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Analysis of Clinical Nursing Judgment

Steven Lukac

Nursing Department, Youngstown State University

NURS 4852: Senior Capstone

Dr. Kim Ballone and Wendy Thomas

March 16, 2020

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Abstract

Clinical nursing judgment is something that all great nurses have and improve constantly. In this

paper, I will first analyze the definition of clinical nursing judgment. Then, I will explain why it

is important for a nurse to have and how it shows competency. Lastly, I will describe one of my

own personal experiences with my developing nursing judgment.

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Analysis of Clinical Nursing Judgment

Clinical Nursing Judgment Defined

In the nursing profession we are given instructions on how to complete certain tasks,

whether that is medication administration, wound care, or obtaining specimens for tests.

However, nurses do much more than simply following the orders on the patient charts. Nurses

are on the front lines in healthcare, keeping the patient up to date, making sure that everything

that is being ordered and done to them is improving their health, and assessing their patients so

that healthcare personnel are constantly informed and the continuum of care between them all is

kept on track. This is where the clinical judgment of nurses comes into play. Wendy Manetti

concluded a definition in her article Sound Clinical Judgment in Nursing: A Concept Analysis.

In this article, there are many different sources cited with their takes on what exactly clinical

judgment is, for nurses and physicians alike. After reviewing all the literature Manetti collected,

it was determined that clinical judgment is:

… a cognitive process in which the nurse forms a holistic assessment of a patient

situation. Critical thinking, clinical reasoning, practical wisdom, and intuition are used in

the decision making process that ensues. Through careful deliberation, the nurse chooses

among alternative actions in light of anticipated outcomes in the best interest of the

patient. The nurse reflects on and monitors the patient’s responses and modifies actions

accordingly. Afterward, further reflection empowers nurse with the improved judgment

for future situations. (p. 106)

This entire process explains how a nurse should think, act, and reflect to get the best possible

outcome for all the patients will encounter through their career.
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Importance of Clinical Nursing Judgment in Nursing Practice

Sound clinical judgment is what the foundation of nursing is built on. It arms the nurse

through knowledge, experience, and decision-making skills to ensure positive progress of the

sick patient. However, nursing judgment is not something that suddenly takes over a nurse.

Mary Cazzell and Mindi Anderson wrote that this judgment is acquired over time through many

different clinical experiences, in school and at work (p. 83). Clinical nursing judgment is not

something that is simply taught directly in the classroom (i.e., symptoms of a certain disease

process) but also acquired through exposure in the care of patients, allowing the nurse to know

how to help in specific situations in a seemingly natural way. But what makes it important is

that it helps guide the nurse in their practice so that they can effectively treat their patients. Kay

et al. stated that there are three themes in this wisdom: balancing and providing good for another,

use of intelligence and affect in problem solving, and demonstration of experience-based

understanding in problematic situations (p. 14), further supporting the fact that nursing judgment

is important in the overall care of every patient that nurse will come into contact with.

Furthermore, clinical nursing judgment can be tracked to determine the competency of the nurse.

Manetti states that clinical nursing judgment is measurable by looking at multiple areas, such as

the ability to notice changes in a patients condition, taking thorough histories and physical

assessments, interpreting the data collected accurately, personalizing potential actions to the

specific patient, prioritizing those actions appropriately, and carrying out the plan with

precession (p. 107). Because these are all measurable or able to be examined later, it can show

the quality of the nurse themselves and what areas they may need to work on to better their

profession.
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My Experience of Clinical Nursing Judgment

Through my own clinical experiences, I have had the opportunity to use clinical judgment

to guide my advancement in nursing knowledge. My personal scenario I will tell is from an

experience during my preceptorship on the medical-surgical floor. This was a patient that had

been on the unit for a few days post femur fracture repair after a fall. The incident had kept the

patient in bed due to high pain and inability to move the injured leg, which ultimately lead to the

insertion of a urinary catheter. During my assessment, I had found that this previously alert and

oriented patient started to exhibit agitation with my presence and general confusion. With a fall

patient there is a concern of how they fell, if they hit their head causing a concussion, or worse,

intracranial hemorrhage. However, this patient did not hit their head, nor was there any

significant findings with a previous CT scan. I looked for something simpler than a life-altering

incident. From previous clinical experiences, I have seen the effects of CAUTIs, or catheter

associated urinary tract infections, before. In general, urinary tract infections can cause extreme

agitation and delirium in patients, especially those who are elderly, due to the irritation of the

urinary tract and the worsening condition of a possible bloodstream infection. Because of my

clinical nursing judgment, having experience and knowing the process of the problem, I

determined that this was the most likely cause. I assessed further, looking at the urine coming

out near the top of the Foley catheter (which was cloudy and pale) and obtained a temperature

just above 100 degrees Fahrenheit. The final confirmation was when I obtained a urine sample

for the lab to test. this came back positive. The patient was immediately started on antibiotics

and continued IV fluid administration.

In conclusion, clinical nursing judgment is an important part of every nurse’s career.

While my example was simple, it demonstrates the key points of nursing judgment, that of
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critical thinking, practical wisdom, and intuition from experience. In continuing my career and

performing my own research into topics, I know that my clinical nursing judgment while only

grow, allowing me to continue to help those in need.

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References

Cazzell, M., Anderson, M. (2016). The impact of critical thinking on clinical judgment during

simulation with senior nursing students. Nursing Education Perspectives, 37(2), 83-90.

Matney, S. A., Avant, K., Staggers, N. (2016). Toward an understanding of wisdom in nursing.

Online Journal of Issues in Nursing, 21(1), 14.

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Wiley Nursing

Forum, 54(1), 102-110. doi: 10.1111/nuf.12303