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Scholarly Paper
Putting it to use
Kristen Johnston
3/19/2018
As a Registered Nurse we are the ones who do the hands on care with the patients.
Nurses are the ones giving the medicines, putting in Foley catheters, wound dressing changes
and any other patient care. That is why clinical nursing judgement is so important. Nursing
Clinical judgement is the most important factor that helps decrease the incidence of injury to a
patient (Pouralizadeh, Khankeh, Ebadi, Dalvandi, 2017). Through-out nursing school we are
told that clinical judgement is one of the most important parts of being a nurse. Each semester
since our sophomore spring year we have had clinicals each semester and we were always told
use your clinical judgement; which I did not feel like we could do as a nursing student! We
always had an instructor go with us into a patient’s room to give medicine or do a dressing
change, or insert a Foley Catheter; we were never really by ourselves to be able to use clinical
judgement. Since we are doing our preceptorship we are given more freedom to be able to make
clinical judgement decisions. Clinical judgement is a very important part of the nursing process.
Research has shown that there are five factors that influence nursing student clinical
judgement “thoughtful behavior, professional ethics, use of evidence based care and context of
(Pouralizadeh, Khankeh, Ebadi & Dalvandi, 2017). All of these things we learn in nursing
When we first heard of concept maps we all decided immediately that we hated them and
we did not understand why they were making us do this. According research making concept
maps are one way to build critical judgement skills (Gerdeman, Lux, Jacko, 2017). Concept
mapping; everyone loved to complain about them! Even though we did not like them; they truly
did help us develop critical judgement. They helped us understand if this is a problem what can
we do to try and help this problem. Looking back now I wish I would have just tried a little
harder when working with them; when we did them I just thought they were away for the
professors to just give us busy work. Concept maps help us nursing students make better clinical
This semester we are all working side by side with our preceptor; which allows us to us
our clinical judgement that we have developed throughout our class career. One way that I
showed my clinical judgement was on my 5 day of doing my preceptorship. I had a patient who
was 58 years old; was admitted for nausea and vomiting. The patient had a history of diabetes
mellitus, hypertension, GERD, congested heart failure, and depression. This patient was to be
given Lantus, metformin, aspirin, Humalog, protonics, lovenox, and Lasix. At the beginning of
our shift the patient’s blood sugar was 70, the night nurse gave her crackers and a juice to drink,
and said she should check it again before we gave her any of her medicines. The patient was
asymptotic so it wasn’t an emergency situation. My preceptor gave me all of her medicines and
told me to go give her the medication and do my assessment on the patient. Before I gave her the
medicines a re-checked her blood sugar; which was 82. After I did that I went to talk to my
preceptor.
With my patient’s blood sugar being so low I did not think it was a good idea to give her
all of these blood glucose medicines. Her blood glucose was already on the low side and I did
not want it to drop any more than it already had. When I told my preceptor we decided to hold all
of her medicines and call the attending physician to see what they wanted us to do. We both
know that that was too much blood glucose medicine. My preceptor said we need to talk to the
charge nurse and get her opinion on what we should do. She agreed with us that was too much
medicine for her blood glucose. This patient has been there for two days before me and Latosha
had her as a patient. We had to make a call out to the doctor and explain that her blood glucose
was kind of low and we did not think it was a good idea to give her all the blood glucose
medicine. In the end the doctor told us to give the metformin, and hold everything else. We
used our clinical judgement skills when dealing with this patients low blood glucose levels and
the amount of diabetic medicine she was on. Later in the day our patient’s blood glucose went to
120 around lunch time. My preceptor told me that she see things like this happening all the time;
which is sad.
This is just one example of when I had to use clinical judgement. As nursing
students we have studied ways in using clinical judgement but until now some of us having got
to use what clinical judgement skills we learned. As we become registered nurses we will get to
use this skill more. Clinical judgement is something that we learned and when we apply it we can
do great things, and help save lives. Our classes teach us about diseases, how they happen and
what’s going on inside the body; what medications should be given to a person with this disease
process, and how to pass the NCLEX, but learning about it is one thing; but actually getting to
POURALIZADEH, M., KHANKEH, H., EBADI, A., & DALVANDI, A. (2017). Factors
Analysis in an Iranian Context. Journal Of Clinical & Diagnostic Research, 11(5), 1-4.
doi:10.7860/JCDR/2017/25753.9822
Gerdeman, J. L., Lux, K., & Jacko, J. (2013). Using concept mapping to build clinical judgement
skills. Capital University , 13(1), 11-17. Retrieved March 117, 2018, from
http://www.nurseeducationinpractice.com/article/S1471-5953(12)00104-7/pdf
POURALIZADEH, M., KHANKEH, H., EBADI, A., & DALVANDI, A. (2017). Factors
Analysis in an Iranian Context. Journal Of Clinical & Diagnostic Research, 11(5), 1-4.
doi:10.7860/JCDR/2017/25753.9822