The 6 Cognitive Steps of the CJMM
1. Recognize Cues: Identify relevant vs. irrelevant clinical data in the client’s EHR (vitals, labs, subjective complaints).
2. Analyze Cues: Connect cues to client conditions and understand why a finding is significant (e.g. associating rising BUN/creatinine with aminoglycoside toxicity).
3. Prioritize Hypotheses: Rank client problems based on urgency, likelihood, and risk of death (Maslow, ABCs, survival potential).
4. Generate Solutions: Identify expected outcomes and define evidence-based nursing interventions that should or should not be ordered.
5. Take Action: Implement selected priority interventions (administering medications, client positioning, emergency escalation).
6. Evaluate Outcomes: Compare observed patient status against expected outcomes to determine if the intervention was effective or if deterioration has occurred.
Scoring Rules: +/- Scoring vs. 0/1 Scoring
Under NextGen scoring rules:
• 0/1 Scoring: Used on single-response and matrix multiple-choice items where 1 point is given for correct and 0 for incorrect.
• +/- Scoring: Used on select-all-that-apply (SATA) and multi-select items. You earn +1 for each correct selection and lose −1 for each incorrect distractor chosen, with a minimum score of 0 (no negative total scores). Do not guess extra options if uncertain!