Clinical Nursing Judgement

Madison Mistovich

Senior Capstone

Youngstown State University

 Clinical judgement can be defined as the conclusion or enlightened opinion at which a

nurse arrives following a process of observation, reflexion and analysis of observable or

available information or data. Nurses are required to have clinical judgement every day on the

job but, does the education we receive include clinical judgement? It is difficult to teach

something in class that is learned with experience and when the RN title comes after your name

you are expected to do just that. But, is the term clinical judgement being taken over with the

term critical thinking? According to Tanners Clinical Judgment Model, clinical judgement

includes four factors: noticing, interpreting, responding, and reflecting (Cazzell and

Anderson,2016). Whereas, critical thinking is defined as executive cognitive functions. This

includes goal-oriented abilities that set place in high acuity environment that have to do with

planning ahead, problem-solving, emotional regulation, information processing, and working

memory (Cazzell and Anderson, 2016).

“The Impact of Critical Thinking on Clinical Judgement During Simulation with Senior

Nursing Students” (Cazzell and Anderson, 2016) included a study of 160 nursing students during

a pediatric clinical evaluation. This study shows that educators need to utilize and develop new

teaching strategies that focus more on clinical judgement. According to Cazzell and Anderson

(2017), clinical judgement and critical thinking should require two separate definitions. They

also provides research on the factors that affect the ability for a student to learn critical thinking

and clinical judgment. These factors include ethnicity, gender, Health Science Reasoning Test

deduction, and analysis. The average scores with the Health Science Reasoning Test was 25/38

proving that what is taught does not require enough clinical judgement.

Clinical judgement is not only necessary for clinical decision making but is also known

for being a part of high quality nursing care (Pouralizadeh, Khankeh, Ebadi, & Dalvandi, 2017).
Since clinical judgement is learned through experience and interacting in a clinical setting there

are other factors that are involved such as cultural factors, social factors, and clinical

environment. This concern is worldwide and must be addressed so new nurses will be able to go

out into the field with more confidence and clinical judgement. Pouralizadeh et al. (2017) found

five categories that can play in the student learning of clinical judgement including: professional

ethics, thoughtful behavior, use of evidence based care, context of learning environment, and

individual and professional features of clinical teachers. These categories explain how the

student’s surroundings and attitudes can affect the student’s ability to learn clinical judgement.

An example for category 5 is that there are many difference types of teachers. Ones who focus

more on skills, one who focus more on knowledge, and others. Depending of the type of teacher

can also depend on how much of clinical judgement is taught or the lack of.

Nurse’s clinical judgement and decisions are important because it promotes health gain

and prevents harm. For years educators have been applying a diverse range of qualitative and

quantitive research techniques to nursing judgement and decisions (Thompson et al, 2014).

These techniques included interventions that are made for a patient. Aa previously stated, clinical

judgement includes many factors which makes every patient different. Not every person in

uncertain environments can all be “right” together but this doesn’t necessarily mean this is a bad

thing. Variation does become a problem when the nurse does know the interventions to do. An

example would be knowing that when nurses make decisions does not mean they are making

clinical judgements. Decisions are simply choosing between alternatives. Studies show nurses

given the same information, making the same decisions, but will make consistently difference

judgments and decisions. Each patient is different and the variables that are included must be

addressed (Thompson et al, 2014).

 A part of clinical nursing judgment is determining where a patient belongs to receive the

best care according to their condition. In the Burn Intensive Care Unit there was a patient who

came into the emergency department at 2AM with an oil burn to the arm. In the outpatient clinic

the nurse popped the blisters to see the underlying skin to see how deep the burn was. The burn

was a second degree burn but would be known as 5% burn so the nurse sent the patient home

with bacitracin ointment, zeoform, gauze, and ACE wraps. The patient was directed to have a

follow up appointment. The nurse recognized the severity or lack of the situation to determine if

the patient should be admitted or not.

In conclusion, there are many factors that go along with clinical judgement. Clinical

judgement is a balance between knowledge, skills, and tuition which makes it difficult to teach

or learn in a class room. Clinical judgement is also confused with other similar words such as

critical thinking or decision making. The research studies between qualitative and quantitive

techniques have improved clinical judgement since the 1960’s but, there is still a long way to go.

References

Cazzell, M., & Anderson, M. (2016). The Impact of Critical Thinking on Clinical Judgment

During Simulation With Senior Nursing Students. Nursing Education

Perspectives (National League for Nursing), 37(2), 83–90.

https://doi.org/10.5480/15-1553
POURALIZADEH, M., KHANKEH, H., EBADI, A., & DALVANDI, A. (2017). Factors

Influencing Nursing Students’ Clinical Judgment: A Qualitative Directed

Content Analysis in an Iranian Context. Journal of Clinical &

Diagnostic Research, 11(5), 1–4.

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

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2014). An agenda for clinical decision

making and judgement in nursing research and education. International Journal

of Nursing Studies, 50(12), 1720–1726.

https://doi.org/10.1016/j.ijnurstu.2013.05.003