Developing Clinical Judgment: An Analysis Of Learning Outcomes And Evidence

Learning Outcomes

At the beginning of the semester, I was able to set enthusiastic goals to be achieved after completing the course. As a trainee nurse, I have always strived towards ensuring that the services I offer to my clients meet the set global standards through advancement of effective personal judgments, use of scholarly and proven scholarly evidences when making decisions and enhancement of my reflection capabilities in fostering clinical assessments and judgments. Some of these objectives included:

• To inculcate evidence based practices when advancing professional decisions
• To identify a  competent nurse in practice as a role model in my decision making processes
• To acquaint myself with  professionally and clinically proven assessment techniques

The ensuing sections of the study undertake a critical analysis of the judgments based on the learning sessions of this course throughout the semester. Pertinent issues such as the learning outcomes, evidence, judgment and further action are assessed. Murray et al. (2015) and Patterson et al. (2016) describe the Gibb’s reflective model as one of the most effective frameworks of analyzing nursing modules that call for implementation contemplative writing. On the other hand, Lestander, Lehto and Engström (2016) explain that Gibb’s model embraces a reflective cycle with six stages that are identified as description, feelings, evaluation, analysis, conclusion and action plan.

At the beginning of the course, I had developed higher levels of optimism that the module would play a significant role in stirring my critical thinking abilities, my potencies in making clinical judgments that are well informed and based on scholarly evidences. Further, I had developed the vision of enhancing my interactions through the multiple media considered as avenues of enhancing the delivery of content for the module. Similarly, I had developed great expectations on the module’s ability to instill sober ways of developing my career as a future nurse by inculcating the skills needed to identify and do away with personal, interpersonal and institutional factors that could act as barriers to effective decision making.

The module was highly effective I developing my abilities to make clinical decisions that depict higher levels of professionalism. According to Dreifuerst (2015), Shaban, (2015) and Ten Cate et al. (2016), decision making in nursing as an area of practice calls for inclusion of avenues aimed at fostering critical reasoning, judicious reflections and decisive judgments. On the other hand, Jefford and Fahyz (2015); Gerber, Thevoz and Ramelet (2015); and  Øberg, Normann and  Gallagher (2015) reveal that a nurse’s levels of effectiveness in making decisions that are based on skillful thinking greatly rely on the scholarly knowledge acquired during training as well as their ability to pay attention on the issues of care that need to be prioritized. Consequently, the efficacy of the module in enlightening me on how advanced and skilled practitioners in nursing make their clinical decisions played a crucial role in developing my ability to explicate the issues of practice that could be considered to be salient as well as the capacity to avail evidence based responses to the prevailing situations.

Evidence

Similarly, the inherent capabilities of the instructors to teach pertinent topics contained in this module such as the barriers to effective decision making, advancing clinical judgments, relating the procedures of clinical evaluation to patient care and the essential roles of reflection in clinical practice played an essential role in changing the perspectives I initially held for nursing. Before undertaking the course, I considered nursing as a passive career in which practitioners were only required to offer bedside services among their patients. However, studying this module made me realize that nursing requires professionals that depict higher levels of capabilities by displaying the potencies of thinking in a critical way by applying inductions, personal deductions, defying certain known assumptions and viewpoints, and assessing the data availed in different settings as a blueprint of guiding their decision making endeavors. According to Ilgen, Eva and Regehr (2016); Thomson, Petty and Moore (2014), critical thinking calls for inclusion of professional experiences and the knowledge acquired in different settings while putting into consideration multiple possibilities in order to arrive at the desired endpoint. The fact that the syllabus acquainted me with diverse viewpoints on how effective professionals foster their decision making ventures challenged me to apply both the deductive and inductive cognitive potencies acquired in different areas of practice.

By relating the processes of clinical evaluation when delivering patient care through selection and implementation of the most appropriate tools, the course was highly influential in making me recognize the importance of social relationships in advancing the nursing profession. According to Baker-Ericzén, Jenkins, Park and Garland (2015), clinical reasoning and the nursing professional in particular thrives in an environment where the environment of practice allows for the development of an inclusive environment for the patient’s fami.ly members, the community and the multidisciplinary team of caregivers. For effective reasoning, Delany and Golding (2014) reveal that expert nurses must advance a role that place them at the center of the facilities they serve with their viewpoints being bounded by the issue under consideration. Consequently, the instructions availed by the module made me realize the fact that as a nurse, I must be socially concerned of the issues put forth by the people that may be affected by my actions. Further, the aspect of emotional reasoning as advanced by the instructor made me realize that to be an effective nurse, I must be able to show my capabilities of fostering emotional access to the family members of the patients I attend to while showing that I am  concerned with their particular healthcare requirements.  On the other hand, the module challenged me to develop the traits aimed at enhancing my relational skills as an aspect of understanding the needs and concerns of the clients I serve.

I achieved both the personal and subject goals set at the beginning of the semester. For instance, I had set the goal of acquiring a competent nurse that I would consider as my role model. Based on the module outcomes, it was a requirement for students to undertake a critical reflection of how advanced practitioners make their clinical decisions.  As a consequence, I made the step of creating professional relationships with nurses in the university’s infirmary. I consider the ties established with the leading RN in this facility as one of the most significant leaps in my career life. By observing the steps of this caregiver, I was able to change the perspectives I initially held about the profession. To date, I am well aware of the fact that nursing is an area of practice that requires the service of clinicians that are able to advance proper character, effective relational abilities as well as habits aimed at enabling them to comprehend and perceive the needs and concerns of their clients. On the other hand, the module was of great essence in developing my interaction potencies. Initially, most of my peers considered me as a person with minimal social skills. However, the fact that the syllabus included a compulsory online platform played a crucial role in enhancing my interactions. For instance, the platform allowed students to post their comments, respond to issues and even identify the flaws put forth by their peers.

I consider the entire process of learning this module to be of great essence in fostering both my career and social developments as a future nurse. In particular, the subject was of great influence in advancing my abilities to apply the knowledge acquired in class and personal experiences in identifying the problems put forth by the patients I will be offering my services to while applying the direct clinical adjudications that may result from patient outcomes. One of the most important aspects learned in this module is the fact that nursing is not a passive career but an area of practice that requires the advancement of critical thinking through integration of scholarly knowledge, clinical and social experiences, as well as clinical reasoning. I learned that realize that nursing requires professionals that depict higher levels of capabilities by displaying the potencies of thinking in a critical way by applying inductions, personal deductions, defying certain known assumptions and viewpoints, and assessing the data availed in different settings as a blueprint of guiding their decision making endeavors. Similarly, I gained insight of the fact that clinical reasoning and the nursing professional in particular thrives in an environment where the environment of practice allows for the development of an inclusive environment for the patient’s family members, the community and the multidisciplinary team of caregivers.

The knowledge acquired in this module was highly effective in advancing my clinical reasoning, judgment and decision making skills. At the beginning of the course, I had developed higher levels of optimism that the module would play a significant role in stirring my critical thinking abilities, my potencies in making clinical judgments that are well informed and based on scholarly evidences. While most of the goals I had initially set were effectively achieved, I feel that there is need for further actions to be undertaken. For instance, I believe that I may enhance my clinical judgment capabilities by enhancing my professional relationships. On the other hand, there is need for the module to increase the avenues of interaction in order to advance my communication competencies.

References

Baker-Ericzén, M. J., Jenkins, M. M., Park, S., & Garland, A. F. (2015, February). Clinical decision-making in community children’s mental health: Using innovative methods to compare clinicians with and without training in evidence-based treatment. In Child & youth care forum (Vol. 44, No. 1, pp. 133-157). Springer US.

Delany, C., & Golding, C. (2014). Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. BMC medical education, 14(1), 20.

Dreifuerst, K. T. (2015). Getting started with debriefing for meaningful learning. Clinical Simulation in Nursing, 11(5), 268-275.

Gerber, A., Thevoz, A. L., & Ramelet, A. S. (2015). Expert clinical reasoning and pain assessment in mechanically ventilated patients: a descriptive study. Australian Critical Care, 28(1), 2-8.

Ilgen, J. S., Eva, K. W., & Regehr, G. (2016). What’s in a label? Is diagnosis the start or the end of clinical reasoning?. Journal of general internal medicine, 31(4), 435-437.

Jefford, E., & Fahy, K. (2015). Midwives? clinical reasoning during second stage labour: report on an interpretive study. Midwifery, 31(5), 519-525.

Murray, D. J., Freeman, B. D., Boulet, J. R., Woodhouse, J., Fehr, J. J., & Klingensmith, M. E. (2015). Decision making in trauma settings: simulation to improve diagnostic skills. Simulation in Healthcare, 10(3), 139-145.

Øberg, G. K., Normann, B., & Gallagher, S. (2015). Embodied-enactive clinical reasoning in physical therapy. Physiotherapy theory and practice, 31(4), 244-252.

Shaban, R. (2015). Theories of clinical judgment and decision-making: A review of the theoretical literature. Australasian Journal of Paramedicine, 3(1).

Ten Cate, O., Hart, D., Ankel, F., Busari, J., Englander, R., Glasgow, N., … & Touchie, C. (2016). Entrustment decision making in clinical training. Academic Medicine, 91(2), 191-198.

Thomson, O. P., Petty, N. J., & Moore, A. P. (2014). Clinical decision-making and therapeutic approaches in osteopathy–a qualitative grounded theory study. Manual therapy, 19(1), 44-51.

Lestander, Ö., Lehto, N., & Engström, Å. (2016). Nursing students’ perceptions of learning after high fidelity simulation: effects of a three-step post-simulation reflection model. Nurse education today, 40, 219-224.

Patterson, C., Moxham, L., Brighton, R., Taylor, E., Sumskis, S., Perlman, D., … & Hadfield, L. (2016). Nursing students’ reflections on the learning experience of a unique mental health clinical placement. Nurse education today, 46, 94-98.