Running head: SCHOLARLY CAPSTONE PAPER

Scholarly Capstone Paper

Shauna Letcher

Youngstown State University

NURS 4852 Senior Capstone

Kim Ballone and Wendy Thomas

March 3rd, 2019

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SCHOLARLY CAPSTONE PAPER
Define

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

make considered decisions or come to sensible conclusions.

An early definition suggests clinical decision making includes identifying, prioritizing,

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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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

possible solution.” (Sedgwick, M. G., Grigg, L., & Dersch, S.)

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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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,

professional, patient-centered care.” (2nd)

Personally, in my transition’s rotation in the emergency room, I see a lot of clinical

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

(Dicyclomine) to be contraindicated in kidney stones. This situation taught me great clinical

nursing judgement skills and to advocate for patients always.

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Works Cited

Berragan, L. (2014). Learning nursing through simulation: A case study approach towards an

expansive model of learning. Nurse education today, 34(8), 1143-1148.

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

making and judgement in nursing research and education. International Journal of

Nursing Studies, 50(12), 1720-1726.

Van Graan, A. C., & Williams, M. J. S. (2017). A conceptual framework to facilitate clinical

judgement in nursing: A methodological perspective. health sa gesondheid, 22(1), 275-

290.
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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

4852 capstone paperubric ksb2017