2 21 23 Capstone Paper
2 21 23 Capstone Paper
2 21 23 Capstone Paper
Kelsey Rising
The concept of clinical nursing judgement has been around long before even Florence
Nightingale became a nurse. This skill can be innate or learned, but is essential to the nursing
practice. Without proper nursing judgement underlying symptoms might go undetected, patients’
needs might not get met, and care may become lackluster. I have been grateful for the
opportunity to strengthen my clinical nursing judgement over the last four years, so that I can
Over the last four years, in my clinical and work experience, I have encountered many
different patients that have challenged me in many different ways. Experiencing a variety a
diagnoses, patient backgrounds, and demeanor has allowed me to become very adaptable to a
multitude of situations. I believe experience is one of the main ways to develop clinical nursing
The definition of clinical nursing judgement to me is the ability of the nurse to adapt to
many situations, anticipate patients needs, and think analytically to provide the best possible care
for each patient. This definition is purposefully vague because I think that each person defines it
a little bit differently. It is a very personal attribute, and each person knows what their strength is
Over the next few paragraphs, I will discuss a few patients that I believe really helped me
to develop my own clinical nursing judgement. These patients challenged me, and helped me to
grow into the nurse I am today. These situations were complex and made me use my critical
thinking skills. I will also offer some research articles that relate to the patients I present in this
piece.
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An Exploration of End of Life Care in the MICU
One patient that stands out among the rest is one that I took care of during my Complex
Care clinical last semester. I had clinical at St. Elizabeth Youngstown hospital in the MICU unit.
I was the first one to arrive, and my clinical instructor always gave the best, worst, or most
interesting patient on the unit. So I got a patient that allowed me to use my nursing judgement
often! This patient that I was caring for that day was found on the floor after falling and lying
there for days. This patient had extensive wounds on one side of the body that actually attracted
maggots while lying on the floor. In a research article I later read, I found out that maggots are
beneficial to wound healing, as they naturally debride the tissue and eat any potentially
pathogenic bacteria (Yoshida, 2022). They were in severe respiratory distress, on a ventilator,
and had the most IV lines connected to one patient that I had ever seen before. There were so
many that the nurse took the time to use sticker labels and organize all of them. This was an
unusual case because the routine patient care I was used to giving such as wound dressing
changes, suctioning, turns, morning and afternoon medications did not occur. What I was used
to, and how most of my days prior to this one had been organized, went out the window. We
were doing everything we could to keep this patient alive to see their family for one last time.
My day was turned on its head, and I relied on my clinical judgement to get me through. When it
was time to get vitals, but the family had just gathered in the room to reminisce, I had to use my
intuition and judgment to realize that vitals were not a worthy interruption at that time. The
patient had extensive wounds that needing dressing changes and I so badly wanted to be the one
to change them. However, we did not even touch the tape. Doing so could’ve thrown off the
delicate balance the patient was maintaining and throw them into an even worse state. All care
and interventions were focused solely on maintaining the state they were in and nothing more.
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An Exploration of End of Life Care in the MICU
This patient was in such a fragile state that we were touching them as little as possible in an
On top of the fact that they were such a high acuity patient, this case also had a heavy
mental load. They were considered a confidential case due to the nature of how they were found.
Only the police were allowed to say who could have information on this patient because a
criminal charge was being processed to a family member for allowing the patient to remain in
such a state of disrepair. The other family members were estranged and had not seen the patient
for many years. I was able to witness a call to the daughter of the patient who hadn’t seen the
patient in over three years. That phone call was very difficult to sit through, and the nurse on the
patients case had to call a few other people and have the same conversation. In an article I
discovered, the quality of communication given over the phone from nurse to family members
can aid in decision making, assure, comfort, and support the patients family in times of need
(Dees, 2022). This is especially critical when the patient is gravely ill and the family has to step
up to be the decision maker for the patient due to an inability on the patients part. To see their
reaction to seeing their family member in this state was heartbreaking. They had a family
meeting on the day I was caring for the patient and ultimately decided to change the code status
of the patient from Full to DNR-CC. The meeting was held in a private room on the unit and
lasted for over an hour. These meetings are imperative to communicate with family members so
the patients wishes and needs an be fulfilled. In a study I read, it showed that these types of
meetings facilitated less psychological stress, fewer unmet needs, improved quality of life, and
better end-of-life care for the patient (Hudson, 2021). These things are all very important when
dealing with the stressful situation of having a family member in the hospital and then
transitioning into letting them go and anticipatory grief. Later that day, after my clinical day had
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An Exploration of End of Life Care in the MICU
ended, the patient sadly passed away. I grieved that day because I had never taken care of a
patient so sick before, but looking back I am very grateful to have had that experience with the
support of my clinical group and instructor. This day, and many others on the MICU, is what led
References
Yoshida, T., Aonuma, H., Otsuka, S., Ichimura, H., Saiki, E., Hashimoto, K., Ote, M.,
Matsumoto, S., Iwadate, K., Miyawaki, T., & Kanuka, H. (2022). A human tissue-based
assay identifies a novel carrion blowfly strain for Maggot debridement therapy. Scientific
Reports, 12(1). https://doi.org/10.1038/s41598-022-16253-9
Hudson, P., Girgis, A., Thomas, K., Philip, J., Currow, D. C., Mitchell, G., Parker, D., Liew, D.,
Brand, C., Le, B., & Moran, J. (2020). Do family meetings for hospitalised palliative care
patients improve outcomes and reduce health care costs? A cluster randomised trial.
Palliative Medicine, 35(1), 188–199. https://doi.org/10.1177/0269216320967282
Dees, M. L., Carpenter, J. S., & Longtin, K. (2022). Communication between registered nurses
and family members of Intensive Care Unit Patients. Critical Care Nurse, 42(6), 25–34.
https://doi.org/10.4037/ccn2022913