Caputi Clinical Judgment
Step 1 : Getting the information
Give me at least 2 competencies
S-
Sleep Disorders
Trouble sleeping?
A-
Assessment
O
P
O- Onset
When did the pain start
P- Palliation/Provocation
What makes the pain better or worse
Novice
Student Nurse
By the book
follows the rules
little to no experience
Step 2: Making meaning of the information
Give me at least 2 compentieces
P-
Problems eating or feeding
Eating and feeding yourself okay
D
Diagnosis
Q
R
Q-Quality
What does the pain feel like (sharp, dull, stabbing, burning)
R-Region/Radiation
Where is the pain, and does it move?
Advanced Beginner
1 to 2 yrs
Graduate Nurse
Past experience guides action
Step 3: Determining actions to take
Give me at least 2 competencies
I-
Incontinence
Do you know when to go?
P
Planning
S
T
S-Severity
Rate the pain 1-10
Rate at rest and activity
T-Timing
Pain constant or intermittent/how long does it last
Competent
2-3 years
Plans well
Good time management
Care done in a good time frame
Step 4: Taking Action
Give me at least 2 competencies
C-
Confusion
Are you confused?
I
Implantation
U
U- Understanding
What do you think is causing the pain
How is it affecting you
Pts perception of pain
Proficient
3+ years
Has holistic understanding
Step 5: Evaluating outcomes
Give me at least 2 competencies
E-
S-
Evidence of falls
Skin Breakdown
E
Evaluation
V
V- Value
What is a tolerable level of pain
Other symptoms
Anything else about your pain
Expert
Quick
Flexible can go with the flow
Highly proficient
teaches others