Running head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment

Ian Hileman

Youngstown State University

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Nurses are faced with many challenging decisions throughout their careers that can define

the outcome of their patients. Because of this, clinical nursing judgement is of the utmost

importance. Through the use of research and my own experiences thus far, I will examine

clinical nursing judgement and its impact on my own future nursing practice.

Clinical nursing judgment is a widely used term that can be defined as “an interpretation

or conclusion about patient’s needs, concerns, or health problems and/or the decision to take

action, use or modify standard approaches, or improvise new ones as deemed appropriate by the

patient’s response” (Benner, 2005, p 204). The term “clinical judgment” is often interchanged

with other terms such as problem solving, decision making, and critical thinking. The concept of

clinical judgment is a concept that requires sound understanding of the problem at hand, as well

as the ability to interpret it and respond appropriately and timely. Within nursing practice, there

are several complicating factors, including the number of patients the nurse is responsible for and

the prioritization of care based on the patient’s condition and needs.

In the article, “Clinical judgment and decision-making in nursing – nine modes of

practice in a revised cognitive continuum” the concept of clinical nursing judgment is evaluated

by identifying revisions required for the application of judgment within nursing. Standing

(2008) states that the use of clinical judgement indicates that, “In addition to knowing why an

intervention is needed and how to perform it competently, nurses have a professional

responsibility to ‘justify, explain and defend judgements and decisions” (p 125). The cognitive

continuum theory was used to relate different challenges with different ways of thinking and

responding to them. This theory demonstrated how tasks are related to different thought
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processes and how identifying these can help optimize decision making. A revised version of this

continuum was developed to outline the nature and variety of patient-centered judgment tasks

and decisions within nursing and how to use this to identify the best way to provide safe and

effective care for that patient (Standing, 2008).

According to the article “Nursing Judgment: Educating Nurses to Make Decisions in

Practice” nurses have taken part in decision making since the rise of nursing. These decisions can

range from clinical judgement to ethical concerns, to organization and leadership. This article

states that clinical judgment starts when the nurse first realizes the problem at hand. The nurse

then analyzes the situation and responds based on their own knowledge of the patient’s

condition. Reflection is a key component of clinical judgement. During the reflection phase, the

nurse is able to expand upon background knowledge from their clinical practice. Clinical

judgment is something that can be taught but is an ever-changing concept throughout a nurse’s

career (Schoessler et all, 2012).

“Clinical Reasoned Judgment and the Nursing Process” identifies a model that integrates

the nursing process with a conceptual model of critical thinking to help nurses develop better

critical thinking skills, reason accurately, and make appropriate decisions based on the patient’s

response. Eight different elements were used to provide a structure of thought processes and

were applied to each step of the nursing process. These included: clarity, accuracy, precision,

relevance, depth, breadth, and logic. This article states that critical thinking is an acquired

behavior that can be integrated into nursing practice by helping to assess, diagnose, plan and

implement, evaluate and revise patient care as needed. This, in turn, will help nurses become
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better at making clinical decisions along with more accurate professional judgements (Huckabay,

2009).

During my past three years of nursing school there were many instances where I was

required to use clinical nursing judgment in order to provide the best care possible for my

patients. During my critical care rotation in the Surgical Intensive Care Unit, many of my

patients required complex levels of care which aided me in my development of better nursing

judgment. Many of the patients within this unit required mechanical ventilation along with

hourly care. Due to the severity of their conditions, it was critical for me to closely monitor and

identify any abnormal findings that may warrant further intervention. An example of this

included monitoring the patient’s oxygenation status and deciding the best treatment option

depending upon the patient’s circumstances. Some of the possible treatments included checking

all ventilator connecting, repositioning, increasing the Fi02 or suctioning the patient. It was

crucial for me to use clinical judgement when assessing my patients so that I could correctly

improve their status.

Clinical nursing judgment is a critical part of a nurse's career, aiding in giving their

patient's the best outcome for the foreseeable future. Without this, we would fail our patient's

every day. Although this is a learned process that can change and expand daily, I feel that

throughout my clinical rotations I've learned an extensive amount of helpful information that I

will be able to reflect on in my future career. I'm confident that this judgement will help me to

become a successful nurse, provide my patient's with the best possible care and overall a better

and more comfortable experience.

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References

Huckabay, L. M. (2009). Clinical Reasoned Judgment and the Nursing Process. Nursing Forum,

44 (2), 72-78.

doi:10.1111/J.1744-6198.2009.00130.X

Benner, P. 2005 Using the Dreyfus Model of Skill Acquisition to describe and interpret skill

acquisition and clinical judgment in nursing practice and education. The Bulletin of

Science, Technology and Society Special Issue: Human Expertise in the Age of the

Computer. Vol. 24 (3) 188-199.

Standing, M. (2008). Clinical judgement and decision-making in nursing – nine modes of

practice in a revised cognitive continuum. Journal of Advanced Nursing, 62 (1), 124-134.

doi:10.1111/J.1365-2648.2007.04583.X

Schoessler, M., Brady M., Engelmann, L., Larson, J., Perkins, I., & Shultz, C. (2012). Nursing

judgment: Educating nurses to make decisions in practice. Nursing Education

Perspectives (National League for Nursing), 33 (6), 422.