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Clinical Nursing Judgement Reflection

Andrew Edie
Youngstown State University
NURS 4852 Senior Capstone
Mrs. Thomas
March 3, 2020
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Abstract

Clinical nursing judgment is a very important skill to have to provide best possible care of the

patient. The nurse has to be able to exhibit this skill of clinical judgment in order to keep their

patient safe and allow them to have an improved health status as a result of the care given in the

healthcare setting. Throughout this paper, different reasoning and ways to improve clinical

nursing judgement will be discussed.

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Nurses have many responsibilities in their line of work. They assess, provide care,

administer medications, advocate and much more. However, to do this, the nurses have to have

good clinical nursing judgement. The patient comes into the care of the nurse sometimes in their

most vulnerable time. Whether it be in- patient or out-patient, that patient is putting their trust

and sometimes their lives in the hands of a nurse. In order to provide the best patient care, the

nurse must know what they are doing. Nursing has been viewed as just taking orders from the

physician and administering the care. However, the nurse is the person that is there with the

patient for sometimes twelve hours at a time and they see that patient’s progress. They have to be

the ones to know when to call the doctor or bump up the sedation of the intubated patient when

they are becoming agitated. Nurses must exhibit good clinical judgement in order to provide safe

and effective care for their patients.

In the article, “Professional Nurses’ Understanding of Clinical Judgement: A Contextual

Inquiry” by Anna Van Graan, Martha Williams, and Magdalena Koen, they discuss the

importance of the nurses providing care having clinical nursing judgment. Throughout the article

the authors discuss the different effects the nurse’s judgement has on the patient. The patient’s

health status may be rapidly declining and the nurse has to know how to act quickly on their feet

and know when to do a certain task (Anna C. Van Graan, et al, 2016). The authors focused on

the importance of experiences and how that allows the nurse to have a better clinical judgment.

They go in depth on the importance of student nurses being given the opportunities to have the

experiences that would enhance their clinical judgement. In this article it states, “Clinical

decision making is facilitated when students have an opportunity to integrate scientific

knowledge, experiences and clinical judgement in a specific situation. Such opportunities guide

nursing students to a deeper understanding of the clinical situation…” (Anna C. Van Graan, et al,
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2016). This quote from the article shows that the student nurse will benefit from having

opportunities to exhibiting clinical judgement in situations to better their understanding of it. If

the student nurse is given the opportunity to be a part of and provide care for the patient with a

specific disease, they will learn more from that experience and allow them to become a better

new-graduate nurse. This will lead them to become a better experienced nurse in the future. In

the bigger picture of things, nurses are there to provide the best care possible for their patients.

Allowing nursing students to have the experiences and opportunities to better their clinical

nursing judgement will do just that.

Another article reviewed discussed the relationship between clinical nursing judgement

development and the performance in the simulation and clinical setting. This was a quantitative

study that was conducted. This study consisted of eighty participants. Of that eighty, sixty-five

female participants. They were all enrolled in a four-year baccalaureate nursing program and

were younger than thirty years old (Joyce Victor, et al, 2017). Every week, the participants

would complete a simulation which included a quiz, prebriefing, scenario and debriefing. If the

participant did not pass the simulation, they would remediate and attempt the scenario again.

This went on for thirteen weeks. At the end the clinical instructors of the students were asked to

evaluate each participant. After the first evaluation, the participants were evaluated again in the

simulation setting (Joyce Victor, et al, 2017). The results show that the students showed that they

had established a significant positive relationship between clinical nursing judgment and their

performance in the simulation setting. This shows that there is a significant effect of being

exposed to and learning from situations in the clinical setting (Joyce Victor, et al, 2017). The

students not only learned about the task they were performing, but they learned the clinical

judgment that went along with it.

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In the final article reviewed, it discusses the importance of being proactive in order to

keep the patient safe. The nurse who has clinical nursing judgement has the best patient

outcomes when it is related to patient safety. This nurse can see something before it becomes a

problem. This could be something as simple as making sure the head of the bed is elevated when

a patient is receiving a tube feed or making sure the bed is in the lowest setting and the wheels

are locked. The nurse who can see that the patient receiving that tube feed can aspirate and

develop pneumonia if the head of the bed is not elevated is exhibiting good clinical nursing

judgment and being proactive in their patient care. Nurses are there to help the patient and if the

nurse is not proactive in keeping the patient safe, they are not providing the best care

possible[ CITATION Ste18 \l 1033 ]. The article discusses the importance of documenting. This is

sometimes the way to communicate with other healthcare providers. If the nurse does not

document something that would be important, the other providers may not focus on it when they

are there and it can be left untreated. The nurse has to know and be able to judge whether or not

that is worth passing along to the next person and charting it in the electronic health

record[ CITATION Ste18 \l 1033 ]. The nurse having good clinical judgement allows them to

provide the most safe and effective care for their patient. This is why having good clinical

nursing judgement is so important.

A personal experience in which good clinical judgement was used was to hold a

medication. A patient had been prescribed a beta blocker for hypertension. Prior to administering

this medication, the vital signs were checked and their heart rate was only in the low fifty’s. It

was decided to hold the medication and notify the physician in order to prevent the patient’s

heart rate from dropping any further as a result of the medications.

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In conclusion, clinical nursing judgement is very important for providing care for

patients. The nurses must be able to have the skill to know what to do in a situation for the safety

of the patient. It is best to teach nurses this skill of clinical judgement earlier on. Many studies

show that school for nursing is the best time to start teaching this skill of clinical judgement.

Nurses are here to help patients in their time of need and provide the best care possible. The act

of exhibiting good clinical nursing judgement allows the nurse to provide that care and help the

patient.
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References

Anna C. Van Graan, M. J. (2016). Professional Nurses' Understanding of Clinical Judgement: A

Contextual Inquiry. University of Johannesburg.
Davis, S. S. (2018). The Key to Safety: Proactive Prevention. AORN Journal, 351-353.
Joyce Victor, W. R. (2017). Examining the Relationships Between Clinical Judgment,
Simulation Performance, and Clinical Performance. Nurse Educator.
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