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Clinical Nursing Judgment

Haley Davis

Nursing Department, Youngstown State University

4852: Senior Capstone

Dr. Kim Ballone & Wendy Thomas

March 6, 2020
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Introduction

When nurses are asked what they think clinical judgment means, no two responses are

the same. The concept of clinical judgment consists of many parts. No nurse can ever obtain a

“perfect” clinical judgment because each area that contributes to nursing judgment can always be

enhanced. The definition of clinical nursing judgment as presented in the journal, Nurse

Education Today as, “An interpretation or conclusion about a 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 patients’ response” (AL Sabei & Lasater,

2016, p. 42). In another journal article, Advances in Nursing Science, they define clinical nursing

judgment as, “The culmination of education, experience, and insight that allows nurses to

execute the best action possible on behalf the patient” (de Tantillo & De Santis, 2019, p. 266). In

both definitions the list of skills and factors contributing to clinical judgment are in-depth,

however different. One theme they have in common is, the patient. The end goal is to do what is

necessary to receive the best outcome for the patient and keeping the patient safe.

Nursing Students

In the article, Nursing Judgment, it states, “As health care continues to transform, nursing

care demands are also changing… as a consequence, nursing judgment has become more vital

than ever” (de Tantillo & De Santis, 2019, p. 266). It is apparent that nursing judgment should

start being enhanced in student nurses from the very beginning of education. New graduates

going into healthcare facilities are not meeting the expectations for their performance in regard to

nursing judgement and it is shown in recent literature (van Graan et al., 2016, p. 281). The

authors further explain through their research and data collection where the education lacks for

nursing students and what is leading to the deficit. Participants of the journal’s “World Café”
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data collection describe clinical accompaniment of nursing students as, “…problematic,

inefficient and not conducive to the development and demonstration of clinical judgment” (van

Graan et al., 2016, p. 284). It is in the clinical setting that students can provide nurse-patient care

and gain that nursing judgement. Research includes that, “…collaborative dialogue between

students, educators and clinical mentors as role models during nurse-patient interaction is a

powerful learning tool in facilitating clinical judgment (van Graan et al., 2016, p. 282). The

dialogue is minimal for the students though because the faculty-student ratio and the

unwillingness or inaccessibility of clinic staff.

It is important to remember that when a nursing student reaches the end of their education

program, the program provided whatever it could. In the article, Nursing Judgement they

conclude, “As is it not possible for every possible scenario to have been taught in nursing

education programs, nursing judgement will help the nurse make the best nursing decision under

the circumstances” (de Tantillo & De Santis, 2019, p. 269). They are not going to be able to

cover every situation and prepare their students for everything they will encounter. However,

new graduate nurses will have to use the knowledge they gained and their resources to make the

best clinical judgment possible.

Debriefing

Debriefing is part of simulation-based learning and research supports that debriefing

benefits clinical nursing judgement in nursing students (AL Sabei & Lasater, 2016, p. 42). The

research further breaks simulation into three parts consisting of pre-briefing, the scenario, and

debriefing. The authors evidence declared, “Debriefing is emerging as the most important phase

of simulation though all three phases set the stage for learning” (AL Sabei & Lasater, 2016, p.

43). Unfortunately, there is no guidelines how to properly debrief. Educators are not getting the
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most out of their simulation-based learning. The reason research is supporting simulation-based

learning is because it is a student-centered approach to teaching. The Nursing Education Today

journal explains, “During the scenario, a student either has a role of an active participant as nurse

or an observer. Regardless of the role, students engage during the debriefing by responding to

higher order thinking questions that arise from genuine curiosity to help learners link knowledge

with practice in their clinical judgements” (AL Sabei & Lasater, 2016, p.44). A more structured

approach to lead simulation-based learning needs to be further researched and published, this

would be a great tool to adopt and utilize for nursing programs.

My Experience with Clinical Nursing Judgment

Throughout nursing school, at Youngstown State University, I felt I was not getting

enough experience in clinicals. After researching more into the topic of Clinical Nursing

Judgement, I now can see all the factors that have affected my clinical experiences, some which

have robbed me of opportunities to grow as a student and future nurse. My nursing judgment

now, close to being a new graduate registered nurse, is not as strong as it could be.

The spring semester of my senior year, the semester I am currently in, proves differently.

In the courses, Nursing Transitions and Complex Care Nursing, my experiences have allowed

my nursing judgment to grow immensely.

Precepting at Southwoods

My preceptorship at The Surgical Hospital at Southwoods has allowed me to carry the

responsibilities of a registered nurse under the supervision of my preceptor. This one-to-one

learning opportunity has enhanced my skills, nursing judgment being one of those. I fulfill the

duties of a student nurse and tend to all the areas of care and need for each of my patients. The

decisions for patient care are in my court, my nurse preceptor is there to guide and correct me if
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she feels my actions or decisions are not appropriate. Either way I am growing. If I successfully

perform, I have made the right judgements and can add to my knowledge and experience. If I do

not make the right judgment, since I have constant supervision, my nurse is able to walk me

through the appropriate way to look at or perform in that specific situation.

Complex Care Clinical

Mrs. Calcagni is not only the professor for the Complex Care Nursing lecture but, my

clinical instructor too. This is the first time I have had the opportunity to continue learning from

my professor in the clinical setting. She applies what she teaches in class to my experiences in

the hospital which allows me to understand the material more in-depth. She also is a very

encouraging and helpful educator no matter the setting. This helps eliminate fears that may keep

me from asking questions and growing my skill of clinical judgment.

There are many examples of how my nursing judgment has specifically grown

throughout this course. The easiest example to explain is from our post conference debriefing.

During our preconference Mrs. Calcagni pointed out a specific patient on the floor and explained

his condition. She told us to look at the patient situation more throughout clinical if we had time.

At the end of the day we all talked, step by step, through what the patient disease process looked

like and the appropriate measures to take while providing care to the patient. Each student

identified a different treatment option and why it would be used. This enhanced my clinical

judgment, because it helped me break down my thought processes and better understand the

treatment. Even though I was not providing hands on care to this specific patient, I spent time

applying my knowledge, and was still able to receive feedback. Debriefing at the end of clinical

is critical, we can each talk over our own patients and the care provided, thus helping us make

more sound judgments in the future.

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Conclusion

Clinical nursing judgement is not a simple concept. A lot of factors affect the decisions

and actions of a nurse. Education needs to do everything in its power to enhance the ability of

nursing students in making sound nursing judgments when they enter the workforce.
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References

AL Sabei, S. D., & Lasater, K. (2016). Simulation debriefing for clinical judgment development:

A concept analysis. Nurse Education Today, 45. https://www.elsevier.com/nedt

de Tantillo, L., & De Santis, J. P. (2019). Nursing Judgment. Advances in Nursing

Science, 42(3), 266–276. https://doi.org/10.1097/ANS.0000000000000245

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

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

http://ees.elsevier.com/hsag/default.asp