Clinical Nursing Judgment

Elizabeth DeSalle

Nursing Capstone 4850

Dr. Heasley

March 1, 2024
 What is Clinical Nursing Judgment?

Clinical nursing judgment is a vital process that is needed in healthcare and within the

nursing proffession. The model was introduced in 2006 by Chris Tanner, he compiled over 200

articles investigating the way nurses think within their scope of practice. The first topic nursing

students learn in school is the nursing process or ADPIE, which stands for asses, diagnose,

planning, implementation, and evaluation. This is a scientific process approach and it is taught

repeatedly throughout nursing school. Although this thought process is beneficial, Tanner

inferred that nurses in the workforce use flexibility of thought and brainstorm ideas to come to a

conclusion. (Modic 2013). In an Article, Tanner defined Clinical Judgment as “an interpretation

or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take

action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate

by the patient's response.”(Calcagni et al., 2023). The process of clinical nursing judgment

encapsules noticing, interpreting, responding, and reflecting. When a nurse is noticing they are

becoming cognizant of the important information presented in a situation.This step is based on a

composite of background, circumstantial, and patient knowledge. These aspects combined can

give a nurse an expectation of what might happen during their time of care. After gathering

information, the next step is interpreting, which is clarifying what was noticed and deciding a

course of action. Deciding and performing a course of action with the perceived data is the next

step called responding. After an action is performed in order to learn, grow, and improve their

skills, an evaluation is key to determine if the actions taken were appropriate, beneficial, or if

revision is needed. (Modic, 2013).With Tanner's approach to clinical nursing judgment The

National State Board of Nursing recognized how vital and effective nursing care is they in turn

built upon Tanner's model to develop a next generation clinical judgment model that
encompasses observation, cognitive processes, environmental and individual contexts to address

client needs and to make clinical decisions. (Calcagni et al.,2023). This is a significant step in the

right direction and for the future of nursing by combining models from different people and

times to create one to improve the nursing profession.

In addition to discussing what clinical judgment incorporates, why it is important is very

critical to understand and implement into practice and education. In the article(calcagni), it states

that new graduate nurses are lacking the obligatory clinical judgment needed to provide attentive,

and competent patient care. This decline in judgment has been on the rise over the last two

decades and only a small percent of new graduates meet the benchmark for acceptable clinical

judgment.(Calcagni et al., 2023). Lacking this crucial aspect can jeopardize the safety of patients

and result in failure to make the appropriate outcome.

With the healthcare system changing rapidly and with higher level acuity patients,

education programs need to adapt and adjust current practices to better prepare new graduate

nurses in the field. Over the years nurses have expanded their scope of practice, and are

responsible for completing more tasks. Being accountable for these tasks requires critical

thinking and having the ability to properly use clinical judgement.(Connor et al.,2023). The

overall goal of nursing is to enhance patient outcomes and through this improvement of the

quality of care nurses perform is dependent on the nurse being able to prioritize based on

relevance and promptly choose appropriate interventions. Being proactive is another obligation

nurses have, especially noticing if a patient is deteriorating even if the signs and symptoms are

subtle.Clinical judgment is vital because it acts as a guideline to establish pertinent nursing

diagnosis , decision making, and outcomes. (Connor et al.,2023).

 Personal Experience

I work at Akron Children’s in Boardman as a nurse technician and I did an internship

over the summer in the nicu. With this I have some baseline knowledge of how to properly

change a diaper and what an abnormal abdomen looks like. One of the nurses became busy and

asked me to do a routine diaper change and do an axillary temperature. When I entered the room

the baby just had a very large emesis, even though the head of the bed was elevated. I changed

the sheets, got a new sleep sack and sleeper and gave a quick bath. The baby was very lethargic

and not crying which is unusual while doing care. While changing the diaper I looked at the

baby's abdomen which was very distended, hard, and the veins were visible. Loops were even

noticeable and that is when air or food is trapped and the intestines are visible through the

skin.The baby's skin was also very mottled. I noticed these were all abnormal and with my

knowledge I knew I should be concerned for NEC. My nurse over the summer told me to look at

the whole picture. I measured the abdominal girth, grabbed a full set of vitals , and checked her

capillary refill. I took my findings to a nurse and she came in right away and I voiced my

concerns. She understood and ultimately agreed the baby needed to be evaluated right away. The

baby was ordered a STAT x-ray and labs were drawn. The baby ended up transferring out of the

special care nursery to the nicu to revive a higher level of care, then needed to be transferred to

Akron Main campus because her status was deteriorating and possibly needed surgery. The

charge nurse was very impressed that I noticed the abnormal findings and was able to confidently

come to her with my concerns.I asked if there was anything differently I could have done or

improved my approach and she gave me some advice. Since I used critical thinking by looking

at the whole picture and using my judgment, deciding this is something I need to take action on

the baby would have gotten much worse because their status can change rapidly.
 References

Calcagni, L. , Lindell, D. , Weaver, A. & Jackson, M. (2023). Clinical Judgment Development

and Assessment in Clinical Nursing Education. Nurse Educator, 48 (4), 175-181. doi:

10.1097/NNE.0000000000001357

Connor J, Flenady T, Massey D, Dwyer T. Clinical judgment in nursing - An evolutionary

concept analysis. J Clin Nurs. 2023 Jul;32(13-14):3328-3340. doi: 10.1111/jocn.16469. Epub

2022 Jul 25. PMID: 35880251.

Modic, M. B. (2013). Tanner’s Model of Clinical Judgment Applied to Preceptorship: part 1.

Journal for Nurses in Professional Development, 29(5), 274–275.

https://doi.org/10.1097/01.NND.0000433907.85137.2e