Clinical Judgment Is The Process Of Integrating Evidence Bas

Clinical Judgment Is The Process Of Integrating Evidence Based Practic

Clinical judgment involves the integration of evidence-based practice, critical thinking, the Nursing Process, knowledge, skills, attitudes, and the application of theory to practice with the goal of providing safe, high-quality care to clients across diverse healthcare settings. It requires nurses to assess situations critically, analyze data, and make informed decisions to prioritize patient needs and interventions effectively. This process is essential in emergency departments, where rapid and accurate judgment can significantly impact patient outcomes. In this context, effective clinical judgment ensures that each patient receives appropriate care based on their unique condition, current evidence, and nurse expertise.

Consider a scenario in a busy urban emergency department with a diverse nursing staff, including an experienced trauma nurse, a new graduate nurse, and a nurse from a medical-surgical background. Assigning the appropriate patient to each nurse requires evaluating the complexity of each case, the nurses’ experiences, and the critical nature of the patients’ conditions. A 76-year-old involved in a motor vehicle accident presents with hematuria, indicating potential renal or urinary tract injury; a 38-year-old with kidney stones experiences severe pain; a 24-year-old with diabetes has an urinary tract infection requiring discharge teaching; and an 80-year-old with no bowel movement in four days involves a concern for possible bowel obstruction or dysfunction.

Paper For Above instruction

In an emergency department setting, nurse staffing and patient assignment are critical components that can influence patient outcomes significantly. Effective clinical judgment, heightened by experience and knowledge, guides these decisions to ensure safety, efficiency, and high-quality patient care. This paper explores the optimal assignment of patients to nurses with varying backgrounds and experience levels, considering the acuity and complexity of each case, supported by relevant literature.

The experienced trauma nurse, with 12 years of ED experience, is well-versed in handling complex cases involving trauma, severe injuries, and acute emergencies. According to Benner’s Model of nursing expertise, such seasoned nurses have developed intuitive clinical judgment capable of promptly recognizing subtle changes in patient conditions (Benner, 1984). Given the patient's presentation, the 76-year-old involved in a motor vehicle accident with hematuria should be assigned to this nurse. Hematuria in trauma patients raises concern for renal trauma, bleeding, or other potentially life-threatening injuries, demanding swift assessment, stabilization, and decision-making skills. The trauma nurse’s expertise equips her to prioritize interventions, coordinate diagnostic tests like imaging, and alert physicians promptly, thereby preventing deterioration (Guerra, 2020).

The new graduate nurse, with six months of ED experience, is still developing clinical judgment skills and requires cases that allow safe learning while ensuring patient safety. She may have limited exposure to managing complex trauma cases but can handle patients with less acute needs or those requiring education and routine care. In this scenario, the 24-year-old diabetic patient with a urinary tract infection in need of discharge teaching is well-suited for this nurse. Managing uncomplicated infections and providing patient education falls within her capacity, fostering her confidence and skill development while maintaining safety standards (Turner & McCarthy, 2019). This assignment also allows her to practice communication skills and reinforce her knowledge of diabetes management without the immediate pressure of critical emergencies.

The nurse from the medical-surgical unit with eight years of experience possesses a broad skill set applicable to various patient scenarios, especially those involving chronic health conditions and complex assessments. This nurse’s experience with diverse patient populations, including elderly care and chronic disease management, makes her suitable for managing the elderly patient who has not had a bowel movement in four days. The concern for possible bowel obstruction or severe constipation requires careful assessment, monitoring, and potentially less emergent interventions, making this nurse well-equipped to handle the case confidently (Potter & Perry, 2021).

In conclusion, assigning patients based on the nurses' experience and the complexity of each case optimizes patient safety and care quality. The trauma nurse is best assigned to the trauma case with hematuria; the new graduate is suited for the uncomplicated infection requiring education; and the experienced medical-surgical nurse is appropriate for an elderly patient with bowel issues. Such strategic allocations, rooted in clinical judgment, enhance team efficiency and improve patient outcomes in high-pressure environments like the emergency department.

References

• Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Prentice Hall.
• Guerra, J. (2020). Trauma nursing: Managing complex injuries in emergency settings. Journal of Emergency Nursing, 46(3), 297-305.
• Potter, P. A., & Perry, A. G. (2021). Fundamentals of Nursing (12th ed.). Elsevier.
• Turner, J., & McCarthy, S. (2019). Nursing Education and Clinical Judgment Development. Nursing Education Perspectives, 40(5), 285-289.
• Jefferies, D., et al. (2018). Critical thinking and decision making in nursing. Sigma Theta Tau International.
• Billings, D. M., & Halstead, J. A. (2016). Teaching in Nursing: A Guide for Faculty. Elsevier.
• Benner, P., Tanner, C., & Chelminski, P. (2010). Expertise in nursing practice: Caring, clinical judgment & ethics. Springer Publishing Company.
• Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. Prentice Hall.
• McKenna, H. P., et al. (2020). Developing clinical judgment in nursing students. Nurse Education Today, 84, 104259.
• Walker, J. (2018). Evidence-based practice in nursing: How to make clinical decisions. Journal of Nursing Education, 57(1), 4-12.