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The Key to Nursing: Clinical Nursing Judgment

Mikayla Shiels

Youngstown State university

NURS 4852: Senior Capstone

Mrs. Randi Heasley

March 3rd, 2023

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The Key to Nursing: Clinical Nursing Judgment

Clinical judgment is an important part of nursing that takes time for nurses to develop.

Clinical nursing judgment is being able to notice when problems are happening with a patient

how to properly react. Clinical judgment takes time to develop and is especially important for

nursing students to develop. Many tasks are included in the use of clinical nursing judgment

including “cognitive process, observation of relevant cues of patients early, gathering

information by assessment, interpreting, and prioritizing patient data '' (Uppor et al. 2022 p. 934).

All these tasks must be completed on every patient in order to prevent any negative outcomes.

Another important part of clinical judgment that is hard to teach is confidence. It is

important for nurses to be confident in not only their skills but also their ability to make

decisions. Nurses must be able to review lab results and be able to trust their judgment on what

to do. They also must be able to be confident in communicating with the interdisciplinary team

even when the time may not be ideal for the other members of the team. They also must be

confident in their skills to help reduce patient anxiety and doubt in the healthcare team.

It is also important to avoid basis in the use of clinical nursing judgment. Unconscious

bias is a very dangerous idea that many people have without even noticing. In order to properly

use clinical nursing judgment a nurse must avoid all bais especially in documentation as this can

cause important cues in patients to be missed. “Further, developing an understanding of how

biased documentation may influence decisions and judgements allows for the development of

training practices that can reduce the impact of bias.” (Krystle el at. 2022, p 905). For example, if

a patient has chronic obstructive pulmonary disease a nurse may not pay close attention to the

patient's breathing due to an underlying condition. Many patients with chronic obstructive

pulmonary disease have this condition due to smoking, if a nurse has the mentally that the patient
THE KEY TO NURSING: CLINICAL NURSING JUDGMENT 3

did this to themselves. They may fail to document the trouble breathing the patient is

experiencing, which would cause the patient harm and discomfort that no patient should have to

experience.

Clinical nursing judgment is very important as it can help prevent harm to patients that

could be avoided. The most important part of learning clinical nursing judgment is to develop

critical thinking skills. “Critical thinking allows clarifying objectives, assumptions and evidence,

holding others accountable for their actions, and evaluating conclusions” (Marques et al. 2022, p

2). Critical thinking is the most important skill to be put to use in clinical nursing judgment.

Critical thinking is very important as it allows nurses to look at what clinical cues the patient is

exhibiting and make decisions on how to act accordingly. Good use of clinical nursing judgment

allows nurses to feel confident in the care they are providing to the patient as well as to prevent

any harm to the patient.

Not only does clinical nursing judgment allow the nurse to feel confident but it can allow

the nurse to catch any mistakes. For example, nursing students when learning about pediatric

medication doses are always thought to triple check the dose based on the patient’s weight in

kilograms. If the patient was prescribed a medication that would not be a safe dose for the

patient, it is part of the clinical nursing judgment to perform the math calculation and ensure the

dose is safe. If the nurse does the math calculations themselves, they could prevent a medication

error. If the nurse was to do the calculation and find the dose not safe, it is their job to use their

decision-making skills to reach out to the prescribing physician for a change in the dosage. If the

nurse did not do this there could be potential negative outcomes for the patient that could lead to

injury or even death. All these topics continue to prove how important it is for nurses to develop

good nursing judgment especially during their time as a s student nurse.

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An example of a time I used clinical nursing judgment was seen in was a 81 year old

female admitted to the surgical unit for 4 days of diarrhea. Patient has a history of hypertension,

atrial fibrillation, and previous small bowel obstructions. Patient had a very short surgical history

with only one exploratory laparotomy where a small bowel obstruction was discovered. She then

had a corrective surgery for the small bowel obstruction. Patient had a medication history of

Eliquis to prevent blood clots due to atrial fibrillation and metoprolol to treat hypertension.

Patient had been seen by physical therapy and occupational therapy who originally suggested the

patient be sent to a skilled nursing facility but later after 2 days of work suggested she be sent

home with home healthcare. Patient shared that her daughter died unexpectedly from breast

cancer leaving her to live in her home with only her son. Patient shared with me that she believes

her son has been stealing her money and he also does not help take care of her at all even when

she asks him. Although, the patient still wanted to be discharged home instead of being

discharged to a facility.

When the patient was getting ready for discharge the son arrived to take her home. The

son arrived and immediately began fighting with his mother. Most of the conversation was spent

with the son yelling at the mother and being extremely rude. The son was being borderline

verbally abusive to the mother and proceeded to tell staff that he doesn’t have food in the house

and doesn't plan to put any in the house. The son also began yelling at the me in a very

threatening matter. I as well as the rest of the staff used our judgment and decided to call Adult

Protective Services. I used all my nursing skills to decide that this would be the best course of

judgment since we are mandated reporters for the elderly. This was an important step as the

safety of the patient in question was at risk and needed further investigation.
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In conclusion, nursing judgment is a very important part of nursing that takes time for

nurses to develop. It is important that nursing students are taught to use their clinical judgment

skills from the first day of school as it is very hard to develop these skills on their own. It is

crucial to the safety and wellbeing of patients that nurses are confident in their skills as this can

be the difference between them seeing their family again or spending their last days in a hospital.
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References

do Céu Mendes Pinto Marques, M., José Lopes, M., Domingues Cabral Magalhães, M.

D., & Mota Sousa, L. M. (2022). Development of Critical Thinking in Nursing

Students. Revista Baiana de Enfermagem, 36, 1–10.

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live&scope=site

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://eps.cc.ysu.edu:8443/login?url=https://search.ebscohost.com/login.aspx

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Uppor, W., Klunklin, A., Viseskul, N., & Skulphan, S. (2022). A concept analysis of clinical

judgment in undergraduate nursing students. Nursing Forum, 57(5), 932-

937.https://eps.cc.ysu.edu:8443/login?url=https://search.ebscohost.com/login.aspx?

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