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Scholarly Capstone Paper

Maci Musolino

Centofanti School of Nursing, Youngstown State University

NURS 4850 Nursing Capstone

Dr. Heasley

March 1st, 2024

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Scholarly Capstone Paper

Clinical judgment is one of the key aspects to professional nursing. Clinical judgement in

nursing is the process by which nurses make decisions based on nursing knowledge, evidence-

based practice, critical thinking, and clinical reasoning. Nurses use these skills to assess patients

for important information to help fulfill patient needs. Clinical judgment is an attribute in health

care that is learned through experience and practice. There are many significant characteristics of

a nurse that develops clinical judgement. Some of these characteristics include decision-making

skills, intuition, and autonomy. A nurse’s ability to use these skills reflects their ability to be skilled

in clinical judgement. The article by Seidi, J., Alhani, F., & Salsali, M. states, “Previous studies

have explored and identified some of the main characteristics of nurses’ professional practice,

clinical judgment, and clinical decision-making. These characteristics included using knowledge

and conceptual models in practice, adopting an interdisciplinary collaborative decision-making

approach, including clinical judgment in nursing educational programs, and using evidence,

intuition, and autonomy” (2015). This study defines exactly what clinical judgement is and the

characteristics needed to develop it.

Autonomy is important in clinical judgment because it allows nurses to use their intuition

to make their own decisions. It helps them in establishing relationships and interacting with others

to use their knowledge and wisdom in their clinical practice. A nurse’s intuition is created from

experience of making clinical judgments in their practice, which is why it is a significant

characteristic. The more practice a nurse has using clinical judgment, the more efficient their

clinical judgment and outcomes will be. The development of clinical judgement is necessary

because it leads to appropriate nursing diagnoses and health promotion which improves the quality

of patient care.
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Patient-centered care is one of the most important aspects of nursing. Without clinical

judgement, patient needs are hard to fulfill which results in poor outcomes. This is one of the many

reasons why clinical judgment is necessary for nurses to be skillful in. Nurses are at the front line

of patient care and are with the patients more than any other healthcare team member. Nurses

discover patient concerns, complaints, and problems that are important in determining the best

course of action. Nurses communicate their assessment findings with the doctor and the other

members of a patient’s healthcare team. The nurse’s information obtained, and their judgement of

that data has the biggest influence on a patient’s diagnosis and decisions that the doctor will be

creating for them. The article by Arkansas State University says, “Clinical decision-making

missteps and diagnostic errors can be detrimental to patient outcomes. Biases, lack of education

and experience contribute to poor clinical judgment. This can harm patient safety and heighten

malpractice risk. Additionally, they can cause reputational harm to individual nurses, facilities,

and the profession” (2022). This article proves how nurses must be efficient in clinical judgement

to prevent errors that can harm a patient. Not only will it affect the patient, but it can negatively

impact the facility and the profession of nursing.

As a student nurse, I had to make many clinical judgment decisions so far in my nursing

career. One clinical judgement decision I had to make was in a shift at the Boardman Emergency

Department as a student nurse extern. The nurse I was assisting asked me to get blood work on a

patient and send it over to the lab to be analyzed. This patient was a 72-year-old male presenting

to the ED for an abnormal laboratory result. As I walked into the patient’s room, he was

complaining of severe chest pain and shortness of breath. I immediately assessed the situation and

started asking questions. These questions included: “What does the chest pain feel like? Is the pain

radiating anywhere? Do you have a history of heart problems? What makes this pain worse or
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better? When did this start?”. As I was asking these questions, I was also checking the patient’s

vital signs and pulse oximetry reading. I saw that this individual’s oxygen saturation was low, so

I got a nasal cannula and gave him oxygen. I then got the EKG machine and performed an EKG

on the patient. I brought it to the attending doctor so it can be interpreted accurately. After notifying

the doctor, I went and got my nurse to explain everything that happened to make sure I did the

right thing. She said I did very well, and it was great that I took initiative for this patient. The EKG

came back abnormal, and this patient ended up getting transferred out to be treated for a myocardial

infarction. In this situation, I made the clinical judgement to assess the patient’s complaint, give

oxygen, perform an EKG, then notify the doctor and nurse. I did not ignore the patient’s complaints

by just doing the blood work and not assessing the situation. I was very proud of myself for trusting

my intuition and using what I’ve learned in nursing school to make a good clinical judgement for

this patient. If I did not make this clinical judgment, the situation could have turned out differently

and a medical emergency could have not been treated as quickly as one should be.

Overall, clinical judgment is one of the most important decisions nurses must make to

create the best outcomes for our patients. Clinical judgment is a process that is learned through

experience which involves making a decision for a patient based off of evidence, knowledge, and

reasoning. This significant aspect of nursing is why nurses are trusted by people around the world

to care for and treat the sick. Nurses have been ranked #1 in Gallup's annual Most Honest and

Ethical Professions Poll. According to Levine, Z., “Nurses have been able to maintain their ranking

in this poll by providing high-quality, patient-centered care to individuals, families, and

communities across the country and in every conceivable health care setting” (2023). Our clinical

judgment is one of the many reasons why we can provide the best patient-centered care and uphold

this amazing achievement.

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References

Arkansas State University. (2022, May 16). Why Is Sound Clinical Judgment Vital to Primary
Care? Arkansas State University Online. https://degree.astate.edu/online-
programs/healthcare/msn/fnp/sound-clinical-judgment-primary-care/

Levine, Z. (2023, January 10). Americans Continue to Rank Nurses Most Honest and Ethical
Professionals. American Nurses Association. https://www.nursingworld.org/news/news-
releases/2022-news-releases/americans-continue-to-rank-nurses-most-honest-and-ethical-
professionals/

Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses’ Clinical Judgment Development: A
Qualitative Research in Iran. Iranian Red Crescent Medical Journal, 17(9).
https://doi.org/10.5812/ircmj.20596