Clinical Judgment

B260: Fundamentals of Nursing

Definition

Clinical judgment is “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” (Tanner,
2006*).
Nursing Care Is Not Linear
• One must consider
multiple complex
variables for clinical
Multiple
reasoning.
factors

No clear-cut
answers
Attributes of Clinical Judgment

• Involves a holistic view of the patient

situation.
• Requires reasoning and the interpretation of
data.
Unique Situation
• The nurse must recognize the unique
situation of the patient, including a deep
understanding of both the clinical situation
and the nurse’s contribution to the patient
care situation.
• Each patient situation and each nurse is
different; so, too, is the clinical reasoning that
leads to clinical judgment.
IDENTIFY THE WAYS THAT NURSES
MAKE JUDGMENTS
Clinical Judgment Process

• Noticing
• Interpreting
• Responding
• Reflecting
Model of Clinical Judgment

Clinical judgment is not a linear process.

Noticing

• A nurse notices things about a patient in the

context of the nurse’s background and
experience, context of environment, and
knowing the patient.
• A nurse is looking for patterns that are
consistent with previous experiences and
uses that information to guide care.
Interpreting
• Interpreting is the process of assembling
information to make sense of it.
• Types of reasoning patterns tend to vary with
the experience of the nurse.
– Novice nurses tend to rely on analytic
reasoning.
– Expert nurses draw from a variety of
reasoning patterns—analytic, intuitive, and
narrative.
Responding

• Responding is the implementation of actions

and interventions, based on patient needs.
• Depending on the level of expertise, the
nurse may or may not be able to judge the
effectiveness of the intervention before
initiating it.
Reflecting
• Reflecting is the process of thinking and
learning from experiences.
– Reflection-in-action happens in real time
while care is occurring.
– Reflection-on-action happens after the
patient care occurs.
• Reflecting is critical for development of
knowledge and improvement in reasoning.
Experience, Knowledge, Expertise

• Clinical judgment requires deep clinical

knowledge and several types of thinking.
• Experience does matter, but it is not solely
responsible for clinical judgment.