NUR 553 Module 2 Paper: Clinical Judgment Scenario Using Tanner's Model Example

Reviewed by Ingrid Vasterling, MSN, RN Arizona State University Updated October 2026

This NUR 553 Module 2 sample is the Week 2 Clinical Judgment Scenario paper in Dynamics of Professional Nursing II, a course in the nursing master's program for working RNs. For ASU NUR 553, students describe a situation from their own practice, without identifying details, and work through each step of Tanner's Clinical Judgment Model, ending with reflection, which the syllabus treats as the key step. The composite telemetry nurse describes an 82-year-old man receiving IV diuretics for heart failure who became restless and confused at 0200. She traces what she noticed, the explanations she weighed, the bladder scan that found urinary retention and what reflection taught her about the label she almost applied.

CourseNUR 553 Dynamics of Professional Nursing II
ModuleModule 2
Paper typeClinical judgment scenario paper
LengthAbout 700 words, 5 pages
FormatAPA 7 student paper
SchoolArizona State University
ProgramMS in Nursing
UpdatedOctober 2026

Free sample paper for NUR 553 Module 2

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Restless at 0200: Applying Tanner's Clinical Judgment Model to New Confusion in an Older Man With Heart Failure

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 553: Dynamics of Professional Nursing II

Instructor Name

Month Day, Year

What this page is doingThe title names the moment that began the judgment and the model used to examine it, so the reader knows both the case and the method.
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Restless at 0200: Applying Tanner's Clinical Judgment Model to New Confusion in an Older Man With Heart Failure

Introduction

Tanner (2006) built her model from research on how experienced nurses think: four linked phases, each colored by the nurse's background, her knowledge of the patient and the setting. This paper applies her model to a composite night on my telemetry unit when an older patient's new confusion could have been labeled "sundowning" and left at that.

The Scenario

Mr. L. is a composite 82-year-old man admitted with a heart failure exacerbation and receiving intravenous furosemide twice daily. At the start of my shift he was alert, oriented and joking about the hospital food. He wore an external condom catheter because he had trouble reaching the urinal. At 0200, his telemetry showed sinus tachycardia at 112, up from the 80s. When I went in, he was trying to climb out of bed, picking at the sheets and saying he needed to "get to the truck." He did not know where he was.

Noticing

What I noticed first was the change from his baseline. Tanner (2006) emphasizes that noticing depends on the nurse's expectations, which come from knowing the patient and the typical course of a condition. I had talked with Mr. L. four hours earlier, so I knew this was new. I also noticed his heart rate, that he was pressing on his lower abdomen and that the condom catheter bag held almost no urine despite a diuretic dose at 2000.

Interpreting

I considered several explanations. Delirium from hypoxia was possible, but his oxygen saturation was 95% on two liters, unchanged. Electrolyte disturbance from diuresis was possible, especially low sodium or potassium, and his evening labs were not yet back. A new arrhythmia or low blood pressure could reduce brain perfusion, but his rhythm was sinus and his blood pressure was 148/86. "Sundowning" or dementia was tempting, but he had no history of cognitive impairment. Pain could cause agitation. The small urine output after a diuretic, the abdominal pressing and the tachycardia together pointed toward urinary retention, which is a recognized precipitant of delirium in older adults (Inouye et al., 2014). Tanner calls this analytic reasoning, working through possibilities systematically, which I used alongside intuition from having seen similar patients.

Responding

I stayed with Mr. L., spoke calmly and reoriented him. I performed a bladder scan, which showed about 850 mL. Following our unit's protocol, I performed a straight catheterization, draining 900 mL. Within 20 minutes his heart rate was 92, he stopped trying to get up and he said he felt "a lot better down there." I notified the night hospitalist, who ordered a basic metabolic panel, a urinalysis and a plan to monitor post-void residuals. His labs returned showing mild hypokalemia, which was replaced. I documented the change in mental status, the scan result and his response.

Reflecting

Reflection in action. During the event, I caught myself starting to think "he's sundowning." What stopped me was the mismatch with his baseline and the empty bag. I adjusted my thinking in the moment, which is what Tanner describes as reflection in action: recognizing that my initial response might be wrong and changing course.

Reflection on action. Afterward, I asked what I could learn. First, I had not checked his output closely during the evening, assuming the condom catheter was working. Second, new confusion in an older patient is a medical change until proven otherwise, and labels such as "sundowning" or "confused at baseline" can close off the search for causes. Third, older men with heart failure on diuretics have several risk factors for urinary retention, including enlarged prostates and reduced mobility, so I now check output and consider a bladder scan whenever I see new agitation. I shared the case at our next unit huddle.

Conclusion

Tanner's model made visible a process that happened quickly at the bedside, the kind of judgment our course text places at the heart of professional nursing (Friberg & Saewert, 2024). Knowing Mr. L.'s baseline let me notice the change; systematic interpretation led me away from an easy label; my response treated the cause; and reflection turned one night into a habit I will keep.

What this page is doingEach step of Tanner's model has its own heading tied to specific facts in the scenario, and the reflection section distinguishes reflection in action from reflection on action, which the syllabus calls the key step.
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References

Friberg, E. E., & Saewert, K. J. (Eds.). (2024). Conceptual foundations: The bridge to professional nursing practice (8th ed.). Elsevier.

Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922. https://doi.org/10.1016/S0140-6736(13)60688-1

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 553 Module 2 instructions ask for

The posted syllabus describes the Week 2 paper, Critical Judgment Scenario: Thinking Processes for Nursing, as an application of Tanner's (2006) Clinical Judgment Model and its four phases. Students think about their clinical experiences, write a scenario in which they applied clinical judgment to a patient care decision, following HIPAA guidelines, and respond to the required prompts for each step. The syllabus singles out the fourth step, reflection in action and reflection on action, as the key. The paper is one of three worth 35 points in total. Choose a situation where your thinking changed during the event, since that gives you something real to reflect on.

How the NUR 553 Module 2 example is put together

Tanner's model is introduced in one paragraph, and the scenario follows in two: a patient's baseline, then the change at 0200. Four headed sections apply the model. Noticing identifies what was new against the baseline. Interpreting weighs five explanations against the data and names the reasoning pattern. Responding describes the bladder scan, the catheterization, the patient's response and the notification. Reflecting is split into reflection in action, catching the "sundowning" label, and reflection on action, three lessons and a huddle. A short conclusion ties the four steps together. Three sources support the paper: Tanner's article, the course text and a review of delirium in older people.

NUR 553 Module 2 rubric: what earns full marks

Within the papers' 35 points, this one is likely graded on a clear, HIPAA-compliant scenario, accurate application of each step of Tanner's model, depth of reflection, especially the distinction between reflection in action and on action, and APA writing. Papers earn most when each step is tied to specific facts in the scenario rather than defined in general. Interpreting is stronger when several explanations are considered and weighed against data. Honest reflection about what the writer almost missed shows the growth the model is meant to build. Because the syllabus calls reflection the key step, it deserves the most developed section, with at least one lesson that changed how the writer practices.

NUR 553 Module 2 help with common mistakes

Many scenarios describe what happened without showing the thinking. Write what you noticed, what you considered and why you chose your response. Another weakness is a reflection that only praises the outcome; say what you would do differently. Avoid any identifying detail about the patient or facility. If you describe a clinical situation to the desk, a paper can be drafted around your own reasoning. Separate reflection in action, during the event, from reflection on action, afterward, since the syllabus asks for both, and give the second one a concrete change you made. A short note on what you would teach a newer nurse from the event shows that the learning carried forward. Hold the story to a paragraph or two so the four steps get the space, and cite Tanner for the model.

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 Arizona 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 553 Module 2 questions, answered

Where can I find a free NUR 553 Module 2 sample paper?

This page carries a full NUR 553 Clinical Judgment Scenario sample applying Tanner's model to new confusion caused by urinary retention.

What does the NUR 553 clinical judgment paper ask?

Write a HIPAA-compliant scenario from your practice and respond to prompts for noticing, interpreting, responding and reflecting in Tanner's model.

What are the steps of Tanner's Clinical Judgment Model?

Tanner's model runs through noticing, interpreting, responding and reflecting, with reflection happening both during care and once the event is over.

What is the difference between reflection in action and on action?

Reflection in action happens during the event and changes what you do; reflection on action happens afterward and changes future practice.

Can urinary retention cause confusion?

Yes. In older adults, urinary retention is a recognized trigger of agitation and delirium, which is why new confusion warrants a search for causes.