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Running Head: CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Sarah Obradovich

Nursing Department, Youngstown State University

NURS4852: Senior Capstone

Dr. Ballone & Dr. Thomas

March 15, 2020

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Clinical Nursing Judgement

Senior Capstone: Clinical Nursing Judgement

The purpose of this paper is to analyze clinical nursing judgment and its importance. Manetti

(2019) describes clinical judgement as “synonymous with the term decision-making” and

explains that it “results from critical thinking and clinical reasoning.” Clinical practice often

requires the nurse to multitask and use their judgement to make health promoting decisions

while providing care to their patients. Clinical nursing judgement allows the nurse to practice

safe patient care and decreases the risk of errors in the field by analyzing all aspects of the

patient. According to Dr. Christine Tanner, who is a clinical teacher, the nurse’s actions are

based upon what the nurse notices about their patient and how they interpret the situation

(Rodger, 2019). Tanner explains the steps in her clinical judgement model (CJM) which outlines

four major topics a nurse educator can focus on when teaching new nurses to have clinical

nursing judgement. The steps include: Noticing, Interpreting, Responding, and Reflecting. By

taking each step of the model, the educator can focus on the student’s actions and allow the

student nurse to become familiar with their own clinical nursing judgement. The steps allow the

educator to improve the student’s judgement by reflecting on their actions. Although her

model focuses solely on new nurses, all nurses can take these steps into account when looking

at their own clinical judgement. Reflecting on their actions helps build confidence and learn

from past actions.

In order to have a better understanding of clinical nursing judgement, the nurse must

first have an understanding of the Nursing Process. Melin-Johanson (2017) states that the main

focus of this process is problem solving. The five stages of the nursing process include:

assessment, nursing diagnosis, planning, implementation, and evaluation. This process is

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Clinical Nursing Judgement
important because it allows the nurse to reach informed decisions on the plan of care

surrounding each individual patient by carefully analyzing the patient’s current status and by

identifying their needs. Critical thinking is another major component in the nursing process and

clinical nursing judgement. This is a skill new graduates can struggle with because it is

developed through education and clinical practice. Lee (2017) describes critical thinking in the

nursing process as “the process of purposeful thinking and reflective reasoning where

practitioners examine ideas, assumptions, principles, conclusions, beliefs and actions.”

Educators can help improve critical thinking skills by providing opportunities in clinical settings

to teach and ask questions to increase a student’s deep thinking process. Another way of

improving critical thinking is through simulations. Simulations in a lab help the nursing student

to work through the situation and demonstrate how they would provide care; then allow the

instructor to provide feedback. Growing a student’s ability to critically think will ultimately grow

their clinical nursing judgement.

As for myself, I do my best to stick to the nursing process when providing patient care to

better my clinical nursing judgement. An example of a time I demonstrated clinical nursing

judgement was during my mental health rotation at Trumbull Memorial Hospital. This was a

rotation where I learned a lot of critical thinking. Each mental illness had specific treatment

strategies and there was an abundance of patients with different illnesses each week. One

situation that improved my clinical judgement was with a Bipolar patient experiencing a manic

episode. The patient spent lots of time pacing back and forth in the hallway. He never sat down

to rest or join in on the group therapy sessions. Using the nursing process we assessed that the

patient was highly active and in a manic state. We gathered both subjective and objective data
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Clinical Nursing Judgement
from the chart and observation. Following along with the nursing process, we knew this patient

was not taking time to sit down and eat his meals; therefore our nursing diagnosis was risk of

nutritional deficits. He was expending extra energy in his manic state because of how much

activity he was enduring with the consistent pacing. In the planning step of the nursing process

and by using critical thinking, we decided that providing high calorie finger foods was most

beneficial to the patient and would decrease the risk of nutritional deficits. This way, he was

replacing the expended energy and it was a food he could easily pick up and carry with him. We

supply finger foods to manic patients because it is often difficult to calm them down to a point

where they are willing to sit down and eat a meal. To implement our plan, we set out

sandwiches, trail mix packs and granola bars. We set them up in a place he always paced by so

it was easily accessible and we informed him that they were there for him to enjoy. After a few

minutes we successfully completed the last step of the nursing process by evaluating the

outcome of our implementation. He almost instantly picked up one of the sandwiches and ate it

as he continued to pace the floor.

In conclusion, nurses must actively provide care following the nursing process and using

critical thinking to improve their clinical nursing judgement. Clinical nursing judgement is

developed through clinical practice and improves the safety of care provided by the nurse.

Overall, if nurses continue to improve their clinical judgement then there will be improved

patient outcomes and a decrease risk of harm and error in the clinical setting. It is important for

the nurse to be competent when providing care; and it is important that they do everything

they can to promote the highest standard of safety in their patient care.
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Clinical Nursing Judgement
References

Lee, DSK, Abdullah, KL, Subramanian, P, Bachmann, RT, Ong, SL. (2017). An integrated review of

the correlation between critical thinking ability and clinical decision‐making in nursing.
Retrieved March 14, 2021, from https://doi-org.eps.cc.ysu.edu/10.1111/jocn.13901

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

54: 102– 110. https://doi-org.eps.cc.ysu.edu/10.1111/nuf.12303

Melin‐Johansson, C, Palmqvist, R, Rönnberg, L. (2017). Clinical intuition in the nursing process

and decision‐making—A mixed‐studies review. J Clin Nurs. 26: 3936– 3949. https://doi-
org.eps.cc.ysu.edu/10.1111/jocn.13814

Pouralizadeh, M., Khankeh, H., Ebadi, A., & Dalvandi, A. (2017). Factors Influencing Nursing
Students' Clinical Judgment: A Qualitative Directed Content Analysis in an Iranian
Context. Journal of clinical and diagnostic research : JCDR, 11(5), JC01–JC04.
https://doi.org/10.7860/JCDR/2017/25753.9822

Rodger, K. (2019). Learning to Think Like a Clinical Teacher, Teaching and Learning in Nursing.
Retrieved March 14, 2021, from https://www-sciencedirect-
com.eps.cc.ysu.edu/science/article/pii/S1557308718301422?via%3Dihub
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4852 Capstone
Scholarly Paper Rubric

Scholarly Capstone Paper

 A component of the capstone course, worth 20% of the final grade
 An in-depth exploration on the topic “Clinical Nursing Judgment”
 3 page paper
 APA format
 Minimum of 3 references citing recent Nursing Journals
 Define the concept, identify the importance of clinical nursing judgment, and then discuss
a personal experience where you used “clinical nursing judgment” in a specific situation.

Requirements: Possible Points Achieved

Points
1. organization and clarity of topic present 20 _________
2. content quality 20 _________
3. reflection of topic 20 _________
4. APA format and correct grammar 20 _________
5. Cited References 20 _________

Final Grade

_________/100 points

4852 capstone paperubric ksb2017