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Scholarly Capstone Paper

Ashley J. Walton

Nursing Department, Youngstown State University

NURS 4852: Senior Capstone

Dr. Kim Ballone, Mrs. Wendy Thomas

March 15, 2021

Clinical nursing judgement is in the center of nursing as a whole. It is the judgement that

nurses use to ensure competent quality and safe patient care. The clinical judgement used by

nurses allows them to understand problems or concerns of their patients and decide how they, as

caregivers, should respond. This skill is learned, however it is enhanced throughout a nurses

career. The pieces that a nurse has to take into account are as follows; “changes in patient status,

uncertainty about the most appropriate course of action, accounting for context and the nurse’s

practical experience” (Benner, Sutphen, and Leonard, 2010). Clinical nursing judgement is also

continually changing, it is not something that will stay the same throughout the shift for one

patient. This is because it relies on whether the patient is stable or deteriorating (Lavole, Clarke,

and Clausen, 2020). The decision making process that goes along with clinical judgment is

founded on four different aspects; “the nurse’s theoretical knowledge, ethical perspectives,

relationships with patients, the patient’s caregivers, and the community, and the understanding of

the influence of systems on health care outcomes” (Benner, et al, 2010). Decision making goes

hand in hand with clinical judgement and this quote describes it the best, “decision making is

acting on clinical judgement by choosing the best available option and applying it to practice”

(Griffith and Board, 2018). Griffith and Board go into detail specifying that in order to establish

competent clinical judgement the decision making process needs to be understood. To make

decisions nurses must take into account multiple facts from multiple sources, including

observations of the patient, vital signs, diagnostic test results, research studies, colleagues

opinions, etc (Griffith and Board, 2018). In the decision making process the nurse also must take

into account the patient's thoughts and feelings. Reflection of past decisions helps the nurse

develop their overall skills and aids in clinical judgement. A research study done by Griffith and
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Board concluded that to aid in the development of clinical nursing judgement, nursing students,

specifically, improve this skill by education and self reflection.

The importance that clinical nursing judgement in the nursing practice is extremely

crucial. It is crucial that nurses understand all of the components of quality nursing care to

maintain a safe environment for the patient. “Clinical judgement development is necessary

because it leads to appropriate nursing diagnoses, clinical decision-making and health

promotion” (Seidi, Alhani, and Salsali, 2014). Without the use of clinical nursing judgement the

nurse would be unable to facilitate proper care to the patients that entrust those of the nursing

profession with their care. Clinical nursing judgement is developed independently by each

individual nurse and it evolves throughout their career with the more experience they gain.

“Making judgements in practice [with] substantiated with evidence that integrates nursing

science in the provision of safe, quality care for diverse patients and their families in

collaboration with the health care team” (Benner, et al, 2010).

According to Lavole et al the nursing handoff report “consists of an exchange of

information between nurses so that they establish a shared mental model and where the nurse

taking over forms clinical judgements regarding a patient’s situation” (Lavole, et al, 2020). By

this you deduct that the start of the nurse’s formation of their clinical judgement occurs at the

handoff report. However, this is not the end of developing the clinical judgement; it continues

into the assessment of the patient and talking with them to learn their concerns. Although the

handoff report is where the start of the judgement takes place Lavole et al describes several

issues that can arise that only increase the importance for a nurse to come to their own clinical

judgement of each situation. “An individual’s perception of the information can never be

perfectly reliable as it is always modulated by one’s perceptive capacities and by characteristics

of the data” (Wright and Scardaville,2021). This quote describes one way handoff reports can

influence one’s clinical judgement. Each person perceives situations differently based on their

past experiences and own judgement.

I have several personal experiences when I, as a student nurse, used clinical nursing

judgment. One example is when I had a patient at St. Joseph’s my third year. When I received

the hand-off report from the night shift nurse about this patient it was reported that he was stable,

however complaining of ongoing and worsening abdominal pain and he had not passed a stool in

three days. This patient was in his early 40s, morbidly obese, suffered from COPD, diabetes

mellitus type 2, and several other medical conditions. After completing the hand-off I went in to

do my assessment and morning care for the patient, while my nurse went to receive report on her

remaining patients for the day. When I introduced myself to my patient I asked him if he was still

experiencing pain. He answered yes and that it was increasing, even though the night nurse had

given him pain medication right before the end of his shift. I also asked if he had the urge to have

a bowel movement. He said no and that he had not had one in the last couple of days, which

matched what the previous nurse had reported. While assessing my patient I found evidence of

an abdominal bleed, which was not mentioned in the report. The patient’s abdomen was

obviously distended and hard as a rock. The patient was also pale and very tired. I took the

patient’s vital signs and his blood pressure was low when compared to his previous results. All of

this combined was concerning to me, so I went to find my nurse. After not being able to find my

nurse I went to my instructor and explained the situation to her. She came and assessed the

patient, as well, to confirm what I thought was going on. She agreed with me and we found my

nurse and then contacted the doctor. The patient was taken to get an abdominal CT and there was

diagnosed with a gastrointestinal bleed. The patient was taken for further testing and possible
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surgery near the end of my time on the unit that day. I believe that my ability to understand the

signs and symptoms of an abdominal bleed, as well as listening to the patient's concerns and

putting it all together allowed me to make the conclusion that a problem had arisen and the

patient was in danger. If I had not used my clinical nursing judgement in this situation, the

patient outcome could have been very different.

References

Benner, P., Sutphen, M., & Leonard, V. (2010). Practical/Vocational Nursing Program

Outcome: Nursing Judgement. Retrieved March 14, 2021, from

http://www.nln.org/docs/default-source/default-document-library/nursing-judgment-final.pdf?sfv

rsn=0#:~:text=Clinical%20judgment%20refers%20to%20ways,ways%20(Benner%2C%202010)

Griffith, L., & Board, M. (2018). Influences on clinical decision-making during a

community placement: reflections of a student nurse. British Journal of Community Nursing,

23(12), 606–609. https://doi-org.eps.cc.ysu.edu/10.12968/bjcn.2018.23.12.606

Lavole, P., RN, PhD, Clarke, S., RN, PhD, FAAN, & Clausen, C., RN, PhD. (2020, July

09). Nursing handoffs and clinical judgments regarding patient risk of deterioration: A

mixed-methods study. Retrieved March 14, 2021, from

https://onlinelibrary-wiley-com.eps.cc.ysu.edu/doi/full/10.1111/jocn.15409

Seidi, J., Alhani, F., & Salsali, M. (2014, July 03). Nurses' Clinical Judgment

Development: A Qualitative Research in Iran. Retrieved March 14, 2021, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601210/pdf/ircmj-17-09-20596.pdf

Wright, J., & Scardaville, D. (2021). A nursing residency program: A window into

clinical judgement and clinical decision making. Nurse Education in Practice,

50http://dx.doi.org.eps.cc.ysu.edu/10.1016/j.nepr.2020.102931
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