All Our Work

Viable Model of Working with NDx

  • Staff Need an Environmental Culture that Encourages, Expects and Rewards Working with Nursing Diagnosis

How to Create This Environmental Culture

  • Multipliers Must be Equipped to Solve Doubts and Concerns
    • Identify Reference Nurses – They can Help Others
    • Create an Email Account for Questions
    • Create a “Help” or “Knowledge” Page in an Internal Website
  • Training for All Staff:
    • Offer Continuous Competency-Based Training

How to Create This Environmental Culture

  • Continuous Case Studies
    • Create a Routine of Studying
    • Invite Nurses to Present Their Most Difficult Case or Cases in Which They Achieved Very Good – or Unintended – Outcomes
    • Create a Culture of “NO FEAR” to Learn from Negative Outcomes

Staff Training Must Have a Frameworkof Critical Thinking

Living Learning Cycle (LLC)

Framework for a Critical Thinking-Based Staff Training Program

(Chanes and Leite 2008)



  • A Learning Opportunity Provided by Video, Educational Games, Exercises, Speeches, etc., Which can Introduce or Increase Knowledge About New Concepts


(Chanes and Leite 2008)



  • A Moment for Students/Staff to Verbalize and Discuss Their Point of View About Concepts or Experience
  • Teacher/Facilitator Asks Participants: “What are Your Feelings/Perceptions About These Experiences/Concepts?”


(Chanes and Leite 2008)



  • A Moment for Individuals to Think About Their Answers, to Find the Reasons Why They Think/Feel This Way
  • Teacher/Facilitator Asks Participants: “Why Do You Think That Those Feelings/Perceptions Occur?”


(Chanes and Leite 2008)



  • A Moment for Participants to Think About Structures/Behavior Changes They Need to Consider in Order to Implement Concepts
  • Teacher/Facilitator Asks Participants: “How can You Use These Concepts on Your Unit?”


(Chanes and Leite 2008)


With This Structure, Students can Achieve:


(Chanes and Leite 2008)


Model of Political Articulation in Power Layers

The Nurse Manager Must Act as a Political Leader with a Position/Voice Based on Facts, Numbers and Measured Information to Reduce Health Profesional Barriers and/or Misconceptions



Nurse Administrators can Show that NDx Improves Patient Outcomes, Quality of Care, and Professional and Organizational Image


Dealing With Political Barriers

  • Act as a Voice for Staff
  • Show Energy, Enthusiasm and Certainty
  • Appear at (or Provide Some of) the Staff Training/Case Studies to Emphasize Their Importance
  • Base Messages on Facts, Numbers and Measured Information
  • Showcase Own Beliefs
  • Support Patient Safety and Outcomes, the Nursing Role and Nursing Process


Nurse Administrators Must Champion the Need for Nurses with Expertise in Clinical and Diagnostic Reasoning, and Who Appropriately Utilize the Entire Nursing Process, in an Evidence-Based Manner, to Support Patient Safety and Improved Patient Outcomes



Chanes M, LeiteMMJ (2008) Measuring knowledge acquired though leadership educational game. Nursing, São Paulo 10: 70-74. 

Morgan G. (2006) Images of Organization. São Paulo, Brazil: ATLAS.