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.
As an avatar patient, nurse Atsumi Yoshida introduces Mr. Teo Kimura, a long-term patient at Neighborhood Clinic. Previously to her visit, Mr Kimura had complained of continuing physical problems which had not been satisfactorily addressed. Yoshida spoke about possible triggers for symptoms and concern for them lasting, but did not show any apparent attempt to conduct a thorough analysis of causes. She recorded observable signs and some basic history, but it had been noted that she might not have gone deep enough exploring lifestyle, psychosocial influences, and cultural factors.
Evaluate the nurse’s application of clinical judgment based on what she stated and explain your reasoning.
Yoshida exhibits some signs of clinical reasoning, especially in the noticing part of the process, by recognising that Mr. Kimura’s symptoms were worthy of being noticed and followed up. Her interpreting component seems to be somewhat underdeveloped, however, as there is little evidence that she combined patient information in order to investigate broader 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 response seems task-driven, rather than comprehensive, considering overall effects. There is also some limited evidence of reflection, which is necessary for enhancing subsequent clinical decision making (Tanner, 2006). Overall, Yoshida has basic clinical skills, but her clinical judgment could benefit from 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.
I would look at things in a much more comprehensive way when I consult with Mr. Kimura. Of course, due to the limited assessment, I’d dedicate special attention to symptom progression, symptom severity, and any extra or new symptoms or concerns. I would also look at other factors that could contribute to the problem and have been missed, such as chronic illnesses, stress factors, and medication-related issues. It is also significant to pay attention to nonverbal indicators like discomfort or “hesitation” as a way to establish awareness that may have something to prompt the patient to voice a concern that is not voiced right now.
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 help him or her recall details of symptoms, including their onset:
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 which could impact his health, such as:
- “How have things been going for you at home or work?”
- “Have you experienced any recent stress or major life changes?”
- “What does your typical diet and physical activity look like?”
- “Do you have a support system you can rely on?”
- “Are there any cultural or personal beliefs that influence how you manage your health?”
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. During the noticing phase, I would collect as much information as I could, such as physical symptoms, history, and contextual factors. In interpretation, I would review this data to look for patterns or etiologies, taking into account physiological and psychosocial factors. During responding, an individualized care plan (including diagnostic testing, patient education, or referral) would be formulated and implemented. Lastly, when reflecting, I would review the effectiveness of interventions and see what changes needed to be made. These are in line with evidence-based models of clinical judgment in which informed decisions are made continuously throughout the process, a process of evaluation and continuous improvement (Tanner, 2006).
Are there questions about cultural competence and/or implicit bias in this scenario? Explain your thinking.
Cultural competence and implicit bias are relevant factors in this situation. Mr Kimura’s culture may influence his level of understanding of clinical signs and symptoms and his concerns regarding the use of health care providers. Continual self-inquiry and self-awareness about the healthcare power dynamics represent the characteristics of cultural humility (Tervalon & Murray-García, 1998). Failure to consider these cultural factors may result in misunderstandings and/or an incomplete evaluation. Furthermore, the implicit attitude may affect how the provider interprets what a patient is exhibiting, both in terms of behavior and symptomology, and therefore the disparity in care. The need to be culturally humble, ensure questions are sensitive and open-ended, and avoid assumptions about Mr Kimura’s beliefs and/or behaviour.
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.
According to Serena Miranda, her 1-month-old son Jorge does not have a strong latch, which is why he consistently falls off the breast after a short period of time and either goes to sleep or starts fussing. Jorge has not consistently regained his birth weight and is not as alert as he should be for his age. Serena appears stressed and exhausted, stating that she does not know if she has enough milk and if she is feeding Jorge properly. The information is critical because, at 1 month of age, this will increase the chances of dehydration, hypoglycemia, and delayed growth, and all of these need clinical judgement and action (Giouleka et al. 2023).
Based on this information, what concerns would you have about Jorge’s condition?
My first concern, based on Serena’s report, is what he is eating. Other contributing factors for Jorge possibly being undernourished, dehydrated, and/or experiencing low blood sugar or being underweight can be attributed to motor issues related to latching and the amount of time he spends feeding. The issues with latching and feeding duration may be related to mechanical issues (e.g., tongue tie, inability to coordinate suck and swallow reflexes) or maternal issues (e.g., discomfort with nursing, low milk supply) (Borowitz, 2023). Along with this, the reduced alertness of Jorge could be a sign of inactivity from a lack of calories, a serious concern, and should be checked right away. Chronic undernutrition within the first month can lead to dysmaturity and a deficiency of immune response without treatment.
If your concern were failure to thrive, what questions would you ask to understand more?
If I wanted to check if Jorge is failing to thrive, I would ask these questions that would be specific to the topic:
- What is the total number of wet/dirty diapers Jorge has in 24 hours?
- Has Jorge vomited, spat, or defecated frequently after eating?
- 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?
- Are there any changes in Jorge’s behaviour (lots of sleepiness, inconsolable crying, difficulty waking for feeds, etc.)?
- 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, by physical examination, determine growth parameters –such as length, weight, and head circumference– from a standard growth chart and review percentiles and trends to determine changes over time, with special attention to Jorge. I would check for dehydration – sunken fontanelles, 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. But low activity and subnormal muscle tone should be of concern, signaling that the baby is sustaining significant nutritional and/or metabolic derangements (Figueiredo et al., 2026). In addition, I would see to see if there are anatomical challenges that would make feeding difficult, such as ankyloglossia (tongue-tie), cleft palate, or high arched palate. Finally, a full feeding attempt would be observed to determine the latch, sucking pattern, swallowing, and/or mother positioning.
Explain your next steps for Jorge and Serena Miranda based on components of the nursing process and your
In my next intervention of the nursing process, I will assess, collect the entire feeding history, and perform a head-to-toe physical assessment of Jorge, noting his 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. In addition to this, I would also create goals such as feeding for 10 – 15 minutes on each breast and gaining 20 – 30 grams per 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. For this, he would re-assess within 24-48 hours after Jorge was weighed and observed the number of diapers and see if he had improved his nutritional state through stool interventions (Koivu et al. 2026). This structured approach will allow us to act on both the symptoms (acute nutritional deficiencies) and the causes.
Explain aspects of clinical judgment—noticing, interpreting, responding, reflecting—that would support your decision making.
At the noticing phase, I found Jorge’s feeds to be short and ineffective; he did not gain weight, and he was neither alert nor exhibiting normal infant behaviour. While in the session, responding to these signals, I would create a range of problems such as feeding problems (mechanical), not transferring milk, mothers’ lack of confidence, 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. Personally, I would consider reflecting on how successful the changes I made to Jorge’s weight and eating habits were, along with what other help I may have had before or after the visit that contributed to the changes, and how that learning may benefit my clinical work with babies in the future (Koivu et al., 2026). Reflection plays a vital role in a nurse’s ongoing learning, growth, and development related to decision-making.
References
Borowitz, S. M. (2023). What is tongue-tie, and does it interfere with breast-feeding? – a brief review. Frontiers in Pediatrics, 11(11), 1086942. https://doi.org/10.3389/fped.2023.1086942
Figueiredo, M., Figueiredo, M., Vieira, F., Marçal, M., & Tuna, M. (2026). Severe hypernatremic dehydration in an exclusively breastfed neonate. Cureus, 18(2), e102947. https://doi.org/10.7759/cureus.102947
Giouleka, S., Gkiouleka, M., Tsakiridis, I., Daniilidou, A., Mamopoulos, A., Athanasiadis, A., & Dagklis, T. (2023). Diagnosis and management of neonatal hypoglycemia: A comprehensive review of guidelines. Children, 10(7), 1220. https://doi.org/10.3390/children10071220
Koivu, A., Ashorn, U., Borghi, E., Hasman, A., Menon, P., Pulungan, A., Ruel-Bergeron, J., Shaker-Berbari, L., Singh, M., Thacker, N., Were, W. M., Ylikruuvi, K., & Ashorn, P. (2026). Global assessment of childhood growth monitoring: Cross-sectional survey of national policies and practices. Journal of Global Health, 16, 04034. https://doi.org/10.7189/jogh.16.04034
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211. https://doi.org/10.3928/01484834-20060601-04
Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233