CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Kristy Vrona

Youngstown State University

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Introduction

Everyone has experienced nursing care, whether for themself or a loved one. The way

the nurse treats and cares for a patient makes an impact on not only the patient but the

family involved in their care as well. Graan, Williams, & Koen, (2016) some people

associate nursing with the physical tasks concerned with keeping the sick person safe,

comfortable, nourished and clean. Some view nursing as assisting the doctor by

carrying out tasks associated with medical treatment. The more experienced a nurse is

in what she does the less likely the patient may be to recognize what specific

interventions have been done (Graan, Williams, & Koen, 2016).

Clinical Nursing Judgment Definition

In nursing research the term ‘clinical judgement’ is synonymous with critical

thinking, decision making and clinical reasoning ​(Hallin, Haggstrom, Backstrom, &

Kristiansen 2015). Clinical judgement is a multidimensional process that is influenced by

critical thinking, problem solving, communication, and motivation. Without these key

factors a nurse’s clinical judgement will remain stagnant or nonexistent. As nurses there

must be a motivation to make clinical judgements, an aspect of critical thinking and

problem solving for all clients but especially rapidly deteriorating patients, and

communication with nurses, doctors, patients, families, and anyone else they come in

contact with. ​Clinical judgement is central to the safe and effective functioning of health

services. Not only is it central to safe, effective care, it is also the most difficult element
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of professional practice to define, and to implement in terms of how it relates to

organisational needs and priorities (Lockwood, 2011).

Clinical Judgement Importance

Clinical nursing judgement is fundamental to being a nurse. There are many

components and skills that make up clinical nursing judgements. Nurses must use their

assessments, observation, knowledge, and decision making skills in order to to make

important clinical judgements. ​Clinical judgement has been recognised as a vital skill

that enable​s nurses to determine the appropriate nursing interventions when planning

patient care (Graan, Williams, & Koen, 2016). It is very important to build your skills as a

nursing student and novice nurse to build your clinical nursing judgement. The more

experience and exposure a nurse gets the more they rely on their judgement instead of

questioning it. ​At all times, nurses are responsible for their actions and are accountable

for nursing judgment and action or inaction.

Personal Experience of Using Nursing Judgement

During my practicum I had a really good opportunity to use my clinical nursing

judgement with a pediatric patient that was three days post operation of a tonsillectomy.

The patient was a five year old female that was discharged after surgery and returned to

the emergency department in three days because of lack of urine output. The patient

was admitted to the floor and a urine specimen was obtained. The urine was dark coca

cola colored and was straight blood. I had never witnessed anything like that especially

in a what seemed to be healthy child. I had to use my clinical nursing judgement to

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assess and observe the patient so that when I talked to the doctor I could be prepared. I

used my knowledge and decision making skills to perform a target assessment and

monitor the patient for worsening symptoms. I utilized my critical thinking skills while

caring for the patient and observing for signs and symptoms of shock or deterioration.

The entire time I cared for the patient I was making constant nursing judgements. I

researched medications before administering, tracked input and output, assessed for

pain, and closely checked vital signs. I was very nervous I would miss something or

make a mistake but my preceptor assured me to continue caring for the patient and be

confident in my skills that I have learned thus far. This advice was very helpful to me

because when becoming a new nurse I can ask questions but I also need to rely on my

own nursing skills and the knowledge that I have learned throughout school and clinical

to care for my patient.

Conclusion

Nursing judgement is a vital skill when caring for patients. The more experience

you can get the more your clinical nursing judgement will grow and expand. As a new

nurse we must be confident in our nursing skills that we have practiced throughout

school, but also understand that we can ask for help or advice. Nurses are constantly

learning and the more you learn and experience different patients and environments,

the greater your judgement will be. At all times, nurses are responsible for their actions

and are accountable for nursing judgment and action or inaction.

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Reference

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. Retrieved March

20, 2018, from ​https://www.sciencedirect.com/science/article/pii/S1025984816300047​.

Hallin, K., Haggstrom, M., Backstrom, B., & Kristiansen, L. (2015). Correlations Between

Clinical Judgement and Learning Style Preferences of Nursing Students in the Simulation Room.

Global Journal of Health Science,8​(6), 1. Retrieved March 20, 2018, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954907/​.

Lockwood, C. (2011). Clinical judgement and decision-making in nursing and interprofessional

healthcare. ​International Journal of Evidence-Based Healthcare,9​(1), 69-70. Retrieved March

20, 2018, from

https://www.nursingcenter.com/journalarticle?Article_ID=1680630&Journal_ID=1658605&Issu

e_ID=1679917.