Running Head: CLINICAL NURSING JUDGEMENT IMPORTANCE

Clinical Nursing Judgement Importance

McKenzie Drapola

Youngstown State University

3/15/2021
Clinical Nursing Judgement Importance

In our world today, nursing is one of the most well-known and trust-worthy professions.

Nursing, as a profession, has existed throughout history, although it has evolved considerably

over time. The origins of nursing can be traced back to the mid-19th century and traditionally

began with Florence Nightingale. Florence Nightingale defied social conventions when she

decided to become a nurse. She cared for the injured soldiers in the Crimean War in the 1850s

and played a significant role in changing the nature of the nursing profession (News Medical

Life Sciences, 2019).

Along with the knowledge and skills a nurse requires, one of the most important

components of the nursing occupation is having good clinical nursing judgement. Clinical

nursing judgement can be defined as the observed outcome of critical thinking and decision

making. It is an iterative process where clinical judgement uses nursing knowledge to observe

and access presenting situations, identify a prioritized client concern, and generate the best

possible evidence-based solution in order to deliver safe client care according to The National

Council on State Boards of Nursing (NCBSN). Clinical judgment development is necessary

because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion

(NCBI, 2015). According to the International Journal of Nursing Studies (2013), nurses’

judgement and decisions can help healthcare systems allocate resources, promote patient benefit,

and prevent patient harm. The University of Johannesburg (2016) also states that, “The

distinction of nursing care by professional nurses lies in the clinical judgement inherent in the

processes of assessment, diagnosis, implementation and evaluation. Knowledge forms the basis

of the patient needs assessment and determines the action to meet these needs; professional

accountability for decisions and actions, including the decision to delegate to co-workers and the
Clinical Nursing Judgement Importance

structured nurse patient relationship, which incorporates the professional code of ethics and

SANC regulation's.”

As previously stated, clinical nursing judgement is one of the key principles of nursing. It

is based on a nurse’s knowledge and experience as well as their reasoning, intuition, clinical

thinking, and evidence-based practice skills. Education at the undergraduate level helps students’

to develop this skill early on before starting in their field. They develop this skill by critical

thinking, and understanding how judgements and decisions are made in the healthcare

environment. Nurses are lifelong learners and continue to build on this skill by accumulating

more knowledge, expertise, and experience. Clinical nursing judgement is important because

nurses use these skills to assess patients and the environment to interpret and understand patient

information in order to completely fulfill the patient’s needs. A structured approach to patient

care is an important characteristic of structured professional nursing judgement. Another

characteristic that makes a professional nurse stand out is their cognitive ability rather than their

psychomotor ability. Margaret McCartney (2017) states in her Journal that “Nursing practice

demands that practitioners display sound judgement and decision-making skills as critical

thinking and clinical decision making is an essential component of nursing practice. Nurses’

ability to recognize and respond to signs of patient deterioration in a timely manner plays a

pivotal role in patient outcomes.” Nurses are responsible for all of their actions and should

always use nursing clinical judgement to avoid as many errors and mistakes as possible.

Throughout all of my experiences at clinical, I remember using clinical nursing

judgement with every patient I had. I always thought it was important to use clinical nursing

judgement with every patient because they are all different and they all require different needs. I
Clinical Nursing Judgement Importance

have also learned in school and at work that a patient’s status can drastically change at any given

moment. In order to recognize this, one has to have a good clinical nursing judgement.

One specific time I will always remember when I had to use good clinical nursing

judgement was when I had a patient at clinical who had coronary artery disease. Most of her

heart was blocked off and she was scheduled to go to the cath lab the next day to have stents

placed. However, I was taking care of her the day before. She was alert and oriented, from home,

and did well ambulating. She stated she had to use the restroom. Before I helped her to the

commode, I asked her nurse for the day if it was for sure okay to assist her to the toilet. She gave

me the okay, so I assisted the patient to the toilet. The toilet is located right next to the bed, so

the patient did not have far to walk. When she was finished, I helped her back on to the bed and

noticed she looked very pale and diaphoretic. I asked if she was okay or if she was feeling light-

headed. She replied that she felt very light-headed and then proceeded to pass out and fall back

onto the bed. As soon as this happened, I checked her carotid pulse while simultaneously asking

her nurse to come help me. She had a pulse and was breathing. We sat her up in bed, got her

situated, and assessed her. She became conscious after a couple minutes and stated that is why

she came to the hospital. She has been passing out at home due to the clogged arteries and not

receiving enough oxygen. She did end up being fine and everything was normal the rest of my

clinical. This was a good opportunity for me to use clinical nursing judgement by assessing the

patient, planning, implementing, and evaluating. I got to use my critical thinking and act on it. It

was a good learning opportunity.

Another example of when I used good clinical nursing judgement was when I was

precepting in the intensive care unit. My patient had multiple issues wrong with her, but the what

I remember the most was watching that her Troponin was elevated and continued to the elevate.
Clinical Nursing Judgement Importance

It started at 1.07, then rose to 33 then 55. On the monitor she also showed perfect ST elevation.

We decided to call he cardiologist and have a 12 lead EKG ordered. The EKG confirmed she

was having an active MI and we decided to call a STEMI alert. They took her to the cath lab and

found that her heart was perfectly clean and she got diagnosed with Broke Heart Syndrome. I

learned so much that night and felt that I really improved on my clinical nursing judgement.

Although it turned out to not be an MI, I am glad that we acted on it rather than not.

As years go on, nursing will continue to grow and evolve, but it will always have to have

the skill of good clinical nursing judgement. If one chooses this career, they will need to have

this skill in order to be a professional nurse and take excellent care of their patients. Nurses must

continue their education and engage in lifelong learning to become a competent nurse. The

overall goal is to use this skill to be the best nurse one can be by providing the greatest care and

keeping the patient safe.

Clinical Nursing Judgement Importance

References

D'Antonio, P. and Buhler-Wilkerson, . Karen (2020, November 12). Nursing. Encyclopedia.

Britannica. https://www.britannica.com/science/nursing

McCartney, M. (2017). Nurses must be allowed to exercise professional judgment. BMJ.

https://doi.org/10.1136/bmj.j1995

Seidi, J., Alhani, F., & Salsali, M. (2015, September 28). Nurses' Clinical Judgment
Development: A Qualitative Research in Iran. Iranian Red Crescent medical journal.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601210/.

Smith, Y. (2019, February 27). History of Nursing. News Medical Life Sciences.
https://www.news-medical.net/health/History-of-Nursing.aspx.

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013, June 5). An agenda for clinical
decision making and judgement in nursing research and education. International Journal of
Nursing Studies.
https://www.sciencedirect.com/science/article/abs/pii/S0020748913001442.

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.
https://doi.org/10.1016/j.hsag.2016.04.001