clinical judgment

Instructions

Respond to the post below using the following approach:

• Suggest how the colleague’s advanced knowledge of the 3Ps also could aid him/her as a nurse educator. Based on the situation the colleague described, suggest how he or she might provide guidance to a patient, patient’s family member, nursing student, or staff in a clinical setting using advanced knowledge of the 3P (physical assessment, pathphysiology, and pharmacology.

• Justify your response with a 2 current Reference Classroom Resources Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation.

San Francisco, CA: Jossey-Bass. Chapter 2, 4, 5, 6, 10,12 Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing practice: Caring, clinical judgment, and ethics (2nd ed.). New York, NY: Springer. Chapter 7,8, 11 Post Clinical Situation

a new nurse on a cardiac step-down unit, I cared for a great deal of pulmonary and cardiac patients who required heart rate and oxygen saturation monitoring continuously.

Working nights, we cared for more patients than the day nurses did, which still happens today. I feel like despite it being night time the patients still require the same amount of care and it staffing should all be equal, maybe one day I will see that happen. I still remember the busy night I had on the step-down unit and how it did not end so well.

I was assigned six patients that evening, and it seemed like they all wanted me at the same time. I was a new nurse, and all I could think about is all the things I had to get done by a particular time. I had assessments to complete and chart for 8 p.m., medications due by 9 pm, blood sugars to check and cover by 10 p.m., provide bedtime care and snacks on my six patients. I was busy that night, but I felt as though I was getting things done from my long list of tasks that I had to complete.

I finally got to my last patient, and he was sleepy, resting with his eyes closed he would give a little moan when I was trying to talk to him, but that was about it. It was late, and he had no meds due for him at the time, so I thought it was best that I let him get his rest. As the night went on my other patients kept me quite busy. I felt as though I never stopped all night.

I was so thankful that Mr. M was sleeping and was one of my only patients who was not ringing the call bell or trying to get out of bed. My shift ended and I reported off to the day nurse relieving me and I was so grateful that I survived the night.

However, when I returned that night, I was surprised to find out that Mr. M had been transferred to the intensive care unit that morning. When the day nurse went to see him, she could not arouse him at all and ordered a stat ABG which showed his CO2 to be remarkably elevated requiring non-invasive mechanical ventilation which failed and shortly after required intubation.

From being a novice and not recognizing that this patient’s presentation was indeed a result of Hypercapnic respiratory failure and not just sleeping. Hypercapnia results from C02 retention and usually a result of hypoventilation (Abdo & Heunks, 2012).  When the alveoli are ventilated but not able to be perfused CO2 is retained, the accumulation of CO2 causes the pH of the blood to decrease resulting in respiratory acidosis and life-threatening complications if not treated (Abdo & Heunks, 2012).

I have since advanced my knowledge in three P’s; pharmacology, pathophysiology, and physical assessment and can now put it all together which has enabled me to gain more in-depth knowledge and better understanding (Laureate Education 2013b). As I have advanced my skills and experience, I have also gained clinical salience and can now respond to the change in a patient’s condition and intervene before they need a higher level of care and transfer to the ICU (Benner, Tanner, & Chesla, 2009).

Knowing about CO2 retention is great but its not enough, you need to be able to put all the pieces together and use clinical judgment to use that knowledge and experiences and be able to recognize patterns to make the best decisions for your patients (Laureate Education 2013a).  As an educator, it will be essential to reinforce problem-solving and not just the following protocol and completing tasks but also having the ability to have situation awareness.

Situation awareness is something that I did not have yet, which is the ability to notice the change in condition, interpret what was happening, and anticipate what the patient needs and what it could progress to (Laureate Education 2013a). This experience was a great learning experience for me, and I even use this example to help precept student nurses when they rotate to the ICU as a great teaching opportunity.   References Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing practice: Caring, clinical judgement, and ethics (2nd ed.). New York, NY: Springer. Laureate Education (Producer). (2013a). Clinical judgment [Video file]. Retrieved fromhttps://class.waldenu.edu. Laureate Education (Producer). (2013b). Course overview and advice [Audio file]. Retrieved from https://class.waldenu.edu. Abdo, W. F., & Heunks, L. M. (2012). Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care, 16(5), 323. https://doi.org/10.1186/cc11475