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Scholarly Capstone Paper
Scholarly Capstone Paper
Scholarly Capstone Paper
Shauna Letcher
To define clinical nursing judgement, one must break down the words individually to
completely understand the definition. Webster dictionary has definitions for clinical, nursing and
judgment. Clinical is defined as relating to the observation and treatment of actual patients
rather than theoretical or laboratory studies. Nursing is defined as a profession within the health
care sector focused on the care of individuals, families, and communities so they may attain,
maintain, or recover optimal health and quality of life. Judgement is defined as the ability to
establishing a plan of care, and evaluating the outcome of the care provided, resulting in the
generation of reasoned judgements. (Sedgwick, M. G., Grigg, L., & Dersch, S.)
When those definitions are analyzed separately and then analyzed as a whole, one can
conclude that clinical nursing judgement in laymen terms is coming to a clear and concise idea in
relation to the patient via the data collected through the nursing process. It is imperative for
nurses and physicians to have sound observational and reasoning skills to make the best possible,
responsible clinical judgement to treat the patient and their vast conditions. Reasoning and
critical thinking is acquired through knowledge, experience and is crafted over time. (Thompson,
C., Aitken, L., Doran, D., & Dowding, D.) “Deep clinical reasoning and decision making is a
function of reflection and self-correction that requires a critical self-awareness and is more about
how nurses think than what they think. The degree of sophistication in reasoning of experts and
novices is at times equivalent in that the reasoning of experts and novices can be somewhat
limited and focused primarily on human physicality and less on conceptual knowledge. To
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SCHOLARLY CAPSTONE PAPER
become proficient in clinical reasoning, practice is necessary.” (Sedgwick, M. G., Grigg, L., &
Dersch, S.)
Importance
If nurse graduates do not have the ability to think critically or have poor clinical
reasoning skills, they often fail to detect impending patient deterioration, including failure to
synthesize and act on clinical information (Van Graan, A. C., & Williams, M. J. S.) When
patients are in the care of nurses, the nurse becomes their caregiver, nurturer, healer and
advocator. Without the development of the clinical nursing judgement skill, the nurse will be
lacking in the areas of caregiving, nurturing, healing and advocating. Nurses must be able to use
their skills that they have homed in on in their clinical experiences and work experiences to
accurately use the nursing process of assessing, diagnosing, outcome identification, planning,
implementation and evaluating. Using the nursing process accurately allows the registered to
nurse to appropriately make clinical decisions, health promotion and recommendations to the
patient’s physicians. “Deep clinical reasoning and decision making is a function of reflection and
self-correction that requires a critical self-awareness: awareness of the need to seek out the best
The role of the nurse is becoming increasingly more complex as the health care
environment has come to demand an emphasis on patient-centered care, patient satisfaction and
evidence-based practice. (Berragan, L.) Research in the medical field is constantly changing,
morphing to the new research the is constantly coming to light. It is the registered nurse’s
responsibility to keep up on their skills, their research, and their clinical practices. This is why
registered nurses are required to continue their education through certifications and conferences.
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SCHOLARLY CAPSTONE PAPER
Personal Experience with Clinical Nursing Judgement
Every clinical experience the past three years has been giving nursing students the
experiences they require to gain the confidence, skill, and professionalism to adequately assess
their patients. “Nurse graduates have to be able to think critically and innovatively, should be
competent in reflection and self-critique, synthesize information, link concepts and become self-
directed lifelong learners. They must also be able to decide when and why higher order thinking
is essential. This will have a positive impact on patient outcomes as required for competent,
nursing judgement portrayed by my precepting nurse. Many patients walk through those
emergency room doors every day, some traumas, others just have the flu, but both patients alike
require the proper assessment, diagnosis, outcome planning, implementation, and evaluation.
One particular instance my precepting nurse showed great clinical nursing judgement and
advocacy for our patient, this particular patient came in the with flank pain and was diagnosed
with a kidney stone migrating in their ureter via cat scan. My preceptor nurse had been
questioning the providers orders all day, believing the provider was ordering unnecessary tests
impertinent to their chief compliant. After ordering unnecessary tests all morning, my nurse
finally advocated for our patient when the provider ordered Bentyl (Dicyclomine) for our patient
with kidney stone pain. Bentyl (Dicyclomine) is a medication used for stomach cramping in
individuals who are diagnosed with irritable bowel syndrome. My precepting nurse found the
order to be inappropriate for his diagnosis, held the order, contacted pharmacy and found Bentyl
Works Cited
Berragan, L. (2014). Learning nursing through simulation: A case study approach towards an
Sedgwick, M. G., Grigg, L., & Dersch, S. (2014). Deepening the quality of clinical reasoning
and decision-making in rural hospital nursing practice. Rural & Remote Health, 14(3).
Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision
Van Graan, A. C., & Williams, M. J. S. (2017). A conceptual framework to facilitate clinical
290.
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4852 Capstone
Scholarly Paper Rubric
Final Grade
_________/100 points