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Clinical Nursing Judgement

Madison E Bova

Youngstown State University

NURS 4850: Nursing Capstone

Dr. Heasley

March 1st, 2024

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Clinical Nursing Judgement

The actual meaning of clinical nursing judgement is accumulating knowledge and skills

over time empowers nurses to analyze and synthesize patient presentations, incorporating both

objective and subjective data. This proficiency enables the delivery of evidence-based nursing

interventions, contributing to proficient clinical decision-making and boosting overall patient

outcomes. When I think about what clinical nursing judgement means to me, I think about how

the nursing process applies to a clinical setting. The nursing process entails assessment,

diagnosis, planning, interventions, and evaluation. In every phase of this process, you consider

the steps required to deliver quality care to all patients, ultimately aiming to continuously

enhance outcomes. During nursing school, we acquire knowledge about the nursing process and

develop the skills to apply it in clinicals, labs, and simulations. Upon graduation, there is an

expectation to further build on this foundation of knowledge.

As you enhance your nursing skills and draw upon the knowledge gained in nursing

school, the ability to engage in critical thinking becomes essential in a clinical environment.

Critical thinking is a key component of clinical nursing judgement, demanding not only a grasp

of the necessary steps in the nursing process, but also the capacity to apply critical thinking skills

throughout the process, particularly in the face of complex cases. In the article, clinical judgment

and nursing, it highlights the impact critical thinking has on clinical judgement as exemplified

below:

The clinical reasoning process is encompassed by critical thinking. This means that when

engaging in the process of clinical reasoning, you should systematically analyze your

own thinking so that the outcomes are clear, rational, creative, and objective with limited

risk of judgment and error. (Clinical Judgment and Nursing, 2021)

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The article proceeds to explore into the clinical judgement steps, closely resembling the nursing

process. These stages involve recognizing cues, analyzing information, prioritizing hypotheses,

generating solutions, implementing actions, and evaluating outcomes. In my experiences these

past four years of nursing school, I have seen many nurses make clinical nursing judgements

based on their patients’ needs and their own critical thinking.

I witnessed two distinct scenarios in the clinical setting, each demanding a structured

approach. The first scenario is relatively general, while the second involves a more in-depth and

critical situation. Both instances highlight the significance of critical thinking in shaping nursing

judgement, emphasizing the essential need for thoughtful and careful consideration in these

clinical contexts. We'll discuss the specifics of the first scenario, and then, we'll explore into a

more detailed examination of the second situation.

Initially, a patient had an order for metoprolol to manage their high blood pressure.

However, specific parameters were set for administering this medication, requiring certain

conditions to be met, those conditions being systolic pressure above 100 and heart rate greater

than 60. Before administering metoprolol, the nurse diligently assessed the patient's vital signs,

including blood pressure and heart rate. Upon evaluation, it was noted that the patient's systolic

pressure was below 100. Recognizing the potential risk of administering metoprolol in this

situation, which could lead to a critical drop in blood pressure, the nurse exercised clinical

judgement and decided to withhold the medication in accordance with the established

parameters. This decision exemplifies the importance of critical thinking in nursing practice,

where patient safety remains crucial.

In a heightened critical scenario observed in the intensive care unit, a patient receiving

levophed or norepinephrine experienced a significant drop in blood pressure. In response, the

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nurse titrated the medication within established parameters, which is five micrograms every five

minutes. However, despite these initial interventions, there was no observable improvement in

the patient's medical condition. The nurse was then challenged with worsening status of the

patient, so they increased the titration frequency, striving to achieve an enhanced hemodynamic

state. Simultaneously, recognizing the urgency, the nurse quickly contacted the doctor,

requesting a reevaluation of the patient's status. This proactive approach emphasizes the critical

nature of adaptive clinical decision-making in the intense environment of the intensive care unit.

The article, evaluating of academic nurses’ clinical judgement skills in a critical care

unit at Babylon City, Iraq, explains how clinical nursing judgement is needed to provide the

safest and most effective care for the patients as exemplified below:

Clinical judgement is a necessary ability for nurses and a critical component of nursing

practice to provide safety, efficient, and effective patient care in a healthcare system

complicated today. Furthermore, new nurses entering the healthcare system with a good

clinical judgment and excellent practice knowledge are needed to assist patients’

complicated care requirements and contribute to the best possible decisions about patient

care. (Jasim, 2022)

In the two presented scenarios, both nurses were required to use critical thinking and clinical

judgement. However, the second scenario demanded an elevated level of critical thinking and

enhanced situational awareness to ensure the delivery of effective patient care and improve

overall patient outcomes.

In the article, clinical judgement in nursing – an evolutionary concept analysis, it talks

about the extensive work done by Tanner in 2006 around clinical judgement and relating it to the

way nurses process and reason to manage their patients. The process is described as ‘thinking
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like a nurse’ and Tanner developed the Clinical Judgement Model based on the four phases that

include, noticing, interpreting, responding, and reflecting.

Nurses are expected to notice cues and changes in patient conditions, regardless of how

subtle they may be, to be proactive in the prevention of further harm and swift in the

detection of deterioration in a patient's condition. (Conner, 2022)

That quote exemplifies just how important clinical judgement, critical thinking, and decision-

making is as a nurse. There are so many factors that contribute to a nurse’s job that are not seen

on the outside.

In conclusion, the multifaceted nature of clinical nursing judgement is underlined by the

continuous growth of knowledge and skills over time. This process empowers nurses to navigate

the complexities of patient care, emphasizing the incorporation of objective and subjective data

to deliver evidence-based interventions. Critical thinking arises as a foundation in this journey,

infiltrating every phase of the nursing process and shaping clinical judgment.
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References

Clinical judgment and nursing. Introduction to Health Assessment for the Nursing Professional

Part I. (2021, December).

https://pressbooks.library.torontomu.ca/assessmentnursing/chapter/clinical-judgment-and-

nursing/

Connor, J. (2022, July 25). Clinical judgement in nursing – an evolutionary concept analysis.

Journal of Clinical Nursing. https://onlinelibrary.wiley.com/doi/10.1111/jocn.16469

Jasim, A. (2022, March). Evaluating of academic nurses’ clinical judgement skills in a critical

care unit at Babylon City, Iraq. International Journal of Health Sciences.

https://www.researchgate.net/publication/306418542_Professional_nurses’_understanding

_of_clinical_judgement_A_contextual_inquiry