CLINICAL NURSING JUDGEMENT WYANT 1

Clinical Nursing Judgement

Emily Wyant

Youngstown State University

March, 19, 2018

 CLINICAL NURSING JUDGEMENT WYANT 2

Throughout nursing school, I have learned about the importance of developing critical

thinking skills along with clinical judgement. “Critical thinking is a purposeful thinking

involving reflective reasoning prior to deriving a conclusion, which leads to a clinical decision”

(Lee et al., 2017). The decision made will be one of many options I, as the nurse, can choose

from to better help my patient. Nurses improve their clinical judgement through experience in

the clinical setting. An experienced nurse will have the ability to assess important information

regarding patient status, and accurately start implementing treatment sooner than the novice

nurse. “Nurses’ judgements and decisions have the potential to help healthcare systems allocate

resources efficiently, promote health gain and patient benefit and prevent harm” (Thompson,

Aitken, Doran, & Dowding 2013). This is why it is imperative for a nurse to learn and improve

on clinical judgment.

A study in Wiley Journal of Clinical Nursing, discusses the use of emotions in clinical

decision making. “Emotional intelligence (EI) is defined as the ability to recognize emotion in

self and others, and employ emotional knowledge and reasoning to drive forward cognition and

behavior” (Hutchinson, Hurley, Kozlowski, & Whitehair 2017). Experienced nurses are

available to use this while making decisions for their patients. Additionally, this makes the nurse

more comfortable and empathetic with patients. Nurses’ are more willing to challenge decisions

that are based on protocol, accomplishing better advocacy for patients when using emotional

intelligence. “As clinicians become more emotionally aware, and able to regulate their own and

others’ emotions, rapid emotional signals that may otherwise have been described as ‘gut

feelings’ were instead interrupted as meaningful emotional responses and cues” (Hutchinson et

al., 2017). A novice nurse learning to develop and use EI can help improve their decision

making along with the quality of care delivered.

 CLINICAL NURSING JUDGEMENT WYANT 3

As a student, my experience in using critical thinking and decision making occurred

during my preceptorship. A patient was transferred to my floor to receive a blood transfusion for

a low hemoglobin level. No orders had come from the doctor for patient, even the order for him

to have a blood transfusion, so those had to be obtained first. The patient was scheduled to have

surgery the next week to fix a pin on an external fixator on the lower leg. Once the patient was

settled in the room, he had taken himself to the bathroom and bumped the external fixator. He

began to bleed but he still proceeded to go to the other side of the room. Upon my entrance to

the room, I saw that the patient was actively bleeding and there was blood all over the floor.

From my assessment, I concluded he was bleeding from the external fixator. After I instructed

the patient to keep the leg elevated and to not move around the room, my nurse and I called the

doctor. I believed that someone needed to come look at his foot because the bleeding would not

stop. The patient would continue to move around the room despite my instruction to keep still,

so the blood would not slow.

When the doctor was called, they were out of town and had another doctor covering

them. When the doctor covering was called, they stated that they did not know the patient, and

therefore will not provide any care for them. I had wrapped a chucks and kerlix over the external

fixator to apply some pressure and had a basin below the foot to catch the blood. I was worried

the patient was losing too much blood. The charge nurse knew the patient was bleeding, but did

not know how extensively. I had to tell the charge, “you have to see the amount of bleeding. I

think this man has a chance of bleeding out if something isn’t done soon.” Still with no luck

from a doctor, I finally decided that it was crucial something was done. Finally, a RRT was

called on the man so he could get some medical treatment because orders were still unable to be

obtained for the patient. My nurse and I knew the patient needed to be seen by a doctor and we
 CLINICAL NURSING JUDGEMENT WYANT 4

were not getting anywhere over the phone. Clinical nursing judgement was used by calling the

RRT to get critical treatment for the patient.

A nurse will usually be the first person to notice changes in a patients’ status and call a

physician. “Estimates vary but nurses make lots of decisions: acute care nurses facing a decision

or judgement “task” every 10 minutes [and] critical care nurses every 30 seconds” (Thompson et

al., 2013). To develop critical thinking skills is a very important aspect of being a nurse.

“Novice nurses gradually gain clinical expertise by learning from experience and acquisition of

knowledge, their critical thinking is enhanced and used for good clinical decision making” (Lee

et al., 2017). Patients’ put their trust in nurses to provide care and to prevent harm. Nurses are to

pull important information from assessments to give competent and efficient care to each and

every patient.

Each patient is unique and care needs to be provided in such a manner. Using clinical

judgement is vital while providing patient care. “For novices, every decision involves deliberate

consideration of relevant signs and symptoms, whilst experts often appear to make decisions

effortlessly” (Thompson et al., 2013). Every nurse through school is taught how important it is

to use critical thinking, and we are given simulations and clinicals to develop it. However,

“critical thinking and clinical decision making are both abstract construct and subjective and thus

challenging to measure” (Lee et al., 2013). According to the study reviewing a correlation

between critical thinking ability and clinical decision making, only four of the nine studies

reviewed showed a positive correlation, but there is not a specific tool used to measure critical

thinking in nursing. Further studies are needed with a more validated tool. I know that the key to

deliver quality and competent care to my patients is through critical thinking skills that I learned

in school and will continue to develop throughout my career.

 CLINICAL NURSING JUDGEMENT WYANT 5

References

Hutchinson, M., Hurley, J., Kozlowski, D., & Whitehair, L. (2017). The use of emotional

intelligence capabilities in clinical reasoning and decision-making: A qualitative,

exploratory study. Wiley Journal of Clinical Nursing. 27, e600-e610.

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

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

nursing. Wiley Journal of Clinical Nursing. 26, 4065-4079.

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, 1720-1726.