Running head: NURSING JUDGMENT 1

Senior Capstone-Clinical Nursing Judgment

Olivia Gerke

Youngstown State University

Dr. Ballone and Mrs. Thomas, Spring 2019

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Clinical nursing judgment is a concept that is difficult to define. There are many

definitions and interpretations of the phrase when it comes to the nursing profession. According

to Manetti (2019), “Tanner devised the Clinical Judgement Model and defined clinical

judgement as an interpretation or conclusion about 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” (p. 103). Nursing judgment comes with

experience and increased personal confidence. With student nurses and novice nurses, clinical

judgment can be lacking. It can be difficult for these nurses to see the big picture with the patient

and tie all the parts together. These nurses are used to having someone watching over them and

now they are independently caring for multiple patients. Dickison, Haerling, and Lasater (2019),

found “Studies have shown that in the first years of practice, new graduate nurses do not make

clinical judgments at the same level as more experienced nurses (Kavanaugh & Szweda, 2017).

In fact, it can take several years before new nurses can function at a high level when making

quality clinical judgments (Lasater et al., 2015)” (p. 72). Clinical nursing judgment is important

to the nursing profession. It is a key component to making sure nurses provide safe and effective

care to patients (Dickison et al., 2019). Along with clinical judgment there is critical thinking and

critical reasoning. People may use these terms interchangeably but it is important to understand

the difference. According to Manetti (2019), “the nurse analyzes (critically thinks), applies

(clinically reasons), and acts (clinically judges) in the delivery of patient care” (p. 104).

Therefore, clinical nursing judgment is imperative to patient care because it involves the actions

the nurse will be taking to provide safe and effective care to each and every patient.

Research is finding ways to help nurses improve their clinical judgment. It is a concept

that cannot just be taught out of a textbook in school. There is no one single strategy that can be
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used to help nurses develop clinical judgment, it involves different methods and approaches

(Cappelletti, Engel, and Prentice, 2014). Some of these methods used are the SBAR and scenario

situations. “Useful strategies for developing clinical judgment for patient safety can include

embedding cues into scenarios and expecting students to reflect these on the SBAR, which

simultaneously exposes them to the most current interdisciplinary communication technique”

(Lancaster, Westphal, and Jambunathan, 2015, p. 33). This helps nurses gather information, look

at clinical cues with their patients, try to determine what should be done, and the communicating

this information to the health care team (Lancaster et al., 2015). Simulation experiences give

nurses the opportunity to think quickly on their feet and to make decisions for their patients.

Simulations experiences can prepare you for what to do in a similar situation with a real patient.

Capelletti et al., (2014) found that “Compared with other educational methods, such as written

case studies, high fidelity simulation may more closely resemble the clinical setting (Yang &

Thompson, 2011); thus, it shows strong potential in helping to bridge the theory–practice gap

(Lasater, 2007)” (p. 457). Although it can be difficult for nurses to develop their clinical

judgment, it first has to start with knowledge. Nurses need to know about diagnoses their patients

have and how that effects the body as a whole. Nurses need to be able to see subtle changes in

patient status and know how to react, by knowing signs and symptoms to watch for. Knowing

medications and labs and how they affect the patient is also important. Manetti (2019), explained

that “A solid knowledge base precedes the development of sound clinical judgment. A nurse

must understand rationale behind actions and expected responses” (p. 106). With the knowledge

nurses have and additional experience, it begins to help the nurse develop his or her clinical

nursing judgment.
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An instance where clinical nursing judgment was used was during precepting. A patient

who presented to the emergency room two days before with hypokalemia was admitted to the

intermediate care unit. On admission her potassium level was 2.2 mEq/L. Orders were put in for

intravenous potassium. On the day of care, in the morning, her potassium was 4.6 mEq/L, and

throughout the day her potassium increased to 6.7 mEq/L. At this time the doctor was to be

notified of the increased potassium level. The doctor put in two orders which were to obtain

another stat potassium level and start Kayexalate 15g/60mL. Using clinical nursing judgment, it

was decided to wait for the potassium level to come back before giving the Kayexalate. This

saved the patient from having diarrhea, which she was not having to begin with, and unwanted

side effects of the medication. During this time it was imperative to monitor the patient for signs

and symptoms of hyperkalemia, which were not present. The new potassium level came back

and was 5.1 mEq/L, which meant the Kayexalate did not need to be administered. Clinical

nursing judgment was used to prevent the patient from the effects of Kayexalate and possible

hypokalemia and retreatment of intravenous potassium.

In the end, nurses are the part of the health care team that spend the most amount of time

with the patients. It is important for nurses to be able to use their clinical judgement so changes

are not missed and information can be relayed to other health care team personnel. If nurses do

not have the clinical judgment skills it could lead to minor or even major bad outcomes for

patients. It is important, whether you are a student, novice, or experienced nurse, to always be

expanding your clinical judgment. It is important to keep up with changes in health care to

provide safe and effective care to all patients. Just as a nurse is never done learning, he or she is

never done developing clinical nursing judgment.

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References

Cappalletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment and

reasoning in nursing. Journal of Nursing Education, 53(8), 453-458. Retrieved from

https://eps.cc.ysu.edu:2255/docview/1626533362/fulltextPDF/6B03CAC53C9D49EAPQ

/1?accountid=29141

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the national council of state

boards of nursing clinical judgment model into nursing educational frameworks. Journal

of Nursing Education, 58(2), 72-78. Retrieved from

https://eps.cc.ysu.edu:2255/docview/2175939314/fulltextPDF/7D20A3A24B344169PQ/1

?accountid=29141

Lancaster, R. J., Westphal, J., & Jambunathan, J. (2015). Using sbar to promote clinical

judgment in undergraduate nursing students. Journal of Nursing Education, 54(3), 31-34.

Retrieved from

https://eps.cc.ysu.edu:2255/docview/1661986846/fulltextPDF/BB43F2EBFBE74829PQ/

1?accountid=29141

Manetti, W. (2019). Sound clinical judgment in nursing: a concept analysis. Wiley, 54, 102-110.

Retrieved from

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