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Clinical Nursing Judgement

Autumn L Gettings

Centofanti School Of Nursing, Youngstown State University

NURS:4852 Senior Capstone

Dr. Kim Ballone, Miss. Randi Heasley

March 13th, 2023

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Clinical Nursing Judgement

How does a nurse provide care for patients who are critically sick while also providing

emotional support and interventions to the public? Nursing is a broad scope of practice and

includes a variety of tasks, skills, and delegations that occur daily within the profession. Nurses

make important decisions every shift that impact the quality and care of patients. Nursing clinical

judgement is a skill that is used to collect data about a patient, interpret the data, problem solve,

and use critical thinking skills (Martin, et al. 2020). Clinical nursing judgement is a vital tool that

is used to improve quality of care in health care settings.

According to the article, “Imparting clinical judgement leading to sound clinical decision-

making and patient advocacy,” Embler states, “Clinical judgment is 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; clinical decision making

(para 7. 2021). The nursing process is a vital step in the task of using clinical nursing judgement.

The steps to the nursing process include assessment, diagnosis, planning, intervention, and

evaluation (Williams, et al.2016). Nursing clinical judgment is a combination of many different

factors including knowledge, years of experience in the medical field, and education levels

making it an ongoing learning process. The evolution of health care environments also makes

nursing judgement change and adapt throughout years. According to the article, “Professional

nurses’ understanding of clinical judgement: A contextual inquiry” Williams, Van Graan, Koen,

state, “As the acuity of hospitalized patients and the prevalence of chronic illness increase, the

length of hospital stays shortens” (para. 5, 2016). Therefore, making judgement decisions for a

nurse even more difficult let alone a new graduated nurse with not much experience.
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The idea of clinical nursing judgement is believed to need to be taught in nursing school.

According to “Teaching Circle to Improve Nursing Clinical Judgement in an Undergraduate

Nursing Program”, Martin, Greenawalt, Palmer, Edwards, state,” Establishing a clear

understanding of nursing students’ cognitive thought processes when participating in activities

assessing higher-order cognitive constructs of nursing clinical judgement and understanding how

to influence this process, poses a challenge for many faculty” (para 7, 2020). Nursing faculty

often have a difficult time deciphering and measuring a nursing students underlying cognitive

thought process of decision making. It is vital that nursing faculty implement strategies such as

teaching circles, case studies, NCLEX style questions, and debriefing in both clinical and

classroom (Martin et al. 2020). Additionally, students should expand on their skills of basic

assessments in the clinical scene and work to use their own critical thinking for their patients.

Post-clinical conference with both clinical faculty and other students allows for reflection and

students can learn from each other (Embler, 2021). A nurse must think quick on their feet when a

patient’s status and vital signs are declining rapidly. A nurse with good clinical judgement can

choose the best response to a problem among alternative options and intervene smoothly.

Without these skills, quality of care is limited within the nurse’s practice (Martin et al. 2020).

A situation that we the nursing staff used clinical nursing judgment was in the labor and

delivery unit. During a precepting shift the nursing student was assigned to titrate the Pitocin drip

as normal protocol to 10 mU/ min after 30 minutes to continue induction of labor. However,

upon assessment of the fetal heart rate decelerating along with each contraction the student

decided to consult with the nursing staff and ask to half the Pitocin and reposition the mother to

promote fetal heart rate while continuing to monitor the patient and intervene with the physician.
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Another situation that the student got to use clinical nursing judgement included a

medical surgical clinical. After getting a morning baseline set of vitals the nursing student

performed the daily clinical duties including bathing, feeding, and then administering medication

with a faculty member. Upon reassessment the nursing student noticed the patient’s blood

pressure was 99/65 with a pulse of 62 and informed the instructor they should hold the patient’s

daily dose of metoprolol until they could assess the situation more.

Using clinical judgement is important in many situations and can prevent an accidental

harm to a patient. Nursing students and staff must continue to be educated on the importance of

using evidence-based practice to improve outcomes of patients (Williams et al. 2016). Clinical

nursing judgement is a vital tool that is used to improve quality of care in health care settings.
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References

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

making and patient advocacy. Wolters Kluwer . Retrieved March 13th 2023, from

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

judgement#:~:text=Clinical%20judgment%20is%20the%20accumulation,patient%20outcomes

%3B%20clinical%20decision%20making

Martin, B., Greenawalt, J. A., Palmer, E., & Edwards, T. (2020). Teaching circle to improve

nursing clinical judgment in an undergraduate nursing program. Journal of Nursing

Education,  59(4), 218-221. doi:https://doi.org/10.3928/01484834-20200323-08

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

of clinical judgement: A contextual inquiry. Health S A, 21(1), 280-293. Retrieved March 10,

2023, from https://doi.org/10.1016/j.hsag.2016.04.001