Clinical Nursing Judgement

Shauntiaonia Johnson

Senior Capstone Scholarly Paper

Youngstown State University

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Clinical Nursing Judgment can be descripted and broken down in a few different ways,

but the most common definition and understanding received regarding nursing judgment would

be that it refers to and is done strictly for the best outcome of the patient’s health by using critical

thinking to prioritize care. Clinical nursing judgment is the cognitive processes involved in

making judgments, which includes making sense of data and cues. (Executive, 2015, p.1).

Exhibiting or based on thorough knowledge and experience “Clinical” was defined as,

relating to or conducted in or as if in a clinic: involving direct observation of a “patient” and

“judgment” as “the process of forming an opinion or evaluation by discerning and comparing.”

(Manetti, 2017, p.2). It is considered the “cognitive or thinking process used for analyzing data,

deriving diagnoses, deciding on interventions, and evaluating care.” This includes; clinical

knowledge and experience, effective patient relationships, collection of pertinent evidence,

scientific analysis, organization and prioritization of data, hypothesis generation, and actions

(Khanke 2017, p.1).

Nursing Judgment is comprised of two factors that affect decision making. These two

factors that lead clinical nursing judgement are “initiative and expertise” (Anderson, 2013, p.1).

Nursing is a practice based discipline and one of the basic objectives of nursing education is to

achieve clinical judgment. Whether that be seen in the student’s paperwork, or hands on

experience, all nursing students are taught to build their own understanding of nursing judgment

and they have the opportunity to be a part of the decision making cues as it is accomplished over

the course of the program in the clinical setting.

Clinical Nursing Judgment is considered essential for decision making and is considered

an inseparable part of a high quality nursing care. Therefore, nursing students are expected to
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have relative skills and clinical judgment capability at the time of graduation. It has been

suggested that nursing education requires revisions in order to address knowledge and skills

needed for students transitioning into nurses.

The need for high quality nursing education demands a clear vision and defined direction.

Clinical judgment is necessary for decision making and enhancing nursing student’s

improvements in health care quality. Since clinical judgment is an interactive phenomenon and

dependent on context and culture, it can be affected by many different factors (Khanke, 2017,

p.1). All nurses should have this cognitive process, it is a mandatory skill to have, but sometimes

it can be diminished due to the lack of following formal and informal processes.

Today, shortage of quality nurses can lead to early and independent confrontation

amongst new graduates with judgment and decision making challenges. In health care, this can

increase due to the probability of safety, and system aspects that produce errors, which can lead

to harm to patients. It is important that the skill and critical thinking of new nurses is instilled

enough to help prevent patient harm, but the shortage plays a huge role in the data cues missed

that take place. These decision making skills in solving clinical problems is important to help

prevent patient injuries.

According to the American Organization of Nurse Executives (2015), Patient harm

caused by lack of nursing judgment has encouraged the nursing education systems to plan and

prepare students studying this major and facilitates the development of their own clinical

judgment. However, according to research, a large number of nursing students do not have as

much clinical judgment as expected when graduating. Most new nurses start with a good amount

of initiative due to just finishing their programs and passing their boards but once a nurse
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practices they should develop a sense of expertise where decisions made for a patient are more

factual and accurate, it does not come from the textbook the differentiation between the text book

and hands on care needs to have an established baseline.

Development of clinical nursing judgment in the nursing profession expertise is the other

factor that plays a huge role. Experiential learning is defined as “posing and testing questions in

real situations that deviate from expectations based upon theory and principles” (Chelsea, 2009,

p.2). A nurse’s initiative and expertise create the foundation for the nurse’s clinical nursing

judgement. It has been increasingly recognized that clinical learning environment plays an

important role in the success of clinical training programs and development of thoughtful and

practical skills such as clinical judgment (Chelsea, 2009, p.2).

Identifying the basic factors that underlie the clinical judgment by nursing educators will

help to create a favorable environment for development of this important clinical phenomenon.

Since clinical judgment is an interactive phenomenon and dependent on context and culture, it

can be affected by many different factors. (Anderson, 2016, p.3). The characteristics of the staff

team and the situation could positively or negatively affect clinical decision‐making. Sound

clinical judgment of experienced nurses consist of four features: noticing, interpreting,

responding, and reflecting. In the noticing phase, nurses form an impression of a situation based

on expectations, knowledge, experiences, values, morals, and their relationship with the patient

(Chelsea, 2009, p. 2).

Some personal experiences of Clinical Nursing Judgment that took place during clinical

that was selected to discuss would have to be from a critical care offsite experience in the

emergency department. There was a male patient age 33 that arrived to the ED nonresponsive, he

over dosed on heroin and his neighbor called the ambulance. The patient was given Narcan in the
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ambulance ride but there was still no change, once the patient came into the Emergency

Department CRP and compressions were already started by the EMT, the nursing team took over

once he arrived. He got a pulse after the first shock and 1st round of epinephrine, then coded

again. This code rotation was a total of 20 minutes, until there was finally another pulse. Over

all, he was given 3 rounds of Epi, shocked 3 times, and a femoral catheter was inserted for a line

of access.

The nursing student noticed that clinical knowledge and experience, collection of

pertinent evidence, organization and prioritization of data, and actions were all used to get the

patient stable. Clinical nursing judgement took place as soon as the patient arrived to the unit,

during the cycle of CPR every nurse communicated, worked together, and decided on the best

decision as a unit that could help get the patient back breathing and with a pulse. The student got

to witness first hand clinical judgment and critical thinking skills being used in seconds because

there is no time to over think in a dire situation like this.

The cognitive processes involve a lot more than making sense of data and cues, is it also

an interpretation about a patient’s needs, concerns, or health problems, that will then lead to a

determined course of action for the patient overall. Clinical Nursing Judgment is not only critical

thinking and knowledge it is also about doing what is right for the patient being cared for by the

nursing staff. Building this skill of judgment as a student and a new nurse will increase the likely

hood of quality patient care.

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References

American Organization of Nurse Executives (2015). BSN-level nursing resources. Retrieved

from http://www.aone.org/resources/leadership%20tools/BSN.shtml

Benner P, Tanner C, Chelsa C. (2009) Expertise in Nursing Practices. 2nd ed. New York:

Springer Publishing; retrieved from https://eps.cc.ysu.edu:3258/ContentServer.asp

Cazzell M, Anderson M. (2016). The impact of critical thinking on clinical judgment during

simulation with senior nursing students. Nursing Education Perspect.;37:83‐90.

Retrieved from https://doi.org/10.5480/15‐1553

Dr. Hamidreza Khankeh, and HaMidrEza Khanke (2017). Factors Influencing Nursing Students’

Clinical Judgment: A Qualitative Directed Content Analysis in an Iranian Context

retrieved from https://eps.cc.ysu.edu:3258/ContentServer.asp

Mary Cazzell and Mindi Anderson (2013). The Impact of Critical Thinking on Clinical Judgment

During Simulation with Senior Nursing Students Retrieved from

https://eps.cc.ysu.edu:3258/ContentServer.asp

Wendy Manetti PhD, RN, CRNP (2017). Sound clinical judgment in nursing: A concept analysis

retrieved from https://eps.cc.ysu.edu:3258/ContentServer.asp