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CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Aria Wellington

Youngstown State University

NURS 4855: Senior Capstone

Wendy Thomas

February 8, 2022
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CLINICAL NURSING JUDGEMENT

Nursing is a very critical and demanding profession. Knowledge about the procedure,

medications, and clinical skills are essential to the care a nurse can give to patients. Another

important skill nurses should possess is clinical nursing judgment. Stated by Pam Embler (2022),

“clinical judgment is the accumulation of knowledge and skills, which facilitates to analyze the

patient presentation, data obtained, and then to provide evidence-based nursing.”. Having this

essential skill helps a nurse adapt to changes in patient conditions and advocacy. This in my own

words, is using your knowledge from education and the knowledge you obtain from your

experience within that field or with that specific person to come up with a nursing diagnosis with

evidence and solid data to back it up. In addition to the knowledge needed for a clinical

judgement, Decision-making in nursing practice: An integrative literature review includes key

factors including “influences of the uncontrolled, changeable, time limited, and high pressure

environments” (Nibbelink, 2018).

You might ask yourself why is this so important? Why do nurses have to have judgement

isn’t that for the physician or isn’t a nursing diagnosis just about the sighs and symptoms you

read in the textbook? In conclusion no, nursing clinical judgment is more than just guessing what

they may think is wrong. When making a clinical judgement nurses have to be confident in their

decision for many important reasons but mostly because physicians rely on the nurses skills in

determining a diagnosis. Novice and seasoned nurses have different types of thinking and

experience. The article Improving Physical Assessment and Clinical Judgment Skills without

Increasing Content in a Prelicensure Nursing Health Assessment Course, explains this but also

clarifies that for a nurse to intervene quickly and prevent poor patient outcomes, they must

recognize both the overt and subtle cues when preforming a patient assessment. Without clinical
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judgement there is an increased risk of missing the signs of a patient deteriorating. Being able to

redefine, extended, and adjust the textbook knowledge allows nurses to be confident and

competent in developing appropriate nursing actions. (Kinyon, 2021)

Clinical Nursing judgement is not something they teach you in school. This is something

a nurse obtains within her practice and their specialty. One specific time I can remember about a

personal experience with nursing judgement is during my current job. I had never really took the

time to think about what we were doing until this assignment. I currently work at Pediatric

Specialty Care in Hopewell, PA. We work with children with chronic illnesses from several

etiologies. These children have their own way to tell us what they are feeling, this is why we

have to learn our patients. Learning these kids is something very essential in this job to be able to

preform and advocate for these childrens needs. Examples of when we use nursing clinical

judgement is which kids go to activities and what children get sent out to the local childrens

hospital. One time I had to prepare my patient for activities. This includes getting the child a

shower, new outfit, their splints put on and up in their chair. This one time I had my patient up in

his chair due to his condition and processing pressure wounds he was only allotted an amount of

two hours in his chair. After the boy was in his chair for fifteen minutes he started to cry, became

tachypnic and tachycardic. After consulting with my nurse and explaining how he was

presenting, I suggested we lay him back down and have bed side activities that specific day.

After laying him back into his bed, he calmed down and reverted back to his baseline. That is a

small example of what I have been able to do in my career, but an example I have seen is when

nurses decide to send a child out to hospital due to subjective and objective data. During this

time we had a little boy, age 3, that became very lethargic and did not want to eat — even though

he is a great eater — he was set up with oxygen and he started sleeping all the time. This boy on
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any other day would be up in his crib jumping despite his tracheostomy and vent, watching

YouTube, and having conversations with staff, but this day he was defeating from his baseline.

He was very clingy to me, his aide, and just wanted attention and to be held. When he went to

sleep that night he destated down to 75% and regained stabilization after manually bagging.

After his desaturation the nurse called the on call doctor and reported his condition, the doctor

ordered just to monitor him, give Tylenol, and assess for a as needed tracheostomy change. By

the morning he was not any better so with all the information collected throughout the night, my

nurse used clinical judgement and decided it was best we send him to the hospital to find out

what was wrong. Upon his return a few days later he was diagnosed with aspiration pneumonia.

Without this nurses assessment skills and knowledge about this certain kid, he could have

declined and potentially led to a worsening situation.

Overall, clinical nursing judgement is a very important skill to have. This skill allows the

nurse to gather subjective data, objective data, and experiences to formulate a nursing diagnosis.

Clinical nursing judgment is something that a nurse obtains after a few years of experience.

Physicians use nurses assessments and documentation to their advantage for diagnosing patients.

Clinical judgement is used in all healthcare practices and by all healthcare providers. Having this

skill allows healthcare providers to make sound, confident, and competent decisions about

patient status.
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Citations

Embler, P. (n.d.). Imparting clinical judgment leading to sound clinical decision-making and

patient advocacy. Back to top. Retrieved February 12, 2022, from

https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement 

Kinyon,K.;D’Alton,S.; Poston, K.; Navarrete, S. Improving Physical Assessment and Clinical

Judgment Skills without Increasing Content in a Prelicensure Nursing Health Assessment

Course. Nurs. Rep. 2021,11,600–607. https://doi.org/ 10.3390/nursrep11030057

Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative

literature review. Journal of clinical nursing, 27(5-6), 917–928.

https://doi.org/10.1111/jocn.14151