1

Running head: CLINICAL NURSING JUDGMENT

Capstone Scholarly Paper: Clinical Nursing Judgment

Rachelle M. Firman
Nursing Department, Youngstown State University
NURS 4852: Senior Capstone
Dr. Kim Ballone, Dr. Wendy Thomas
March 15, 2021
 2
CLINICAL NURSING JUDGMENT
Clinical judgement is a very important skill for nurses. It encompasses many skills

including: assessment, intervention, critical thinking, and advocacy. Overall it evaluates the

nurse’s ability to critically think and leads us to the priority goal of patient safety. Throughout

nursing school they teach us about the nursing process and how it encompasses everything that

we do. However, in order to use the nursing process we must be able to critically think.

Throughout our nursing school career we begin to develop our own clinical nursing judgment.

This paper is intended to define the nursing process and the importance of clinical nursing

judgment in the nursing practice, relay a personal experience of nursing judgment, and examine

the effectiveness of simulation based learning through research studies.

The Nursing Process

“According to Tanner’s Model Thinking Like a Nurse, clinical judgment is a problem-

solving activity, beginning with assessment and nursing diagnosis, proceeding with planning and

implementing nursing interventions, and culminating in the evaluation of the effectiveness of the

interventions” (Ballasy, Ruppert, & Victor, 2017). The nursing process is a five-step system

similar to the scientific method. It involves assessment, diagnosis, planning, implementation, and

evaluation. Assessment is the first step and in many ways the most important one. Through it we

can plan the entirety of our patients’ care. Assessment is both an objective and subjective step

through which we obtain a history, examine the patient, review the medical record, and begin to

make inferences on the next step in the plan of care. The diagnosis step involves current issues or

problems that need to be addressed, not just the medical diagnoses but the nursing diagnoses as

well. Through planning we evaluate the patient’s history and assessment and incorporate the

current problems into a plan of care for the patient. Planning involves all members of the

treatment team, as well as the patient and any family members that they choose to include in the
 3
CLINICAL NURSING JUDGMENT
process. During the implementation phase we carry out the necessary interventions to treat the

diagnoses and current problems of the patient as well as prevent any further issues from arising.

The evaluation step is the final, but not least important step, where we review everything that we

have done and evaluate the outcomes of the interventions. During this stage we determine if the

outcomes have been successful and plan for discharge or reevaluate the plan of care if there are

new or continuing problems that need to be resolved.

Clinical Experience

“Clinical judgment is defined as the ability of a nurse (or nursing student) to gather

patient data, make sense of that data, provide appropriate care based on the data, and then

evaluate both the patient’s and one’s own actions” (Bussard, 2018). For nursing students it can

be difficult to develop our own sense of clinical nursing judgment as it is something that comes

through experience and time rather than out of a book or a classroom. One of my experiences

that stands out was a middle-aged patient with pneumonia. They had been COVID free for over a

month, but had frequent returns to the hospital with pulmonary complications. During my first

assessment they were lethargic and uncooperative, despite the previous shift reporting that they

were alert and oriented, up ad lib, and quite talkative. They had bilateral coarse crackles in the

lower lobes with an oxygen saturated of 96% on 2 L/min. Their respirations were even, regular,

and unlabored. Their vital signs were all within normal ranges. I reported the apparent change in

level of consciousness to my assigned preceptor, who then did her own assessment. We

documented our findings and continued to monitor the patient as we updated the physician.

A short time later the patient reported having difficulty breathing. They were diaphoretic

and had labored tachypnea. Their oxygen saturation was 74%. Their lung sounds had increased
 4
CLINICAL NURSING JUDGMENT
bilateral coarse crackles in all lobes and audible expiratory wheezing. I elevated the head of their

bed, turned the oxygen flow rate all the way up and called for my preceptor. We called the

physician to order Duoneb and alert him of the patients change in status. We then called

respiratory for the Duoneb and high flow tubing. The patient began to stabilize at 95% on 7L/m

HFNC after the aerosol treatment. At next rounds the patient again reported difficulty breathing

with an oxygen saturation of 76% on 7L/min HFNC. They had audible wheezing with very wet

breath sounds. The doctor informed us to call a rapid response team as he was not present to

assess the patient. We informed the rapid response doctor that the patient needed Lasix and an

increase in his Ativan dosage, which was not due for another two hours. The doctor agreed and

ordered a chest X-ray. The patient stabilized after an output of 1200cc and was placed on a

BiPAP at 60% FiO2. Afterwards my preceptor and I discussed the situation and the outcomes of

the interventions and how quick and precise interventions can greatly improve the outcome of a

rapidly declining patient.

Development of Nursing Judgment in Schools

Throughout our clinical experiences we observe more than we act, which can hinder our

development of clinical nursing judgment. This is especially so of late with the pandemic, on-

line learning, and the limited interaction with patients over the past year. However, the pandemic

is not the only factor, healthcare has been changing rapidly over the past few decades as our

knowledge of technology and medicine has grown. Therefore nursing programs have

implemented various simulation experiences designed both to assist in the development and to

test the acuity of nursing judgment in students. The positive progression of clinical nursing

judgment has been documented over the past few years and proven to be directly correlated to

the implementation of simulation experiences to the nursing school curriculum.

 5
CLINICAL NURSING JUDGMENT
According to Tanner’s model, clinical nursing judgment is developed through both the

learning of information (school) and experience (time). Studies indicate that the factor with the

greatest significant contribution to nursing judgment is experience through time (Cabrera-Mino

& Shinnick, 2021). The results of a study done by Michelle Bussard showed an increase in

clinical nursing judgment skills in 70 junior nursing students after four simulation experiences.

The study was done to show whether simulation was a good replacement for real life clinical

experience. Although the study did not involve the comparison of real to simulated clinical

experience, it does suggests that simulation based learning has a positive correlation to the

development of clinical nursing judgment (2018).

In summary, clinical judgment is a vital skill in all nurses that comes through learning

and is developed with time and experience. Novice nurses or new grads are expected to have

good clinical nursing judgment. Nursing students develop their clinical judgment skills through

observation of expert nurses, clinical experience, lecture content, and simulation based learning.

Our patients’ health and safety depends on our ability to critically think and implement

appropriate interventions. Through the use of the nursing process and the clinical nursing

judgment skills we have begun to develop we can begin our careers as safe and effective

practitioners. Though we have come far in our nursing school career, we still have a lot to learn,

but with time and experience our clinical nursing judgment skills will grow.
 6
CLINICAL NURSING JUDGMENT
References

Bussard, M. (2018). Evaluation of Clinical Judgment in Prelicensure Nursing Students. Nurse

Educator, 43(2), 106-108. 10.1097/NNE.0000000000000432

Shinnick, M., & Cabrera-Mino, C. (2021). Predictors of Nursing Clinical Judgment in

Simulation. Nursing Education Perspectives, 42(2), 107-109.

10.1097/01.NEP.0000000000000604

Victor, J., Ruppert, W., & Ballasy, S. (2017). Examining the relationships between clinical

judgment, simulation performance, and clinical performance. Nurse Educator, 42(5),

236-239. 10.1097/NNE.0000000000000359
 7
CLINICAL NURSING JUDGMENT
4852 Capstone

Scholarly Paper Rubric

Scholarly Capstone Paper

 A component of the capstone course, worth 20% of the final grade

 An in-depth exploration on the topic “Clinical Nursing Judgment”

 3 page paper

 APA format

 Minimum of 3 references citing recent Nursing Journals

 Define the concept, identify the importance of clinical nursing judgment, and then discuss
a personal experience where you used “clinical nursing judgment” in a specific situation.

Requirements: Possible Points Achieved

Points

1. Organization and clarity of topic present 20 _________

2. Content quality 20 _________

3. Reflection of topic 20 _________

4. APA format and correct grammar 20 _________

5. Cited References 20 _________

Final Grade _________/100 points