Senior Capstone Scholarly Paper

YOUNGSTOWN STATE UNIVERSITY
SPRING 2023
4852 SENIOR CAPSTONE
CLINICAL NURSING JUDGMENT
The purpose of this article is to define and discuss Clinical Nursing
Judgment, summarizing its purpose as it relates to a nurse professionally and
interpersonally. Clinical Nursing Judgment is the process in which a nurse makes
decisions utilizing critical thinking, clinical reasoning, experience, and evidence-
based nursing practices (Clinical). The framework for this process of nursing
judgment was researched and established by Christine Tanner PHD, RN. There are
four main components that a nurse must utilize clinically for effective judgment
(Tanner, 2006):
1. Noticing
2. Interpreting
3. Responding
4. Reflecting
Noticing:
This is the assessment level at which a nurse must recognize the patient's
needs through subjective and objective data. Experience applied within this portion
of the framework enables a nurse to utilize the data more efficiently through an
array of experienced moments of critical thinking and recognizing patient cues
(Rischer, 2015). Noticing enables the nurse to focus on that which is clinically
significant for the patient’s needs.
Interpreting:
During the interpretation phase of nursing judgment, the nurse is utilizing

clinical reasoning to evaluate the patient data. This is a phase of the process where
experienced use of deductive reasoning is used to conclude the best determination
of the patient's needs. A good example would be a comparison of objective data
collected by the nurse, vital signs and lab values, as they correlate to the chief
complaint of the subjective data the patient provided. As clinical reasoning moves
forward within interpretation, the nurse can now begin to make interpretive
decisions from an evidence-based practice.
Responding:
As nurses our response is a pivotal moment of patient outcomes. It isn’t the

conclusion of our nursing judgment entirely, but the first process of
implementation of our nursing judgment through our evidence-based practice. An
example may be raising the head of the bed and administering oxygen to a patient
whose chief complaint was shortness of breath. You noticed a distressed breathing
pattern, interpreted a low SPO2, compared your data with the subjective data, and
now you are responding by implementing an expected evidence-based outcome.
Reflecting:
The reflection phase is a determination of the desired evidence-based

outcome. It allows the nurse to assess and address the decisions made and
determine if the desired outcome was accomplished. If the outcome was not
successful, then the nurse again relies on deductive and clinical reasoning to
determine which step of the clinical judgment process must be repeated in order to
accomplish a positive and effective outcome for the patient.
Now, understanding the defined framework and fundamental process of

Clinical Nursing Judgment, I’d like to move forward and discuss its importance.
Alfaro-LeFevre stated that “critical thinking, plus critical reasoning, equals correct
clinical judgment” (Alfaro-LeFevre, 2013). To me, Alfaro’s statement captures the
essential qualities of clinical nursing judgment. Our desire within a nurse’s role is
to have positive therapeutic outcome for our patients. That becomes the primary
importance of clinical judgment: the ability to have a positive evidence-based
outcome for our patient and their families. As nurses, our clinical judgment is
something that is continuously evolving with our experiences from our patient
population. As we gain experience, we gain knowledge, as we gain knowledge, we
gain a diversity of thinking. The more that we practice and develop our clinical
judgment, the more effective and therapeutic our patient care and outcomes
become.
Our clinical nursing judgment is also of importance on the level of legal and
ethical healthcare practices. When we use our clinical judgment effectively, we are
not only protecting the patient, but ourselves professionally, and the facilities in
which we work. We are ensuring that our nursing decisions are not only clinically
within the framework of our licensure, but also legally.
Lastly, what makes our clinical judgment important is patient safety. It only
requires one error within clinical judgment to have an everlasting negative
outcome upon a patient. It is crucial that clinical judgment is providing safe
practice care to the patient population. The ability of a nurse to apply clinical
judgment to every decision being carried out ensures that patient safety standards
are being met.
This brings me to my own reflection of the opportunities I’ve had to use my

Clinical Nursing Judgment. The example that stands out to me the most occurred
during my preceptorship in the ER. I had a patient in their early thirties that arrived
as a walk-in with the chief complaint of chest pain all day that was radiating into
his jaw.
At first sight of the patient, my nursing observation was that he looked

healthy. He was fit, active, and stated he was in the military. His vitals were stable
and his EKG showed a normal sinus rhythm. I asked some background questions
to make sure there were not any over the counter supplements the patient had taken
that could’ve induced chest pain or heart palpitations. At this point all I could do
was continue to monitor and await on blood work I had drawn to come back. After
about 30 minutes, I received his first Troponin lab, and it was very elevated. As a
standard of care, I gathered a second repeat Troponin and sent it to the lab, which
came back more elevated than the first. I was now able to finalize my interpretation
and respond utilizing my Clinical Nursing Judgment.
My first response was to initiate MONA (morphine, oxygen, nitroglycerin,

aspirin) and try to relieve the stress and ischemia the heart was undergoing. My
second judgment was to repeat the EKG and make sure nothing had changed in
elevation or rhythm since the first strip. Thirdly, I got two IVs started in the
patient's left arm and prepped him for a CT-A. Before transporting the patient to
CT, I reviewed his BMP labs to make sure that his kidney function was within
range for the contrast dye.
As a reflection of my clinical nursing judgment during the care of this

patient, I feel that I accomplished the framework of effective clinical judgment. I
started my care with assessment, obtaining subjective and objective data. I then
took all my data collection to compare and interpret the values in order to utilize
my critical thinking and reasoning (Embler, 2021). Following these steps, I
summarized my patient data to then respond utilizing evidence-based practices
through my clinical nursing judgment. Then, I reflected on my response and
recognized that the BMP value needed to be reviewed before carrying out the CT-
A. The combination of the framework and effective clinical judgment led to a
positive outcome for this patient that later resulted in a full recovery from the
condition he had been undergoing.
In summary, I feel that all my clinical experience here at Youngstown State
University has prepared me to become an entry level nurse, with an in-depth
practice of utilizing Clinical Nursing Judgment. Through repetitive simulations,
case studies, classroom instruction, and expertise clinical staff I have been able to
develop and improve my practice of professional Clinical Nursing Judgment.
References
Alfaro-LeFevre, R. (2013). Critical thinking, clinical reasoning, and clinical
judgment: A practical approach. (5th ed.). St. Louis, MO: Elsevier–Saunders
Clinical Judgment Concept. American Association of Colleges of Nursing: The Voice
of Academic Nursing. (n.d.). Retrieved March 7, 2023, from
https://www.aacnnursing.org/Essentials/Concepts/Clinical-
Judgement#:~:text=As%20one%20of%20the%20key,critical%20thinking%2C
%20and%20clinical%20reasoning
Embler, P. (2021, March 9). Imparting Clinical Judgment Leading to Sound Clinical
Decision-Making and Patient Advocacy. Wolters Kluwer. Retrieved March 7,
2023, from
https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-
judgemen
Rischer, K. (2015, May 7). What Two Types of Nurse Thinking are Required for a
Student to Make a Correct Clinical Judgment? KeithRN. Retrieved March 7,
2023, from https://www.keithrn.com/2015/05/what-two-types-of-nurse-
thinking-are-required-for-a-student-to-make-a-correct-clinical-judgment/
Tanner, C. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical
Judgment in Nursing. Journal of Nursing Education, 45(6), 204–210.

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YOUNGSTOWN STATE UNIVERSITY

During the interpretation phase of nursing judgment, the nurse is utilizing

As nurses our response is a pivotal moment of patient outcomes. It isn’t the

The reflection phase is a determination of the desired evidence-based

Now, understanding the defined framework and fundamental process of

This brings me to my own reflection of the opportunities I’ve had to use my

At first sight of the patient, my nursing observation was that he looked

My first response was to initiate MONA (morphine, oxygen, nitroglycerin,

As a reflection of my clinical nursing judgment during the care of this

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