Running Head: CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Ariel Aiken
Nursing Department, Youngstown State University
NURS 4852: Senior Capstone
Professor Kim Serroka-Ballone, Professor Wendy Thomas
March 2, 2020
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Nursing judgment is an essential topic and concern throughout every nurse’s mind while

working during their shift. Nurses make clinical judgments continuously throughout their day to

make sure that their patients have the best possible care and outcomes of that care. While nurses

do have basic skills and knowledge such as detailed assessments and medication management,

they also make critically thought out choices for each patient they care for. Critical thinking is an

acquired skill that many nurses learn once they start working. With all the advances in care that

are now offered to a wide variety of patients and conditions, nurses need to be able to critically

think in clinical situations and make more judgment calls now more than ever before (Lee,

Abdullah, Subramanian, Bachmann, Ong, 2017).

In the article, An integrated review of the correlation between critical thinking ability and

clinical decision-making in nursing (Lee et al., 2017), the authors discussed how nurses that

graduate should have adequate critical thinking skills that they can demonstrate correct clinical

judgments with a wide variety of patients and their care. The nurse must realize that they must

perform satisfactory bedside care and skills while also being able to critically think during the

care that is being given to those patients. As stated by the authors, “It has often been claimed that

critical thinking is a vital skill needed in healthcare professionals to make sound clinical

decisions and deliver competent patient care” (Lee et al. 2017). Nurses must understand that their

decisions can impact their patient’s lives, and they need to make the best clinical judgment for

the patient.

Assessing, diagnosing, planning, implementing interventions, and evaluating are all

critical components to patient care. That sequence mentioned before helps the nurse determine

what is best for the patient. It is a process that every nurse goes through with every single patient
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that they have to provide them with great care and an accurate clinical judgment can then be

made.

A nurse’s confidence and intuition are contributing factors to being able to make a clinical

judgment. In an integrated review executed by researchers stated that they identified influential

factors related to a nurse’s patient care choices, (Nibbelink and Brewer, 2017). Nibbelink and

Brewer focused on studies with certain search criteria within nursing such as decision-making,

nurse demographics and identification of clinical situations, and factors associated with patients

and their care. They discussed how intuition is a learned asset that nurses obtain through

experience as well as building their confidence in making an impactful clinical decision for a

patient, (Nibbelink and Brewer, 2017). The article, “Decision-making in nursing practice: An

integrative literature review”, focused on processes and factors that could influence a nurse’s

clinical judgment and decision-making to maintain satisfactory patient care throughout all scopes

of the nursing field.

In the article, “Professional nurses’ understanding of clinical judgment: a contextual

inquiry”, described their definition of clinical judgments. The article states, “Clinical judgment

in nursing has become synonymous with the nursing process model of practice, viewed as a

problem-solving activity in which nurses use their critical and creative thinking skills to apply

their nursing knowledge, attitudes, values and logic during patient assessment, utilizing both

deductive and inductive reasoning to express patient care” (Grann, Williams & Koen, 2016).

This statement shows how nursing encompasses problem-solving to provide great patient care

and for each patient to thrive with positive outcomes from that said care. Nursing is not just

about knowledge and logic, it is also about having a caring, compassionate attitude and to have

the mindset of someone who will provide for patients before themselves. Assessment is a crucial
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nursing task; it shows the status and overall well-being of the patient. If a patient starts to

decompensate from a baseline assessment, then the nurse knows that they must do something to

try to get that patient back to or above baseline for the patient to survive. For example, if a

patient’s heart rate starts to increase rapidly while on a monitor, the nurse must intervene to

prevent the patient from going into cardiac arrest or another possible complication. First, they

would calm down the patient and if unsuccessful then they will administer heart rate decreasing

medications such as a common beta-blocker, Metoprolol, to try to solve the problem.

Comparing and contrasting the three articles I chose for this scholarly paper made me

realize that there are many ways to describe a clinical nursing judgment and how to go about

caring for a patient. Judgments can be made for both healthy and critically ill patients alike;

nurses make judgments every day during their work with patient care. There has been one

instance where I have made a clinical nursing judgment during my preceptorship this semester.

The patient had an External Ventricle Drain (EVD) put in place because they had recently had an

aneurysm rupture in their brain, and they had corrective surgery. They also had an EVD placed

for Increased Intracranial Pressure (ICP) monitoring and precaution to help drain out the excess

cerebrospinal fluid from the head that would push on the brain tissue. For the patient to get the

EVD removed, they would have to go through a 24-hour period where the drain was clamped,

and excess cerebrospinal fluid would not accumulate into the brain tissue before the drain would

be able to be taken out. While clamped, the patient had been acting sluggish, they stated that

their headache was unbearable, their speech had become impaired and their intracranial pressure

was increasing out of the range of the normal 10-20. When I did a follow up neurological

assessment on the patient, I noticed these problems and asked my nurse if we could unclamp the

drain to cause the cerebrospinal fluid that built up in her brain to decrease without having
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damage to the patient. The nurse checked the intracranial pressure in her head on the monitor and

stated that it was peaking at 26, we then paged the doctor to unclamp the drain and proceeded to

do so after the doctor said it was okay. I identified the signs and symptoms of increased

intracranial pressure and used logic to make a clinical nursing judgment that prevented further

potential harm to the patient that I was caring for.

Overall, nurses use clinical judgments daily during their work as a healthcare worker,

they use both emotion and knowledge to determine what is best for their patients on the day of

care. Nurses realize that to provide great patient care they must use all their skills wisely and on

time. The three articles I chose have accurately demonstrated ways that nurses use clinical

judgment in their work settings and further explain how nurses choose to provide the best care

possible for their patients.

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REFERENCES

Lee, D. S. K., Abdullah, K. L., Subramanian, P., Bachmann, R. T., & Ong, S. L. (2017,
September 4). An integrated review of the correlation between critical thinking ability
and clinical decision‐making in nursing. Retrieved from
https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.13901

Nibbelink, C. W., & Brewer, B. B. (2018, January 23). Decision‐making in nursing practice: An
integrative literature review. Retrieved from
https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.14151

Graan, A. C. van, Williams, M. J. S., & Koen, M. P. (n.d.). Professional nurses' understanding of
clinical judgement: A contextual inquiry. Retrieved from
https://www.ajol.info/index.php/hsa/article/view/150788