Running head: CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Melissa Walko

Youngstown State University

Senior Capstone
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Clinical nursing judgement 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”

(Manetti, 2019). As nursing students and registered nurses, it is essential to be able to draw a

conclusion quickly from the patient’s demands. Nurses’ judgements must be fair and they must

consistently advocate for the patient. In the article by Pouralizadeh et al. (2017) based five main

categories of clinical judgement, and they are as follows: thoughtful behavior, professional

ethics, use of evidence-based care, context of learning environment, and individual and

professional features of clinical teachers. Within these categories, the same article mentions

subcategories for each one that makes clinical judgement even more important, such as

assessment and how important it is to fully assess the patient so they are fully aware of the

condition. Critical thinking is mentioned as well and it is determined by how many questions we

ask ourselves or what our instructors ask us about the patients being taken care of. Intuition was

also a big thing in the article by Pouralizadeh et al. (2017), and how it is resolved by team work

and what our knowledge tells us to do. Ethics also play a big part of clinical nursing judgement

and figuring our what is right and wrong and what is best for the patient alone. (Pouralizadeh et

al., 2017).

Clinical nursing judgement can only be developed through experience. Nursing students

can only experience so much through clinicals and preceptorships. At that time, it is not a full-

time job and the students are not seeing what actually happens in an everyday basis. New

graduates also suffer from little experience of clinical judgement but it is crucial to build the

knowledge from graduation and on. Manetti (2019) states, “it is important that nurses recognize

when they are unsure of patient care decisions and seek guidance from experienced nurses on the
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unit. This is especially true for the novice nurse, those who are new graduate nurses. In fact,

researchers have found that new graduates relied on others to make sound clinical judgments. It

is more commonly observed that new nurses need the support of more experienced nurses to

validate decisions made. When both knowledge and experience is gained, the need is expected to

diminish over time.” In the article by Lindsey and Jenkins (2013), they discuss how nursing

students’ react and prepare for a rapid response. It is mentioned that “new graduates may be

particularly vulnerable to failure to rescue because they lack the knowledge and ability to make

sound clinical judgments in complex, rapidly changing patient care situations” (Lindsey and

Jenkins, 2013). This article states that even though rapid response simulations are able to

replicate as realistically as it can possibly be, it still isn’t overall very effective, as it states that

“nurses failed to activate rapid response systems when they believed that the patient’s condition

was not serious enough to warrant the call; researchers have asserted that nurses may be

uncomfortable with the level of autonomy rapid response systems bring, and that if care is not

taken to support them through the change process, rapid response systems will not succeed;

inadequate education for new staff and continuing education for existing staff is associated with

low numbers of rapid response calls (Lindsey and Jenkins, 2013). This shows while clinical

simulations are helpful in a sense of what can happen, new nurses still aren’t able to transfer the

simulation into a real-life situation, and therefore endangering the patient and their own job.

However, this does not mean to eradicate clinical simulations. Perhaps an increase in the number

of simulations needed to complete per six months, more or less, could increase knowledge and

clinical judgement. According to Lindsey and Jenkins (2013), “although nurse educators assume

that clinical simulation is effective for teaching technical skills and for augmenting clinical

judgment, researchers should empirically examine outcomes related to clinical simulation, rather
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than focus exclusively on students’ perceptions of learning. This study could be replicated using

multiple sites and random sampling. Future studies could examine clinical judgment in a variety

of situations in which nursing action is crucial to patient safety. Future researchers might

consider evaluating achievement of learning objectives through direct observation of students

during the RRT scenario and eliminating the Code Blue scenario.”

In my personal experience where I had to use clinical judgement, I had a pediatric patient

with cerebral palsy that came in for constipation. I knew that I had to turn this patient at least

every two hours to reduce the occurrence of stress ulcers, to monitor their bowel sounds, and to

clean them up after every incontinent episode. Basically, the main goal was to keep her safe and

comfortable as much as possible. While taking care of this patient, I noticed that the father, while

helping me clean her up, was very rough with the patient while cleaning her genitals, and would

carelessly throw the dirty laundry on the floor towards his wife and even towards me and the

other nursing students that were helping me. Knowing that this wasn’t within the patient’s

comfort range, I decided to bring this event up to the patient’s nurse as well as my instructor to

discuss this. The nurse kept a closer eye out for the patient from then on. From this experience I

truly realized what it meant to be the patient’s advocate. I wanted to do everything in my power

to make sure the patient was safe and comfortable while in the hospital being taken care of.

In conclusion, clinical nursing judgement is a fundamental part of being a nurse. With

teamwork, practice and increasing knowledge, nursing students and new nursing graduates can

safely carry out clinical judgement. While simulations are widely used across nursing schools

and hospitals, they aren’t being used to their fullest potential to make nurses feel safe about

practicing clinical judgement and participating in a life-or-death situation. However, clinical

judgement is also best gained through experience. Nurses are allowed to make mistakes because
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they are human after all, and it is with those mistakes that will make us even better nurses. With

the experience, knowledge and constant practice, patients can get the safety and comfort they

deserve from our clinical nursing judgement.

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References

Lindsey, P. L., & Jenkins, S. (2013). Nursing Students’ Clinical Judgment Regarding Rapid

Response: The influence of a Clinical Simulation Education Intervention. Nursing

Forum, 48(1), 61-70. https://doi.org/10.1111/nuf/12002

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102-110. https://doi.org/10.1111/nuf.12303

POURALIZADEH, M., KHANKEH, H., EBADI, A., & DALVANDI, A. (2017). Factors

Influencing Nursing Students’ Clinical Judgment: A Qualitative Directed Content

Analysis in an Iranian Context. Journal of a Clinical & Diagnostic Research, 11(5), 1-4.

https://doi.org/10.7860/JCDR/2017/25753.9822