Scholarly Capstone Paper

Lauren Makosky

Youngstown State University

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 Clinical nursing judgment is a concept that is taught to nursing students the first

day of nursing school all the way up until we graduate. Clinical nursing judgment

involves many nursing concepts. These concepts include problem solving, ethical

reasoning, critical thinking, structural leadership and collecting and interpreting data

(Schoessler, 2012). Clinical nursing judgment is not something that nurses perfect over

night. This very important concept is something that is used every day in the nursing

world and takes years of experience to really get a good feel for it.

First, clinical nursing judgment begins with observing. As the nurse, you need to

observe that a problem is arising. Observing the problem is based off of the nurses’

knowledge about the patient. The nurse also needs to know what the normal is for that

patient and what their normal responses are. After observing that a problem is arising,

the nurse then needs to reason within the moment with their clinical nursing judgment

and decide what would be best for the patient. As the nurse you have to come up with a

solution and act upon it. Then you observe how the patient reacts and then modify your

actions based upon how the situation is unfolding (Douglas, 2016).

During my preceptorship I feel as though I have used clinical nursing judgment

many times. I am on an orthopedic medical-surgical unit. Being on this unit I have seen

many patients that are in a lot of pain. These patients experience pain due to surgery

related tissue damage and physical activity related to recovery activities. It has been

shown that combining opioids, non-opioids and local anesthetics provide the best pain

management in patients undergoing orthopedic surgeries (Pizzi, 2014). Most patients

state that their pain is moderate to severe. With this, patients who are having total joint

replacements are receiving oral opioids as needed after surgery. As needed dosing is the

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most effective dosing to control a patients pain when the patient understands to request

the medication. The patients have to be very educated on calling the nurse to get the

medication at the correct time.

There are a lot of disadvantages with this medication dosing. If the patient calls

during other nursing activities and the patient does not receive their medication at the

right time the patient feels that this is not ideal for pain control. This then leads to a

decrease in patient satisfaction in some instances, even if we are trying our absolute best

to keep up with the patient requests. Another disadvantage to this is some patients are

afraid to call for their pain medication even if they are in excruciating pain because they

do not want to bother us with what feels like to them is a petty request. I have had the

experience with both types of patients, where if the nurse and I are two minutes late it is

the end of the world and the other will not even call.

A situation I feel that I have used clinical nursing judgment is with a patient who

was post-op day one from a total knee replacement. This particular patient was doing

extremely well getting up and down and was walking the halls with therapy multiple

times that day. He was a patient who never requested pain medication or would only ask

for one pill if he was in a lot of pain. When we would go around and do our hourly

rounding we would ask him if he needed anything for pain and if he was due he would

only want one pain pill.

That afternoon after he was done with his second round of therapy I went to check

on him to see how his pain is being controlled. He said that he is very sore and feels sort

of stiff from sitting in the chair for an hour or two. Using my clinical nursing judgment I

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suggested that he take two pain pills because the day after surgery is a very hard day and

with all the activity he was doing I did not want him to only take one and still be in pain.

He stated that the last time he took one he was still in a little bit of pain afterwards and

that he felt it did not do much. With that information I really encouraged him to take the

two pain pills. He then stated that he agrees that he thinks he should take the two pain

pills because he did not want to be in excruciating pain.

The nurse and I brought him in two pain pills and he took them. After an hour

went by we checked to see how his pain was and he said that it was completely under

control and he thanked me for encouraging him to take the two pain pills instead of just

one. I feel as if I used my clinical nursing judgment in an appropriate way and I helped a

patient be comfortable when he was in a lot of pain.

Clinical nursing judgment is not something that a nurse can perfect over night.

This process takes years to even get a decent grasp on it and in nursing school our clinical

nursing judgment is just starting to develop. As a student it is hard to get a good feel for

clinical nursing judgment because we always have our teachers and other nurses there to

ask questions about what we should do if we have a situation arise. Now that we are

seniors and are about to graduate very shortly I feel as if I have a pretty good grasp of

clinical nursing judgment and trust myself more and more each day.

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 References

Douglas, C., Booker, C., Fox, R., Windsor, C., Osborne, S., & Gardner, G. (2016).

Nursing Physical Assessment for Patient Safety in General Wards: Reaching

Consensus on Core Skill. Journal of Clinical Nursing,25, 1890-1900. Retrieved

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MS, RN, CNE, ANEFF, Perkins, B., OP, PHD, RN, FAAN, ANEF, & Schultz,

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