Jacalyn Patterson

Nursing Scholarly Paper

Dr. Ballone

March 19, 2018

 My scholarly paper is going to define the concept of “clinical nursing judgement” using

three nursing research articles. A “clinical nursing judgement” can be defined as the conclusion

or enlightened opinion at which a nurse arrives following a process of observation, reflexion,

expertise, and analysis of observable or available information or data. The first nursing research

article by Pouralizadeh, Khankeh, Ebadi, and Dalvandi (2017) that I used conducted a research

project on different factors that influence nursing students to develop a nursing clinical

judgement. The second research article by Wane and Lotz (2013) that I researched is about how

simulations help student nurses refine critical thinking in order to develop a sound nursing

clinical judgement through various scenarios. The third nursing research article I found by

Shelestak, Meyers, Jarzembak, and Bradley (2015) researched nursing clinical judgement

through a human patient simulation (HPS) to identify cues, judgements, decisions, and outcomes.

In the first article I research by Pouralizadeh, Khankeh, Ebadi, and Dalvandi (2017) they

set up a qualitative research study that looked at the many different factors that influence a

nursing students’ clinical judgement. The factors this study found and concluded are,

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

environment and individual and professional features of clinical teachers” (Pouralizadeh,

Khankeh, Ebadi, and Dalvandi, 2017). In the study thoughtful behavior is described more into

detail by also including assessment, critical thinking, intuition, and clinical reasoning. This is

huge in my opinion because assessment is everything in order to know what is going on with

your patient and every nurse or student nurse needs to assess the situation appropriately. That

also includes the critical thinking aspect along with the clinical reasoning behind your

assessment and the actions that are needed to be taken to assure that every patient is getting the

best holistic care possible. This helps round out clinical judgement based off of the nurses’
assessment on what is the main problem and what steps need to be taken next based on that

pertinent information. It really pulls in the application of information learned from nursing

school and applying that evidence-based practice.

On the next nursing research article I researched by Wane and Lotz (2013) it looked at

providing clinical simulations relevant to clinical experiences in order to enhance that critical

thinking in nursing students to start developing that important clinical nursing judgment. Using

a simulation to help develop nursing clinical judgement is very helpful and also a safe

environment for students to really take over and start to use that critical nursing judgement based

off of variables such as an assessment, medical history, lab results, and diagnostics. Wane and

Lotz (2013) explained that, “by delving into the client’s medical history and providing pertinent

background materials, the students voiced that they had an appreciation for the amount of detail

necessary to critically analyze a medical situation”. This helped the students comprehensively

put all of the pieces together in order to make a sound nursing judgement based on the patient

individually. Therefore, creating a simulation helps facilitate that critical thinking in nursing

students in order to effectively develop a clinical nursing judgement.

The final research article I found was by Shelestak, Meyers, Jarzembak, and Bradley

(2015) that also conducted a simulation for nursing students but focused on American Cardiac

Life Support guidelines for bradycardia and pulseless ventricular algorithms. This research

study used a human patient simulation and looked at four phases of noticing the problem,

interpreting the data, responding appropriately using nursing judgement, and then reflecting on

the situation. One human patient simulation the students were introduced to was a vagal

response from a patient that was straining during a bowel movement. This led to a drop in heart

rate and blood pressure that was detected by the EKG reading that was available to all students.
The researchers then stopped the simulation in order for the students to write down all of the

information and what steps they thought would need to be taken next. The researchers then had

the students hand in their answers to record and grade their work. At the end they did go over

the correct steps to take based on evidence-based nursing research for bradycardia. In my

opinion as a nursing student myself nothing is better than learning in a simulation because you

are now in charge and have to really develop that critical thinking aspect of nursing in order to

care for your patients. It gives all nursing students an excellent opportunity to learn in a

simulation so when it comes time that they have graduated and are working on the floor they

have that simulation experience to benefit from in order to take the needed actions to care for

their patients.

In conclusion, having clinical nursing judgement in nursing practice is a necessity in

order to care for all of your patients. I remember going through different simulations throughout

nursing school and it really makes you realize that you need to have that knowledge base and

critical thinking in order to work efficiently to diagnose the problem and correct it. For example,

I had a patient who was in a lot of pain post-op that had a heart rate of over 200 beats per minute.

I was a student and started to get overwhelmed, but I needed to focus for my patient, so I got a

set of vitals, assessed the surgical site, assessed lung sounds for a possible pulmonary embolus

and called the doctor stat. I stayed with my patient and made sure he didn’t get worse until

further testing was done to figure out why he became very tachycardic. The patient is relying on

you to care for their health while in the hospital so having that clinical nursing judgement is very

much needed and necessary to have in order to work as a nurse.

 References

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 & Diagnostic Research, 11(5), 1-4.

doi:10.7860/JCDR/2017/25753.9822

Shelestak, D. S., Meyers, T. W., Jarzembak, J. M., & Bradley, E. (2015). A process to

assess clinical decision-making during human patient simulation: A pilot

study. Nursing Education Perspectives (National League For Nursing), 36(3),

185-187. doi:10.5480/13-1107.1

Wane, D., & Lotz, K. (2013). The simulated clinical environment as a platform for

refining critical thinking in nursing students: A pilot program. Nursing

Education Perspectives (National League For Nursing), 34(3), 163-166.