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Clinical Nursing Judgment

Cara Monroe

Department of Nursing, Youngstown State University

NURS 4852 Senior Capstone Seminar

Dr. Kim Ballone, Professor Randi Heasley

January 30, 2023

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Clinical Nursing Judgment

As one of the key attributes of professional nursing, clinical judgment refers to the

process by which nurses make decisions based on nursing knowledge (evidence, theories,

ways/patterns of knowing), other disciplinary knowledge, critical thinking, and clinical reasoning

(American Association of Colleges of Nursing, 2023). “Clinical judgment is an interpretation or

conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take

action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate

by the patient’s response” (Tanner, 2006, pg 204). The term “clinical judgment” is in alignment

with how nurses actually think in a clinical setting to make care more efficient (Ignatavicius &

Silvestri, 2023). Clinical nursing judgment is built and expanded on the nursing process. Good

clinical judgment requires a flexible and subtle ability to recognize aspects of an undefined

clinical situation, interpretation of the meaning and an appropriate and accurate response by the

healthcare team. It requires the illness experience of the patient and the family and their physical,

social and emotional strengths along with healthy coping resources, not the understanding of

pathophysiological and diagnostic aspects of the client’s presentation and disease process alone.

In nursing, clinical judgment is made with prioritizing patient’s health and needs, along

with advocating for patients, resolving family conflict, providing the caregiver with 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,

meaning choosing the most appropriate alternative based on evidence-based practice (Tanner,

2006, pg 205). “Nurses, other health care collaborators, and recipients of health care should be

aware of the role played by nursing judgment to improve patient care and the healthcare system”

(De Tantillo & De Santis, 2019, pg 266). Over time, nurses apply their knowledge (learned and
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observed), skills, performance abilities and experience in determining decisions about patient

care in favor of the patient. Alongside preparation in nursing school, the more clinical floor

experience a nurse has, the better the nurse’s ability to care for patients and improve patient

outcomes using clinical judgment.

Nurses are prepared on how to conduct and make clinical judgment decisions in college.

Nursing courses provide the background knowledge used to determine patient status. Clinical

rotations allow students to have experience with patients on general or specialty units, and allows

the ability to provide physical, hands-on care. Clinical rotations also allow students to make

connections to the content and material learned in nursing courses to apply to the patient’s

condition and diagnosis. Nursing courses that contain simulation apply the information obtained

in courses and clinical rotations and apply it to a false, real-life scenario. “Simulations are

designed to replicate the essential aspects of a clinical situation so that the situation can be

readily understood and managed when it occurs in clinical practice” (Victor et al., 2007, pg 236).

Simulations should be held in an environment similar to a hospital setting. At Youngstown State

University, the nursing student simulations are held in one of the nursing practice laboratories.

As a nursing student, simulations are overwhelming, but very educational. We walk into the

laboratory without knowing any information about our patient like we would on our units of

preference in our careers. In the simulation, we perform basic care, such as an assessment, then

all of a sudden the patient declines and us students have to use our knowledge to perform a quick

assessment and determine the best care for the patient by administering medications or

advocating for the patient. During the simulation, we feel as if we were rushed to determine an

outcome for the patient and did not know how to handle that critical situation, but debriefing

afterwards benefits our knowledge gap and correlates what was taught to a real situation that one
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might experience in the field. As stated in the Nurse Educator article, there is a significant

positive relationship between the development of clinical nursing judgment and performance in

the simulation setting (Victor et al., 2007, pg 236).

I have many experiences where I have used clinical judgment during patient care, but this

specific situation has impacted me majorly. I work at a local hospital, St. Joseph’s Mercy

Hospital and I am a student nurse extern there. I follow a nurse as I float to different units to gain

experiences of specialities in the field. As I was in my very first Intensive Care rotation, I was

asked to help a nurse provide care for a patient with the family present. The patient was deeply

coughing, unable to breathe and the ventilator alarm was sounding. My first observation was that

he had a tracheostomy and was placed on a ventilator. For a few minutes, the patient, DS, was

coughing with his tongue out, turning pale, his oxygen saturation was decreasing and his eyes

were bulging from his eye sockets. The client came in with a decreased level of consciousness

and confusion, so was unable to speak on his behalf. After situating the patient back into bed, I

noticed that his tracheostomy was misplaced. It seemed farther out than the tracheostomy was

meant to be. I told the nurse my observation and she gave me the number to contact respiratory

therapy to assess the patient. When respiratory arrived, they said that the patient’s cuff was

completely deflated because it had been overinflated and burst, and it was replaced. The

respiratory therapist exclaimed, “you saved this patient’s life.” After learning the modes of the

ventilator during this semester, I realized that the patient could not breathe on his own without

help from the ventilator, so in reality, I did save the patient’s life.

In conclusion, the basis of healthcare is clinical judgment. Clinical judgment is analyzing

and interpreting a patient's presentation, subjective and objective data, and collaborating with the

professionals from the healthcare team to provide evidence-based interventions to improve the
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patient’s health status (Embler, 2021). The patient, the family and every healthcare worker

appropriately fitted to care for the patient should revolve around the patient’s care. Clinical

judgment is developed through experience and practice, and with use of knowledge, critical

thinking, critical reasoning and continuous critical analysis. The concept of clinical nursing

judgment is very important in making critical decisions for patients. Most importantly, like a

piece of artwork, the patient’s situation needs to be observed as a whole to understand the full

picture. With every detail taken into consideration, the nurse collaborates with other healthcare

professionals to determine further care that benefits the patient and their family.
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References

American Association of Colleges of Nursing. (2023). Clinical Judgement Concept. American

Association of Colleges of Nursing. Retrieved February 12, 2023, from

https://www.aacnnursing.org/Essentials/Concepts/Clinical-Judgement

De Tantillo, L., & De Santis, J. P. (2019). Nursing Judgment A Concept Analysis. Advances in

Nursing Science, 42(3), 266-276.

https://journals.lww.com/advancesinnursingscience/Abstract/2019/07000/Nursing_Judgm

ent__A_Concept_Analysis.11.aspx

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical

decision-making and patient advocacy. Wolters Kluwer. Retrieved February 12, 2023,

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

Ignatavicius, D., & Silvestri, L. (2023). From Nursing Process to Clinical Judgment | Elsevier

Education - Elsevier Education. Evolve. Retrieved February 12, 2023, from

https://evolve.elsevier.com/education/expertise/next-generation-nclex/ngn-transitioning-fr

om-the-nursing-process-to-clinical-judgment/

Tanner, C. (2006, June). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment

in Nursing. Journal of Nursing Education, 45(6), 204-211.

https://www.researchgate.net/profile/Christine-Tanner-3/publication/7003793_Thinking_

Like_a_Nurse_A_Research-Based_Model_of_Clinical_Judgment_in_Nursing/links/0c96

05294f14427681000000/Thinking-Like-a-Nurse-A-Research-Based-Model-of-Clinical-J

udgment-in-Nur
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Victor, J., Ruppert, W., & Ballasy, S. (2007, September). Examining the Relationships Between

Clinical Judgment, Simulation Performance, and Clinical Performance. Nurse Educator,

42(5), 236-239. https://doi-org.eps.cc.ysu.edu/10.1097/NNE.0000000000000359

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4852 Capstone
Scholarly Paper Rubric

Scholarly Capstone Paper

● A component of the capstone course, worth 20% of the final grade

● An in-depth exploration on the topic “Clinical Nursing Judgment”
● 3 page paper
● APA format
● Minimum of 3 references citing recent Nursing Journals
● Define the concept, identify the importance of clinical nursing judgment, and then discuss a
personal experience where you used “clinical nursing judgment” in a specific situation.

Requirements: Possible Points Achieved Points

1. organization and clarity of topic present 20 _________

2. content quality 20 _________

3. reflection of topic 20 _________

4. APA format and correct grammar 20 _________

5. Cited References 20 _________

Final Grade
_________/100 points

_________/20%