Running Head: CLINICAL NURSING JUDGMENT 1

An in Depth Exploration:

Clinical Nursing Judgment

Natalie Laurence

Youngstown State University

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An in Depth Exploration: Clinical Nursing Judgment

Clinical judgment 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 (Garwood, 2018). This is a hot topic among the nursing community. Everyone has

different preferences of how to complete certain tasks. However, sometimes one nurse’s

preference may be viewed as “wrong” in another nurse’s eyes. The purpose of clinical judgment

is to have nurses critically think through situations or certain procedures to choose the best way

of care to benefit the overall health and wellbeing of the patient. Through the three years of

clinical experience I have been exposed to there has been numerous times I have witnessed my

nurse sit back and critically think about how to go about providing care to her patients. Nursing

care is not black and white, it can be complex and hard as one decision could benefit the patient

in the long run or may put the patient back a few steps in the wrong direction.

In nursing practice, clinical judgment is the most vital skill any nurse can have. Clinical

judgment should be taught early on in nursing school to help students improve their judgment

skills before they become true RNs. In one study, the purpose was to evaluate the use of concept

maps as a teaching strategy in students critical thinking abilities throughout nursing school. The

reason behind this study was to see if the implementation of concept maps truly helps nursing

students be more proficient beginner nurses after they graduate. Researchers found that almost

two thirds of nurse graduates do not have adequate critical thinking skills for a beginner nurse

(Garwood, 2018). After studying 106 junior baccalaureate nursing students who used concept

maps throughout their nursing program, the findings revealed that the use of concept mapping

provided an interactive way to foster the growth of clinical judgment skills in nursing students

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(Garwood, 2018). As a nursing student myself the use of concept maps is something I have

valued throughout nursing school. However, the best experience I have had with clinical

judgment has been with my preceptor.

Nursing transitions has been the most educational experience I have been exposed to as a

nursing student. During transitions I have been able to reevaluate my clinical judgment skills.

They have definitely improved throughout this course. Clinical judgment can be such a difficult

skill to fully grasp as there are so many opinions and options on how to “correctly” carry through

procedures or orders the doctors have put on for a patient. Working as a nurse tends to be very

fast-paced and complex in the hospital setting, it has been proven that graduate nurses do not

have the best clinical judgment skills coming out of the nursing school setting. One study

focused on the importance of nurse preceptors in the new graduates learning. Nurse preceptors

are charged with bridging the gap between new graduates’ learning in school and their

autonomous practice as RNs (Nielson, 2016). From my experience, I have gained knowledge and

critical thinking skills by observing my nurse during shifts. Without this experience I would not

have the up to date critical thinking skills I have now as I have never been exposed to them until

this experience. Findings in the study of the development of new

nurses’ clinical judgment with the support of a preceptor, indicated that having a structured

framework provides objective ways to evaluate and help develop new graduate nurses’ clinical

judgments (Nielson, 2016). The more exposure a student has to the clinical judgment thinking

process, the better prepared they are as they transition to RNs in the true world setting. The

improvement in that skill leads back to the students’ preceptor experiences.

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As I have stated before, clinical judgment can be a very hot topic. Decisions are

individualized and as they are individualized different people may have their own opinions on

that final decision the individual makes on nursing care. Judgment can be based off one or more

theories; “classical” decision-making theory, “naturalistic” decision-making theory, normative

theories, social judgement theories, intuition, etc. just to name a few of the theories that back up

certain decisions nurses make (Shaban, 2015). The most popular theory nurses base most of their

clinical judgment on is intuition. Intuition has been defined as “immediate knowing of something

without the conscious use of reason” or “knowledge of a fact or truth, as a whole, with

immediate possession of knowledge and an independence from linear reasoning process”

(Shaban, 2015). Both definitions can be summarized as intuition generally meaning the notion of

judgement that just happens without true rationale. A major criticism of “nurse intuition” is that

the expertise and “intuition” is grounded around a specific context and is of a specific nature, and

that nurses cannot take their “intuition”, knowledge or skills and apply them out of that context

(Shaban, 2015). From my experience, the nurses I have been able to work with have great

intuition and their judgements have always been appropriate for the patient care. The intuition

the nurses have on patient care has stemmed from their nursing

school experiences and their preceptor experience. Their use of clinical judgment has become

second nature. As their clinical judgments have each been individualized, each of their

judgments has always been spot on for the overall wellbeing of the patient care. I hope to build

on my clinical judgment skills as I believe this is the most important aspect of nursing care.

I have been able to use critical thinking in some scenarios thus far. One of the situations

was during my critical care clinical experience. My nurse was administering a unit of blood

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before the patient was sent down for a procedure. The O2 stats started to decrease from 95 to 91.

This was not a finding that you would want to note as a result of receiving blood. My nurse and I

looked at his history and he had CHF. His intake and output was not equal, as he was holding

onto extra fluid. We listened to his lung sounds and it was evident he did indeed store extra fluid.

My nurse was asking for my opinion during this assessment, even though she knew what needed

to be done. This was a great way for me to critically think. It was a great time to sit and evaluate

the best options for this patient given the turn of events he started to have. The solution was to

administer Lasix to the patient after requesting an order from the doctor. Upon that request, the

Lasix order was verified and later administered. This was the best decision for the best patient

outcome.

Patient care is the most important priority for nurses but the most important skill will

always be clinical judgment. Every decision that is made stems from critically thinking about the

best outcome for the patient’s wellbeing. Every nurse can continually improve in every aspect of

nursing care which makes this line of work so appealing to me because as a nurse you are

continually striving to better yourself.

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References

Garwood, J. K. (2018). The Effect of Concept Maps on Undergraduate Nursing Students’

Critical Thinking. Nursing Education Perspectives, 39(4), 208-214.

doi:10.1097/01.nep.0000000000000307

Nielsen, A. (2016). A framework to support preceptors’ evaluation and development of new

nurses’ clinical judgment. Nurse Education in Practice, 19, 84-90.

doi:10.1016/j.nepr.2016.03.012

Shaban, R. (2015). Theories of clinical judgment and decision-making: A review of the

theoretical literature. Australasian Journal of Paramedicine, 3(1).

doi:10.33151/ajp.3.1.308