NURS 6341 Week 2: Clinical Judgment and Ethics Essay Assignment

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NURS 6341 Week 2: Clinical Judgment and Ethics Essay Assignment

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**

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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Discussion 2: Handling Ethical Dilemmas

Knowing the facts helps families make decisions, and [Sarah] Shannon tells her students they must be clear about the clinical issues because they have a moral responsibility to get it right before they talk to patients and families.… Once [students] are clear about the clinical issues they are dealing with and the treatment options available, she moves on to consider the role of the patient’s preferences in ethical decision making.… Next, she takes up quality-of-life issues, asking students to consider what deficits the patient will have if treatment is pursued. Finally, she introduces the ‘contextual features’ …, telling students sternly, ‘This is where we [healthcare providers] own our own biases.’…

—Benner, Sutphen, Leonard, and Day (2010, pp. 171–172)

Recall that Sarah Shannon, featured in the course text, is a nurse ethicist. She uses her specialty knowledge and expertise in ethics to guide her nursing students in following a framework for ethical analysis. Depending on your background, you may not be an expert in ethics; yet all nurses with advanced knowledge need to anticipate and understand the processes for resolving ethical questions in patient care.

In this Discussion, you draw on your practicum experience to exchange information and insights with colleagues on the nature of ethical dilemmas in specialties of interest and structures for resolving them.

To Prepare

• • Investigate how ethical situations or issues are handled in your practicum setting. What steps or structural elements are in place at the systems level within your practicum setting to address ethical dilemmas?
  • Think of an ethical dilemma that you observed during your practicum and how it was resolved. Consider what you know about the effectiveness of the systemic structure for addressing such dilemmas. Apply information from the text readings this week in evaluating this structure for strengths and/or areas for improvement.

Note: If you did not observe any ethical dilemmas during your practicum experience, you may identify a previous situation from the readings or a previous workplace.

• Research bioethics and nursing literature to find ethical best practices that might be beneficial to your specific practicum setting, or generally within any clinical setting.

By Day 4

Post an explanation of the systemic structure your practicum setting uses to address ethical dilemmas. Explain the effectiveness of this structure by identifying its strengths and/or areas for improvement. Finally, identify one best practice this setting might integrate into their process. Support your response with references to the current literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Validate an idea with your own experience and additional research.

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