Running head: Clinical Nursing Judgement 1

Clinical Nursing Judgement

Alesha Fulton

Youngstown State University

Clinical Nursing Judgement

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As defined by Medical Dictionary “clinical judgement is the process by which the nurse

decides on data to be collected about a client, makes an interpretation of the data, arrives at a

nursing diagnosis, and identifies appropriate nursing actions; this involves problem solving,

decision making, and critical thinking” (2012). This concept in nursing is important because

“nurses must notice subtle cues and changes in a patient’s condition to prevent complications and

detect problems as soon as possible” (Manetti, 2019, p.102).

To show how clinical nursing judgement works, a model case analyzed by Manetti

(2019) looked at the following: Mary, an expert critical care nurse, receives bedside report from

an outgoing novice on a patient 12 hours post a femoral popliteal bypass graft of the right‐lower

extremity. While the outgoing nurse speaks, Mary performs a holistic assessment of the

ventilated, sedated patient. The right‐lower extremity reveals mottling to the thigh, coolness to

mid‐calf, and an intermittent dorsalis pedis pulse by doppler only. Mary quickly conducts a

general assessment and finds the patient otherwise stable. As seen in this case, Mary uses critical

thinking and clinical reasoning as she applies knowledge to the context of the patient’s situation.

She considers different approaches to the problem and potential outcomes. Mary trusts her

intuition and is certain that a problem exists. She considers her knowledge of a normal

neurovascular assessment and her experience caring for other patients recovering from similar

procedures. Based on this knowledge and practical wisdom, Mary concludes the arterial

circulation is compromised and promptly decides to act in the role of an advocate for the patient.

(p.105).

An article by Thompson, Aitken, Doran, and Dowding says “Nurses have a key role to

play in overcoming the major challenges facing developed healthcare systems: ageing

populations; rising healthcare costs; promoting population health through preventative

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healthcare; reducing health inequalities; and employing evidence based practice to produce the

biggest health gains in the most efficient and acceptable manner possible. Health systems require

nurses whose clinical judgements and decisions contribute to, not detract from, the quality of

health systems” (p. 1721). Nurses need to use clinical judgement to make the biggest impact for

the patients. By using it, nurses give the most quality care and advocate for patients in being able

to notice changes and act upon them to have a positive outcome.

In today’s healthcare system there is becoming more and more new nurses as the need for

nurses increases. In nursing school, students are taught how disease processes work and how to

treat them. By not seeing at clinical what is learned in school, it is hard for students to develop

clinical nursing judgement and being able to know what to do in different situations.

Pouralizadeh, Khankeh, Ebadi, and Dalvandi (2017) says “Today, shortage of qualified nurses

inevitably leads to early and independent confrontation of new graduates with judgment and

decision making challenges in health care which can increase the probability of harm to patients”

(p. 2). “This has encouraged the nursing education systems to plan and prepare students studying

in this major and facilitates the development of their clinical judgment . However, according to

research, a large number of nursing students do not have as much clinical judgment as expected

when graduating” (et al p.2). Clinical nursing judgement could be taught better in schools by

doing more simulation based learning to teach students how to react in real life situations in

addition to lecturing from the text.

Nurses use clinical judgement on a daily basis to care for their patients. They look at the

overall picture to decide what is best for the patient. An example where clinical judgement was

used was in the ICU. A patient being taken care of was an 88 year old female that was admitted

for respiratory distress due to septicemia. She was intubated and ventilated on A/C mode. She
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was tested on pressure support mode to see if she would be able to breath on her own without the

tube. She was on P/S mode for about an hour until she started to desaturate and the apnea alarm

continued to go off because she was not taking enough breaths on her own to keep her oxygen

level up. The patient became tired and drowsy. Due to her condition, the respiratory therapist

was called and notified of the findings and asked to assess the patient. It was discussed and

decided that she would go back on A/C mode because she was tiring out and not being able to

tolerate the vent on her own breathing. Clinical nursing judgement was used to prevent the

patient from declining further and having complications from not being adequately oxygenated

on the P/S mode ventilation.

As stated, clinical nursing judgement is very important in the healthcare setting. It uses

problem solving and decision making, allowing nurses to advocate for patients and make the

biggest impact to have the best quality care. As there becomes and increasing number of new

nurses due to the rising need for nurses, there are an increasing number of nurses that lack

critical judgment. This is due to in nursing school, students are not developing critical thinking

skills due to lack of experience. As seen, nursing judgement is used on an everyday basis from

the example shared. Clinical nursing judgement is an important aspect of nursing and needs to be

used to give patients the best outcomes as possible.

References

Manetti, W., PhD, RN, CRNP. (2019). Sound clinical judgment in nursing: A concept analysis.

Nursing Forum, 54(1), 102-110. doi:10.1111/NUF.12303

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Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision

making and judgement in nursing research and education. International Journal of Nursing

Studies, 50(12), 1720-1726. doi:10.1016/J.IJNURSTU.2013.05.003

clinical judgment. (n.d.) Medical Dictionary for the Health Professions and Nursing. (2012).

Retrieved March 2 2019 from https://medical-

dictionary.thefreedictionary.com/clinical+judgment

Pouralizadeh, M., Khankeh, H., Ebadi, A., & Dalvandi, A. (2017). Factors Influencing Nursing Students'

Clinical Judgment: A Qualitative Directed Content Analysis in an Iranian Context. Journal of clinical and

diagnostic research : JCDR, 11(5), JC01-JC04.

4852 Capstone

Scholarly Paper Rubric

Scholarly Capstone Paper

● A component of the capstone course, worth 20% of the final grade

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● An in-depth exploration on the topic “Clinical Nursing Judgment”

● 3 page paper
● APA format
● Minimum of 3 references citing recent Nursing Journals
● Define the concept, identify the importance of clinical nursing judgment, and then discuss
a personal experience where you used “clinical nursing judgment” in a specific situation.

Requirements: Possible Points Achieved Points

1. organization and clarity of topic present 20 _________

2. content quality 20 _________

3. reflection of topic 20 _________

4. APA format and correct grammar 20 _________

5. Cited References 20 _________

Final Grade
_________/100 points