Running Head: CLINICAL NURSING JUDGEMENT 1

Scholarly Capstone Paper

Clinical Nursing Judgement

Marium Khan

Youngstown State University

CLINICAL NURSING JUGEMENT 2

Clinical judgement is an important skill that professional nurses integrate as they work to

provide holistic patient care. Clinical judgment has been recognized as a vital skill that enables

nurses to determine the appropriate nursing interventions when planning patient care, especially

the ability to manage rapidly deteriorating patients (Graan, 2016). The development of clinical

judgment is an important characteristic of nurses. The field of nursing demands a higher

cognitive level of thinking. However, one of the key skills that freshly graduated nursing

students struggle with is the lack of clinical judgement (Pouralizadeh, 2017). In clinical settings

that take place in hospitals or clinics, decision making skills that are strong in solving clinical

problems are the most important factors that prevent patient deterioration and further injuries

from occurring. In nursing school it is very important that nursing students visit clinical sites

where they are required to make sound accurate clinical judgments that support the complex

healthcare and patient’s needs and that contribute to optimal patient outcomes. This process of

using critical thinking in clinical sites paired with the information about the nursing process

covered in class about can help the nursing student become more confident in their clinical

judgement. In the research study performed in South Africa that analyzed the concept of clinical

judgment from the perspective of professional nurses within a specific contextual clinical nursing

environment where undergraduate nursing students were placed for clinical experience. The

study found that collaborative dialogue between students, educators, and clinical mentors as role

models during nurse-patient interaction was considered a powerful learning tool in facilitating

clinical judgment. It further went on to explain that clinical judgement has become synonymous

in the nursing filed with the nursing process model of practice where nurses use their critical

thinking skills to apply their nursing knowledge, attitudes, values and logic during patient

assessment, utilizing both deductive and inductive reasoning to express patient care (Graan,
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2016). A similar research study was performed in Iran where they concluded that the key factors

influencing nursing students’ clinical judgement were broken into five main themes including

thoughtful behavior, professional ethics, use of evidence-based care, context of learning

environment an individual and professional characteristics of clinical teachers (Pouralizadeh,

2017). This is very important to recognize because it enhances nursing student’s confidence in

the field when they graduate. In my own experiences in clinical sites, I have had nursing

instructors that have provided great feedback in my clinical reasoning that helped me better my

clinical judgement. The study conducted in Iran concluded that nursing instructors are important

to help their students “develop their clinical nursing skills by providing a secure psychological

environment, proper training conditions, using instructional strategies to reinforce deep thinking

processes, education of professional ethics and applying scientific evidence and principles”

(Pouralizadeh, 2017).

Research in Singapore was conducted which demonstrated that “new graduate nurses’

confidence depends on the time spent during undergraduate clinical placements and the provision

of workload of patients in conjunction with a preceptor to consistently improve issues of time

management, competence, and confidence with nursing tasks” (Wu, 2016). It is through the

ability to practice our nursing skills in a learning environment with a mentor or preceptor that

will guide us in becoming more confident in ourselves and our clinical judgement develop better.

The Holistic Clinical Assessment Tool (HCAT) was developed during the study conducted in

Singapore to test the clinical competence of nursing students and focuses on holistic learning and

assessment in the clinical environment. This tool would allow nursing instructors and preceptors

to pair together to assess the nursing student’s clinical competence. The HCAT facilitates self-

reflection and monitoring of one’s clinical progress. This type of tool can be beneficial in many
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preceptor and nursing student situations to further the communication on what needs improved

upon and what nursing skills are competent.

In my personal experience, my preceptor has worked with me to allow me to increase my

confidence when taking care of patients. I was assigned a patient for the day that my preceptor

thought would increase my critical thinking and be a good patient to perfect my assessment skills

on. This patient’s history displayed that the patient had one lung removed due to other health

concerns. The patient had been living fine with this situation at home and used oxygen at home

to maintain proper oxygenation. She was admitted to the hospital for decreased oxygenation and

was placed on 6L O2, and even then, her oxygenation was only at 87% saturation. The patient’s

oxygenation status did not improve and instead the patient was very lethargic and sleepy. I

recognized these manifestations as an increase in carbon dioxide buildup in the body, which

makes a person very sleepy, and consulted my nurse and requested that we should obtain blood

gasses from the patient to check the carbon dioxide levels in the body. Once the blood gasses

were drawn and read, her carbon dioxide levels were at 94. The normal carbon dioxide levels in

the body are between 35-45. My preceptor and I discussed this situation and we decided to place

her on the BiPAP machine to increase her oxygenation. This intervention rapidly increased my

patient’s status and she was no longer lethargic or sleepy. I was able to make sound clinical

judgement based on the information I learned in nursing school and by the confidence my

preceptor had in me to let me take care of a patient like that.

In conclusion, clinical judgement is essential for decision making and is considered an

inseparable part of nursing care. Nursing instructors, preceptors, and nursing students must work

together in order to promote the development of higher cognitive skills to ensure safe and

effective nursing care for all patients.

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Reference Page

Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses understanding of

clinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280-293.

doi:10.1016/j.hsag.2016.04.001

Pouralizadeh, M., Khankeh, H., Ebadi, A., & Dalvandi, A. (2017). Factors influencing nursing

students’ clinical judgment: A qualitative directed content analysis in an Iranian

context. Journal Of Clinical And Diagnostic Research.

doi:10.7860/jcdr/2017/25753.9822

Wu, X. V., Enskär, K., Pua, L. H., Heng, D. G., & Wang, W. (2016). Development and

psychometric testing of Holistic Clinical Assessment Tool (HCAT) for undergraduate

nursing students. BMC Medical Education, 16(1). doi:10.1186/s12909-016-0768-0