| Course | NUR-3320 Nursing Science Foundations Theory, Ethics, and Practice |
|---|---|
| Module | Module 1 |
| Paper type | Reflective paper: clinical judgment |
| Length | About 1,049 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3320 Module 1
He Said He Was Fine: Noticing, Interpreting and Responding to a Quiet Change
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3320: Nursing Science Foundations: Theory, Ethics, and Practice
Mentor Name
Month Day, Year
He Said He Was Fine: Noticing, Interpreting and Responding to a Quiet Change
Introduction
Before nursing school I reconciled accounts for a living. I was good at finding numbers that did not add up. On my third clinical shift I learned that patients do not present their problems as discrepancies in a column. This paper examines one moment from that shift, using two models of clinical judgment and a rubric, to understand what I noticed, what I missed and what I will do differently.
The Patient
Mr. Patel is invented for this paper. He was 67, on the first day after a laparoscopic colon resection. At 8 a.m. his vital signs were within normal limits: temperature 37.4 Celsius, heart rate 92, blood pressure 128/76, respiratory rate 18 and a pulse oximetry reading of 95 percent while breathing room air. He said his pain was a 4 and that he felt fine. At 11 a.m. when I returned to help him walk, he was quieter than in the morning, picked at his blanket and asked me twice what day it was. His heart rate was 108, his respiratory rate 22 and his temperature 38.1. He again said he was fine.
Tanner's Model
Tanner (2006) drew on roughly 200 studies of how nurses judge clinical situations to build a four-part model. Noticing means taking in the situation, and what a nurse notices depends on expectations, prior knowledge of the patient and the setting. Interpreting means making sense of the data, whether by analysis, intuition or narrative. Responding is the chosen action. Reflecting happens twice: while acting, as the nurse watches the patient's response, and later, when the nurse looks back to learn. Among her conclusions were that clinical judgment depends more on what the nurse brings to the situation than on the objective data alone, that knowing the patient matters and that reflection is essential to developing judgment.
My Shift Through Tanner's Lens
Noticing: I noticed the confusion only because I had spoken with Mr. Patel at length that morning and knew how clear he had been. A nurse meeting him for the first time at 11 a.m. might not have seen a change. What I nearly missed was the trend in his vital signs, because each value alone seemed only mildly abnormal.
Interpreting: I first thought he was tired. Then I connected the new confusion with a rising heart rate, faster breathing and a fever on the first day after bowel surgery. My instructor's question, what could cause all of these together, led me to consider infection, a leak at the surgical connection or bleeding. I did not know enough to decide among them, but I understood that the pattern meant something was wrong.
Responding: I told the assigned nurse at once, using a brief structured report. She assessed him, found his abdomen more tender and called the surgical resident, who ordered blood work, a lactate level and blood cultures. Mr. Patel was later found to have an early leak at the anastomosis and returned to surgery that evening.
Reflecting: In the moment I kept checking him every fifteen minutes while we waited. Afterward, I realized that if I had relied on his words, I would have accepted that he was fine.
The NCSBN Model
Dickison et al. (2019) described the National Council of State Boards of Nursing Clinical Judgment Measurement Model, developed to test clinical judgment on the licensing exam, and showed how teachers can align it with frameworks such as Tanner's. Its core layer breaks judgment into six cognitive moves, starting with recognizing and then analyzing cues, moving to ranking possible explanations and generating solutions and ending with acting and checking the result. The authors argued that faculty can use the same language in teaching, so that students practice the steps the exam measures.
| NCSBN step | My actions with Mr. Patel |
|---|---|
| Recognize cues | New confusion, heart rate 108, respiratory rate 22, temperature 38.1 |
| Analyze cues | Linked the cues together on day one after bowel surgery |
| Prioritize hypotheses | Infection, anastomotic leak, bleeding; I could not rank them |
| Generate solutions | Report immediately; recheck vital signs |
| Take action | Brief report to the nurse; frequent checks |
| Evaluate outcomes | Watched for further change until the resident arrived |
Rating My Judgment
Lasater (2007) built a rubric on Tanner's four aspects after watching students work through simulated cases. Its eleven dimensions include focused observation, spotting departures from expected patterns, sorting relevant from irrelevant data and communicating clearly, and each is scored at one of four levels: beginning, developing, accomplished or exemplary.
Using the rubric honestly, I would rate my noticing as developing: I recognized the change in mental status but only gradually saw the pattern in his vital signs. My interpreting was beginning to developing: I knew the cues were connected but could not prioritize explanations. My responding was accomplished in communication but beginning in independent action, which is appropriate for a student. My reflecting is where I hope to grow most.
What Knowing the Patient Did
Tanner's emphasis on knowing the patient explains why I noticed anything at all. My morning conversation gave me a baseline that no chart contained. This has changed how I use my time on clinical days: talking with patients is not a break from assessment but part of it.
A Plan to Sharpen Noticing
I will practice three habits. First, I will compare every set of vital signs with the previous set and write the trend, not only the number. Second, I will ask every patient a simple orientation question at each contact, so that changes in thinking are documented. Third, after each clinical day I will write a short reflection-on-action, using Lasater's dimensions as headings, and review it with my instructor once a week.
Limits
This paper reflects one patient and my own perspective. The rubric was designed for simulation and is applied here informally. Mr. Patel is invented.
Conclusion
Tanner's model showed me that my judgment depended on what I brought to the bedside, especially my knowledge of the patient, and that reflection is how judgment grows. The NCSBN model broke the moment into six steps and showed that my weakest step was prioritizing explanations. Lasater's rubric gave me language for rating myself. A patient who said he was fine taught me to trust patterns over reassurance.
References
Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03
Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04
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
What the NUR 3320 Module 1 instructions ask for
TESU's catalog paragraph for NUR-3320 calls clinical judgment the cornerstone of clinical and moral reasoning, so this first module, in the absence of a posted syllabus, takes the form of a reflective clinical judgment paper. Pick one real moment from a clinical day or simulation and give enough data, such as vital sign trends and what the patient said, to analyze it. Apply a research-based model step by step, map the moment to the NCSBN model if your program teaches it, score yourself with a published rubric and finish with habits you can practice on the next shift. Some instructors prefer a simulation case to protect privacy. Find out whether first-person writing is expected and how much patient detail your program allows. A short reflection section after the analysis is usually expected, so leave space for it.
Inside the NUR 3320 Module 1 example
A fictional accelerated BSN student describes Mr. Patel, 67 and a day out from colon surgery, who insists he is fine while his pulse, breathing and temperature creep up and he grows confused. Tanner's four aspects organize the account of the shift. A table maps the same hour onto the NCSBN model's six steps, and Lasater's rubric is used to rate the student from beginning to accomplished on each aspect. Sections on what an earlier conversation with the patient made possible and on three habits to sharpen noticing come before the limits and a short conclusion. Annotations in the margin show where each model step appears in the story.
Where the marks sit in the NUR 3320 Module 1 rubric
Readers look for a specific moment backed by real numbers, a model applied one step at a time rather than summarized and a self-rating that admits what the student could not yet do. Attention to trends across readings, not single values, signals growing judgment. Reporting to the nurse instead of acting alone shows a clear sense of a student's scope. Distinguishing reflection during the event from reflection afterward shows careful reading of Tanner, and a short list of habits to practice gives the reflection a purpose beyond the paper itself. Specific, practicable habits make the reflection credible.
NUR 3320 Module 1 help: mistakes that cost marks
Two problems show up often in clinical judgment papers. Some place the model in one section and the clinical story in another, and the two never meet; others give the writer generous marks with no evidence behind them. Choose one moment, give the data, move through each aspect of the model in order and map the NCSBN steps in a table. Rate yourself honestly against a rubric and end with habits for the next shift. Change identifying details. Share the module prompt with us and expect a free first draft within a day or two. Use trends, not single readings, as evidence that you noticed.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3320 Module 1 questions, answered
Where can I find a free NUR 3320 Module 1 sample paper?
The clinical judgment paper, applying Tanner's model and the NCSBN model to an invented post-surgical patient, is on this page.
What are the four aspects of Tanner's clinical judgment model?
Noticing, interpreting, responding and reflecting, with reflection taking place both during the event and after it.
What is the NCSBN Clinical Judgment Measurement Model?
The NCSBN's six-step model of judgment, from spotting and analyzing cues through ranking explanations, choosing and taking action and checking results, which underpins the Next Generation NCLEX.
What is the Lasater Clinical Judgment Rubric?
Lasater's scoring tool, derived from Tanner, which scores eleven dimensions of judgment at beginning, developing, accomplished or exemplary.
Why does knowing the patient matter for clinical judgment?
A baseline from earlier contact lets the nurse notice changes that a chart or a first meeting would miss.