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Clinical Nursing Judgment

Vince Sferra

Youngstown State University

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Clinical Nursing Judgment

According to Cappelletti, et al, “Clinical judgment refers to the cognitive processes involved in

making judgments, which includes making sense of data and cues and is defined as an interpretation

about a patient's needs, concerns, or health problems, followed by a determined course of

action(Cappelletti,453-458).” This is the definition of nursing clinical judgment and I have noticed

myself, a student, and Registered Nurses incorporate this skill with every patient and situation. There

have been multiple studies conducted regarding clinical judgment in nursing. One doctors article I

enjoyed reading and learning about the continual growth of clinical judgment in nursing was Christine

Tanners'. This article explains and elaborates on how the judgment is generalized, broken down into

five drawn conclusions. The first of these shows how a situation is influenced by a nurses outside

information opposing to the information that is already given prior about the same situation. The

second of these conclusions discusses the nurses knowledge about the patient themselves, their

concerns, and knowing how he or she will respond in a certain situation. Third, depending on the

culture of the floor you are working on, when a situation arises, the clinical judgments are then

influenced by the nursing environment of that floor. These judgments being influenced by the nursing

environment help the nurses to practice the use of several response patterns, whether individually or in

combination with another. A nurses practice of response patterns is the fourth conclusion of this article.

The fifth conclusion is reflection. Reflecting on your practice can be initiated by any disruption in

clinical judgment, which is also critical for the improvement of clinical knowledge and developing

clinical reasoning(Tanner, 204-11). I agree with everything this article states. I felt that I took in a
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large amount of information about this topic that seemed helpful to me, and I think this could also be

helpful to any student or beginner nurse. I feel that learning information that is essential to patient care

not only is helpful but is also required every day. Most students benefit from hands on experience with

practice in the clinical and preceptor setting. The clinical judgment model is a great base for new,

young nurses to assist them in finding their own way as a nurse. This gives the beginner something to

fall back to when caring for patients. This skill will then become second nature, after the nurse has

gained experience through years learning and practice.

According to Dickison, et al, “Sound nursing clinical judgment is at the core of competent and

safe client care. New graduate nurses face increasing challenges that underscore the importance of

investigating how nurse educators teach and measure nursing students' abilities to make clinical

judgments(Dickison, 72-78).” Not only is it difficult for the new students to grasp this concept, it is

also a challenge to educators to evaluate new nurses. There is so much for a new nurse to learn, it takes

time to build a comfortable and efficient routine. Once this routine is established, it is that much easier

for the nurse to provide safe care to the patient. This takes time and has to be evaluated to determine if

the nurse is producing effective care and judgment. They also go on to talk about how the nurse

educators do not have a true assessment model to evaluate the nurse's judgment skills(Dickison, 72-78).

Having a proficient way to measure a nurse's growth and efficiency would benefit the new nurse and

educator. The new nurse would know where they stand and what they need they need to improve upon.

For the educator, this would allow them to help the nurses focus on areas of need. This assessment tool

will greatly aid the new nurse to learn how to make effective clinical judgments in the patient care

setting.
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There are numerous reasons to use nursing judgment everyday in your nursing career. I have

experienced this situation countless times while rotating through each clinical from semester to

semester. One scenario that is a good example of judgment was experienced during my preceptor

hours. This was my second shift at the BHI at St. Elizabeth's hospital, where I meet a patient for the

first time. Upon entering the room, I introduced myself. The patient was confused and became nervous

about where his nurse was. The patient was afraid of me and barely wanted to talk. Instead of leaving

and finding my nurse to help orient the patient, I took the responsibility on myself. I was able to build

trust. Doing so enabled the patient to be more open. I was able to put the patient at ease by building a

therapeutic relationship. I made the decision to stay to talk to the patient and was able to communicate

him. After reassuring and reorienting the patient, I went and found my preceptor. We went back into the

room, the patient recognized me and the problem was resolved. My nurse and patient both appreciated

how I handled the situation. Another time I had to use my judgment skills was during my intensive care

clinical. My patient was ventilated and was very confused. The patient was newly admitted to the unit

and I had the opportunity to give one of the initial assessments. While assessing, I noticed the patient

continuously try to pull her lines and ventilator tubing. The patient disconnected the ventilator and I

knew something had to be done. I reattached the tubing and found my nurse. I told the nurse about the

situation and assumed we should restrain the patient. I am never to sure when to restrain patient, so I

made the decision to inform the nurse about the problem. By using my judgment, I knew what was

needed and proceeded in the proper steps to alleviate the risk the patient was susceptible to, self harm.

In conclusion, nursing clinical judgment is a very important skill a nurse has been and is used

numerously throughout the nurses career. I have had my experience where my judgment was needed.

This skills will become mastered over time with practice and experience. With judgment in nursing, the

nurse bring a lot to the situation. The nurse can influence any situation, can bring in outside values,
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provide responses, and be able to reflect on the judgment call. This is a skill every should have and will

aid in providing safe and therapeutic care for patient.

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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:http://eps.cc.ysu.edu:2089/10.3928/01484834-20140724-

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the national council of state boards of

nursing clinical judgment model into nursing educational frameworks. Journal of Nursing

Education, 58(2), 72-78. doi:http://eps.cc.ysu.edu:2089/10.3928/01484834-20190122-03

Tanner, Christine A,PhD., R.N. (2006). Thinking like a nurse: A research-based model of clinical

judgment in nursing. Journal of Nursing Education, 45(6), 204-11. Retrieved from

https://eps.cc.ysu.edu:2255/docview/203965102?accountid=29141
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