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Clinical Nursing Judgment in Modern Day Practice

Chelsea McNeal
Nursing Department, Youngstown State University
NURS4852: Senior Capstone
Professor Ballone and Professor Thomas
March 15, 2021
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Clinical nursing judgment is a relevant concept that is important for all nurses to

understand and apply in daily practice. It helps better our overall nursing care and quality to

patients. Increased “cognitive skills are essential competencies for nurses joining the

technologically and increasingly complex health care environment to provide safe and effective

nursing care” (van Graan et al., 2016, p. 280). The outcome of clinical nursing judgment

involves making decisions in practice with evidence. Nursing practice focuses on providing safe

and quality care to all patients and their families in collaboration with the rest of the health care

team.

The concept of clinical nursing judgment refers to the way nurses come to understand the

problems, issues, or concerns of patients, in order to focus on the important information. Clinical

nursing judgment is referred to as:

A nurse’s understanding or conclusion about a patient’s health, needs or concerns. The

process leading to a clinical judgment involves the integrated thinking about a patient and

begins when a nurse notices something about a patient’s situation that demands attention.

To make sense of what he or she notices, the nurse employs a variety of reasoning

patterns … to process and integrate information, form judgments and decide on a course

of action. (Lavoie et al., 2020, p. 3791)

By making clinical nursing judgements, it allows nurses to be focused and involved in patients

concerns regarding medical interventions and psychosocial considerations. Nursing judgment is

not only about carrying out medical orders but involves knowing when patients need more than

medical treatment. Caring for patients and understanding them as whole is the most beneficial

way for patients to reach their overall goals. It has been suggested that “the processes and

outcomes of nurses’ judgments are more strongly influenced by both individual (e.g., the nurse’s
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experience, knowledge and values) and contextual factors (e.g., culture and specialty of the unit)

than by the actual patient data” (Lavoie et al., 2020, p. 3791). This allows nurses to use more

than one aspect of nursing care to help make educated judgements to benefit patients. The

concept involves “prioritizing the most relevant data through reasoning, useful for explaining the

patient’s condition and making sense of the data by developing plans for interventions that can

successfully meet the patient’s needs” (van Graan et al., 2016, p. 283). This concept is used by

all nurses throughout healthcare to better patient outcomes and experiences.

Clinical nursing judgment is an important part in the professional practice. It establishes a

foundation that is based on nurse’s knowledge and experience, as well as their reasoning,

intuition, clinical thinking, and evidence-based practice. It gives structure and allows nurses to be

competent advocates for patients in order to deliver the best patient care. Clinical judgment

encourages “nurses [to] draw from their foundational knowledge of patient conditions and

organizational processes and use clinical reasoning” (Rohde & Domm, 2017, p. 411). Holistic

assessments, critical thinking and reasoning, experience and intuition all contribute to the

importance of clinical judgment in nursing. The holistic approach has a main goal, which is to

use all available experience and information to make decisions in the best interest of patients

When working as a Student Nurse Tech at Select Specialty Hospital, I had received

report from the day shift nurses aid who stated that all of their patients from the day were cleaned

and stable except for the male patient in room nine. She stated that the night before she was

informed that he had a wound on his back that started to bleed rapidly but they were able to get it

to stop. She then told me that he was complaining of having difficulty breathing, but she said that

his vitals were slightly on the low side, but normal. I then went in the patient’s room to introduce

myself and write my name, his nurses name, and the patient goal for the night on the white
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board. He began to tell me that he felt the same way he did last night, and I could tell he was

getting anxious. I used my clinical judgment and assessed the patient. As I turned the patient to

examine the site that the previous aid told me was bleeding the night before, I noticed he was

sitting in a puddle of his own blood. I ran out of the room to get the patient’s nurse, the charge

nurse, boxes of gauze and a machine for vitals. His oxygen levels were down in the low 80’s, his

heart rate was over 100 beats per minute, and his blood pressure was around 60/40. He was still

conscious, but it was only a matter of time. We then put a non-rebreather on the patient, and I

was holding pressure on the wound that the bleeding was coming from and we transferred him to

the ICU. By listening to the patients concerns and acting on them, I was able to catch the

bleeding and prevented the situation from escalating. This was the first time I trusted my clinical

judgement and followed my gut that something more was going on with the patient. In order to

give patients the best possible care, all of their thoughts, concerns and questions must be listened

to and heard. Clinical nursing judgment is about identifying a problem, listening, assessing the

situation, and doing what is best for the patient.

Clinical nursing judgments are an essential part in patient care. It allows nurses to use

personal experiences, gained knowledge, and presented information in order to make decisions to

benefit patient care. Clinical nursing judgment “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” (van Graan et al., 2016, p. 283). It is an important tool to help nurses be

better advocates for patients and help better patient’s outcomes. Clinical judgment in nursing has

an ultimate goal to improve patient care.

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References

Lavoie, P., Clarke, S. P., Clausen, C., Purden, M., Emed, J., Cosencova, L., & Frunchak, V.

(2020). Nursing handoffs and clinical judgments regarding patient risk of deterioration: A

mixed-methods study. Journal of Clinical Nursing. doi:10.1111/jocn.15409

Rohde, E., & Domm, E. (2017). Nurses’ clinical reasoning practices that support safe medication

administration: An integrative review of the literature. Journal of Clinical Nursing, 27(3-

4). doi:10.1111/jocn.14077

van Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses' understanding of

clinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280-293. doi:

10.1016/j.hsag.2016.04.001