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What is Clinical Nursing Judgment and Why is it Important to Professional Nursing

Mary Jo Miller

Nursing Department, Youngstown State University

Nursing 40000000: Capstone

Dr. &&&&&&&&

February 05, 2022

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What is Clinical Nursing Judgment and Why is it Important to Professional Nursing

What is “Clinical Nursing Judgment”? Can it be truly defined or even measured? What is the significance and or

importance of quality “Clinical Nursing Judgment” in the education and practice of professional nurses? Such questions

have intrigued scholars, nurse educators, and healthcare administrators for decades. Modern day professional nursing is

vastly different in its approach to education and patient care in comparison to just that of the 1950's and 60's. During the

1960's and prior nursing education and the nursing profession as a whole was very different in its approach to what nurses

should know and the tasks they should accomplish. Nurses then where expected to follow and act with unquestioning, none

deviating obedience to established procedures and ways of thinking. With the ever advancing healthcare technologies,

increasing patient illnesses, increasing demands on nursing staffs, and a host of other reasons nurses now are required to be

critical thinkers. Modern nursing professionals are now expected to rapidly take in a great deal of information from a all

these resources and quickly make sound clinical judgments in regards to the care of their patients.

So what is “Clinical Nursing Judgment” and how best can we define the concept of “Clinical Nurse Judgment”?

Lindsey & Jenkins (2013, as cited in Graan, Koen, & Williams, 2016) best described clinical nursing judgment “as the vital

skill which enables nurses to determine proper interventions especially in the critically ill or injured patient”. The terms

critical thinking and clinical judgment are synonymous with one another when it comes to the nursing profession. Modern

day nurses have to be highly skilled and comfortable with understanding the concepts of critical thinking and thus clinical

judgment decision making. These concepts allow the nurse to make critical treatment plans needed for their patients during

very critical times. Modern nursing professionals must be able to make rapid “clinical judgments based on information

gained through assessment, diagnosis, implementation, and evaluation with little or no time” (Graan, Koen, & Williams,

2016).

Critical thinking and thus critical judgment are higher levels of cognitive skill that cannot simply be taught in a

classroom or basic lab simulation. These are skills and abilities that are learned throughout a lifetime of nursing. Nurse

educators have found through exhaustive research that while the basic fundamentals of critical thinking and clinical

judgment can be taught in a classroom or lab setting, true mastery of each can only come with experience. Educators have

struggled being able to develop these higher level cognitive abilities in their students prior to them entering the nursing

profession. Even more difficult was the ability of the students to gain the confidence and experience required in order to

make these critical judgments. With the use of modern day technology and the use of high functioning automated and
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virtual reality simulation labs nursing students are now able to gain a greater depth of knowledge and experience never

before possible. With the use of such lab experiences student nurses are able to greater numbers of patients, scenarios, and

more importantly see how there judgments affect the patients and their outcomes. These experiences can produce both

positive and negative outcomes for the “patients” based on the judgments and decisions of the nursing student. Such

experiences, however, provide the students with a level of learning and understanding that they may never otherwise

experience. Nursing educators are also able to determine the “knowledge that is based on active learning with problem

solving and critical thinking, which is needed to achieve the ability to determine what is relevant in a particular context”

(Backstrom, Haggstrom, Hallen, and Kristiansen, 2016) for each individual student or groups of students. Such simulation

exercises provide the students the opportunity to understand the importance of communication between everyone involved

in the care and treatment of the patient. The use of high functioning and virtual reality labs allows for the students “learning

to become a matter of collecting experiences from different situations and scenarios with various outcomes and then using

those experiences as a basis for future clinical judgments and decision making in similar like-new situations” (Backstrom,

Haggstrom, Hallen, and Kristiansen, 2016).

“In nursing, critical thinking has often been portrayed as a rational, linear process that is synonymous with problem

solving, and the nursing process” (Backstrom, Haggstrom, Hallen, and Kristiansen, 2016). As modern nursing professionals

are asked to do more with less it has become ever more important for these nursing professionals to be able to quickly,

efficiently, and accurately develop treatment plans for their patients. Nurses now can rely on greatly improved and more

accurate diagnostic technologies and equipment , however, these tools in and of themselves also require a greater deal of

training knowledge. With the advancing technologies, and the costs associated with such technologies, many healthcare

systems are reducing the number of nurses. This then increases the number of patient to nurse ratios. The increased patient

ratios force the nursing professional to be ever more vigilant in their critical judgment development and prioritizing their

time and resources. Modern nurses thus need to have “higher cognitive skills which are essential competencies for nurses

joining the technologically and increasingly complex health care environment to provide safe and effective nursing care”

(Graan, Koen, & Williams, 2016). Nurses of today must be able to obtain relevant vital information from various sources of

information through communication, diagnostic monitoring, or experience. They must “be able to quickly process this

information and through critical thinking develop intervention plans based on their judgment of the individual situations”

(Morris, 2016).

Florence Nightingale described the nursing process in all of its various forms as always being the foundation for
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patient problem management. The nursing processes have gone through many changes just in the last 50 years. Each new

model builds off the previous and is adapted or adjusted to meet the needs of the next generation of nursing professionals

and the technologies of the time. The current generation of the nursing process began in the 1990's and “emphasizes

reflection, outcome specifications, testing given a patient's story” (Morris, 2017). This new process emphasizes the use and

importance of critical thinking and clinical judgment in the nursing diagnosis, care, and treatment of patients. As this new

nursing process and mode of thinking began to emerge and and take hold it quickly became apparent that the education of

nurses would have to also be adapted. A new educational approach to critical thinking and clinical judgment decision

making would have to be created so that nurses entering the field would be ready. Research by Benner, Tanner, and Chesla

in 1997 (as cited in Morris, 2017) showed that “novice nurses were not as sophisticated in their thinking skills as expert

nurses. And that expert nurses did not necessarily use any specific nursing process, but instead relied heavily on experience

and intuition as well as there practical and academic knowledge.”

As the nursing profession continues to advance in technology and diagnostic abilities it is still the nurse at the bed

side who is caring for the patient. The modern nurse must be able to quickly take in a wealth of information from a great

number of resources. As they collect all of this data and information they must then be able to formulate an action plan and

make sound clinical judgments based on their critical thinking of the events. “It is becoming clear that clinical reasoning

includes more than critical thinking and involves elements of creative thinking, systems thinking, ethical reasoning, and

outcome specifications” (Morris, 2017). To begin developing these much higher cognitive skills in critical thinking and

clinical judgment the nursing education models have to change and accept this new nursing process. Nurse educators must

adapt their teaching styles and processes to encourage the nursing student to begin critically thinking through problems and

scenarios. In this way they will begin to develop the clinical judgment abilities that are so critical in modern nursing.

Through the use of high functioning and virtual reality lab experiences nursing students will be able to gain valuable

experience in decision making. These experiences will allow the nursing students to make “safe” mistakes and learn from

both the positive and negative decisions. As they then enter the nursing profession they will have a much higher degree of

experience than previous generations and thus be more prepared for the demands of modern nursing.

Through my own professional experiences I have been able to hone and achieve the higher level cognitive skills of

critical thinking and clinical judgment required of professional nursing. I have worked in the pre-hospital environment for

nearly 20 years. For the last two years I have been working as a Nationally certified Advanced Emergency Medical

Technician with a fire department based ambulance service running over 5000 emergency calls per year. In this position I
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am considered an advanced level provider, only one step under that of a Paramedic. In my capacity I am able to initiate IV's,

place and secure advanced airways, and administer medications solely on my clinical judgment of the patient's condition,

complaints, and my assessment. I have to rely on my experience, critical thinking abilities, and clinical judgments to make

the appropriate patient care decisions. I need to be able to make these critical clinical decisions in a split second. In the

most recent case I assisted another fire department on a 911 call for an elderly female who had an altered mental status.

When I arrived the EMT / Firefighters who had arrived first advised that they believed the patient was having a stroke based

on her altered mental status. As I did my patient assessment including an interview of the patient and her family I began to

develop the impression that she was not in fact having a stroke but instead had suffered from a seizure due to hypoglycemia.

Through further assessment I was able to identify her blood sugar was only in the 30's. I initiated an IV and administered

dextrose. The pt quickly began to become alert and now able to answer questions. It was because of my critical thinking

ability and judgment skills that I was able to properly assess the situation and the patient. I was able to quickly determining

the most likely cause of her altered mental state develop a treatment plan and initiate that plan correcting her medical

emergency.
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Reference

Backstrom, B., Haggstrom, M., Hallin, K., Kristiansen, L.P. (2016). Correlations between Clinical Judgment and Learning

Style Preferences of Nursing Students in the Simulation Room. Global Journal of Health and Science,

Vol. 8, No 6. http://dx.doi.org/10.5539/gjhs.v8n6p1

Graan, A., Koen, M., Williams, M. (2016). Professional nurses' understanding of clinical judgment: A contextual inquiry.

ScienceDirect. Http://dx.doi.org/10.1016/j.hsag.2016.04.001

Morris, B. (2016). Critical Thinking, Clinical Judgment, and the Nursing Process. Nurse Key, Chapter 9.

Http://nursekey.com/critical-thinking-clinical-judgment-and-the-nursing-process/

Morris, B. (2017). The evolving Nature of Nursing Process and Clinical Reasoning. Nurse Key, Chapter 3.

http://nursekey.com/the-evolving-nature-of-nursing-process-and-clinical-reasoning/