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Importance of Clinical Nursing Judgment

Bridget DePascale

Senior Capstone

Dr. Kim Ballone and Ms. Randi Heasley

March 9, 2023
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Importance of Clinical Nursing Judgement

Throughout the nursing career, it is imperative to use critical thinking skills to excel at

patient care. What nurses also need to be aware of is good clinical nursing judgement. This way

of thinking is introduced in nursing school, and is developed as more experienced is gained. To

define clinical judgment would be “the accumulation of knowledge and skills over time, which

contributes to the nurse’s ability to analyze and synthesize the patient presentation, objective and

subjective data, and then provide evidence-based nursing interventions to improve patient

outcomes.” (Embler) This is what nursing is about in order to make sure that patients are cared

for in a safe and effective way. Using this clinical nursing judgement allows nurses to see a

patient problem and adequately improve the patient’s condition using evidence-based practice.

What makes clinical nursing judgement so important is how often it is used in the nursing

practice. Out in the field, nurses need to be able to assess their patient and make a decision on

how to best treat their patient within their scope of practice. The best example I have of this is

from my Professional 2 clinical on the Ortho-Trauma unit at St. Elizabeth’s Youngstown

Hospital.

I was assigned to an older patient with diabetes, I don’t believe that was the reason he

was in the hospital, but it’s the reason why I remember this so clearly. I had gone into his room

around seven in the morning to introduce myself and tell him that I would be taking care of him

for the next eight hours or so. However, he was sleeping, so I figured I would just let him sleep a

little longer because people don’t usually get good sleep in the hospital. I would just come back

in a little bit then to introduce myself. About an hour goes by, so I once again go in his room to

say hi to him, and he’s still not really responding to me. I grab a friend and we try to wake him
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up together, but then we realize that he is very cold and very sweaty, which meant that

something wasn’t right.

I go and get the nurse assigned to him and tell her the situation. She looked at his chart

and told me to check his blood sugar. I do so, and it’s so low that the machine can’t read it. He

needs to have labs drawn in order to get a number for his sugar. He was in a bad hypoglycemic

state. Since diabetes is typically a long-term health condition, it is imperative that the patient is

educated on ways to avoid hypoglycemia as well as ways to improve the blood sugar if they do

fall into a hypoglycemic state. (Kelly) It is of importance that the nurse or aid on the floor is also

checking the blood sugar of the patient at the proper times so these situations can be avoided.

However, it was entirely possible to mistake this as him just sleeping. This is where the clinical

nursing judgement really came into effect.

The nurse is now in his room with me, she drew the labs, and when we got the results

back, he had a blood sugar in the 30s. Per the orders in the patient’s chart, I gave him one of the

two tubes of glucagon gel. He was conscious enough to eat, he just had a very hard time staying

awake. I had to constantly keep him awake so he wouldn’t aspirate on the gel. Once the whole

tube was given to the patient, we check his blood sugar again with the glucometer and it read

somewhere in the 50s or 60s this time. This was still low. The nurse said I could give him the

other tube of glucagon, and that should raise his sugar to a level that we can accept. Once done,

his sugar was back in normal range, and after some time, he was more conscious and able to

communicate better with us.

The more that I think about this scenario, the more concern I get. The nurse hadn’t even

gone into his room yet, I believe she also let him sleep longer just like I did. What would have

happened if I wasn’t assigned this patient? When would he have been noticed? I don’t even
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know how long he was in that state before we got up onto the floor for the day. I’m sure he

would’ve been noticed, but would there have been a point during the morning where it would’ve

been too late? His blood sugar was extremely low. Honestly, I’m glad I was assigned to that

patient. I had kept checking in to see if he had awoken, and once an hour had gone by and there

wasn’t really any change, I got really concerned. At this point in time, I had not yet learned of

the Dawn phenomenon or Somogyi effect, but it’s entirely possible that one of these could have

happened in order for his blood sugar to be that low. Once he was conscious enough to stay

awake, he was able to eat his breakfast, and I don’t recall him having any other problems for the

duration of my time there.

This experience will stay with me for a long time yet. This was during my second clinical

that I had ever had, so I was still pretty new to the clinical setting. Bringing my friend into the

room with me felt like a safe option, and we could validate each other’s opinions when we both

had determined that something wasn’t right with this patient.

Upon reflection of this patient experience, I believe it is incredibly important to use our

clinical nursing judgement to assess these situations quickly and efficiently. Doing this allows

our patients to get better faster than if we didn’t use our judgement to catch problems early on.

This should allow them to have a better quality of life once they leave. For this patient

specifically with his diabetes, education on how to avoid and manage hypoglycemia will go a

long way for him. (Carlton)

Overall, my time with this patient was very well spent, and I had learned a very valuable

lesson about clinical nursing judgement, and how to decide when a patient needs nursing

interventions in order to stay stable.

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References

Carlton, J., Powell, P., Rowen, D., Broadley, M., Pouwer, F., Speight, J., Heller, S. I., Gall, M.-
A., Rosilio, M., Child, C., Comins, J., McCrimmon, R., de Galan, B., & Brazier, J. (2022,
November 18). Producing a preference-based quality of LIFE measure to quantify the
impact of HYPOGLYCAEMIA on people living with diabetes: A mixed-methods research
protocol. Retrieved March 9, 2023, from
https://onlinelibrary-wiley-com.eps.cc.ysu.edu/doi/full/10.1111/dme.15007

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical decision-
making and patient advocacy. Back to top. Retrieved March 9, 2023, from
https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement

Kelly, B. (2021, November). Nursing interventions for people with type 1 diabetes and frequent
hypoglycaemia. Retrieved March 9, 2023, from https://eps.cc.ysu.edu:8443/login?url=https
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