Running head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Sydney J. Hurd

Centofanti School of Nursing, Youngstown State University

NURS 4852: Senior Capstone Seminar

Dr. Kimberly Ballone and Dr. Randi Heasley

February 25, 2023

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Clinical Nursing Judgment

Clinical nursing judgment is a portion of patient care that is constantly discussed amongst

nursing students, newly graduated RNs, and nurses that have worked for decades. What is

clinical nursing judgment and why is it necessary? How does one execute it in a hospital setting?

Clinical judgment in nursing engulfs a competency that all nurses must have and is often

obtained through knowledge, skill, and experience. Jason Lugg, a member of the University

Hospitals Bristol NHS Foundation Trust, composed a scholarly journal that breaks down clinical

judgement in a nursing setting and reviewed “Clinical Judgment and Decision Making in

Nursing” by Mooi Standing. In this journal, Lugg states “Clinical judgment and decision-making

are essential aspects of professional nursing practice.” (Lugg, 2018). Nurses must know what

clinical judgment is, why it’s important in the healthcare field, and how to implement it into real-

life scenarios.

To begin, clinical judgment is known as the outcome that is observed after a healthcare

professional uses critical thinking and clinical reasoning (Hussein et al., 2022). So, to better

understand clinical judgment, one must also understand these concepts. The skill of critical

thinking involves evaluating credibility and relevance of claims that one is trying to get us to

believe and/or apply (Finn, 2019). In the article Concept Mapping to Enhance Critical Thinking

in Nursing Students, Sija Binoy states “Critical thinking leads to improved decision-making.”

(Binoy & Raddi, 2022). The ability to perform clinical reasoning is also an essential quality in

nurses. Clinical reasoning, in layman’s term, is the ability to “think like a nurse.” It entitles

critical, creative, scientific, and formal reasoning used when deciding what to do in a clinical

setting (Muhammadi et al., 2021). Overall, the combination of critical thinking and clinical
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reasoning allows nurses to make the best decisions in relation to nursing interventions and come

to adequate choices in clinical nursing judgment.

Continuing, clinical nursing judgment is performed by RNs with a main goal of

promoting optimal patient care. In the journal Sound Clinical Judgment in Nursing: A Concept

Analysis, Dr. Wendy Manetti states “educators and administrators can use valid and reliable

methods to identify the presence, foster the development, and measure the existence of clinical

judgment in novice nurses with an ultimate goal to improve patient care.” (Manetti, 2019). This

skill is important in many aspects of wellness and, to practice nursing safely and effectively, RNs

need to develop clinical nursing judgment. (Lugg, 2018). Judgment in a clinical setting is also

important, in that it is ever-changing and going through reform. Clinical nursing judgment is an

idea that can develop and transform with unexpected situations and new developments, such as

the COVID-19 pandemic, which brought an influx of world-wide illness and was followed by

the production of vaccines to help prevent it. Nurses must adapt to dynamic and modified ways

of teaching, assisting, and managing processes to make efficient and up-to-date decisions.

(Rabelo-Silva et al., 2022).

It is also important to recognize that, with the need for appropriate clinical nursing

judgment, comes the requirement of nurses to maintain an unbiased and objective view of

patients. Krystle Martin, in the article Investigating the Impact of Cognitive Bias in Nursing

Documentation on Decision-Making and Judgement, focuses on the effect of biased healthcare

workers on patient care, specifically within the mental health specialty. Martin states, “It is the

ethical responsibility of mental health clinicians to avoid errors in judgement and to act

impartially when making observations or decisions about the individuals in their care.” This

author continued with saying “cognitive bias is an issue that needs our attention in healthcare and
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in nursing documentation.” (Martin, 2022). While Krystle Martin wrote this article with a focus

on behavioral health, non-biased nursing interventions and documentation is vital amongst all

area of healthcare. This is a concept that must be understood and implemented to ensure proper

clinical nursing judgement and, in turn, continue to improve the quality of patient care.

As an example, I used clinical nursing judgment when I obtained EKG strips on a patient

in the SICU that displayed sinus tachycardia. When I interpreted the EKG strip and noted that the

patient had a heart rate of 110bpm, I immediately remembered a lecture in Complex Care where

I learned that a heart rate of 110-150bpm signaled sinus tachycardia. While this patient did have

a history of sinus tachycardia, I wanted to do a follow-up assessment to see what interventions, if

any, were needed. After all, we are taught in nursing school that assessing a patient and their

status is always most important, regardless of what a history or monitor says. During my

assessment, vitals were obtained that showed no fever, regular blood pressure, and adequate

oxygenation via AC ventilation. I used the CPOT scale for pain and the RASS scale for agitation.

My patient did not display signs of agitation, but did have a CPOT score of 4, which indicated

mild/moderate pain. This patient was intubated and, therefore, unable to communicate verbally

and say if they were experiencing pain. So, I checked his chart and saw that he was overdue for

an analgesic medication. I consulted his nurse and assisted in administering the medication. I

also took further steps for patient comfort. I lowered the lights, closed the curtain for adequate

privacy and to prevent over-stimulation, and played relaxing music on the television. When I

went back to reassess my patient 30 minutes later, his CPOT score had went down to a 1 and his

heartrate was 90bpm. This indicated to me that the medication and nonpharmacological measures

had worked. Through critical thinking and clinical reasoning, I was able to assess my patient and

recognize that the root cause of the sinus tachycardia was pain. I displayed clinical nursing
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judgment when I interpreted my assessment and provided both pharmacological and non-

pharmacological measures. My prior knowledge and use of clinical judgment in a nursing setting

presented my nursing skills and, most importantly, improved the quality of my patients care.

In conclusion, clinical nursing judgment is an area of nursing competency that is essential

for providing top-notch patient care. Using critical thinking and clinical reasoning, nurses in all

specialties of healthcare can make decisions that are best for their patients and perform proper

nursing interventions. While the standards of adequate clinical nursing judgement are ever-

changing, the goal stays the same. We, as nurses, must recognize the importance of clinical

nursing judgment and notice how it effects our scope of practice. With an understanding of what

clinical nursing judgment is and its importance to patient acuity and unbiased care, nurses will

only continue to increase their expertise and thrive in the clinical setting.
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References

Binoy, S., & Raddi, S. A. (2022). Concept Mapping to Enhance Critical Thinking in Nursing

Students. International Journal of Nursing Education, 14(2), 159–164. https://doi-

org.eps.cc.ysu.edu/10.37506/ijone.v14i2.18008

Finn, P. (2019). Critical Thinking Is a Noble Endeavor–A Response to Paul’s Question: An

Invited Essay. American Annals of the Deaf, 164(4), 355–362.

Hussein, M. T. E., Olfert, M., & Hakkola, J. (2022). Clinical judgment conceptualization scoping

review protocol. Teaching & Learning in Nursing, 17(1), 84–101. https://doi-

org.eps.cc.ysu.edu/10.1016/j.teln.2021.10.003

Lugg, J. (2018). Clinical Judgement and Decision Making in Nursing. Emergency Nurse, 25(9),

16. https://doi-org.eps.cc.ysu.edu/10.7748/en.25.09.16.s18

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102–110. https://doi-org.eps.cc.ysu.edu/10.1111/nuf.12303

Martin, K., Bickle, K., & Lok, J. (2022). Investigating the impact of cognitive bias in nursing

documentation on decision‐making and judgement. International Journal of Mental

Health Nursing, 31(4), 897–907. https://doi-org.eps.cc.ysu.edu/10.1111/inm.12997

Mohammadi, S. F., Khankeh, H., & HosseinZadeh, T. (2021). Clinical reasoning in nursing

students: A concept analysis. Nursing Forum, 56(4), 1008–1014. https://doi-

org.eps.cc.ysu.edu/10.1111/nuf.12628
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Rabelo-Silva, E. R., Monteiro Mantovanie, V., & Lumertz Saffi, M. A. (2022). Knowledge

translation and advances in health and nursing practices. Revista Gaucha de Enfermagem,

43, 1–2. https://doi-org.eps.cc.ysu.edu/10.1590/1983-1447.2022.20220165.en