Developing Nurses' Clinical Judgment in Pain & Sedation Management of Burn Patients

Background: Developing clinical judgment (CJ) is essential for safe nursing practice, especially when managing pain and sedation. Underdevelopment of CJ puts patients at risk for safety events. Local Problem: Half (50%) of the medication safety event reports in the Burn Trauma Intensive Care Unit (BTICU) involved analgesia and sedation drugs. Over half (53%) the nurses on this unit have less than two years of nursing experience. Methods: The Model for Improvement was used as the conceptual framework to create a simulation-based experience (SBE) focused on the pain management of burn patients and the development of CJ skills. Interventions: After piloting the simulation, 12 participants attended a 4-hour SBE with structured prebriefing and debriefing. Pre/post-simulation surveys were used to gather data from participants to assess demographic data, attitudes, perceptions, biases, and knowledge of administering analgesia and sedation medication. Awareness of the impact of implicit bias on CJ was also assessed. Post-simulation self-evaluation CJ scores were collected using the Lasater Clinical Judgment Rubric (LCJR). Results: The SBE resulted in an increase in knowledge, confidence, decision-making skills, and understanding of the influence of implicit bias on patient care. Post-simulation LCJR scores ranged from 29 to 39 (mean 34.83). Conclusions: Simulation is a feasible and acceptable method to increase knowledge, confidence, and decision-making skills and increase awareness of implicit bias in newer nurses, which may positively influence patient outcomes. An increase in CJ could not be determined through a single SBE, however future simulations will allow for trending participants' LCJR score over time.