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Judgement
Olivia Millsop
Senior Capstone: Clinical Nursing Judgement
Youngstown State University
02/27/2017
Senior Capstone: Clinical Nursing
Judgement
Judgement is defined by the Merriam-Webster dictionary (2017) as
comparing. Entering the nursing program, students are told use your
million different things to each student. As time has gone on, those
words have come to mean something more simple for me. I define
are now responsible for a patient and need to make medical decisions
for the patient based on the head to toe assessment each student must
a critical care setting (Thompson, C., Aitken, L., Doran, D., & Dowding,
D,2013). This came as quite a shock. I would have never guessed that
nurses make decisions or judgment calls this often during a shift when
caring for a patient. But when thinking about this statistic, it becomes
more clear. When nurses ask a patient about how they would rate their
Senior Capstone: Clinical Nursing
Judgement
pain, nurses make a decision to either give the patient a stronger type
patient about pain, but also making a judgement call based on blood
by patients (Thompson, C., Aitken, L., Doran, D., & Dowding, D, 2013).
differently. With being a student comes the decision to follow what you
student I had patient in the ICU who was there for a gunshot to the
abdomen. The patient had recently come back from surgery with many
catheter, and two Jackson Pratt drains in the abdomen. This patient
had blood draining from every site, and at an amount that seemed to
amount of blood, and his blood pressure was running 89/40 with a MAP
in the 50s. The cover nurse was not concerned for this patient at all
even though I had told her the clinical findings multiple times. The
concerned with the current status of our patient. But when the
little more concern then the nurse did. The attending wanted to give
order to take the patient back to surgery to find the source of the
bleeding and ordered two units of PRBCs. The nurse in that time made
decompensating right before her eyes. From this experience I can say
that the cover nurse showed poor nursing judgement. This was an
clinical practice for role taking (Van Graan, A. C., Williams, M. J., & Koen,
and in turn does not help the students clinical judgement skills. When
in the clinical setting student tend to say Well I will get the nurse for
start making those clinical judgements because in a few years they will
expert nurse. According to Van Graan, Williams, & Koen (2016) most
graduate nurses do not meet the expectations for entry level clinical
expert, but that comes with time. Nurses are always learning new
changing field, nurses need to apply those changes when they are
down to the bottom line, nurses need to make the best decision for the
Reference
Coulter Smith, M. A., Smith, P., & Crow, R. (2014). A critical review: a
combined conceptual framework of severity of illness and clinical
judgement for analysing diagnostic judgements in critical illness.
Journal of Clinical Nursing, 23(5-6), 784-798. doi:10.1111/JOCN.12463
Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for
clinical decision making and judgement in nursing research and
education. International Journal of Nursing Studies, 50(12), 1720-1726.
doi:10.1016/J.IJNURSTU.2013.05.003
Van Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses'
understanding of clinical judgement: A contextual inquiry. Health SA
Gesondheid, 21, 280-293. doi:10.1016/J.HSAG.2016.04.001