NURS 6341: Week 2: Clinical Judgment and Ethics Essay Assignment Paper

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NURS 6341: Week 2: Clinical Judgment and Ethics Essay Assignment Paper

NURS 6341: Specialty in Clinical Nursing | Week 2

If you judge, investigate.

—Seneca

Think back to your early clinical experiences as a nurse. How did you apply your developing knowledge of physical assessment, pharmacology, and pathophysiology (the 3Ps) in making care decisions for your patients? How did you learn to prioritize, to know what was needed most or must be done first in a routine situation or, even more vitally, in an acute one?

Although you may have a variety of answers to those questions, consider the dictum above from the ancient Roman philosopher and how it applies to clinical judgment. The changing nature of illness demands constant investigation into the condition and needs of a patient. The many human variables among patients and health care professionals make working from assumptions the potential seeds of error.

As you enter the clinical setting as an advanced nurse, the expansion and application of sound clinical judgment is still your priority. However, looking ahead to your role as a nurse educator, you can use your practicum experience to investigate how increased knowledge of the 3Ps contributes to clinical judgment.

Learning Objectives

Students will:

• Evaluate the impact of advanced knowledge of physical assessment, pharmacology, and pathophysiology (3P) on clinical judgment
• Analyze influences of advanced knowledge of physical assessment, pharmacology, and pathophysiology on nurse educators
• Construct learning objectives to guide practicum experiences
• Evaluate contributions of practicum learning experiences to personal development as an advanced nurse educator
• Evaluate systemic structures for effectiveness in addressing ethical dilemmas
• Analyze ethical best practices
• Evaluate a practicum experience in the context of quality indicators*
• Evaluate evidence-base of quality indicators*
• Construct a detailed practicum log**

* You continue working on the Assignment related to this Learning Objective, first introduced in Week 1 and submitted in Week 3.

** You continue working on the assignment related to this Learning Objective, first introduced in Week 1 and submitted in Week 3.

Learning Resources

Required Readings

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.

• • Part Two, “Teaching for a Sense of Salience” (pp. 93–95)

 

This introductory section describes the challenge of guiding nursing students in making the transition from textbook learning to the actual clinical experience.

 

• • Chapter 5, “Paradigm Case: Diane Pestolesi, Practitioner and Teacher” (pp. 97–108)

 

This chapter spotlights a veteran nurse educator and advanced critical-care nurse and how she draws from her own practice in teaching nursing students.

We have advanced nursing paper writers to help on NURS 6341: Week 2: Clinical Judgment and Ethics Essay Assignment Paper

• • Chapter 6, “Strategies for Teaching for a Sense of Salience” (pp. 109–126)

 

The authors describe specific strategies (for example: using questions, rehearing for practice, or reflecting on learning) for guiding and supporting application of knowledge in a clinical setting.

• • Part Four, “Teaching for Moral Imagination” (pp. 165–167)

 

• • Chapter 10, “Paradigm Case: Sarah Shannon, Nurse Ethicist” (pp. 169–175)

 

• Chapter 12, “Formation from a Critical Stance” (pp. 201–209)

Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing practice: Caring, clinical judgment, and ethics (2nd ed.). New York, NY: Springer.

• • Chapter 7, “Clinical Judgment” (pp. 199–232)

Through commentary and interviews with expert nurses, the authors present how clinical judgment develops and how skilled nurses apply decision making in patient care.

• • Chapter 8, “The Social Embeddedness of Knowledge” (pp. 233–278)

This chapter considers the social aspects of skilled nursing, including the role of engagement with patients and families in order to become more finely attuned to a patient’s signs, symptoms, and needs; as well as the importance of sharing perspectives and learning from expert nurses in a clinical setting.

• • Chapter 11, “The Nurse-Physician Relationship: Negotiating Clinical Knowledge” (pp. 335–367)

The authors discuss changes over time in the physician-nurse hierarchy and the expanding role of nurses in providing clinical support and guidance to physicians. Based on studies that demonstrate better patient care and outcomes when there are positive relationships between nurses and doctors, they make the case for more cooperation and recommend approaches for negotiating with physicians on patient care decisions.

Required Media

Laureate Education (Producer). (2013). Clinical judgment [Video file]. Retrieved from https://class.waldenu.edu.

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Pat Ebright and Dr. Mary Sitterding discuss how nurse educators use advanced knowledge on the 3Ps to improve their clinical judgment, as well as the clinical judgment of those they teach.

Discussion 1: Clinical Judgment in Practice Settings

“I had a sense of what was going on, and I looked at the patient and there were two things that I noticed right off. One [was] that her abdomen was very large and very firm, and the other thing that her knees were mottled, and I said, ‘She has a dead bowel.’ And they said, ‘She doesn’t have a dead bowel.’ And I said, ‘She has a dead bowel.’ All right, trying to back off a little bit, I said, ‘Would we consider that maybe she has an ischemic bowel’.

The poor nurse taking care of the patient was devastated… because she had been trying to manage this all morning and not having the experience. She’s kind of going along with what they’re doing, which is, which is fine. If you don’t know, how can you, you just don’t know.”

—Benner, Tanner, and Chesla, 2009, pp. 227–228

Recall this nurse’s story from this week’s readings. Ultimately, the attending physician and others did not respond to the expert nurse’s clinical judgment in time to save the patient. Consider the lessons in this anecdote of how this nurse repeatedly applied her 3P knowledge in both her care and advocacy for the patient. In addition, reflect on the feelings of the novice nurse. Despite her best efforts, why did the patient’s true health care needs initially go unnoticed?

To Prepare

• Reflect on past clinical situations, particularly your first nursing experiences that required basic knowledge of the 3Ps.
• Select one clinical situation to revisit for this Discussion. Your example should be one that you are comfortable sharing with colleagues and would consider offering as a learning example to those you will teach as a nurse educator.
• Think back to the details of the specific situation (e.g., the setting; the patient; your role; others involved, such as clinical staff and patient’s family members) and how you provided patient care. Then consider your current 3P knowledge and how it has advanced since this particular situation occurred.
• Imagine being faced with a similar patient and/or situation today and consider how your current 3P knowledge might impact your clinical judgment. What might you do differently? What other knowledge might contribute to your clinical judgment today that was not present or as developed in the past?

By Day 3

Post a brief explanation of the clinical situation that you selected, including the clinical environment and your role in the provision of patient care. Explain how your 3P knowledge has advanced since this situation and how it might impact your current clinical judgment in a similar situation. Justify your response with references to this week’s Learning Resources and current literature as appropriate.

Read a selection of your colleagues’ responses.

By Day 5

Respond to at least two of your colleagues on two different days 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 3Ps.

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