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CLINICAL NURSING JUDGEMENT

Senior Capstone:

Clinical Nursing Judgement

Michael Turnbull

Youngstown State University

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CLINICAL NURSING JUDGEMENT

Clinical nursing judgement is driven by education through lecture and nursing

experiences. Critical thinking encompasses problem solving, decision making, clinical

judgement and creativity. These are all skills that you acquire and build upon throughout your

nursing career. One challenge of clinical nursing judgement is looking at the patient looking at

their medical diagnosis and taking into their psychosocial considerations as well.

According to Profetto-Mcgrath, J. (2003):

“The national accrediting body for nursing programs, has mandated that baccalaureate

programs demonstrate the assessment of critical thinking as a student outcome. Thus, to

become nationally accredited and maintain accreditation, critical-thinking skill

development needs to be evident in students throughout the program and measurable at

the time of graduation.”

This is an extremely important process that you build upon through nursing school which helps

us, as novice nurses, implement safe effective care to our patients. One way we build upon our

clinical nursing judgement is through simulation. In Davis, A. H., & Kimble, L. P. (2011) study,

human patient simulation has been increasingly used in nursing education to meet the variety of

challenges that are faced by today’s nursing faculty. With technological advances, we can simulate

applicable nursing simulations which we are able to build on our skills as novice nurses. I feel that

simulation is a major advantage in Youngstown State University’s nursing program. Each semester

we are called upon to be a nurse in a situation where it is applicable to a situation that we have

studied in lecture. These simulations bring lecture to life and make us, as students, think outside

of the box to implement optimal care. During simulation, we as a team run into learning situations

that we debrief which bring our episode to life.

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CLINICAL NURSING JUDGEMENT

One time I have implemented clinical nursing judgement, I was in my medsurg 2 course

with Professor Bonnie Thompson. Professor Thompson has been known to be a tougher instructor

who wants you to know nursing by the book. As a student, I have the utmost respect for he because

I feel that this clinical was the largest step in my nursing career. I was on an Orthopedic floor at

Northside Medical Center where I had a patient who have had a clean tibia-fibula break. This was

extremely interesting to me because I have broken my leg before and I feel like I had a good grasp

of what was going on. I was focusing on the neurovascular assessment feeling pulses above and

below the cast, capillary refill, the temperature distal to the cast, and checking to see if there was

any numbness or tingling present. This is important because of compartment syndrome is one

complication of casting. One aspect of care was to control the patients pain level. In class we learn

that pain control is important because it is harder to retract pain once it gets so severe. Being an

elderly patient, he had this stigma that he didn’t want to take pain meds because he felt that he

would become addicted. This is where I then had spoken to him telling him the advantages of the

medication and that if he is in such pain that it would be most beneficial to take the medication to

retract pain. These medications slow the respiratory rate, alter cardiac functioning and balance. I

used this as a teaching point for my patient to make sure that they are taking their time when

moving so that they are less prone to self-inflicted injury. Other interventions that we had

implemented were cryotherapy and elevating his leg. Cryotherapy in casting is beneficial because

it decreases the inflammation that can overall be detrimental to the extremity causing a loss of

circulation, oxygenation, and perfusion. The impeded circulation can cause a patient to lose their

lib if it progresses long enough for the worse. Elevating his leg also helped promote venous

circulation back to the heart to minimize the pooling of blood. I feel that during this clinical I

relayed the best care I possibly could especially because I was familiarized with it through my
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experiences in simulation. Other aspects of care I was able to promote through patient teaching

was how to use crutches appropriately.

In Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013), “An Agenda for Clinical

Decision Making and Judgement in Nursing Research and Education”:

“Nurses’ judgements and decisions have the potential to help healthcare systems allocate

resources efficiently, promote health gain and patient benefit and prevent harm. Evidence

from healthcare systems throughout the world suggests that judgements and decisions

made by clinicians could be improved: around half of all adverse events have an error at

their core. For nursing to contribute to raising quality though improved judgements and

decisions within health systems we need to know more about the decisions and judgements

themselves, the interventions likely to improve judgement and decision processes and

outcomes, and where best to target intellectual and educational resources.”

We use evidence-based practice is utilized a whole relayed through lecture, clinical, and with

utilization of our technological advances through simulation. Building through these core concepts

holistically helps improve patient care and patient outcomes. The future of nursing relies on

research that create interventions and approaches that can be utilized for the best care possible.

I feel that I have grown as a nurse based upon current practice standards that have made

me into a competent novice nurse. My goal as a nurse is to grow each day so that I can relay safe

effective care with proper clinical nursing judgement which Youngstown State University’s

nursing program has given me all of the intangibles to mold and grow into the best nurse I can be.

I cannot imagine where I would be if I didn’t buy into the program or if I had gone to school

elsewhere. Nursing school has been the best decision of my life.

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References

Davis, A. H., & Kimble, L. P. (2011). Human Patient Simulation Evaluation Rubrics for Nursing

Education: MeasuringThe Essentials of Baccalaureate Education for Professional Nursing

Practice. Journal of Nursing Education,50(11), 605-611. doi:10.3928/01484834-20110715-01

Profetto-Mcgrath, J. (2003). The relationship of critical thinking skills and critical thinking

dispositions of baccalaureate nursing students. Journal of Advanced Nursing,43(6), 569-577.

doi:10.1046/j.1365-2648.2003.02755.x

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