Tanner's Model of Clinical Judgement

[succinate]

**Wow it's been a year since I logged in on this website. A lot has changed!

This is a question about Tanner's Model of Clinical Judgement. For those who are unfamiliar with this model, it's basically an explanation of what clinical judgement means. It has four stages: noticing, interpreting, responding, and reflecting.

I have most trouble understanding the difference between noticing and interpreting. Could anyone please provide me examples (patient care scenarios) that illustrate the main difference between noticing and interpreting?

For example, you are assigned to a child who shows obvious signs of bruises and fractures. The "noticing" part would be that I can see the bruises and fractures. The "interpreting" means that this child is abused because I'm aware of the parents being violent and etc cetera.

Am I doing this right? Any suggestions or advice would be greatly appreciated. Thank you!

[amoLucia]

OP - DISCLAIMER---I have never even heard of this model but I am intrigued and will look it up. But given from the example as you have posted it, I question your interpretation of interpretation'??? Rather have you jumped & made an assumption??? Wouldn't 'interpretation' better mean 'to question'?

From your post, I would have 'noticed' the bruises and interpreted (questioned) as abuse, accident (deliberate negligence or true accident), anticoagulants (overdose?), hx of idiopathic thrombocytopenia, etc.

My response would highlight my investigation (history by parents and child, labs, CT, etc) and then reflect (evaluate) my response, which really sounds like evaluation.

I may be off or just missed something as I AM NOT familiar with this model, but like I said, it looks like you just made one big jump. You may suspect abuse because you do know the family's dysfuntion, but could this really be an accident and you made a misjudgment too quickly?

I'm a new set of eyes and am looking at your scenario totally unbiased, so FWIW...

I truly hope I may have helped???

Or did I combine your interpret phase with reflect? Didn't mean to make things more muddy..

[firstinfamily, RN]

I will be reading Tanner's Model of Clinical Judgement, however, I have to warn you that interpreting cannot lead to assuming. In regards to your example of a child with multiple bruises and fractures----how would you know that the parents are violent?? That is a huge leap. It is possible you may have a child abuse case here, it is also possible you have a child who may have some coordination issues or some blood disorder. I would be cautious and I would be looking for patterns: is this the first time the child has been hospitalized, have there been other injuries etc. My middle son was very adventurous and active, he had a few traumatic occurrances in his early childhood. He got hit in the eye socket with a croquet ball(wooden), he had his pinkie finger almost completely severed from a plastic slide board, he fractured his arm when he jumped from a swing about 12 feet in the air. My husband and I did not abuse our children, but we had a very active child who was also clumsey and had some coordination problems. By the way, he is a great, adult now!! You should take what observations you are seeing and use those observations to help interpret what is going on with the child/patient. Also look into the history, look at lab values, medications etc. For example, I am around the elderly the most, so if I see an elderly patient with multiple bruises and no history of a fall, I usually ask if they are on a blood thinner. Most of them are, and that can cause the bruising and tissue paper thin skin that goes along with those type of medications. I would not accuse their family member of abusing the patient unless I observed other symptoms or indications such as the social interaction between the pt and their family member etc. Was the dosing of blood thinners too much for this patient or were they on more than one type of blood thinner?? You take the information you have and look for other signs and symptoms through all the data gathering you then interpret and question and solve the puzzle. Or ask for more testing to be done to validate the hypothesis. It is a matter of scientific application. Assumption is not based on facts, it is leaping to another conclusion and then hoping the facts show that support. That is really not the way to apply Tanner's Theory. Take the facts, data, signs and symptoms and then interpret, you may have various paths to proceed to a conclusion, but they must be based on the previous information you have gathered. You might be surprised to know that in abused child cases, the child usually runs to the person who is the abuser, they usually show their affection to that person first. It is not always the way we think it should be, but the way that is shown to us. You cannot ever assume anything in healthcare. Ever.

[HouTx, BSN, MSN, EdD]

From what I can recall, the "interpreting" piece has a lot of parallels with Critical Thinking - realizing all the different ways that the phenomenon could be interpreted means knowing what additional pieces of information you will need to gather prior to making a confident decision. Interpreting requires you to draw upon your declarative and experiential knowledge base.