Running head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Chandace Regano

Youngstown State University

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In order to provide patients with the highest quality of care, nurses must make effective

use of their clinical judgment. The concept of clinical nursing judgement is essentially viewed as

the process in which all nurses use pertinent data regarding a patient followed by interpretation

of that information so as to form a logistical diagnosis upon which those nurses would base their

actions. Further examination into the high significance of clinical nursing judgement will be

done through the utilization of simulation in educating nursing students, clinical judgment in

relation to critical illness, and conclusions in medication administration.

The cruciality of clinical nursing judgment is reflected is the expectation to respond

appropriately to constantly changing situations and possibly rapid deterioration in a client’s

condition. Despite the obstacle that student nurses face with the lack of exposure to emergent

situations, one way programs have made it possible to gain insight and tactile experience is

through simulation. One journal examined the impact of this educational tool from the

subjective side of the students. In accordance with one reported study in the journal, students

conveyed “…improved awareness of their processes and clinical judgment thinking” (Lindsey &

Jenkins, 2013) and another study yielded that “…students reported improvement in psychomotor

skills, confidence, and clinical judgment” (Lindsey & Jenkins, 2013). Allowing students to

participate in a scenario that creates the realistic emergence or complication ridden atmosphere,

but in a controlled environment, gives them the opportunity to practice critical thinking and

make clinical judgments while being able to make mistakes and learn from them. Through the

objective sense in congruency with subjective feedback, one study “devised a rubric…[that]

rated student nurses’ clinical judgment in the following dimensions: communication,

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intervention, skill, self- analysis, and commitment to improvement” (Lindsey & Jenkins, 2013).

With a more structured, concrete basis to evaluate the effectiveness, the study was able to also

conclude the success of simulation in regards to culminating analysis and decision making skills

in progressing students. Entering the field as a newly registered nurse is accompanied by some

disadvantages, including lack of familiarity with different patient situations. Although

simulation cannot account for all possible future scenarios, it is an effective method of building

confidence and increasing that use of decision making based on what is presented to the nurse.

As nurses continue their transition within their clinician role, they will come across

patients with varying severities of illness. According to Margaret Coulter Smith et al., a nurse’s

assessment is often primarily focused with identifying and describing the patient’s current

condition in comparison to the medical diagnosis which focuses on concrete definition of the

illness paired with expected treatments (2014). Using clinical judgement when examining and

evaluating the present state of a client will determine what further actions are appropriate for this

particular person. For a nurse to correctly draw conclusions from the information they have

acquired that relates to the patient, he or she must ensure that the data stems from multiple facets:

“…attributes of severity of illness…may also be important when assessing the patient’s current

clinical state and identifying early clinical deterioration, including the medical history, co-

morbidities, physiological reserve…” (Coulter Smith et al., 2014). To increase the accuracy of

the analysis and decisions based off of it, the nurse must take into account various aspects of the

patient’s case, which includes other present conditions, vitals, intake/output, neurological

function, etc. because a certain piece could change the resulting judgement. In addition to
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severity of illness, Coulter Smith et al. refer also to the importance of the timing of assessments

and sub-sequential clinical action, citing an international example: “In the UK, suboptimal care

of general ward patients prior to ICU admission was noted to increase morbidity and

mortality” (2014). In other words, lack of attention and action in earlier stages of an illness lead

to increase disease and the chance of death. Nurses are most often the primary caregivers to

patients and the first ones on the scene, therefore, they must pay attention to the details and any

changes in conditions and make the appropriate call to help guarantee the safety and health of all

clients.

The final aspect in advocating support for the significance of clinical nursing judgment is

medication administration, which is one of the most well known parts of a clinical nurse’s job.

According to Rohde and Domm:

“Clinical reasoning is an integral component of safe medication administration as nurses

assess patients and situations, apply foundational knowledge, plan and administer

medications, evaluate patients’ responses to medications and teach patients about taking

their medications safely” (2018).

The one thing standing between a patient and a chemically altering substance is a nurse’s ability

to understand its function and monitor its effects as well as to know the dosage, route, and other

characteristics of safely administering medications. This journal also attests to the importance of

the nurse’s judgement because it is:

“…clinical reasoning that lead to nurses’ clinical decisions that surround patient care and

medications, such as withholding or administering medications, changing doses or

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making decisions to call a healthcare provider when concerned about a patient; these are

crucial factors for safe patient care” (Rohde and Domm, 2018).

As doctors are capable of mistakes, negligence, and poor judgment, it is the nurse’s final say

whether or not a patient should receive a certain medication, so he or she is ultimately

responsible for the appropriate action.

In regards to a personal experience, there have been several brief instances in which I had

use my clinical judgement to decide what would best aid the patient. For one particular case,

there was an intubated elderly woman who was a new admission to the unit and had been

reported to have hypotensive episodes following surgery. While I was in the room, I noticed her

pressure was steadily dropping until her MAP was about sixty. Once I realized it was not going

to go back up, rather dropping more, I knew I had to do something to ensure her organs were

receiving perfusion. With few medical resources available, I simply nudged her a little and

suctioned her mouth which subsequently shot her blood pressure and MAP back up to normal.

In conclusion, clinical nursing judgment is a vital aspect of nursing. It is what ensures

patients are receiving the proper care, treatment, and medications, especially in cases of critical

illness and emergency. Critical thinking and judgement should continue to be pushed as

foundations in excellent nursing.