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Clinical Nursing Judgement: A Key Aspect of Nursing Care

Ashley Gladd

Nursing Department, Youngstown State University

NURS 4852: Senior Capstone

Dr. Kim Ballone/Wendy Thomas

March 2, 2020
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Clinical Nursing Judgement: A Key Aspect of Nursing Care

The concept of clinical nursing judgement is often hard to define, as this concept is often

integrated with critical thinking. Although a nurse must possess the ability to think critically to

carry out clinical judgement, the two concepts are completely separate.

There is not a simple definition that can completely define the concept of clinical nursing

judgement, but through extensive research on this topic, a basic understanding of this concept

was sought for and found.

Manetti (2019) discusses multiple factors within the definition of nursing clinical

judgement. Clinical judgement includes interpreting a patient’s needs and health problems and

the action the nurse takes or chooses not to take in regards to their findings (p 103). It is easy to

imply that the two concepts, critical thinking and clinical judgement, as one, but in a broader

sense clinical judgement is the actions a nurse takes after implementing their critical thinking

skills.

Throughout nursing school, students are tested and evaluated on their ability to think

critically, but not evaluated enough on their ability to use clinical judgement. Anderson &

Cazzell (2016) state, “In current nursing education research on simulation, much of the focus is

on evaluating improvements in CT post simulation, ran than CJ” (p 83). Nursing students need to

be educated and evaluated on clinical judgement, because once a basic understanding of this

concept is achieved, they can begin to understand how important this concept is to implement

into their everyday nursing care.

When a nurse attains the ability to use clinical judgement, they are able to assist patients

with more positive outcomes. Manetti (2019) states, “For patients, sound clinical judgement
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results in improved outcomes due to early detection of problems, quality nursing care, and

prevention of complications” (p 106).

A nurse with this ability can recognize when the needs of their patients change and take

action to accommodate these changes. For example, a nurse who has good clinical judgement

will recognize that their post-op patients wound has worsened by changes in the patient’s vital

signs and appearance and take necessary action to contact the provider and stabilize the patient,

which leads to a better outcome for the patient. A nurse who does not inhibit good clinical

judgement, may not recognize these early changes and attribute it to the wound. This nurse may

only see that the wound is worsening when they directly look at the wound or when a negative

outcome has taken place, such as infection leading to septic shock. Dalvandi et al. (2017)

reinforces this by stating, “Clinical judgement and decision making skills in solving clinical

problems is the most important factor in preventing such injuries” (p 1). Patient outcomes are

greatly reflected on the care the patient receives by nursing staff. It is important for nurses to

understand and use good clinical judgement in their every day practice, so positive outcomes for

the patient and family can be consistently maintained.

According to Dalvandi et al. (2017), “However, according to research, a large number of

nursing students do not have as much clinical judgement as expected when graduating” (p 1).

This is likely due to the concept of critical thinking and clinical judgement being merged into

one concept, rather than two separate concepts. As discussed previously, clinical judgement is a

very important skill for a nurse to understand and implement, and nursing school should be the

place that this understanding begins. As a nursing student who will be graduating in just a few

months, I feel that my nursing educators have taken the time to educate me on this concept. I feel
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that I have a basic understanding of clinical nursing judgement and would like to discuss a time

where I was able to implement this concept into my nursing care.

During my preceptorship I took care of an elderly diabetic patient who had just returned

from a five-hour treatment of dialysis. Upon his return, he was exhibiting signs of confusion

which were different from his baseline documented neuro assessment. Due to these offset signs

of confusion I quickly performed a neuro assessment of my own. I looked at his chart thereafter

and found that he was not given anything to eat while at dialysis and was given his insulin as

ordered. I proceeded to retrieve the blood glucose monitor and test his blood glucose, which

came back at a level of 50. I immediately notified my preceptor of my findings and the blood

sugar protocol was implemented. The patient was given a turkey sandwich, peanut butter

crackers, orange juice and IV Dextrose. Along with implementing the blood glucose protocol, we

held his evening dose of insulin as ordered and monitored his blood glucose according to

protocol over the next couple of hours. I feel that I implemented good clinical judgment and in

return my patient had a positive outcome. In this same situation, if a nurse did not have the

understanding and ability to use clinical judgement, they may have attributed his confusion to

sundowning, which could have led to a negative positive outcome. As Manetti (2019) stated,

“Bedside nurses must notice subtle cues and changes in a patient’s condition to prevent

complications and detect problems as soon as possible” (p 102).

In conclusion, nursing clinical judgment is a quality that every nurse should be able to

implement. Good clinical nursing judgement leads to better outcomes for the patient and

maintaining positive patient outcomes is something every nurse should strive for daily.
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References

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

simulation with senior nursing students. National League for Nursing, 37(2), 83-90.

https://doi.org/10.5480/15-1553

Dalvandi, A., Ebadi, A., Khankeh, H., & Pouralizadeh, M. (2017). Factors influencing nursing

students’ clinical judgement: a qualitative directed content analysis in an Iranian context.

Journal of Clinical and Diagnostic Research, 11(5), 1-4.

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

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

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