Running head: CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Nicole Rodomsky
Youngstown State University

Senior Capstone 4852

Dr. Kim Serroka Ballone & Mrs. Wendy Thomas
March 4, 2019
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Why is my patient slurring their speech and easily confused when they were alert and

oriented 45 minutes ago? My patient has diabetes. When was the last time their blood sugar

was checked? When was the last time they had something to eat or drink? Their blood sugar is

now 40mg/dL, what am I going to do? This is the process to making a clinical judgement in

nursing. In addition to basic skills and knowledge, clinical nursing judgement has become an

essential skill for all nurses to relay the highest patient outcomes. Since the clinical setting of

nursing is becoming more complex as the field of nursing is advancing, there is an increased

need for nursing clinical judgement (Graan, Williams, & Koen, 2016). Clinical judgement

involves looking at the big picture of your patient and deciphering important information to

determine what is going wrong with your patient and how you can fix it as the nurse.

In the article, Sound clinical judgement in nursing: A concept analysis (Manetti, 2018),

Dr. Manetti discussed how clinical judgement is defined and used in nursing, as well as the

importance of its use. Critical thinking is the process to making a clinical judgement for your

patient. The nurse must perform bedside care and nursing skill, as well as clinical judgement. A

nurse is to analyze their patient in all aspects through critical thinking and make a clinical

judgement that would be best for the patient. The clinical judgement nurses make could be to

act or take no action at all (Manetti, 2018). Dr. Manetti stated “nurses possessing sound clinical

judgment have evidence based knowledge, intuitively and quickly identify the salient

information in a given situation, prioritize patient needs and nursing responses” (Manetti,

2018). Through steps, such as assessing, analyzing, and prioritizing, a clinical judgement could

be made for the good of the patient.

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Critical thinking is needed to perform appropriate clinical judgement. Critical thinking is

considered the 7th C in nursing, in addition to compassion, care, communication, competence,

commitment, and courage. It is critical thinking that connects research and evidence based

practice in the patient setting, which is a responsibility of nurses, and keeps patients’ needs and

outcomes as the priority in nursing care (Ritchie & Smith, 2015). Therefore, critical thinking

needs to be greatly implemented in daily nursing practice to make a sound clinical judgment

and achieve high patient outcomes in the workplace.

In a study discussed in Health Sa Gesondheid, the researchers van Graan, Williams, and

Koen studied 11 professional nurses’ knowledge of clinical judgement, as well as the aspects

that influenced the development of clinical judgement in the workplace in their article titled

Professional nurses' understanding of clinical judgement: A contextual inquiry (2016). The

nurses’ knowledge was analyzed through interview, drawings, narratives, discussion, and

reflection, referred to as the ‘world café’ method in the article. The participants in the study

believed that clinical judgment is not a skill learned in nursing school and one that nurses

cannot teach students during a clinical experience because the students seem to function as

the gaps in the understaffed nursing workforce as well as focus on learning basic nursing skills.

The study concluded with the discussion that nurses understand critical thinking insufficiently

for how important it is in decision-making skills (Graan, Williams, & Koen, 2016). This study

emphasized the importance of clinical judgement in nursing and how nurses need to improve

on their clinical judgement in the workplace for the good of their patients.

Clinical nursing judgement is a skill that takes experience to develop. As a student nurse,

I try to pick up on an experienced nurse’s thought process when caring for patients to give their
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patient the highest outcome. My best experience with clinical nursing judgement was during

my preceptorship at the Cleveland Clinic. My nurse and I had a patient with breast cancer that

had metastasized to the lymph nodes, who was admitted to the unit for symptoms of a

chemotherapy reaction. Her chief complaint was back pain. The morning (0400) she was

admitted, the nurse taking care of her had to call an emergency medical team because the

patients’ blood pressure was continuously increasing to dangerous numbers into a hypertensive

crisis. The team got her blood pressure decreased to an acceptable level and the crisis was

suspected to be pain induced. My nurse and I came onto our shift shortly after this had

happened. The patient was agitated and mainly in pain, rated a 10/10, in her back and newly in

her legs. My initial thought was she had a hypertensive crisis a few hours that was suspected to

be pain induced and that priority for me this shift was to get her pain under control, to an

acceptable level, to prevent another hypertensive crisis. Throughout the whole shift, I

monitored her pain level, looked at what pain medications I could give her, informed her of

what time she was able to get another pain medication, reassessed her pain after administering

the medication and monitored her blood pressure. About 6-7 hours into our shift, I assessed my

patient’s pain, and she denied pain. Her afternoon (1600) blood pressure was high, I rechecked

it a 30-45 minutes later and it had increased a little more. I now have my patient in no pain,

however, her blood pressure was rising and she was asymptomatic. Now what can I do to

prevent a hypertensive crisis from happening again? There were no prn blood pressure

medications ordered, so we needed to call the doctor to order one. Hydralazine was ordered

for our patient to be given when there was a systolic blood pressure over 170. After

administering the blood pressure medication and reassessing her blood pressure 30 minutes
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later, her blood pressure had come down to an acceptable level. Through critical thinking, I

made a clinical judgement, controlled my patient’s pain, and prevented another hypertensive

crisis from occurring.

Sound clinical judgement has proven to be very important for the patient in research

and in the clinical setting. The nurse needs to utilize the nursing process to critically think and

make nursing clinical judgment. Clinical judgements may be needed to be made immediately

and it is our responsibility as nurses to make an appropriate judgment that is going to benefit

our patients. It is appropriate clinical judgement that makes the difference between a good

nurse and a great nurse.

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References

Graan, A.C., Williams, M. J.S., Koen, M.P. (August 2016). Professional nurses’ understanding

of clinical judgement: A contextual inquiry. Health Sa Gesondheid, 21. Retrieved from

https://www.sciencedirect.com/science/article/pii/S1025984816300047?via%3Dihub

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

54(1), 102-110. doi:10.1111/NUF.12303

Ritchie, G., & Smith, C. (2015). Critical thinking in community nursing: is this the 7th C? British

Journal of Community Nursing, 20(12), 578–579.

https://doi.org/10.12968/bjcn.2015.20.12.578