NUR 2571 Discussion Clinical Judgment

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NUR 2571 Discussion Clinical Judgment

NUR 2571 Discussion Clinical Judgment

Module 1 Discussion

Clinical Judgment

Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings.

Keeping that in mind, answer the following scenario:

You are the Charge Nurse in a large Urban Emergency Department (ED). You nursing staff include:

RN with 12 years of Trauma ED experience

New RN with 6 months ED experience

RN from the Medical Surgical floor with 8 years of experience

The following patients are in the ED, which patient will you give to each of the nurses and why?

A 76-year-old client who was involved in a motor vehicle accident and has hematuria.

A 38-year-old client with kidney stones complaining of severe pain.

A 24-year-old diabetic client with an acute urinary tract infection who will require discharge teaching.

An 80-year-old client that has not had a bowel movement for 4 days.

Defining Clinical Judgment

While several terms are used interchangeably to describe the competencies needed to deliver safe and effective patient care, they have different meanings; educators should understand the distinctions among them to educate students appropriately. The following terms are interrelated and represent important processes that lead to the comprehensive application of evidence-based practice (EBP).

  • Clinical judgment is the conclusion, decision, or opinion a nurse makes after they consider the issue, based on critical thinking or clinical reasoning.
  • Clinical reasoning is the process used to consider issues at the patient’s bedside or point of care to prevent or manage a problem.
  • Critical thinking is a broad term that includes reasoning inside and outside of the clinical setting (Alfaro-Lefevre, 2017).

Figure 1 shows the relationship between these terms.

There have been conversations on the use of critical thinking versus the nursing process by nurse education experts. The American Nurses Association (ANA) standards state that the nursing process serves as a critical thinking model that promotes competent care of patients (ANA, 2015). If the nursing process serves as a critical thinking model, then it is a tool for clinical reasoning as well as considering the correlation of these concepts (Alfaro-Lefevre, 2017).

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Critical thinking, which leads to clinical reasoning and ultimately clinical judgment, is “purposeful, informed, outcome thinking that:

  • is guided by standards, policies, ethic codes, and laws;
  • is driven by patient, family, and community needs, as well as nurses’ needs to give competent and efficient care;
  • is based on principles of the nursing process, problem-solving, and the scientific method;
  • focuses on safety and quality, constantly re-evaluating, self-correcting, and striving to improve;
  • carefully identifies the key problems, issues, and risks involved [while] including patients, families, and key stakeholders in decision-making early in the process;
  • uses logic, intuition, and creativity and is grounded in specific knowledge, skills, and experience; and
  • calls for strategies that make the most of human potential and compensate for problems created by human nature (e.g., finding ways to prevent errors, using technology, and overcoming the powerful influence of personal views).” (Alfaro-Lefevre, 2017, pp. 6-7).

In 1985, Benner first noted that critical thinking was based on attitudes and skills relative to logic, rationality, and reasoning (Benner et al., 2009). A person’s knowledge, skills, and attitudes (KSAs) drive their critical thinking. The Quality and Safety Education for Nurses (QSEN, n.d.) competencies, which focus on positive patient outcomes, highlight the importance of KSAs in student and graduate nurses. Table 1 shows the critical thinking opportunities that lead to clinical judgment.

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