Running Head: Clinical Nursing Judgment

Clinical Nursing Judgment

Alyssa Streb

Youngstown State University

Running Head: Clinical Nursing Judgment

Nurses deal with a broad range of issues related to the conditions of each patient and their

nursing judgment is one of the most important things to determine the patient’s outcomes.

Nurses are always with the patient seeing their improvements and complications, so being

observational and having good reasoning skills helps the nurse make sound, reliable clinical

judgments. Nurses must have great hands on skill’s, but they also need the knowledge to make

decisions for their patients. Every nurse has a different mindset, so they are going to have a

different clinical nursing judgment. Some nurses will have a list of complications that is going on

with their patient and a lot of information, whereas an emergency room nurse may only have a

little bit of information on the patient which makes it difficult for sound nursing judgment.

Nursing clinical judgement allows the nurse to analyze information they see, review it, and

analyze the data from a nursing perspective. For example, if there is a patient who is bedridden

and who eats few proteins, the nurse is going to conclude that the patient is at risk for developing

a pressure ulcer and will implement the desired nursing interventions.

Clinical nursing judgement can be defined in many ways. Clinical nursing judgment is

when the nurse decides on data to be collected about a client that may be experiencing a

complication, makes an interpretation of the data, and identifies appropriate nursing

interventions to take place. Clinical nursing judgment involves problem solving, decision

making, and critical thinking. A nurse who is prepared and trained will have the ultimate skills of

problem solving, decision making, and critical thinking thus using clinical nursing judgment and

protecting their patients from injury. The nurses experience plays a big role in the speed and

ability that a nurse can make sound clinical judgment. Technology is a big factor on nurses for

using nursing judgment when they should just be able to identify problems with their own skills.

Tanya D.T (2017) said:

Running Head: Clinical Nursing Judgment

We have a sepsis risk assessment tool. It’s helpful if a patient is truly septic, but

sometimes those measurable values are normal or baseline. I think it’s helpful for

when it’s busy, and you might overlook an abnormal value. But I still use my

nursing judgment in the end. Have we come to rely on technology so much that

nurses are losing skill or “sense”? (p.13)

Clinical nursing judgment is so important in nursing practice. Nurses make a lot of

decisions that can impact a patient’s life forever. Acute care nurses face a judgment every ten

minutes, critical care nurses every thirty seconds, and family or public health nurses make up to

ten judgments for every contact they have with new mothers (Thompson, 2013, p. 1721). Also,

around one and a thousand patient encounters result in fatality (Thompson, 2013, p. 1721). From

these statistics, you can tell that what nurses do really affect their patient’s life and how

important clinical nursing judgment really is.

Clinical nursing judgment is one of the key factors of education in nursing students and

we use it almost every day as well in our clinical experiences and transitions. One study reported

that only 24% of new nursing graduates meet clinical judgment expectations (Pouralizadeh,

Ebadi, Khankeh, & Dalvandi, 2017). As such, it is the role of teachers and educators to continue

to convey the merits of clinical judgement. Their influence may allow new nurses to think of

prevention of complications, to focus on what is really happening with their patient and

developing interventions in the scope of their profession.

As a nursing student, I have used clinical judgment almost every day during clinical and

during my preceptorship hours. During my clinical hours on the MICU floor at Saint Elizabeth’s

downtown, I had a patient in acute respiratory failure. I did my head to toe assessment and I

noticed while listening to their lung sounds that I heard crackles bilaterally in both lobes. I also
Running Head: Clinical Nursing Judgment

saw on the ventilator settings that the Fio2 was set a lot different than what the patient was

doing. Obviously, that is something that you do not want to hear and see so I went up to my

clinical instructor and she asked me what I can do as a nurse to help with the crackles and the

Fio2. During this time, I thought hard and used my clinical nursing judgment. I told my

instructor we could either elevate the head of the bed and that may help, or we could suction the

patient and get all those secretions out of the patient and see if they would start breathing better.

We suctioned the patient and then I listened to the lung sounds and they were clear and the Fio2

improved as well. I thought to myself that if I didn’t hear those lung sounds and suction properly,

the patient would be in distress. Another time I used clinical nursing judgment is when I was

precepting on the epilepsy monitoring unit floor at The Cleveland Clinic. My doctor told me that

he wanted the patient to have a seizure, so they could see what part of the brain was causing her

seizures and to come up with some ways that may induce a seizure. I had my patient walk a

couple laps around the unit and got the recumbent bike out because I thought that stress on the

body and exercise may cause a seizure. Another thing I did was tell my patient to stay up as late

as they can because being sleep deprived could also cause a seizure. She rode the recumbent bike

for twenty minutes and then ten minutes later she ended up having a seizure. I was so happy with

what I had accomplished, and I hoped that what I did would help the patients diagnosis.

Clinical nursing judgment is a hard topic to discuss. Every nurse and nursing student uses

it differently, but everyone should acquire the skill and knowledge to use it appropriately.

Clinical nursing judgment can help save a life one day if used properly and it should be

something that is taught in school so each new nurse understands what is expected of them.
Running Head: Clinical Nursing Judgment

Works Cited

Pouralizadeh, M., Khankeh, H. R., Ebadi, A., & Dalvandi, A. (2017). Concept Analysis

of Clinical Judgment in Nursing Students: A Hybrid Model. Iranian Red Crescent

Medical Journal, 19(5), 1-9. doi:10.5812/ircmj.45373

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

Risk Tools vs. Nurse Perception : AJN The American Journal of Nursing. (2017, June &

july). Retrieved March 14, 2018, from

https://journals.lww.com/ajnonline/Fulltext/2017/07000/Risk_Tools_vs__Nurse_Percepti

on.7.aspx
Running Head: Clinical Nursing Judgment
Running Head: Clinical Nursing Judgment