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Applying Nursing Clinical Judgment and Critical Thinking

Gina Bellotta

Nursing Department, Youngstown State University

NURS 4852 Senior Capstone

Professor Wendy Thomas

March 7th, 2020

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In the field of nursing, clinical judgment is a concept that is exercised every day. Clinical

nursing judgment refers to how a nurse considers and understands the problems and concerns of

their patients and families and how they arrive to conclusions through close observation and

analysis. The concept of clinical nursing judgment serves great significance because “Nurses’

judgments and decisions have the potential to help healthcare systems allocate resources

efficiently, promote health gain and patient benefit and prevent harm” (Thompson et al., 2013).

Nurses play such a vital role in patient care because “nurses exercise their clinical judgment and

decision making skills in clinical environments and have been used as exemplars for decision

and judgment research since the 1960’s” (Thompson et al., 2013). Despite the many challenges

that have developed in healthcare systems, nurses must continue to contribute to and improve the

quality of health systems through health promotion and clinical judgment in the most efficient

manner possible.

Within the healthcare system, “nurse graduates have to be able to think critically and

innovatively, should be competent in reflection and self-critique, synthesize information, link

concepts and become self-directed lifelong learners” (Van Graan & Williams, 2017). The goal

when using efficient clinical judgment, is to have a positive impact on patient outcomes. It is

important for a nurse to be able to carry out successful clinical judgment because “if nurse

graduates do not have the ability to think critically or have poor clinical reasoning skills they

often fail to detect impending patient deterioration, including failure to synthesize and act on

clinical information resulting in a failure-to-rescue which effects quality care and patient safety

(Van Graan & Williams, 2017). Within the healthcare setting, nurses carry out the majority of

patient-centered care, therefore increasing the complexity of the role of the nurse because of the

high demand in patient satisfaction.

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It is essential to emphasize the importance of understanding how to efficiently carry out

clinical judgment within the nursing education setting so that new nurses are adequately prepared

to apply these skills in their future career setting. Often a lack of preparation “has resulted in

novice professional nurses often discovering their shortcomings when arriving in the healthcare

environment. They are reluctant to make high-level decisions in an independent manner due to a

lack of competence and a fear of making mistakes and being criticized by peers (Van Graan &

Williams, 2017). If a nurse is lacking higher order thinking skills, they may be putting their

patients in danger because they are at risk for not being able to detect acute patient changes and

complications. With failure to make these realizations, their patients may deteriorate which can

be harmful and result in poor quality care. When making appropriate choices and decisions in

the healthcare setting, it is referred to as “thinking like a nurse.” Students often aren’t given the

opportunity to practice these decision-making skills anywhere other than the clinical

environment, which isn’t always often. According to Jeanne Mann, “typically, critical thinking

exercises follow an instructional method, but students are not actually taught how to use critical

thinking and clinical judgment in a healthcare situation” (Mann, J., 2012). Often these teaching

strategies do not help the student understand and apply the clinical reasoning process therefore

causing them to struggle to transfer this learning to future situations. With that being said, when

making the transition from the education setting to the healthcare setting, it is important to

consider that “critical thinking and clinical judgment have been identified as essential skills for

practicing nurses” (Mann, J., 2012). It has been shown that these skills have effectively been

developed through simulation and debriefing by improving the students’ cognitive abilities and

confidence. Through simulation and debriefing, students are given an opportunity to exercise

these skills by relating their actions to patient outcomes through interpreting laboratory test
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results and medication administration which enables them to recognize the interconnectedness of

all factors.

When reflecting on my own personal experiences using nursing clinical judgment, I find

that I have mostly exercised these skills in my precepting setting. While consistently shadowing

and observing a nurse working full shifts, my skills in critical thinking and applying nursing

judgment have been given the opportunity to expand. While precepting, I am able to interact

with multiple patients daily and grasp a better understanding of concepts which allows me to

become more competent in nursing judgment. When considering a specific situation with a

patient where I had to apply my knowledge to carry out a clinical judgment, I remember having a

patient who was post-operative for a hip surgery. I discussed with my nurse that I felt it would

be important to help transfer the patient from their bed into the chair to help prevent the

development of any sores or pressure ulcers and to encourage the patient to ambulate as tolerated

to benefit future mobility. This specific patient did not want to take any narcotics for the pain so

I retrieved a fresh bag of ice for her to place on the site of discomfort and both my nurse and I

encouraged her to take Tylenol for the pain since it was not such a strong pain medication. At

first she was hesitant, but then she trusted our judgment and took the Tylenol. Although these

may seem like simple gestures, as a student, it felt rewarding to have been able to contribute to

making decisions in the best interest of the patient and encourage them in ways that would

improve their physical outcomes. Most of all, I took pride in knowing I was able to gain my

patient’s trust while providing the best care. I am grateful for the opportunity to observe a nurse

and advance my skills in nursing clinical judgment and critical thinking to help prepare me for

future situations within my career field.

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References

Mann, J. (2012). Critical Thinking and Clinical Judgment Skill Development in Baccalaureate

Nursing Students. Kansas Nurse, 87(1), 26–31.

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision

making and judgement in nursing research and education. International Journal of

Nursing Studies, 50(12), 1720–1726. https://doi.org/10.1016/j.ijnurstu.2013.05.003

Van Graan, A. C., & Williams, M. J. S. (2017). A conceptual framework to facilitate clinical

judgement in nursing: A methodological perspective. Health SA Gesondheid, 22, 275–

290. https://doi.org/10.1016/j.hsag.2017.01.004
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