RUNNING HEAD: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment

Kaitlin North

NURS 4832 Capstone

Youngstown State University

February 27, 2017

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Nurses are professionals with many tricks up their sleeves. Assessment tools such as

auscultation, palpation, inspection, percussion, and observation are taught in nursing school in

order to teach students to effectively care for patients. However, one of the tools not easily taught

but one of the most important is clinical nursing judgment. Clinical nursing judgment is one of

the tools nurses use every day for every patient they care for. Since the 1960s, nurses have been

used as a tool to aide in research on judgment and decision making because of their use of

nursing judgment on a daily basis (Thompson, Aitken, Doran, & Dowding, 2013).

Clinical nursing judgment has many definitions and meanings. Cappeletti, Engel, and

Prentice described it as the cognitive process of interpreting data relating to patient needs and

problems, and express clinical judgment and reasoning as the hallmarks of professional

nursing (2014). Fedko and Dreifuerst define it as, noticing patient cues, developing

interpretations and forming hypotheses, responding through nursing action, and evaluating the

actions that occurred through reflection (2017). While the wording is different, the general

consensus is that it is the process and reasoning behind choosing a nursing action that best

benefits the patient based on the information gathered by the nurse. It is how a nurse assesses if

they are delivering safe, quality care to a patient, which is the primary goal of passing the

NCLEX and gaining licensure.

Throughout my time in nursing school I have had opportunities to develop nursing

judgment. One instance that comes to mind was during a med-surge clinical. Upon entering the

unit and getting my assignment, the nursing assistant personnel (NAP) were gathering routine

vital signs with the rolling vital sign machine. After introducing myself to the NAP, I inquired

about the vital signs of my patient, which showed a blood pressure of 85/50 mmHg. Alarmed, I

went and took it manually twice to ensure accuracy, which came out to 101/55 mmHg. While the
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blood pressure I took was significantly better, the issue was that they had a blood pressure

medication scheduled for that morning. The order parameters were set to hold the medication if

the systolic blood pressure was less than 100, which the patients blood pressure barely qualified.

Just looking at their vital signs (all other vital signs were stable), the medication was technically

safe to give. I looked through their chart and saw that there were other instances where their

pressure was on the border and other nurses gave them the medication without incident.

However, part of using clinical judgment is using what you observe, not what others observe, to

make a decision.

Based on just the order the medication was safe, however I was not comfortable with

their pressure and was concerned that it would plummet if given the medication. The other

concern was that if the medication was held, their pressure would elevate too much and still put

them at risk, but changing the time on the dose to later in the morning and monitoring their

pressure was an easy solution to this. My nurse, instructor, and I all agreed to this, and

conveniently the physician was rounding on the floor while this was happening so letting them

know about the situation was easy enough and they also agreed that holding the dose was the

safest way to care for the patient at this time. Throughout the day I monitored their pressure,

which peaked at 115/60 mmHg, which showed me that my instincts were right to be concerned

about administering that medication because their pressure stayed within normal limits without

it.

Instances like this show why nursing judgment is so important, because the patient could

have starting declining had a blood pressure medication been administered when their pressure

was already low. Cappeletti, Engel, and Prentice ascertain that making sound clinical judgments

is essential to providing appropriate patient care and by improving ways to teach the
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development of these processes in both nursing students and practicing nurses, nurses can learn

to balance intuitive and evidence-based thinking to make moral and effective clinical decisions

(2014). Nurses play a huge role in healthcare and having nurses with sound clinical judgment

helps to improve patient outcomes and ensure safe, effective care. According to research

presented by Thompson, Aitken, Doran, and Dowding, acute care nurses use nursing judgment

for decisions every 10 minutes, while critical care nurses use nursing judgment every 30 seconds

(2013).

Cappeletti, Engel, and Prentice conclude that nursing judgment is a process that takes

time to develop while the nurse reflects and responds to their actions (2014). Clinical nursing

judgment is an important skill utilized by nurses everywhere to provide quality care to patients.

While based on knowledge, it is a skill not necessarily taught but learned through experience.

Thompson, Aitken, Doran, and Dowding maintain that throughout the world, 19 million nurses

use clinical judgment before making a decision regarding the care of patients (2013). In order to

continue to properly educate nurses, teaching the importance of nursing judgment is imperative

so that they can provide competent, safe care for their patients;
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References

Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment and
reasoning in nursing. Journal Of Nursing Education, 53(8), 453-458.
doi:10.3928/01484834-20140724-01

Fedko, A. S., & Dreifuerst, K. T. (2017). Examining the relationship between clinical judgment
and nursing actions in prelicensure students. Nurse Educator, 42(1), 47-50.
doi:10.1097/NNE.0000000000000290

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision
making and judgement in nursing research and education. International Journal Of
Nursing Studies, 50(12), 1720-1726. doi:10.1016/j.ijnurstu.2013.05.003