Determining Clinical Judgment Among Emergency Nurses During a Complex Simulation

Details

• Personal Author:
  Callihan ML ; Cole H ; Eyer JC ; Mohabbat S ; Rice M ; Robinson S ; Rogers S ; Stokley H ; Tice J ; Wolf L
• Description:
  Introduction: Clinical judgment is imperative for the emergency nurse caring for the acutely ill patients often seen in the emergency department. Without optimal clinical judgment in the emergency department, patients are at risk of medical errors and a failure to rescue. Methods: A descriptive observational approach using the Lasater Clinical Judgment Rubric evaluated nurses during a task that required recognition of clinical signs of deterioration and appropriate clinical care for simulated patients. Results: A total of 18 practicing emergency nurses completed only 44.6% of the patient assessments leading to low levels of clinical judgment throughout the simulation. Nurses expressed 4 levels of clinical judgment: exemplary (n = 1), accomplishing (n = 6), developing (n = 9), and beginning (n = 2). On average, nurses completed 69% of required tasks. Discussion: Assessments were completed less than half the time, demonstrating a breakdown in the noticing phase of clinical judgment. The nurses shifted to task completion focus with minimal use of clinical judgment. As the nurses remained task oriented, several medication and medical errors were noted while caring for the simulated patients. Experience and education did not influence observed clinical judgment among the participants. Given the extreme demands placed on the emergency nurse, it cannot be assumed that nurses have developed or can use clinical judgment when caring for their patients. Time and training targeting clinical judgment are essential for emergency nurse development. [Description provided by NIOSH]
• Subjects:
  Decision Making Emergency Responders Health Personnel Nervous System Occupational Health Safety
• Keywords:
  Author Keywords: Emergency Nurse Clinical Judgment Clinical Tests Cognitive Function Decision Making Emergency Care Failure To Rescue Health Care Workers Medical Examinations Nurses Patient Outcome Assessment

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• ISSN:
  0099-1767
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Alabama ; OSHA Region 4
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  222-235
• Volume:
  49
• Issue:
  2
• NIOSHTIC Number:
  nn:20067746
• Citation:
  J Emerg Nurs 2023 Mar; 49(2):222-235
• Contact Point Address:
  Michael L. Callihan, PhD, RN, CEN, Capstone College of Nursing, University of Alabama, 650 University Boulevard East, Tuscaloosa, AL 35401
• Email:
  mlcallihan@ua.edu
• Federal Fiscal Year:
  2023
• Performing Organization:
  University of Alabama at Birmingham
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Emergency Nursing
• End Date:
  20270630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5adfb184b45cfa3a50b91bf80b07ca1867ace227e28b208e4d5828487cd81674d47121072110272ef375491edc615d6ccd52468b53e0c864c5d6080b4265fcf3
• Download URL:
  https://stacks.cdc.gov/view/cdc/230007/cdc_230007_DS1.pdf
• File Type:
  [PDF - 254.96 KB ]