CAPSTONE SCHOLARLY PAPER 1

Capstone Scholarly Paper

Christopher J. Maronen

Youngstown State University

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Nursing clinical judgement can be described in many different ways, but each way

basically means the same thing. It is an integral part of nursing care. As students, we take our

time during the nursing program to eventually learn and adapt to the skills that will be applied

during our nursing career. The skills from the textbook are merely objective. Nursing care is and

should be holistic which means that the care we perform consists of more than just performing

skills. Taking a look at the bigger picture is essential to providing confident and adequate nursing

care. But what does it take to see the bigger picture? The answer is clinical judgement.

When caring for a patient, a nurse should be cognizant of many factors pertaining to a

patient. Some of these many factors include cues, emotions, responses, lab values, and vital

signs. The field of nursing is not black and white, so of course there are more factors than the list

above. The few named are just some that come to mind. Nurses observe cues every single day of

being on the floor. Observable cues can be verbal and nonverbal. It is important to pay attention

to these cues because they can give us a window into the patient. We as nurses can learn a lot

about a patient and their feelings by listening to what they say and watching how they react to

care. This leads to emotions or the lack-there-of. Emotions can be observed through body

language or simply conveyed through verbal means. Patients will have responses to care and

skills performed. It is important to take these responses into account because we clock in to care

for THEM. When a nurse steps on the floor, that nurse has a job to properly care for their

assignments and their actions should be suggested by the orders of the doctors and the needs of

the patients. Perhaps, the most important look into a patient’s body are diagnostic results that the

patient may not be able to convey to us. These diagnostic results are lab values, vital signs, and

images of the inside of the body. Although we may have numbers, images, cues, and emotions

that tell us what is going on with a patient, it is our job to interpret these things.
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Nursing clinical judgement can be viewed as the interpretation of our findings using our

accrued knowledge, ethics, and skills that we learn throughout our entire career. By interpreting

and observing information that the patient and their body is giving, we can further tune their

needs. Although nurses exercise clinical judgment every day, there are always certain scenarios

that will stick out in their minds as unique. A particular patient comes to my mind when I think

about how I used clinical judgment and was able to identify a solution for the best interest of my

patient.

During my preceptorship, one of my patients was an Arabic 60 year old male who came

to the ED for abdominal pain and was ultimately admitted for a sigmoidectomy. I believe this is

the first patient I have had during schooling that had a foreign origin. His surgery resulted in a

large midline abdominal incision and a left colostomy. He also was initially intubated and had an

NG tube placed. Upon assessment, his tongue had a dark brown coating on it so I was able to

identify that oral care was especially important for this patient. The fact that his chief complaint

was directly affecting his GI tract makes the oral care even more pertinent. The patient’s wife

told me this coating on his tongue was present before admission. This patient was also

intermittently non-compliant to nursing care and was oriented only to himself so he was placed

on two point restraints. Additionally, the patient’s primary language was Arabic and he spoke

minimal English. His wife told me that he did in fact speak English, but in the current situation

he was in, he decided to mostly use Arabic.

While brainstorming about how my preceptor and I could effectively perform dressing

changes, perform oral care, and other basic nursing skills, I had an idea. Since the patient

primarily used Arabic, I decided to speak with his family about communication. His family

understood the situation and the patient’s need for continuous care. While trying to perform oral
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care, I had the patient’s wife speak to him in Arabic and explain to him the importance of the

medical care. This action worked for two reasons. The first being that someone close to him that

he trusted was telling him why he needed care. And the second reason was that the use of his

primary language may have been comforting. The patient allowed me to successfully perform

oral care.

Another instance where I used the family for communication and consoling was to

reinforce the importance of complying with his NG tube and restraints. The patient had pulled

his NG tube out twice previously and constantly flexed his arms in an attempt to free himself

from the restraints. The family had asked why the patient was restrained and I had explained that

he would attempt to pulled at his lines and tubes. After the explanation, the family understood

the necessity. I’m sure it’s not easy to see a family member restrained in an acute situation like

the SICU, but it is often necessary for recovery. The patient often made himself agitated and this

constant state of agitation is not conducive for recovery. The patient’s sons and daughters sat

with him and explained to him that the more he complied, the faster he would heal. And the

quicker he healed, the quicker he could return to home. After spending time with his family, the

patient was more compliant with the nursing staff as we obtained vitals and performed a dressing

change. This experience just helps me realize the importance of using clinical judgment and

using the resources around you. It also helps me the realize the positive effect that culture and

family can have on the a patient’s recovery.

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References

Phaneuf, M., R.N., Ph.D. (2008, December 17). Clinical Judgement – An Essential Tool in the

Nursing Profession. Retrieved March 1, 2018, from

http://www.infiressources.ca/fer/ Depotdocument_anglais/Clinical_Judgement

An_Essential_Tool_in_the_Nursing_Profession.pdf
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Tanner, C., R.N., Ph.D. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical

Judgment in Nursing. Journal of Nursing Education, 45(6), 204-2011. Retrieved

March 1, 2018, from https://www.ccdhb.org.nz/working-with-us/nursing-and-

midwifery- workforce-development/preceptorship-and-

supervision/tanner-2006.pdf.

Modic, M., DNP, RN (Ed.). (2014). Clinical Judgment: Developing Skills in Reflection. Journal

for Nurses in Professional Development, 30(3), 157-158. Retrieved March 1, 2018, from

https://journals.lww.com/jnsdonline/Citation/2014/05000/

Clinical_Judgment__Developing_Skills_in_Reflection.13.aspx.
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