Kristy Farkas

Senior Capstone
Scholarly Paper / Nursing Judgment
3/19/18

Clinical nursing judgment is defined as “an interpretation or conclusion about a patient’s

needs, concerns, or health problems, and/or the decision to take action (or not), use or modify

standard approaches, or improvise new ones as deemed appropriate by the patient’s response

(Tanner, 2006). Nursing clinical judgment is a skill that is developed overtime with experience in

the field. The more knowledge and experience a nurse has at recognizing cues and relationships

between cause and effect can help to make the process of nursing judgment come easier or

quicker. For example, an ER nurse who has worked in the field for over ten years would

recognize and put together patient data and cues quicker because they have seen similar patient

scenarios throughout their career; whereas a new ER nurse who is just beginning their career

make take a longer time to process the data and come to a conclusion as to what is going on with

their patient if they are not familiar with data or cues.

“Clinical judgment is viewed as an essential skill for every nurse and distinguishes

professional nurses from those in a purely technical role (Lasater, 2007)”. Nursing judgment is

developed after patient history is obtained as well as assessment of the patient which helps the

nurse to therefore develop a proper nursing diagnosis from the data they receive. It requires the

nurse to know what the priority of care is from the data they collected so they can develop a care

plan for the patient and then properly implement it in a timely manner. The beginning

development of nursing judgment starts in nursing school, with the beginning of patient care in

the clinical setting as well as the knowledge base we develop in class. We first learn about the
body systems and disease processes and then when put in all together in the clinical setting. By

seeing patients one on one, and watching nurses on the floor care for patients, we start to put

together our assessment data with our knowledge base to form educated conclusions about what

is going on with the patient and what needs to be done to restore health through the nursing

process. Simulations used in nursing school also help to develop clinical nursing judgment and

give students the opportunity to see real life situations in a controlled environment where they

can hear the opinions of their peers, and instructors to collectively develop the best plan of care

for the patient based on the scenario at hand. From the very first day of nursing school students

are told to “think like a nurse”. In the journal of nursing education, Tanner states that “thinking

like a nurse involves the four phases of the clinical judgment model; noticing, interpreting,

responding, and reflecting”. Noticing is referred to as the nurses understanding of the situation at

hand that is based on the nurse’s knowledge of a particular patient and their specific pattern of

responses as well as the nurse’s clinical experience, their knowledge base of similar situations,

their knowledge base and the nurse’s individual values. Interpreting is the nurse’s ability to take

patient cues and gathered patient data to develop an understanding of the situation in order to

determine the proper course of action and respond. Responding is implementing the

interventions put in place for the patient based on the interpretation of the data collected. Finally,

reflecting is the nurse’s ability to read the patient and how they are responding to the

interventions that were implemented and what may need to be tweaked and based on those

interventions and patient responses the nurse gains further clinical judgment for the future. All of

the experiences endured in class, clinical, and simulation along with the feedback from the

instructors and other nurses help to mold early clinical nursing judgment and the development a

nurse’s intuition.
 Nursing judgment is very important because it is what helps nurses keep their patients

safe, stable, and properly cared for while in the clinical setting. According to Thompson’s

International Journal of Nursing Studies; the timing, delivery, and management of such

judgments nurses receive from patient data can dictate whether or not an intervention or plan of

care will be beneficial. If the nurse doesn’t recognize certain cues from the patient, properly

assess the patient situation, initiate the proper treatment or proper timing of a treatment it can put

the patient at risk or deter there recovery. Therefore, clinical nursing judgment is one of the most

important things for a nurse to develop along with a knowledge base and clinical skills to provide

the best care for their patients.

In my own clinical experience one example of nursing judgment that really sticks in my

head was with a patient on my OB rotation. I had a mom who was one day postpartum with a

history of heroin abuse and a baby with NAS. The mom has stated on her admission that she had

been clean from heroin for over 5 months but had been taking oral methadone for withdrawal

since and was prescribed them in the hospital postpartum. When I went into her room and began

her assessment I noticed that she looked very uncomfortable, unable to sit still in her bed, her

vitals were elevated and she was diaphoretic. She told me she had been having a lot of cramping

and was in a lot of pain from her c-section. She wasn’t having any unusually bleeding or signs of

DVT or infection of her incision. Her first dose of methadone was ordered at 8am so i went

ahead and gave her the methadone immediately and some ice packs for her incision and I

planned to reevaluated her pain in a half hour. When I went back into her room 30 minutes later

her pain had not subsided at all and she was crying and shaking in her bed unable to sit still from

the pain. Having experience in what withdrawal symptoms look like due to a family member, I

decided to ask her some questions about her drug use and told her there was no judgment but that
she needed to be truthful for us to help her. She confided in me that she may have slipped up a

few times recently and used after what she had originally stated. I thanked her for being honest

and lowered the lights and told her to close her eyes and take some deep breaths and try to focus

on something else while I went to tell her nurse and look at her orders. I went and explained to

the nurse what she had told me and that I thought she may need something else for her

withdrawal symptoms and pain other than the methadone. She immediately called the doctor to

explain the situation and to get a new medication order for the patient that we administered

immediately. Half an hour later, the patient seemed more relaxed and her vitals stabilized. She

thanked me for caring enough about her situation to ask and making her feel comfortable enough

to confide in me something she was embarrassed about.

References:

Nielsen, A., Lasater, K., & Stock, M. (2016). A framework to support preceptors’ evaluation and

development of new nurses’ clinical judgment. Nurse Education in Practice, 19, 84-90.

doi:10.1016/j.nepr.2016.03.012

Tanner, C.A. (2006). Thinking like a Nurse: A Research-Based Model of Clinical Judgment in

Nursing. Journal of Nursing Education, 45(6), 1-9.

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