Running head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment:

Scholarly Capstone Paper

Edzarae Bell

Youngstown State University

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Are you, as a medical professional using clinical judgement or critical thinking? Often

the two terms are confused or sought to have the meaning. Margot Phaneuf, R.N., Ph.D., defines

clinical judgment as “Clinical judgement is the conclusion or enlightened opinion at which a

nurse arrives following a process of observation, reflection and analysis of observable or

available information or data.” Clinical judgment is important not only as nurses, but also other

medical professions too such as doctors, respiratory therapists, physical therapy, and even social

work. There are countless studies that review what clinical judgement is and how nurses use it,

some of which I can apply to situations I have seen on the units as a nursing student.

According to Vann Graan, Kreon and Williams:

“A learning environment conducive to critical thinking provides opportunities for

flexibility, creativity, support for change and risk taking. Interactive dialogue facilitates

the building of connections to open up ideas, creates a way for thoughts and reflections to

be made public and enables the dissemination of insight. Facilitators should not provide

students with answers. A questioning attitude should be encouraged for students to

develop interpretive, analytical, evaluative, inferential and explanatory skills to come to

clinical judgement (Yıldırım, 2011:258).”

Clinical judgement involves problem solving, decision-making and critical thinking. It is doing

what is right for the quality of care for the patient. All the information we gather as nurses such

as, subjective data, objective data, diagnosis, and nursing diagnosis, along with patients wants

and needs is all used together to form clinical judgment on that patient. Clinical judgment also is

based around the nurse’s experience and knowledge. Clinical judgment is specifically different
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for each patient because of his or her different wishes, wants and needs, and also varies from

different nurses.

As nurses we should be using clinical judgment every second we are caring for our

patients. From the minute we start assessing the patient, at the beginning of the shift to the very

end of the shift, we should be using our best clinical judgment for that patient to give them the

best possible outcome. It is so important because it determines how nurses care for the patient. It

determines what they need immediately and determines their care throughout the shift.

Clinical judgement also varies on the specialty of nursing as well. Peter Martin has done

a study on clinical judgement specifically in mental health nursing. He developed an outline

including three concepts: self, the client, and the functions of the nurses’ social system. He then

further divides in sub concepts of specific roles such as professional, healthcare and nurse to

patient relationship. Martins study establishes that the self- concept of how nurses decided

clinical judgement was a “gut feeling.” Client- concept involves reading the client charts and

using interactions with the client. Lastly, the social system the nurse uses, involving

prioritization and other issues going on with the floor that day. The sub-concepts establishes that

the professional relationships can affect the work of the nurse in a good or bad way. Healthcare

roles establishes that the nurse is working with the other members working to take care of the

client. The last sub-concept the nurse–client relationship is building a rapport and trust (p. 277-

278).

Nursing school has provided students the opportunity to use both critical thinking and

clinical judgement. During nursing school, in my clinical rotations I have seen clinical

judgement when it comes to administering pain medication. We have learned that the patient is
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always right, and if the patient says they are in pain 10/10, but seem very relaxed with vital signs

all within normal range do you administer the pain medication or do you wait? I feel as a nursing

student it is a hard judgment call. Also, dealing with pain medication, in the ICU there are many

intubated and sedated patients. When, and or how does a nurse know it is the right time, if there

is a right time to give pain medication?

“Intensive Care Pain Treatment and Sedation: Nurse’s Experiences of the Conflict

between Clinical Judgement and Standardized Care: and Exploratory Study” by Hilde Woien and

Ida Torunn Bjork discusses using the right assessment tools and judgement for pain medication

administration in the ICU. The authors came to the conclusion that a nurses’ attitude, practice

and knowledge were hindering standardized care (p.128). The research contained four

assessment tools for pain: numerical rating scale, the Richmond Agitation and Sedation Scale,

the Adaptation of Intensive care environment, and the delirium monitoring instrument for

monitoring ICU patients, the Confusion Assessment Method (p.130). There was protocol in

place for the sedation, delirium and pain assessments. In the study it was found that nurses would

first use their own judgement in their assessment and then use the tools when and if necessary.

There were many improvements with use of the of the assessment tools.

As I develop from a nursing student to a nurse in the clinical setting I can see the

difference, and how my clinical judgment will change over time. It is based on my experience

and my knowledge, which will grow in the years to come. As I start out I have realized I will

have to use my gut feeling and self-concept of the patient. Also I will build rapport with the

patient, and I will have to use my basic assessment tools to make my best clinical judgment.

Clinical judgment is the nurse’s way of making the best decisions for the quality of the patients

care and the patients’ outcome.

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References

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

clinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280-293.

Martin, P. J. (1999). Influences on clinical judgment in mental health nursing. Journal of

Research in Nursing, 4(4), 273-281.

Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession.

Retrieved March 13, 2018, from

http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement–

An_Essential_Tool_in_the_Nursing_Profession.pdf

Woien, H., & Bjork, I. T. (2012). Intensive care pain treatment and sedation: Nurses’

experiences of the conflict between clinical judgement and standardized care: An

explorative study. Intensive and Critical Care Nursing, 29(3), 128-136.