Scholarly Capstone Paper: Clinical Nursing Judgement

Abigail Schuster

Centofanti School of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Kimberly Serroka Ballone and Wendy Thomas

February 28, 2022

 Clinical nursing judgement is one of the most valuable tools in the practice of nursing. It

can help provide quality patient care and improve patient outcomes. Clinical judgement involves

using clinical thinking and reasoning to help nurses recognize patient problems, evaluate them,

and make appropriate decisions regarding the best care that can be provided for the most optimal

patient outcomes. The process involves the nurse using clinical knowledge, assessment skills and

communication skills in everyday practice. This may be used in many nursing situations from

determining focus assessment areas based on patient needs to determining the best interventions

for the patient. As well as questioning orders if need be, such as when the order may not be in

your patients’ best interest. Often, using clinical judgement can help make the nurse a better

patient advocate because the nurse can take what they have learned and observed to help give

their patients a better quality of care. In the beginning of a nurse’s career this can often be a

difficult task. It requires taking all the data they have observed, the knowledge they have

obtained and utilizing the data to figure out what would be in best interest of the patient. Clinical

nursing judgement can be used more efficiently when done in a set of tasks. These may include

gathering relevant information, choosing defined questions and problems, examining any

relevant information, using, and determining the most effective ideas, outcomes or solutions. As

well as comparing the outcomes against current standards, having an alternate solution available

if necessary, considering all the consequences of the plan, and lastly communicating with others

to provide the highest quality of care possible.

Clinical judgement is important for many reasons. Many of these reasons could include

patient safety, patient advocacy, patient assessment, and proper nursing interventions. Patient

safety involves using clinical nursing judgement because the nurse must use their judgement to

determine whether it is safe to give medication or it must be held because of factors in the

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patient’s condition such as their heart rate, blood pressure, the function of their kidneys and liver,

the patient’s neurological status and other treatments that can’t be given at the same time. Safety

can also be important when using clinical judgement because the nurse must determine how

much oxygen a patient should receive. The nurse must use knowledge and clinical judgment to

assess the patient’s respiratory status, determine the lowest level of oxygen necessary to keep the

patient’s respiratory status at optimal level which will decrease the risk for respiratory failure.

Safety can be important for clinical judgement when the nurse must decide an acceptable level of

mobility for the patient as well. This is since many patients can be at risks for falls if they get up

but are at risks for blood clots and venous stasis if they stay in bed, so the nurse must use their

best clinical judgement to determine an appropriate and safe level of activity for each patient.

Clinical judgement is also important to patient advocacy. Nurses must use their clinical

judgement skills to become patient advocacy this can occur in situations where the nurse is

expected to give a medication that could be harmful to the patient in this situation, He or she can

use their clinical judgement to hold the medication and call the physician to explain why they

feel that this medication is not in the patient’s best interest. Patient advocacy can also play a part

in clinical judgement when the nurse must make decisions about what nursing interventions are

best for the patient. If the family or other staff suggest something that may be harmful to the

patient it is the nurse’s responsibility to use his or her judgement to provide an explanation as to

why that activity may not benefit and even potentially harm the patient. Patient assessment also

requires clinical nursing judgement because the nurse must determine what is an acceptable

normal for each patient, since not all patients can meet all the same standards. An example of

this would be having a normal SpO2 of 95-100 is normal for one patient that is in good health

but expecting an SpO2 of 88-90 might be an acceptable level for someone with COPD.

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Determining what is normal for a patient helps the nurse to determine what nursing care should

be provided.

In my personal nursing experience, I haven’t got to make many of my own clinical

nursing judgements because I am usually assisted by a nurse, and I am still learning to connect

all the data I have obtained to make the best decisions for my patients. However, during one of

my clinical experiences my instructor and I used our clinical nursing judgement to determine

which medication could and could not be given to a patient receiving a dialysis transfusion. This

patient had many medications important to his wellbeing but not all could be given to him prior

to him receiving dialysis because they would be transfused out of his blood and not have time to

properly take effect. This led to my nursing instructor and I going through each of the patient’s

medications and determining which of them were safe to give and which of the must be held

until after the patient received his dialysis.

Overall, clinical judgement and clinical reasoning can be used in almost every nursing

situation to help create the best overall care to each patient. Nurses must be highly alert to the

errors and dangers that could occur when they are not actively using their best clinical judgement

to do patient assessments, patient interventions, patient safety, medication passes, and when

communicating with other healthcare team members to create an adequate treatment plan. Nurses

hold a unique place in the treatment team because they get to assess all aspects of the patient,

provide hands on patient care, talk with other healthcare members, talk to the patient and family,

and provide many of the treatments required for best patient outcomes. If nurses do not use their

clinical judgement while providing care many more errors would be made, many of the patients

would lose anyone to advocate for them and a lot of negative outcomes could occur. Therefore,

clinical judgement is so important in the field of nursing and must be as active part of daily care.

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 References

Diamond-Fox, S., & Bone, H. (2021, May 13). Advanced Practice: Critical Thinking and

Critical Reasoning. British Journal of Nursing.

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Kinyon, K., D'Alton, S., Poston, K., & Navarrete, S. (2021, September 1). Improving Physical

Assessment and Clinical Judgment Skills without Increasing Content in a Prelicensure

Nursing Health Assessment Course. Nursing Reports.

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live&scope=site

Whiteman, K., Yaglowski, J., & Stephens, K. (2021, April 1). Critical Thinking Tools for

Quality Improvement Projects. Critical Care Nurse.

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e&AuthType=ip,uid&db=rzh&AN=150233468&site=ehost-live&scope=site