Running Head: CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Marissa Wiesen

March 15, 2021

NURS 4852: Senior Capstone

Kim Ballone & Wendy Thomas

Youngstown State University

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Clinical Nursing Judgment

A book titled Educating Nurses: A Call for Radical Transformation by Benner, P.,

Sutphen, M., Leonard, V., & Day, L. (2010), defines clinical nursing judgement as “ways nurses

come to understand the problems, issues, or concerns of patients, to attend to salient information,

and to respond in concerned and involved ways”. This is done through the nursing process

which is assessment, diagnosis, planning, implementation, and evaluation of each patient in an

individualized and holistic approach. During this process, it is very important as a new nurse to

have and continue to develop adequate critical thinking skills and abilities.

A study by Lee, S. D., Abdullah, L. K., Subramanian, P., Bachmann, T. R., & Ong, L. S.

(2017), states that “critical thinking is pertinent in the enhancement of the decision-making

process and that includes clinical judgment.”. To have good critical thinking skill, it starts with a

good foundation of knowledge which is developed through lecture, exams, and countless hours

of studying. Only then can we put our knowledge into practice at clinical, precepting, and soon

as a new registered nurse. None the less, critical thinking has many different definitions.

According to an article by Lee et al. (2017), critical thinking involves the ability to effectively

solve a problem though reasonable logic and analyzing information then forming a conclusion.

In my experience as a student nurse, I have withheld a blood pressure medication from my

patient who was hypotensive. Based on my clinical judgment and knowledge of this medication,

it would have further decreased the patient’s blood pressure which could have caused more

problems. I was able to do this because as a nurse, I am allowed to withhold a medication but

never change the dose or time that the medication is to be given. The patient’s physician was

then notified and approved that the medication should be withheld.

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There have been many other instances where I used my clinical nursing judgement to

provide safe and effective care for my patients. For example, a recent patient of mine had a

bowel resection and an ostomy created on his abdomen. He was in a great deal of pain from this

procedure and had to cough but doing so increased his pain. I provided him with pain

medication and more importantly a blanket to help bind the site which allowed him to effectively

cough thus clearing his secretions. Also, during my summer job as a nurse’s aide at an assisted

living facility, I had a patient who was very confused and was in and out of the hospitals due to

numerous falls. I was working midnight by myself due to short staffing and this patient had

gotten back from the hospital during my shift. After continued attempts to keep him in bed to

prevent another fall, I used my clinical judgement knowing my shift was close to being over and

the dayshift nurse would soon be in to help with this patient. I knew all the other resident were

okay for the time being and I could continue with my other duties after the nurse arrived.

Therefore, I stayed with this resident until the time came.

On the other hand, a study by Peet, J., Theobald, K., & Douglas, C. (2019) concluded that

nursing surveillance needs to be changed because it does not allow nurses to be heard. Nurses

are the with the patients the most, are able to pick up on patient deterioration quickly and add

valuable input on patient condition. The study states that nursing surveillance gives nurses little

value in their role in patient care again because their input is not heard. The study encourages

the use of emancipatory practice development where the central focus is to build a person-

centered approach leading to improved patient care and patient safety. Furthermore, it allows for

open safe communication between all health care professionals included registered nurses. I

have learned in all of my nursing courses and clinical rotations that nursing care should always

be focused on the patient. For instance, when assessing one of my older adult patients I noticed
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that a cap was missing from her PEG tube. This can be a potential problem if the tube started to

leak stomach acid onto her abdomen which would cause irritation to her already fragile skin. So,

I was instructed to wrap the tubing in a washcloth to prevent that from occurring while also

replacing the Lopez valve. My focus was centered completely on the patient and her safety

while the wound care nurse misunderstood my intentions and was very irritated with what I was

trying to do for the patient. In this situation, there was not open communication or focus on the

patient by the wound care nurse. This taught me the importance on interdisciplinary

communication between health care professionals along with advocating for my patients and

assertiveness.

Additionally, Strand, K., & Tveit, B. (2020) developed a study to analyze quality

improvement in third year nursing students. They define quality improvement as “a process to

design and test changes and continuously improve the quality and safety of health care systems

with the aim of leading to better patient outcomes and professional development”. This study

found that it is important for nursing education to allow future nurses to initiate, plan and

implement the best nursing practices. This leads to better quality of care and patient safety.

With each of my clinicals, my instructors allow me to implement care for my patients under their

supervision and guidance. They have always made me recall why it is important to do certain

things such as turning patients every 2 hours to prevent pressure ulcers or knowing the side

effects of medications I administered. Moreover, during my pediatric rotation, I developed a

concept map on a patient I had with diabetic ketoacidosis. This project required me to identity

the nursing diagnosis related to this condition along with the key assessments, in depth

interventions and evaluation of the outcomes I implemented. This has allowed me to develop

safe and effective nursing care.

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Overall, understanding the nursing process is a vital part of being able to implement the

proper and safe care for my patients. This begins with a good individualized and holistic

assessment of each patient. My clinical nursing judgement and critical thinking skills started

with a strong foundation of knowledge that was taught in the classroom, along with hours of

studying, and in the clinical setting where I am able to implement my understanding of current

nursing practices. Finally, I am fortunate to be able to further practice my clinical nursing

judgement and other skills in my job as a nurse’s aide. This includes things such as prioritization,

organization, and patient education.

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References

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: a call for radical

transformation. San Francisco: Jossey-Bass

Lee, S. D., Abdullah, L. K., Subramanian, P., Bachmann, T. R., & Ong, L. S. (2017). An

integrated review of the correlation between critical thinking ability and clinical

decision-making in nursing. Journal of Clinical Nursing, 26, 4065-4079.

Doi: 10.1111/jocn.13901

Peet, J., Theobald, K., & Douglas, C. (2019). Strengthening nursing surveillance in general

wards: a practice development approach. Journal of Clinical Nursing, 28, 1924-

2933. Doi: 10.1111/jocn.14890

Strand, K., & Tveit, B. (2020). Planning and implementing quality improvement projects in

clinical practice: third-year nursing students’ learning experiences. Journal of

Clinical Nursing, 29, 4796-4783. Doi: 10.1111/jocn.15521