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Scholarly Capstone Paper: Clinical Nursing Judgment

Madison Kessler

Youngstown State University

NURS 4850: Senior Capstone Seminar

Dr. Randi Heasley

March 1, 2024
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Scholarly Capstone Paper: Clinical Nursing Judgment

Clinical nursing judgment is the ability to properly make judgments while using critical

thinking techniques and maintaining autonomy and advocacy for the patient. Adequate nursing

judgment is acquired through nursing education and competency within patient care experience

(Bussard, et al., 2024). To avoid malpractice in the nursing field, nursing educators must provide

students with techniques to establish assertive decision-making. Secondary to nursing education,

the next-generation NCLEX licensure examination focuses specifically on nursing clinical

judgment to ensure safe practice and improve patient outcomes (Bussard, et al., 2024). By

practicing clinical nursing judgment early with in nursing careers, effective decision-making can

be utilized with appropriate reasoning. Multiple research studies have been organized among

nursing students to determine the education level of clinical nursing judgment before taking the

NCLEX and beginning a nursing career. Ongoing research is also being conducted among

registered nurses currently practicing in the nursing field to assess clinical nursing judgment

knowledge influenced by the workplace (Calcagni, et al., 2023). Social norms change clinical

nursing intervention based on the values, attitudes, behaviors, and beliefs of the patient in

comparison to patient care expectations. As education techniques provided by nursing programs

change and social norms within the workplace change, several nurses of various generations

have different levels of clinical nursing judgment knowledge (Brito do Canto, et al., 2021).

Nursing clinical judgment is essential for proper decision-making during critical

situations to provide the best outcome for the patient. As current registered nurses and nursing

students work through proper problem-solving techniques, it is crucial to reflect on the clinical

judgment action and maintain them within order. Nursing educators instruct students how to

properly notice, interpret, respond, and reflect when faced with decision-making opportunities.
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(Brito do Canto, et al., 2021). When noticing a scenario that requires nursing judgment, it is

important to question oneself “If nothing is done, will the outcome be crucial or unsafe for the

patient”. To interpret the patient findings in clinical nursing judgment, the individual must look

at patterns of the findings and critically think about the means of the observation and potential

outcomes with interventions. When an individual responds to a situation requiring proper nursing

judgment, this requires proper and appropriate education on the problem needing to be addressed

and consulting interprofessional team members as needed. When reflecting, the individual will

determine if the response to the situation calling for the nursing judgment was effective and

determine the next steps (Martin, et al., 2020). An example of using these phases in the clinical

nursing judgment process is a patient experiencing symptomatic bradycardia the registered nurse

would notice this on an EKG strip, then interpret the patient’s symptoms compared to the EKG

strip. The nurse may respond by staying with the patient while contacting the healthcare provider

and mentioning atropine. The nurse will then reflect on the patient assessment vitals and repeat

EKG findings to determine the effectiveness of the atropine and plan for the next steps.

From the perspective of a current nursing student that has not taken the NCLEX yet or

started a position as a registered nurse, I have already learned clinical nursing judgment

strategies from nursing educators and supervised clinical experience. During a clinical

experience on a progressive intermediate unit, also known as a step-down from intensive care, I

used my clinical nursing judgment with 3 years of knowledge as a nursing student. I had a

patient that was complaining of chest pain radiating down the arm and with further assessment of

the pain the patient rated the pain a 10 on a 0-10 scale and described the pain as heavy and

tingling. As the nursing student, I reported my findings to the registered nurse assigned to the

patient. The bedside nurse responded to me that my findings were related to anxiety and not a
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concern with no further action being needed. Utilizing my clinical nursing judgment, I got a 12

lead EKG on the patient and reassessed symptoms. The EKG displayed st-elevation indicating a

myocardial infarction, also known as a STEMI. My nursing clinical judgment was crucial during

this critical situation as serious tissue damage or potential death could have resulted from the

poor interventions of the bedside nurse. The reasoning behind the knowledge deficit of clinical

nursing judgment of the bedside nurse is unable to be determined, although the knowledge that I

actively am gaining from my nurse educators compared to the bedside nurse’s knowledge from

several years ago is strongly considered a precipitating factor.

Nursing clinical judgment is an ongoing skill learned throughout a nursing career that

displays an individual’s ability to properly make judgments while using critical thinking

techniques and maintaining autonomy and advocacy for the patient (Bussard, et al., 2024).

Although the process of noticing, interpreting, responding, and reflecting is an effective

technique that nursing educators provide students with, more research regarding reliable clinical

nursing judgment strategies is needed. Although there is a lack of strategies for nursing clinical

judgment, research among undergraduate nursing programs has determined that professional

faculty is necessary to prepare nursing students for contemporary practice (Martin, et al., 2020).

Reliable assessment methods to effectively determine nursing clinical judgment in clinical

situations are also needed. Assessment methods to determine proper clinical nursing judgment

must be able to detect to registered nurse’s ability to analyze objective and subjective data about

the patient’s status. Individuals practicing nursing who lack appropriate nursing judgment must

determine which area within the judgment process is deficit; the process areas include noticing,

interpreting, responding, and reflecting (Brito do Canto, et al., 2021). To improve nursing clinical
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judgment skills, registered nurses and student nurses must be flexible and put the patient’s needs

before the opinion of other team members that do not support patient outcomes.
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References

Brito do Canto, V., Goncalves da silva, T., Aragao dos Santos, G., Campos de Carvalho, E.,

Coelho Ramalho Vasconcelos Morais, S., & Farias de Queiroz Frazao, C. M. (2021, June

28). Clinical judgment performance of undergraduate Nursing students. Off-campus

authentication for Library Resources. https://www-ncbi-nlm-nih-

gov.eps.cc.ysu.edu/pmc/articles/PMC8253357/

Bussard, M. E., Jessee, M. A., El-Banna, M. M., Cantrell, M. A., Alrimawi, I., Marchi, N. M.,

Gonzalez, L. I., Rischer, K., Coy, M. L., Poledna, M., & Lavoie, P. (2024). Current

practices for assessing clinical judgment in nursing students and New Graduates: A

scoping review. Nurse Education Today, 134, 106078.

https://doi.org/10.1016/j.nedt.2023.106078

Calcagni, L., Lindell, D., Weaver, A., & Jackson, M. (2023). Clinical judgment development and

assessment in Clinical Nursing Education. Nurse Educator, 48(4), 175–181.

https://doi.org/10.1097/nne.0000000000001357

Martin, B., Greenawalt, J. A., Palmer, E., & Edwards, T. (2020). Teaching circle to improve

nursing clinical judgment in an undergraduate nursing program. Journal of Nursing

Education, 59(4), 218–221. https://doi.org/10.3928/01484834-20200323-08