Professional Documents
Culture Documents
Caylin Corns
4852 Capstone
Dr. Ballone
March 2018
2
Scholarly Paper
Critical thinking is a vital element of the nursing profession. Clinical judgment is the
way nurses incorporate critical thinking into their work while directing decision making and
actions that ensure health care quality and safety. These decisions are based on the nurse’s
observations, reflections, and analysis of information related to each patient. Clinical nursing
judgment is a complex concept requiring one to incorporate critical thinking, reasoning, and
State University, the nursing process enables nursing students and the practicing nurse to “think
systemically and process pertinent information about the patient” (p. 72). The nursing process
gives the nurse the ability to obtain valid data, create a nursing diagnosis regarding the obtained
data, and devise a plan of care. Next, the nurse will implement, evaluate, and revise the care.
Huckabay claims that critical thinking and accurate reasoning is required in each step of the
nursing process (p. 72). Richard Paul and Linda Elder’s handbook (as cited in Huckabay, 2009)
Whenever we think, we think for a purpose with a point of view based on assumptions
leading to implications and consequences. We use data, facts, and experiences to make
This quote defines clinical judgment very well. In any healthcare organization, nurses
are important decision makers (Thompson, Aitken, Doran, Dowding, 2013). As a nurse, every
thought running through your mind is imperative. We must reason with a purpose repeatedly to
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competently care for our patients. Our interpretations are some of the most substantial because
we are the staff member that sees the patient the most. It is our obligation to be attentive and
process helps assist with critical thinking. The importance of clinical nursing judgment is
astounding. It could be the deciding factor between life and death of a patient.
commended for my clinical judgment. I had just arrived to the hospital and was going into the
patient’s room to introduce myself and do an initial assessment. She was admitted for intractable
vomiting. When I entered, the patient was sleeping. I attempted to wake her up by quietly
saying her name. When I lightly shook her, she still did not awaken. She was snoring, so I
thought she must just be a heavy sleeper. I could still get her vital signs while she was sleeping,
After obtaining vital signs, I had a gut feeling that a problem existed. After a few more
minutes of lightly shaking her and speaking loudly, she still did not wake up. I decided to alert
my clinical instructor, Ms. Esmail, of the situation. Unfortunately, she was off the floor with
another student. I quickly found the patient’s nurse and explained the situation to her. The nurse
and I went back into our patient’s room and she rechecked the vital signs. Again, everything was
within normal ranges. She brushed it off and said the patient is probably just exhausted and
sleeping heavily. Although I still felt uncomfortable, I believed the nurse and continued to do
my head to toe assessment on the patient. I thought to myself, “I am just a nursing student, she
has been a nurse for a long time. She would understand this situation better than me. She has
also seen this patient all day, whereas I have no previous encounters with her.”
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Once I finished my assessment, I attempted to wake her up again. Still, she did not
respond to me. Although I did not know this patient’s normal actions, I knew something was not
right. I decided to get another opinion and finally found Ms. Esmail, who came to assess the
patient as well. She agreed that something did not seem right. We decided to call the physician,
who promptly arrived to the room to assess the patient. The physician and residents attempted to
get an arterial blood gas (ABG) while also applying painful stimuli to the patient. The patient
did not react to the multiple ABG attempts, fingernail pressure, loud yelling, or aggressive
shaking. When one of the residents performed a sternal rub on the patient, she finally woke up.
When the patient’s ABG results showed no abnormalities, the doctors decided to do a
CAT scan on the patient’s brain. This test revealed that the patient had a brain tumor that was
likely causing her vomiting that brought her to the hospital initially as well as these intermittent
comatose states. The nurse and Ms. Esmail both came up to me afterwards and told me I did a
wonderful job at being observant and promptly reacting to a situation. My instructor also said
that if it was not for me, this situation could have been discounted and the CAT scan revealing
her brain tumor could have never occurred. It was this clinical experience that taught me to trust
Mary Schoessler et al. (2012), declares that instinctual, critical, or narrative processes are used to
develop an action when there is a potential issue. You cannot begin the process of clinical
judgment until you notice a problem is present. Once you declare there is a problem, this is
when one’s knowledge comes into place. Having background knowledge, as well as knowing
the context of the situation, allows one to notice any abnormal occurrences. In my clinical
experience mentioned earlier, I immediately noticed a problem. Even though I knew very little
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about this specific patient, I was aware that it is abnormal for a patient to be unresponsive to
shaking and yelling. Although the nurse told me not to worry, my knowledge and my instinct
improve a nurse’s ability to make critical decisions? In Thompson and Stapley’s systemic
review (2011), it was found that educational interventions work, but not consistently. Only in
some situations did the interventions provide positive results. Thompson and Stapley also stated
thinking because of the vast number of possible interventions possible. Educators use a wide
Schoessler et al. (2012) suggest that clinical judgment can be taught. In this article, it
declares that simulation activities allow students to strengthen their critical thinking skills by
walking them through a situation step-by-step and helping them explore their thinking process.
The use of debriefing allows the student to receive feedback from the faculty about their actions.
Per Schoessler et al., “nurse educators have the responsibility for creating the learning pathways
In closing, clinical nursing judgment is a multifaceted term. It is the way nurses interpret
certain findings and make appropriate actions regarding a patient’s care. Whether or not
education improves clinical judgment, critical thinking and problem solving are extremely
important in nursing.
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References
Huckabay, L. M. (2009). “Clinical Reasoned Judgment and the Nursing Process.” Nursing
Forum, 44(2): 72-78. doi:10.1111/j.1744-6198.2009.00130.x
Schoessler, M., Brady, M., Engelmann, L., Larson, J., Perkins, I., & Shultz, C. (2012). “Nursing
Judgment: Educating Nurses to Make Decisions in Practice.” Nursing Education
Perspectives (National League for Nursing), 33(6): 422.
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. doi:10.1016/j.ijnurstu.2013.05.003
Thompson, C., & Stapley, S. (2011). “Do Educational Interventions Improve Nurses’ Clinical
Decision Making and Judgement? A Systematic Review.” International Journal of
Nursing Studies, 48(7): 881-893. doi:10.1016/j.ijnurstu.2010.12.005