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Development of Clinical Nursing Judgement

Megan Baril
Centofanti School of Nursing, Youngstown State University
4852 Senior Capstone
Kim Ballone and Wendy Thomas
March 15, 2021
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Development of Clinical Nursing Judgement

Critical judgement is essential to the everyday nurse, but as to when or how it is acquired

is unknown to some as it is such an abstract and complex question. Being presented a situation

that is confusing and possibly critical, making a clinical nursing judgement based decision is

crucial to the patient outcome. How does one get to the point of being able to make a decision on

the fly that will result in the best outcome for the patient? What is clinical nursing judgement and

when can it be discerned as proper nursing technique? Why is clinical nursing judgement

important and how does it impact patient care? These questions are often asked with no answers

due to the abstract conceptualization of the making of a thought. The development of clinical

nursing judgement is gradual and essential to the nursing process as well as positive patient

outcomes.

Clinical nursing judgement can be thought of as intuition, or just knowing what to do

because of experience and confidence. Nursing judgement can also be described as including

someone who is an, “independent, critical thinking nurse(s) who can cope with diversity in a

creative way and define their role in a complex, uncertain, rapidly changing health care

environment.” (Van Graan, 2017). Being able to define and act in your role even when faced

with something difficult or abstract is essential to clinical nursing judgement as it is the

cornerstone to it, being able to utilize what you have learned and seen before and being able to

apply it to the situation you are in is important and essential. Clinical nursing judgement is the

ability to put together critical thinking as well as experience utilizing the nursing process to come

to a proper intervention to a nursing situation.

Clinical nursing judgement is acquired in many ways, one being teaching experiences

during school. During simulations one is expected to act as if they are in a clinical setting and
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they must come up with some sort of resolution to said simulation. Simulation acquired critical

judgement is imperative to the new nurse because it is a lot of what they have been used to and

have at hand. A new nurse does not have years of experience as a seasoned one would but having

those teaching experiences makes them all the better in that aspect. As said by Hustad,

“Simulation-based training promotes self-confidence, Understanding from simulation-based

training improves clinical skills and judgement in clinical practice, and Simulation-based training

emphasizes the importance of communication and team collaboration.” (2019). Having the

confidence and discussion after the simulation creates a solid foundation in the building of

clinical nursing judgement. Another way judgement is acquired is through experience, which

there is no way around it other than time and positive clinical interactions and situations. The last

way clinical judgement is acquired would be from learning to think critically, looking at the

overall picture when addressing a situation. All of these different aspects together contribute to

effective clinical nursing judgment which, “results from critical thinking and clinical reasoning”

(Manetti, 2018). We are given the tools to help us evolve from non-critical to critical thinking in

our lectures over the years but clinical reasoning on the other hand comes from the select few

clinicals we are given through the semesters as well as throughout our careers as nurses.

When becoming a nurse, one is expected to use past experiences to guide you to better

and more effective decision making in the clinical setting. Depending on what experiences you

have, you pull certain grains of information from different places such as from student clinical

experiences, lectures, and even life experiences that can lead you to a correct action that leads a

patient to a positive outcome. One certain experience that comes to mind with me is recently

during my precepting hours we had a woman whose foot was hurt, and they just thought it was

from her fall at home. As time went on her other foot began to also degrade and it looked like her
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feet were covered with blisters, and her feet may not have looked like they were swollen but they

were. She was an older and very thin woman, so when you looked at her feet compared to the

rest of her, they were swollen. When we went in to do her dressing change her feet were

absolutely soaked, and she complained that they were itching. After that first dressing change,

we came back in less than an hour and they were completely soaked through again. So using

clinical judgement we decided to elevate her feet while we waited for the doctor to come and do

the dressing change again. There was obviously a build up of fluid that was going straight to her

feet and I know from lectures, clinical experiences as well as personal experiences with people in

my family with heart failure that the first thing we should have done would have been to elevate

the feet. This experience will encourage me to react quicker in the future, as opposed to doing it

after the second dressing change, we should have done it when we saw it seeping when we

changed the first. This is something that can contribute to further enhancing my clinical nursing

judgment in the future as I have seen it before and can react to it quicker. Through these clinical

experiences adequate and essential clinical nursing judgment will and has been developed

gradually through the years.

Clinical nursing judgement is a complex thought process brought about through critical

thinking and clinical experiences. All nurses develop said judgement with time and how much

time at that depends upon the learning program they went through and how long they have been

a nurse. Developing adequate judgement is essential to the practicing nurse because applying

what one knows is much more difficult than just recalling what they know. Application of the

proper techniques and quick reaction times are based upon this clinical nursing judgement and

proper development of this idea reflects on the ability of the nurse as well as the patient outcome.
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What may seem to be an instinct is actually clinical nursing judgement that has been developed

throughout the years beginning with critical thinking and molded through nursing experiences.

References

Hustad, J., Johannesen, B., Fossum, M. et al. Nursing students’ transfer of learning outcomes
from simulation-based training to clinical practice: a focus-group study. BMC
Nurs 18, 53 (2019). https://doi.org/10.1186/s12912-019-0376-5
Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,
54(1), 102-110. doi:10.1111/nuf.12303
Van Graan, A. C., &; Williams, M. J. (2017). A conceptual framework to facilitate clinical
judgement in nursing: A methodological perspective. Health SA Gesondheid, 22, 275-
290. doi:10.4102/hsag.v22i0.1015