Running

head: Scholarly Capstone 1

Scholarly Capstone Paper

Turner Curry

Senior Capstone NURS 4852

Dr. Kim Serroka Ballone and Wendy Thomas

February 26th 2019

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Abstract
Clinical nursing judgment is a controversial topic in medical literature today. The

concept revolves around many other subtopics such as critical thinking and clinical

reasoning. There forth, it is hard for the concept to have a definite definition. However,

this topic is very important for the nurse and the patient. The college nursing senior or

new coming nurse is where the majority of clinical nursing judgments are focused upon.

As a senior nursing student, the concept of clinical nursing judgment is a top priority and

presents challenges throughout a shift.

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Clinical nursing judgment is the backbone of nursing care today. It provides

nurses with vigorous situations that must be thought through to provide adequate care to

the patient. Ebright concludes that clinical nursing judgment is complex as it involves

organizing, prioritizing and decision making to make sure that the patient care is above

satisfactory, while still being able to be open and flexible about care changes (as cited it

Manetti, 2018, para. 1). With such a complex topic, it is hard to have one defying

definition that is so concrete and accurate to clinical nursing judgment. The Stedman

medical dictionary defines clinical judgment as a “cognitive or thinking process used for

analyzing data, deriving diagnoses, deciding on interventions, and evaluating care” (as

cited in Manetti, 2018, para. 4). Even though this definition is adequate, many

researchers of clinical nursing judgment follow Tanner’s definition which is “an

interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or

the decision to take action (or not), use or modify standard approaches or improvise new

ones as deemed appropriate by the patient’s response” (as cited in Manetti, 2018, para. 6).

With years of nursing experience the RN begins to become comfortable with

nursing judgment and understands the role that they perform. Manetti (2018) talks about

how the majority of nursing students and new nurses at the hospital struggle with

developing clinical nursing judgment. Nursing students prioritize themselves on grinding

through notes and PowerPoint’s to pass tests but the clinical aspect plays a huge role.

After obtaining three years of nursing knowledge, the student must be able to take all of
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that information and apply it to a patient. With the help of lab and clinical the student is

able to start developing clinical judgment skills throughout their education. Manetti

(2018) acknowledges that a nurse must understand the rationale behind an action and

knowing how to perform the technical skills of nursing proficiently such has inserting

Foley catheters or starting an nasogastric tube will help free the nurses mind for complex

thinking. Nursing programs all across the country have been trying to find ways for

nursing students to close the gap on sound nursing clinical judgement. According to

Kaddoura, VanDyke, and Shea-Foisy (2016), concept mapping has shown an increase in

meaningful learning and critical thinking. Hussain, Shamsuar, and Schuster state that

concept maps help students actively engage and interpret the data to compare and

correlate relevant information and then to synthesize the ideas (as cited in Kaddoura,

VanDyke, and Shea-Foisy, 2016, para. 3).

Closing the gap between new nurses and clinical judgment is very important and

getting a head start on this while still in nursing school is really helping. It is so

important because sound clinical judgment will affect patient outcomes. Being able to

have a confident assessment, diagnose, intervene and evaluating is all a part of clinical

nursing judgment. Critical thinking and Clinical nursing judgment go hand in hand.

With the skill of critically thinking, it makes clinical nursing judgment easier. According

to Cazzell and Anderson (2016), with several overlapping definitions between the two, it

is hard to find how much critical thinking contributes to sound clinical judgment. Nurse

educators are now being challenged to switch their focus more on sound clinical

judgment but still taking critical thinking into their planning as well (Cazzell and

Anderson 2016).
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In my own experience, we cover being able to critically think and nursing

judgment very well at Youngstown State University. Clinical and my preceptorship is

what have really helped me start to make that beginning push into better nursing

judgment. The simulation labs that we perform in our program are my absolute favorite

for learning how to have sound clinical judgment. It is the perfect opportunity to take

what we learn from class and apply it to a near life situation. I am taking what I learned

from class and starting to apply the interventions and evaluations to my patients. I have

had a couple instances in which I was able to use clinical judgment to have the best result

for my patient. Recently I had a patient who was intubated and very malnourished and

also had hypotensive blood pressures. During the shift, one of my nursing responsibilities

was to start titrating the Levophed that the patient was on. My preceptor and I had to start

titrating him from about 5mcg down to nothing. It was a slow process and took hours

because the patient was so sensitive to the Levophed. We could only drop his dosage by

0.5 mcg at a time because his blood pressures would tank. The process was taking a lot

longer than usual because our patient was so sensitive and eventually one of the doctors

came over and insisted that the nurse and I get the patient off of the Levophed. The nurse

and I became a patient advocate and told the doctor how we didn’t think that it was a

good idea to rush off the Levophed and to take a slower approach. We spent most of the

day balancing the Levophed drip and checking blood pressures. By the end of the shift

we had weaned the patient from 0.5 mcg to off of the Levophed and found a large drop in

blood pressure again. We put him back on 0.5 mcg for the rest of the shift and made a

thorough bedside report to the oncoming nurse. I was really proud to be able and use my

clinical nursing judgment to become a patient advocate. It was scary to voice my opinion
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to the doctor, but with the help of my preceptor I was able to. It could have been a lot

worse situation if we turned off the drip at a higher rate.

Clinical nursing judgment is the backbone of modern nursing today. It is complex

and consists of many different criteria’s to provide a patient the best care possible.

Although many nursing students and new registered nurses are struggling with clinical

nursing judgment, universities and hospitals are helping to close the gap. Hospitals are

offering extensive on the job training with a nurse and universities are implementing

things such as concept maps to help students make those connections from the classroom

to the clinical setting easier.

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Reference Page

1. Cazzell, M., & Anderson, M. (2016). The Impact of Critical Thinking on Clinical
Judgment During Simulation With Senior Nursing Students. Nursing Education
Perspectives (National League for Nursing), 37(2), 83–90. https://doi.org/10.5480/15-
1553

2. Kaddoura, M., VanDyke, O., Cheng, B., & Shea-Foisy, K. (2016). Impact of
concept mapping on the development of clinical judgment skills in nursing students.
Teaching and Learning in Nursing, 11(3), 101-107. doi:10.1016/J.TELN.2016.02.001

3. Manetti, W., PhD, RN, CRNP. (2019). Sound clinical judgment in nursing: A
concept analysis. Nursing Forum, 54(1), 102-110. doi:10.1111/NUF.1230