Clinical Nursing Judgment 1

Clinical Nursing Journal

Jayme Pakalnis

Nurs: 4852 Capstone

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As students enter their senior year as a nursing student, a huge transition we

under-go is student nurse into the formal title “Registered Nurse.” It becomes very

important that we are prepared to make this transition and have all the necessary tools to

become successful in doing so. A major component of this is using our best clinical

judgment when caring for our patients. When using our best clinical judgment we need to

interpret data such as past medical history, lab results, physical assessments, medical

orders, current and past diagnoses, and medications so we can provide the best care to our

patients.

Throughout the nursing program at YSU, we have the pleasure to utilize a

simulation lab where we use manikins to act in place of patients and place us in an almost

realistic situation that we encounter in the hospital. In the lab, we are given a scenario and

have to put together the cues and data the patient reflects onto us in order to determine

the correct care plan. Students have to use their critical thinking skills in order in

implement interventions and have a successful outcome. If we do not act quick enough in

the situation the manikin’s condition gets worse warranting an intervention is needed.

This also becomes important with clinical judgment, that you are able to create a plan of

care in an appropriate amount of time. Being able to implement the cues of a patient with

objective and subjective data is crucial. If we cannot identify the cues given, the less

likely we will be able to provide the appropriate intervention. A research study conducted

between Human Patient Stimulation and student nurses shows this correlation using a

situation for a patient undergoing a vagal response in one situation and then cardiac arrest

in another. During the vagal response trial, students identified cues and interpreted them
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in order to make a judgment. Most of the students in this trial believed the human patient

stimulation were undergoing an issue with pneumonia or renal failure. These students

who interpreted the data incorrectly, were lest likely to make the best clinical judgment

on the patients behalf. In the other trial, students identified that the patient was in cardiac

arrest and even those who could not identified the cues were still able to make partially

appropriate clinical judgments. Communication, interpretations, time management, and

prioritization are keep factors that go into making the best clinical judgment.

Another way we can learn in the stimulation lab to develop our clinical judgment

skills are by acting as an interdisciplinary team. Students usually use the lab in small

groups; each member of the group plays an important role in the scenario. The

interdisciplinary team can include dieticians, respiratory therapist, physicians, nurses,

pharmacists, social workers, and physical therapy as well as many other team members

depending on the patients needs. The family members also play an important role when

considering patient care. Each student is assigned a role in the scenario and is to act the

part while all are working amongst each other. Communication becomes a key aspect

when working together and can provide data that might not be found in a patients chart or

the patient may not be able to communicate him or herself. If the correct information is

exchanged, the more accurate our assessments will be in addition to making the correct

judgment of the situation. Debriefing after each scenario will allow use to utilize all

components used to see what could have done better and what we done successfully. This

becomes a learning opportunity for students as a way to see what skills need worked on
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in order to conduct the best plan of care and to see where our strengths are in the clinical

setting.

While being in preceptorship at Cleveland Clinic Main Campus, I have to make

my own clinical judgments in means of advocating for my patients. I can remember a

particular time where I was working with a 2-day post-op patient who underwent his

second liver transplant. Anyone who works with any kind of transplant patient

understands the importance of anti-rejection medications in order for the patient to

transition over smoothly. Two medications prescribed to this patient were CellCept and

Prograf, both of which are anti-rejection medications. When going into the pyxis system

to do 8 o’clock medications, the Prograf was not available in the patient’s medication

drawer. I went ahead and gave his other medications and then afterwards sent a message

to pharmacy that the medication was not available and for it to please be tubed up to our

floor. After over an hour of waiting to receive this medication, my nurse and I had to take

it a step further and to call down to the pharmacy. When calling, they said that they were

making their rounds and would be there soon to load it into the pyxis system. The

medication was now already over an hour late and it became crucial we received the

medication before then. We explained to the pharmacist that this patient had under gone

his second liver transplant and the medication needed to be sent to the floor. In this

situation, using our best clinical judgment to keep reaching a step further to receive the

medication was to act in place of advocating for our patient. My nurse and I acted

together as a team to develop a clinical judgment by communication. There is no better

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way as to how to further develop your own clinical judgment skills than to be on the floor

working with real life patients in real life situations.

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References

Lee, D. S., MA, BN, RN, Abdullah, K. L., DClinP, MSc, BNSc, Subramanian, P., , MEd,

Bachmann, R. T., PhD, MSc, & Ong, S. L., MSc, BNSc, PhD. (2017). An

integrated review of the correlation between critical thinking ability and clinical

decision?making in nursing. Journal of Clinical Nursing, 26(23-24), 4065-4079.

doi:10.1111/JOCN.13901

Manetti W. Sound clinical judgment in nursing: A concept analysis. Nurs Forum.

2019;54:102‐ 110. https://doi.org/10.1111/nuf.12303

Shelestak, D., Meyers, T., Jarzembak, J., & Bradley, E. (2015, June). A Process to Assess

Clinical Decision-Making During Human Patient Simulation: A Pilot Study.

Retrieved March, 2019, from

https://eps.cc.ysu.edu:3253/ehost/pdfviewer/pdfviewer?vid=4&sid=2412d975-

362a-4c0d-9e0c-4d84dd7d184b@pdc-v-sessmgr02
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