Running Head: CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement:

A Nursing Student’s Analysis

Abby Stein

Youngstown State University

How does one begin to describe something as seemingly abstract as “critical thinking?” “Critical

thinking,” as described by the Oxford Living Dictionary, is, “The objective analysis and evaluation of an

issue in order to form a judgement.” Through the use of critical thinking, people with knowledge in a

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certain content area are able to form conclusions to problems in given areas. Aspects of critical thinking

involve research, experimentation, and evaluation of information related to any given topic. Critical

thinking, to put it simply, is thinking about thinking.

How does critical thinking translate to clinical nursing judgement? Nurses in any area of the

nursing practice must utilize the different aspects of critical thinking that I have described in any given

situation: research, experimentation, and evaluation of information related to any given topic. For

example, a nurse can conduct research in a controlled lab setting, or in an inner-city clinic.

Experimentation can be a nurse reporting to a doctor on the wound healing progress of one type of

dressing as opposed to another. Evaluation can be analyzing a spreadsheet of results or assessment of

intake and output on a post-op patient.

Cazzell and Anderson (2016) attempt to sort out the difference in critical thinking versus clinical

nursing judgement for instructors of nursing. They define clinical nursing judgement, or “CJ,” as,

“understanding followed by responding to problems.” (p.83) For their study, they utilize a cross-sectional

descriptive correlational design. Senior-level nursing students in a pediatric nursing course are asked to

perform a simulation scenario and then perform a cognitive test (i.e. the Tower of Hanoi, an assessment of

cognitive functioning using wooden pegs and pegboards). These students were video recorded performing

the given tasks, and the videos were analyzed by professional research personnel.

From their research, Cazzell and Anderson (2016) concluded that although aspects of clinical

nursing judgement and critical thinking are similar, they are separate concepts and require separate

instruction. (p.87) They further break down their discussion section into suggestions for nursing

instructors related to differentiating aspects of clinical nursing judgement and critical thinking based on

gender and ethnicity. Male-identifying participants scored lower overall than female-identifying

participants, reflecting possible bias toward a stereotypically female-nurturing expectation of nursing. The

researchers point out, however, that their sample size is small and more research needs to be done

regarding gender in nursing and nursing judgement.

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Another study I looked at regarding clinical nursing judgement, An integrated review of the

correlation between critical thinking ability and clinical decision-making in nursing, also looked at

critical thinking and clinical nursing judgement in nursing students. (Lee et al., 2017) Specifically, the

study looked at critical thinking ability and clinical decision making. The researchers in this scenario

conducted a literature review of articles from 1980 to 2015 containing words like “clinical judgement”

and “clinical reasoning.” They also added terms specific to health care and nursing. Elimination criteria

included things like non-English studies.

After elimination of articles and a review of articles that met the research criteria, the researchers

concluded that clinical decision making and clinical nursing judgement are not necessarily predictors of

one another. Their study found a “weak, but positive, correlation” between advance practice and

advanced degree-holding nurses as opposed to nurses holding associates and diplomas. (Lee et al., 2017)

The researchers acknowledge that critical thinking and critical judgement are abstract and

subjective in their measurement, and objectively measuring these components is difficult and may not be

universal. The researchers ultimately conclude that although there is a great deal of importance placed on

critical thinking, that there isn’t necessarily consistent evidence supporting critical thinking and critical

decision making. (p. 4077) This isn’t to say that these aren’t important subject areas, rather, that the

correlation thus far is largely inconclusive.

A third article I found looked at student-created simulation as a source of critical thinking

reinforcement. The article by Wane and Lotz (2015) examines the benefits from student-created lab

simulation experiences. They propose that it is often nursing faculty that propose lab simulations for their

nursing students, but could there be a critical thinking benefit to students creating lab scenarios? They

propose that the creative thinking required in creating a lab simulation scenario could be beneficial to the

development of critical thinking. The researchers concluded that student-created simulations were

beneficial to learning, although their sample size was limited.

I feel as though I have used aspects of critical thinking and clinical nursing judgement in each of

my nursing lecture courses and clinicals. That being said, I have most acutely experienced the use of

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clinical nursing judgement in my Transitions course with my nursing preceptor. My preceptor and I had a

patient who was an inpatient on a Med-Surg/Telemetry floor with vague symptoms relating to what was

believed to be a transient ischemic attack. She was exhibiting periods of confusion, was difficult to arouse

at times, and had been experiencing what seemed to me very much like extrapyramidal symptoms.

On Saturday, the patient was alert and oriented with few if any noticeable symptoms. On Sunday,

she was only oriented to self at times and was only aroused by sternal stimulation. When different tests

were coming back negative, my preceptor and I asked if some of her symptoms could be related to her

high dose of antidepressant medications. When we brought this up with the doctor, he said that could very

well be the case.

I feel that this situation was a good example of using all available data and the psychological

background knowledge I have to give quality care to a patient. Evidence-based practice and critical

thinking involve utilizing all available knowledge based in best practices proven to be beneficial over

time. I feel that clinical nursing judgement and critical thinking are essential to the credibility of the

nursing profession as a whole.

References

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

simulation with senior nursing students. The Research Journal of the National League for

Nursing, 37 (2), 83-90.

Lee, D. S. K., Abdullah, K. L., Subramanian, P., Bachmann, R. T., & Ong, S. L. (2017). An integrated

review of the correlation between critical thinking ability and clinical decision-making in

nursing. Wiley Journal of Clinical Nursing, 26 (N/A), 4065-4079.

https://doi.org/10.1111/jocn.13901

Wane, D., & Lotz, K. (2013). The simulated clinical environment as a platform for refining critical

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Thinking in nursing students: A pilot program. The Research Journal of the National League

for Nursing, 34 (3), 163-166.