XH3002 Assignment Critical Judgment through Assessment

Competency Assessment:

Decision Making for Clinical Judgment

Student Name: Date: May 2026

 Use this template to develop and reflect on the two avatar scenarios at Neighborhood Clinic, the fictional community health center. Your focus is on evaluating information for making clinical judgments. Base your responses on information in the interactive media resource, other Learning Resources, and any resources you identify to support your responses to the following questions. All responses should have evidence cited to support statements made in your document. Your document should be 3–4 pages plus a reference page.

Part 1 – Nurse Scenario: Atsumi Yoshida and Returning Patient Mr. Teo Kimura

• Summarize the information you learned from nurse Atsumi Yoshida about Teo Kimura and his previous appointment at Neighborhood Clinic.

Nurse Atsumi Yoshida, an avatar patient, introduces Mr. Teo Kimura, who has been a patient at Neighborhood Clinic for a long time. Previously to her visit, Mr Kimura had complained of continuing physical problems which had not been satisfactorily addressed. Yoshida discussed the potential causes for symptoms and their potential duration, but he did not seem to make any effort to analyse the causes. She noted some of her observations as well as a basic history, but it was mentioned that she may not have gone far enough in exploring the aspects of lifestyle, psychosocial, and cultural factors.

• Evaluate the nurse’s application of clinical judgment based on what she stated and explain your reasoning.

In a way, Yoshida shows some clinical reasoning, particularly in his noticing and recognizing that the symptoms in Mr. Kimura were worthy of notice and follow-up. It appears that her interpreting skills were somewhat undeveloped, as there is little evidence of her patiently compiling information to investigate further contributing factors or patterns. Christine A. Tanner (2006) asserts that clinical judgment calls a nurse to take patient information beyond the superficial level and allows him or her to engage in a more in-depth analysis. In addition, Yoshida’s reply appears to be task-oriented and not comprehensive, due to the consideration of overall effects. There is also some limited evidence of reflection, important for improving subsequent clinical decision making (Tanner, 2006). In general, Yoshida has basic clinical skills, but her clinical judgment could be better through a more patient-centered and comprehensive approach.

• In your appointment with Teo Kimura, explain what you would look for and pay particular attention to based on the information you received from Atsumi Yoshida and your assessment of her clinical judgment.

When I consult with Mr. Kimura, I will look at things in a much more extensive way. I would obviously focus on symptom onset, symptom severity, and any additional or new symptoms or concerns. I would also consider other factors that may cause the issue, and that have not been identified, such as chronic diseases, stress, and medication side effects. It’s also important to note nonverbal cues such as discomfort or “hesitation” and be aware that this can be a sign to ask “What is that that you are not feeling right now?” and get your patient to say what he/she might be concerned about.

• What questions would you ask Mr. Kimura to understand his physical symptoms?

I would ask specific and open-ended questions to gain a better understanding of each of Mr. Kimura’s physical symptoms. These questions will remind him/her of the symptoms he or she had, including how they started:

Are your symptoms different or have they gotten worse since your last visit?

What makes your symptoms better or worse?

Have any new symptoms developed, e.g., fatigue, pain, change in appetite or sleep habits?

• What questions would you ask Mr. Kimura to understand other factors that may affect his health?

I would ask him questions that would go deeper into other factors that could impact his health, such as:

• “How have things been going for you at home or work?”
• “Are there any recent changes or significant stresses in your life?”
• What kind of diet and lifestyle do you have?
• Do you have a support network you can turn to?
• Have any culture/personal beliefs that impact health management?

These questions will help to better understand the patient, congruent with the steps of culturally competent and patient-centered care practices.

• Explain aspects of clinical judgment—noticing, interpreting, responding, reflecting—that would support your assessment and decision making on Mr. Kimura’s health.

To care for Mr. Kimura, I would use the elements of clinical judgment. As part of noticing, I would gather as much data as I could: physical and psychological symptoms, history, etc., and contextual factors. As an interpreter,r I would analyse this information to search for patterns or causes, including physiological and psychosocial aspects. An individualized care plan (including diagnostic testing, patient education, or referral) would be developed and put into practice during the response. Lastly, when reflecting, I would review the effectiveness of interventions and see what changes needed to be made. They follow evidence-based models of clinical judgment that involve continually making informed decisions during the process of evaluation and continuous improvement (Tanner, 2006). 

• Are there questions about cultural competence and/or implicit bias in this scenario? Explain your thinking.

This is related to the issue of cultural competence and implicit bias. Mr Kimura’s understanding of clinical signs and symptoms and his concerabout of using health care providers may be influenced by his culture. The attributes of cultural humility (Tervalon & Murray-García, 1998) are continual self-inquiry and self-awareness of the dynamics of power in the healthcare system. Not taking these cultural factors into account can lead to misinterpretations and/or an inadequate assessment. In addition, the provider may misinterpret the patient’s behavior and/or symptoms and the difference in treatment. To be culturally humble, to avoid making assumptions about Mr Kimura’s beliefs and/or behaviour, to avoid being dogmatic or judgemental.

Part 2 – Patient Scenario: Serena Miranda and Her 1-month-old Son, Jorge

• Summarize the information you learned from Serena Miranda that would inform your examination of Jorge and application of clinical judgment.

Her 1-month-old son Jorge has a weak latch, so he is always falling off the breast after a few minutes, and either falls asleep or becomes fussy,” says Serena Miranda. Jorge hasn’t always been able to get his birth weight back,k and he’s not as alert as he should be for his age. It sounds like Serena is nervous and tired because she doesn’t know if she has enough milk to feed him or if she is feeding him correctly. This information is essential, as at 1 month of age, it will increase the risk of dehydration, hypoglycaemia, jaundice,ia and delayed growth, all of which require clinical judgement and action (Giouleka et al. 2023). 

• Based on this information, what concerns would you have about Jorge’s condition?

Based on the information in Serena’s report, my first concern is what he’s eating. Other contributing factors for Jorge possibly being undernourished, dehydrated, and/or experiencing low blood sugar or being underweight may be due to motor issues: latching and how long he spends feeding. Latching problems and/or duration may be mechanical (such as tongue tie and suck/swallow coordination) or maternal (such as discomfort when nursing and low milk supply) (Borowitz, 2023). This, in addition, is a potential clue of a lack of activity due to calorie deprivation, which is a serious issue and should be investigated immediately, especially as Jorge’s alertness is diminished. If undernutrition persists for a month or longer, it can cause untreated dysmaturity and an immune deficiency. 

• If your concern were failure to thrive, what questions would you ask to understand more?

To see if Jorge is not thriving, I would ask these questions that would be specific to the topic:

1.How many wet/dirty diapers did Jorge have in 24 hours?

2.Has Jorge vomited, spat, or defecated often since eating?

3.If you currently have a baby who is on a full breastfeeding schedule or is on a formula feeding schedule. If so, how much and how frequently?

4.Has Jorge changed his behavior (a lot of sleepiness, inconsolable crying, not waking for feeding,g etc.)?

5.Have there been any problems in the past with the birth or premature birth?

• When you examine Jorge, explain what you would look for and pay particular attention to in your examination based on the information you gathered.

I would use physical examination to determine growth parameters (such as length, weight, and head circumference) from a standard growth chart as well as percentiles and trends to look for changes over time, particularly for Jorge. I would look for dehydration – sunken fontanel, dry mucous membranes, poor capillary refill, and delayed capillary refill. I would also check the overall muscle tone of Jorge, and his activity and responsiveness. However, low activity and subnormal muscle tone are of concern as the baby is experiencing major nutritional and/or metabolic derangements (Figueiredo et al., 2026). I would also examine whether there was any anatomical problem that would make it difficult for him/her to feed, for example, ankyloglossia (tongue-tie), cleft palate, or a high arched palate. Lastly, a complete feeding attempt will be seen to identify the latch, sucking pattern, swallowing, and/or positioning by the mother. 

• Explain your next steps for Jorge and Serena Miranda based on components of the nursing process and your

In my next phase of the nursing process, I will complete a head-to-toe physical assessment on a patient (Jorge) as well as assess and collect his feeding history, including hydration and growth. When providing a diagnosis of feeding problems, I would take into account the possibility of having growth/development problems and/or low fluid intake at the time of diagnosis. Along with this, I’d also set goals for feeding for 10 – 15 minutes on each breast and for myself to gain weight by 20 – 30 grams a day. I would help the mother position and latch the baby, supply breast milk or formula, and help parents to seek a pediatrician for a follow-up assessment to learn more about a feeding problem and the possible causes (tongue problems or metabolic issues), along with screening parents for any tongue/metabolic issues. To do this, he would re-weigh within 24-48 hours after Jorge’s weight was measured and count the number of diapers and determine if he had improved his nutritional status with stool interventions (Koivu et al. 2026). This systematic approach will enable us to take action on the symptoms (acute nutritional deficiencies) and the cause.

• Explain aspects of clinical judgment—noticing, interpreting, responding, reflecting—that would support your decision making.

In the noticing phase,e I found Jorge’s feeds to be short and ineffective; he was not alert and not displaying normal infant behavior,u,r and had failed to gain weight. During the session, there were a variety of signals that would lead to establishing a range of issues, including feeding problems (mechanical), not getting the milk transferred, mothers not being sure if they feed, fear of breastfeeding, etc. In order to help with feeding issues, I would show her evidence-based actions of assisting with feeding behaviors she witnessed, offering support in creating other stimuli for feeding, referring to lactation help and/or pediatricians, and communicating empathy for her feelings related to her emotional state. I personally would want to think about what I learned to do to help Jorge lose weight and gain benefits from changing his eating habits, what support I might have had before or after the visit that helped him change, and how this learning can support my clinical practice with babies in the future (Koivu et al., 2026). A nurse’s reflection is an important part of his or her learning, growth, and development in decision-making.