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Jayme Pakalnis
under-go is student nurse into the formal title “Registered Nurse.” It becomes very
important that we are prepared to make this transition and have all the necessary tools to
become successful in doing so. A major component of this is using our best clinical
judgment when caring for our patients. When using our best clinical judgment we need to
interpret data such as past medical history, lab results, physical assessments, medical
orders, current and past diagnoses, and medications so we can provide the best care to our
patients.
simulation lab where we use manikins to act in place of patients and place us in an almost
realistic situation that we encounter in the hospital. In the lab, we are given a scenario and
have to put together the cues and data the patient reflects onto us in order to determine
the correct care plan. Students have to use their critical thinking skills in order in
implement interventions and have a successful outcome. If we do not act quick enough in
the situation the manikin’s condition gets worse warranting an intervention is needed.
This also becomes important with clinical judgment, that you are able to create a plan of
care in an appropriate amount of time. Being able to implement the cues of a patient with
objective and subjective data is crucial. If we cannot identify the cues given, the less
likely we will be able to provide the appropriate intervention. A research study conducted
between Human Patient Stimulation and student nurses shows this correlation using a
situation for a patient undergoing a vagal response in one situation and then cardiac arrest
in another. During the vagal response trial, students identified cues and interpreted them
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in order to make a judgment. Most of the students in this trial believed the human patient
stimulation were undergoing an issue with pneumonia or renal failure. These students
who interpreted the data incorrectly, were lest likely to make the best clinical judgment
on the patients behalf. In the other trial, students identified that the patient was in cardiac
arrest and even those who could not identified the cues were still able to make partially
prioritization are keep factors that go into making the best clinical judgment.
Another way we can learn in the stimulation lab to develop our clinical judgment
skills are by acting as an interdisciplinary team. Students usually use the lab in small
groups; each member of the group plays an important role in the scenario. The
pharmacists, social workers, and physical therapy as well as many other team members
depending on the patients needs. The family members also play an important role when
considering patient care. Each student is assigned a role in the scenario and is to act the
part while all are working amongst each other. Communication becomes a key aspect
when working together and can provide data that might not be found in a patients chart or
the patient may not be able to communicate him or herself. If the correct information is
exchanged, the more accurate our assessments will be in addition to making the correct
judgment of the situation. Debriefing after each scenario will allow use to utilize all
components used to see what could have done better and what we done successfully. This
becomes a learning opportunity for students as a way to see what skills need worked on
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in order to conduct the best plan of care and to see where our strengths are in the clinical
setting.
particular time where I was working with a 2-day post-op patient who underwent his
second liver transplant. Anyone who works with any kind of transplant patient
transition over smoothly. Two medications prescribed to this patient were CellCept and
Prograf, both of which are anti-rejection medications. When going into the pyxis system
to do 8 o’clock medications, the Prograf was not available in the patient’s medication
drawer. I went ahead and gave his other medications and then afterwards sent a message
to pharmacy that the medication was not available and for it to please be tubed up to our
floor. After over an hour of waiting to receive this medication, my nurse and I had to take
it a step further and to call down to the pharmacy. When calling, they said that they were
making their rounds and would be there soon to load it into the pyxis system. The
medication was now already over an hour late and it became crucial we received the
medication before then. We explained to the pharmacist that this patient had under gone
his second liver transplant and the medication needed to be sent to the floor. In this
situation, using our best clinical judgment to keep reaching a step further to receive the
medication was to act in place of advocating for our patient. My nurse and I acted
way as to how to further develop your own clinical judgment skills than to be on the floor
References
Lee, D. S., MA, BN, RN, Abdullah, K. L., DClinP, MSc, BNSc, Subramanian, P., , MEd,
Bachmann, R. T., PhD, MSc, & Ong, S. L., MSc, BNSc, PhD. (2017). An
integrated review of the correlation between critical thinking ability and clinical
doi:10.1111/JOCN.13901
Shelestak, D., Meyers, T., Jarzembak, J., & Bradley, E. (2015, June). A Process to Assess
https://eps.cc.ysu.edu:3253/ehost/pdfviewer/pdfviewer?vid=4&sid=2412d975-
362a-4c0d-9e0c-4d84dd7d184b@pdc-v-sessmgr02
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