Scholarly Paper

Cadeesia B. Douglas

Centofanti School of Nursing, Youngstown State University

NURS 4852 – Senior Capstone

Kim Ballone

February 23, 2022

 When it comes to nursing as a profession, it is important to keep in mind the concept of

clinical nursing judgment. This concept consists of the nurses reasoning for certain interventions,

performing the intervention competently, and having the responsibility to explain, defend, and

justify their decisions. Clinical judgement originates from the teachings and findings of Florence

Nightingale in 1860-1992. It is based off the idea of problem solving with the use of the nursing

process. This process includes assessment of each patient to decipher a nursing diagnosis,

planning a route of care, and then implementing nursing interventions to bring the patient back to

health or to the highest quality of life possible for that individual. Clinical nursing judgement

goes beyond the nursing process, and it becomes necessary for the nurse to apply the knowledge

and skills they have acquired to provide each patient with the highest quality of care. The nurse

must use critical thinking skills while caring for each patient and analyze the individual’s

situation in full to determine the best plan of care. Nurses are often responsible for multiple

patients, which can sometimes be overwhelming and complex. Taking into consideration the

background and health history of each patient can help the nurse to individualize care plans and

approach the situation in a prepared way.

Clinical judgement requires a person to use abstract thinking. This type of thinking is

defined as “the ability to understand concepts that are real, such as freedom or vulnerability, but

which are not directly tied to concrete physical objects and experiences” (Stanborough, 2019).

When caring for a patient, being able to look at each aspect of the situation and put together the

puzzle pieces of illnesses is a perfect example of abstract thinking. There is a difference between

just collecting subjective and objective data from the patient as opposed to understanding and

being able to analyze and pull apart the pieces of data. The article titled Nurses’ Clinical

Judgment Development: A Qualitative Research in Iran says that:

 “It is a prerequisite for establishing professional identity and is mainly based on nurses’

knowledge and experience as well as their reasoning, intuition, clinical thinking, and

evidence-based practice skills. Nurses use these skills to assess patients and the

environment and to process and interpret patient information in order identify and fulfill

patient needs. This process results in the establishment of nursing diagnoses, effective

clinical decision-making, problem solving and the improvement of care quality” (Seidi,

Alhani, Salsali, 2017).

Being a nurse not only means caring for your patient’s physical illness, but it also involves being

the patients advocate and speaking for them when they cannot speak for themselves. Nurses can

use their clinical judgement to be a patient advocate in many situations. An example of this could

be that a medication ordered for the patient is unsafe based off recent vital signs. The nurse can

use their knowledge and judgement to hold the medication and contact the physician.

There are a variety of situations in which the nurse must use their decision-making skills

and observation skills to identify relevant information pertaining to the patient. In another article

titled Nurses are Critical Thinkers it says that:

“Clinical reasoning is the process by which nurses observe patients’ status, process the

information, come to an understanding of the patient problem, plan, and implement

interventions, evaluate outcomes, with reflection and learning from the process (Levett-

Jones et al, 2010). At all times, nurses are responsible for their actions and are

accountable for nursing judgment and action or inaction” (McCartney, 2017).

Experience provides the nurse with the ability to rely on their intuition and quickly act in certain

situations. Nurses are continuously gaining more knowledge, expertise, and skills in the

healthcare setting.

Each day becomes a learning opportunity where nurses will be challenged in

unpredictable ways and forced to use critical thinking in unexpected situations. The article

Thinking Like a Nurse, states that:

“In addition, they must manage highly complicated processes, such as resolving

conflicting family and care provider information, managing patient placement to

appropriate levels of care, and coordinating complex discharges or admissions, amid

interruptions that distract them from a focus on their clinical reasoning” (Tanner, 2006).

Being a nurse is far from easy. The path to becoming a nurse is long and hard and comes with

many obstacles. Having knowledge is one thing but being able to apply that knowledge to all

situations is key. As a nursing student I have been in a few situations where clinical judgment

has been used. My most recent experience was during one of my clinicals. A patient was in the

surgical intensive care unit for a gunshot wound to the head. Due to a missing bone flap, he was

unable to be turned on his right side which increases his risk for pressure ulcers. The nurse

decided to use wedges underneath his lower body to help get his sacral area off the bed for a

little while but kept his head midline. In some situations, nurses will need to think outside of the

box to make things work. Clinical judgment plays a big role in this and helps the nurse to decide

what is best for this patient, and how am I going to achieve my goal?

In conclusion, nursing is more than just taking care of sick people. It is an all-

encompassing career that requires an empathetic, kindhearted human being. It involves the use of
critical thinking and clinical judgement to make quick, precise decisions. These patients are

scared and away from home, so making them as comfortable as possible will keep them a little

more at ease.
 References

Seidi, J., Alhani, F., & Salsali, M. (2015, September 28). Nurses' clinical judgment development:

A qualitative research in Iran. Iranian Red Crescent medical journal. Retrieved February

22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601210/

Siewdass, P. (2022, February 16). Nurses are critical thinkers. The BMJ. Retrieved February 23,

2022, from https://www.bmj.com/content/356/bmj.j1548/rr-0

Stanborough, R. J. (2019, September 5). Understanding abstract thinking: Development, benefits

& more. Healthline. Retrieved February 22, 2022, from

https://www.healthline.com/health/abstract-thinking#vs-concrete-thinking

Standing, M. (2008, March 18). Clinical judgement and decision‐making in nursing – nine

modes of practice in a revised cognitive continuum. Wiley Online Library. Retrieved

February 22, 2022, from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-

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