Clinical Nursing Judgement 1

Clinical Nursing Judgement

One of the biggest transitions from a student nurse to a new graduate nurse is clinical

judgement skills and critical thinking. While nursing school prepares the student for the

transition; one can never be too prepared. Research has been conducted to see what best helps

the student nurse become a register nurse. Concept mapping, simulation and precepting are

positive learning experiences that are implemented into most nursing schools.

Throughout the nursing program students are required to prepare concept maps. Concept

mapping has shown to improve critical thinking skills which is a huge part of clinical judgement.

Concept maps help the students link factors to patient care and foresee potential problems.

Having a mapped-out scenario that the student has created and displays the potential problems

for the patient in multiple ways. This allows students to see how one problem can lead to another

problem which leads to another. Concept maps can include interventions and patient responses

which aids the student nurse to develop clinical judgment. Lab values are commonly included

with the reason and potential problems from the abnormal values. One of the greatest asset of

concept maps is that it can be introduced during lectures, simulations, clinical experiences and

examples (VanDyke 2016).

Simulation is implemented throughout nursing school. The first few simulations most

students are nervous and do not know what to expect. At the end of the nursing program students

become more confident and know how to handle the situation. Simulations allow the students to

report confidence, critical thinking skills, importance of clinical judgement, observation of

students, and debriefing. Simulations require the student to implement critical thinking skills

while still doing the basics. Some simulations need quick interventions, or the patient could have

a poor outcome. Students are required to actively think through the problems in the real-life

scenario. If the student struggles through the simulation this is a prime time for a self-analysis
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and see what could have been performed differently. Not only does simulation promote self-

analysis, but a focus group and the instructor provide another perspective to the situation. One

downfall of the simulations are the students may not take the scenario serious, because of the

patient being a manikin. The feeling of anxious and stupid have promoted the student to reflect

back and explain what should have been done and what to expect in the real world (Weaver

2013). As students progress through a nursing program they become more comfortable with

simulations and take away more from the scenario. One of the most important aspects of

simulation is the debriefing at the end. This allows the students to converse and explain why they

did a step before the other. The instructor can intervene and give reasoning behind the steps that

should have taken place.

The last part of developing clinical judgement while still in school is when the student

brings it all together during their preceptorship. According to Lawlor, there are five steps to

precepting called 5Mp Steps. The first step is when the preceptor allows the student to take a

stand and withholds initial comments. The second step is when the preceptor asks the student for

supporting evidence for the response the student gives. This develops critical thinking and

reasoning behind the actions the students have conducted. Step three could be considered the

most important because this is when the preceptor teaches the student. Step four is giving

positive reinforcement to the student to build confidence. The last step is correcting the student’s

errors or any misinterpretations. This is another learning experience for the student. The

preceptor can give constructive criticism to the student.

During my preceptorship at UPMC Horizon in the CCU I have seen step 4 come into

play. Not only to me, the student, but to the whole staff. A new implementation UPMC has

started is starting every meeting and report off with a win. I believe that the preceptorship has the
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most involvement of the student and allows them to develop clinical judgment. At this point in

our nursing careers we still need a crutch at times. This is when the preceptor comes into play

when the student needs to double check with another person before we are the second check.

As a student nurse at Youngstown State University I have taken part in concept mapping,

simulation and precepting. Concept mapping has helped me develop clinical judgement by

seeing the importance of interventions along with patient’s response. Simulation is something a

student needs to become comfortable with, because it greatly helps improve clinical judgment.

While no life is on the line it simulates one is. Throughout the nursing program there have been

simulations when the instructor would have the patient crashing and the student nurses did not

how to respond. Luckily the patient was a manikin at this time. This made me realize that no

action is an action. The debrief with the instructor was very beneficial. This allotted time for the

students, including myself, to reflect back and see where the mistakes were and what should

have been done.

I had a situation where I had to use clinical judgement during my preceptorship quickly.

A code was being called on the floor and being a part of the CCU team we are required to be

there. Essentially the patient was bottoming out after a knee replacement. First, I assessed the

situation and got a very quick report from the patient’s nurse. While one nurse was getting a

manual blood pressure I was putting on the EKG leads, another nurse was getting a glucose

reading, and another nurse was setting up the IV pump to run fluids through. Within minutes we

had a blood pressure of 60/48 and a glucose reading of 98. We were lucky enough that the

patient had a viable IV site that was saline locked. The patient was going in and out still. A nurse

made the call to get the patient back in bed. Physical therapy was standing out in the hall, so we

called them in to help move the patient back to bed. Physical therapy wanted to pick the patient
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up by the body. We immediately intervened and said to use the blanket underneath here. With a

coordinated the patient was back in bed laying supine with the head of the bed lower. The patient

began to wake up and started communicating with the nurses. After a little bit longer, the patient

even made a joke. As a part of the CCU team we asked the attending physician if the patient

would be coming back for closer monitor, but the doctor said no.

Every team member that was involved in this situation had to use clinical judgment

myself included. This showed me that clinical judgment comes with experience and everything

happens very quickly. The more experienced nurses already knew what to expect next while I

was a step behind. Nerves also slowed me down with this being my first code I was actually a

part of. The three topics discussed early help develop clinical judgment, but nothing is better

than first-hand experience where you are being tested. A person never can be too prepared for a

situation.
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References

Lawlor, Yvonne. (2011). A Clinical Teaching Technique for Nurse Preceptors: The Five Minute

Preceptor. Retrieved Mach 01, 2018 from, www.professionalnursing.org/article/S8755-

7223(10)00119-5/fulltext.

Vandyke, Olga. (2016). Impact of concept mapping on the development of clinical judgment

skills in nursing students. Retrieved March, 01, 2018 from,

http://www.jtln.org/article/S1557-3087(16)00010-X/fulltext

Weaver, Christy. (2013).Simulation Evaluation Using a Modified Lasater Clinical Judgment

Rubric. Retrieved March 01, 2018 from

https://search.proquest.com/docview/203965988?pq-origsite=gscholar