Luknis - Capstone Scholarly Paper-2
Luknis - Capstone Scholarly Paper-2
Luknis - Capstone Scholarly Paper-2
Dakota M. Luknis
It is known that during World War I, the nurses were under extreme circumstances with
limited supplies, caring for hundreds, if not thousands of wounded soldiers on a daily basis. It
was at that time that they realized how important rapid triage was and it compelled nurses to rely
extensively on their clinical judgment to provide efficient care to as many soldiers as possible
(Connor et al., 2023). This led to nurses developing problem-solving skills as well as clinical
judgment skills. Over the years, this has continued to evolve into an important skill to learn in
our world of healthcare today. This paper explores the significance of nursing clinical judgment
in today's medical field, its application, and the role it plays in patient outcomes. Additionally, it
discusses a personal experience demonstrating the use of nursing clinical judgment in a patient
care setting.
Analysis, states that sound clinical judgment is the foundation of quality nursing care. The
American Association of Colleges of Nursing defined sound clinical judgment as the outcomes
of critical thinking in nursing practice (Manetti, 2019). Additionally, Dr. Manetti states “nurses
make a multitude of decisions in the clinical practice daily that call for careful thought because
the decisions made impact patient outcomes.” (Manetti, 2019). As nurses, we must notice the
most subtle of cues from either assessment of the patient, or a change in their vital signs to try
and prevent a deteriorating condition or complications regarding the patient's health issues.
Inevitably, this skill could take years to learn. There are a lot of concerns that novice nurses
(new graduates) do not have “sound clinical judgment skills'' and it is important to develop them
by leaning on the more experienced nurses to make the correct intervention decisions. Hospitals
must recognize this and allow nurse educators/administrators to develop training programs for
novice nurses, bridging the gap in sound clinical judgment. This, in turn, can lead to better
3
outcomes for their patients (Manetti, 2019). Additionally, it is imperative for nursing schools to
review evidence-based data and devise plans to incorporate clinical judgment into their
curriculum, thus establishing a solid foundation for good judgment in new nurses.
In my role as an Aeromedical Evacuation Technician within the United States Air Force,
the application of sound clinical judgment is not just a skill but a vital necessity in ensuring the
safe delivery of care during air transit. One could draw parallels to what the nurses experienced
during World War I, we have a lot of the same degraded circumstances while we are airborne.
We have to perform a rapid, yet extensive triage on any number of patients on the ground and
then get them up in the air as safely and as efficiently as possible. Our capabilities in the air are
rather remarkable because we are basically setting up a flying hospital, but with that also comes
risk. First and foremost, the aircraft environment poses unique challenges, characterized by its
inherently unsterile nature. As such, meticulous attention to wound care and infection prevention
becomes paramount to safeguarding patient well-being. Secondly, the transition to flight severs
heavy reliance on our clinical protocols (AECPs), collective experience, and collaborative
teamwork to make decisions that yields the best and safest results for our patients. Furthermore,
the stressors inherent to flight introduce an additional layer of complexity to patient care. The
physiological and psychological stress experienced during flight (stressors of flight) can
significantly impact patients, potentially exacerbating their conditions and hastening their
extended flights, to promptly identify and address any emerging concerns. Finally, despite being
equipped with a kit and an array of essential equipment, our available supplies are significantly
4
limited. The variability in patient load and the severity of their conditions pose a constant risk of
pivotal flight, marking the first time our team transported a patient requiring ECMO
(Extracorporeal Membrane Oxygenation) support. The urgency of the mission was underscored
necessitating immediate transfer to Texas. The gravity of the situation was compounded by the
deterioration within the hospital setting. In response to this critical scenario, a collaborative
effort ensued, bringing together the expertise of the US Army's medical team, our Aeromedical
Evacuation (AE) crew, and Critical Care (CCATT) specialists. Through extensive deliberation
and the application of clinical judgment, a collective decision was reached to embark on the
high-stakes journey to Texas, where a higher echelon of ECMO care awaited. Despite the
inherent risks associated with transporting a critically ill patient, including the potential for
adverse outcomes during flight, the consensus was to pursue this course of action in pursuit of
the patient's best chance of survival. I am happy to report that he ended up surviving the flight
and making a full recovery thereafter. Reflecting on this experience, I am filled with profound
admiration for the remarkable capabilities and advancements in medical technology that played a
imperative to begin this journey within nursing schools and gradually enhance it over time. To
quote Samantha Dix, “Educational experiences need to allow students to link concepts, provide
opportunity for decision making and encourage reflection to allow for the building of increasing
5
responsibility to not only acquire but also to actively apply the vital clinical judgment skills
honed in our skills labs and clinical rotations to the patient’s in the field. We can be the change
we want to see.
6
References
Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2023). Clinical judgement in nursing – An
Dix, S., Morphet, J., Jones, T., Kiprillis, N., O’Halloran, M., Piper, K., & Innes, K. (2021).
Perceptions of final year nursing students Transfer of clinical judgment skills from simulation to
https://doi.org/10.1016/j.nepr.2021.103218
Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,