Luknis - Capstone Scholarly Paper-2

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 6

1

Sound Clinical Judgment: A Crucial Skill in Nursing

Dakota M. Luknis

Bitonte College of Health and Human Services, Youngstown State University

NURS 4850: Capstone

Dr. Randi Heasley

February 26th, 2024


2

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.

According to Dr. Manetti, author of Sound Clinical Judgment in Nursing: A Concept

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

our direct communication channels with ground-based healthcare professionals, necessitating a

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

deterioration. As such, maintaining vigilant oversight becomes imperative, particularly during

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

depleting our resources.

An example illustrating the application of sound clinical judgment occurred during a

pivotal flight, marking the first time our team transported a patient requiring ECMO

(Extracorporeal Membrane Oxygenation) support. The urgency of the mission was underscored

by the US Army's identification of a servicemember in critical condition in Washington state,

necessitating immediate transfer to Texas. The gravity of the situation was compounded by the

presence of an undisclosed/unidentified internal bleed, precipitating the patient's rapid

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

pivotal role in shaping the outcome of this critical situation.

In conclusion, to witness a meaningful improvement in nurses' clinical judgment, it is

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

knowledge and understanding.” (Dix et al., 2021). As students, we bear a significant

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

evolutionary concept analysis. Journal of Clinical Nursing, 32, 3328–3340.

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

clinical practice: A qualitative study. Nurse Education in Practice, 56, 103218.

https://doi.org/10.1016/j.nepr.2021.103218

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102–110. https://doi.org/10.1111/nuf.12303

You might also like