AN EXPLORATION OF NURSING CLINICAL JUDGMENT 1

An Exploration Of Clinical Nursing Judgment

Morgan Cole

Youngstown State University

4852 Senior Capstone Seminar

Dr. Ballone and Mrs. Heasley

January 25, 2023

AN EXPLORATION OF NURSING CLINICAL JUDGMENT 2

An Exploration of Nursing Clinical Judgment

When approaching the concept of nursing clinical judgment, it is essential to view it as a

complex topic with many components. Nursing environments use it interchangeably with terms

such as problem solving, decision making and critical thinking. Sound nursing clinical judgment

cannot be taught in a single day. It is acquired over an extensive period of time through both

repeated lecture and clinical components. According to Dwyer et al., (2022):

Clinical judgment is arrived at through clinical reasoning and is not only based on clinical

knowledge, but other factors such as nurses’ personal values and familiarity with the

patient. It is professional consideration and understanding of a problem or need,

concluding in a judgment of what to do next, as appropriate to each individual

circumstance. (p.4)

Every patient is different, so the picture of what clinical judgment looks like is ever changing.

The primary goal of nursing school is to pass the final NCLEX examination while also being

competent enough in the clinical settings to effectively take care of patients. Clinical nursing

judgment is important because as nurses, we are the ones on the front lines that are tasked with

evaluating the condition of the patient and assessing for any signs of deterioration.

Examples of utilizing clinical judgment within the scope of our practice could be

knowing when to call a rapid response team, holding a medication, and understanding when to

contact a physician about a patient’s condition. Dwyer et al. (2022) states:

Patient acuity, new technology and the increasing expectations placed on healthcare

provision have all influenced contemporary nursing practice, driving quality and safety

standards which have influenced how nurses perform their practice.

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All these factors, in addition to nursing staffing shortages and borderline unsafe patient to nurse

ratios make developing clinical judgment even more vital. This exemplary decision making can

improve patient outcomes, reduce patient hospital stays, provide higher job satisfaction and lead

to a better coordination of care between the healthcare team. Determining clinically important

information can also improve patient handoffs and communication within the healthcare team.

Throughout my time at Youngstown State University, I have been working at cultivating

my own sense of clinical nursing judgment with the learning tools that have been provided to me

such as hours spent on hospital floors and attending challenging classes. The particular

experience that has aided my clinical judgment a tremendous amount has been in a simulation

lab. Our lab consists of electronic patients that are able to display vital signs such as heart rate

and blood pressure, and there is even one that gives birth. An example of how I strengthened my

nursing judgment during a simulation lab was when we had to react to a patient having a seizure.

At the moment, the student has to recollect all the information about the responsibilities of the

nurse’s role in that situation. Some examples of what nursing interventions can be utilized to

showcase clinical judgment are to protect the patient from injury, ensure a patent airway, provide

supplemental oxygen, verify medication orders with physicians, review labs, and get a set of

vital signs at the conclusion, just to name a few. Lindsey and Jenkins (2013) noted that “some

studies were done to evaluate the effectiveness of simulation labs and at the conclusion students

said that the scenarios promoted learning and encouraged critical thinking, which ultimately

boosted their confidence, psychomotor skills and clinical judgment” (p.63). As a nursing student

myself, I agree that simulation is a valuable tool for improvement.

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Another personal experience where I used clinical nursing judgment was the rotations

that I did at the various hospitals. An example of how I used nursing judgment in the clinical

setting was when I was assigned to a patient with congestive heart failure. Using knowledge

from the classroom, I was able to perform a targeted head to toe assessment and monitor my

patient for any adverse symptoms. This would include any worsening edema, persistent chest

congestion, any new cardiac arrhythmias, and signs of a blood clot forming. Throughout the day,

some interventions that I performed for my patient included passing medications with my

instructor which consisted of a beta blocker and a diuretic, strict intake and output

documentation, reviewing the CBC, urinalysis and electrocardiogram, and encouraging deep

breathing exercises. However, clinical nursing judgment goes beyond just the medical needs of

the patient and challenges the nurse to also assess for spiritual or holistic needs. I tended to my

patient to make sure that there was limited anxiety, a peaceful environment, and that they had all

the tools that they needed to heal.

Overall, I am excited to grow on the foundation of clinical judgment that Youngstown

State University’s baccalaureate nursing program has started me with. Graan et al. (2016) stated

that “guidance from an experienced and knowledgeable clinical accompanist is essential for

fostering critical thinking skills and ultimately, clinical judgment” (p.285). The faculty and

educators have prepared me to be able to synthesize all the information I have learned to

adequately be an advocate for patients. Obviously, I hope in my career to further my clinical

judgment and I truly believe that learning is a lifelong process and can always be built upon.

Sound clinical judgment can lead to a better interpretation of symptoms, but also aid the patient

in satisfying their physical, spiritual, and psychological needs.

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References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgment in nursing – an

llllllllllllevolutionary concept analysis. Journal of Clinical Nursing, 1–13.

llllllllllllhttps://doi.org/10.1111/jocn.16469

Graan, A. C., Williams, M. J. S., & Koen, M. P. (2016). Professional nurses' understanding of

llllllllllllclinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280–293.

llllllllllllhttps://doi.org/10.1016/j.hsag.2016.04.001

Lindsey, P. L., & Jenkins, S. (2013). Nursing students' clinical judgment regarding rapid

llllllllllllresponse: The influence of a clinical simulation education intervention. Nursing Forum,

llllllllllll48(1), 61–70. https://doi.org/10.1111/nuf.12002