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Running head: The Importance of Nursing Clinical Judgment

The Importance of Clinical Nursing Judgment

Ashley Wetzel

Senior Capstone
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Abstract

In the following essay, I will define the concept of clinical nursing judgment. I will discuss a

couple personal experiences where I used clinical judgment as a nursing student in a specific

clinical situation. I will also be discussing a few examples of how to have a strong foundation in

understanding and implementing the use of sound clinical judgment as a nurse.

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Before I get into defining the concept and the importance of clinical nursing

judgement, I must first define what clinical judgment is. According to www.medpro.com,

“clinical judgment refers to the thought process (clinical reasoning) that allows healthcare

providers to arrive at a conclusion (clinical decision-making) based on objective and subjective

information about a patient”. It goes without saying, clinical judgment is a vital component in

the safety, wellbeing, and the recovery of all patients.

One way to achieve maximum success and have high rates of registered nurses

who are competent in clinical nurse judgment, is to start with a solid education foundation for

nursing students prior to becoming licensed in the field (and even education courses to maintain

competency beyond graduation).

As mentioned above, I will discuss a couple experiences where I’ve had to use

clinical judgment as a nursing student to help my patient. During one of my critical care

clinical’s this semester, I was given the opportunity to start an IV access point to draw blood.

The patient had a good vein in his right AC, but it was positive for ecchymosis, that surrounded

the area. So, the next place I looked for a vein was in his hand. I found a vein that I liked and

began to insert his IV. Shortly after pushing a saline bolus I noticed a big bubble distal to the

insertion site. In that moment, I realized that he was at risk for his vein to blow. I stopped

flushing saline and was thinking/ mentally preparing to possibly discontinue that site and remove

it completely. Luckily, that option did not have to be implemented because the swelling went

down soon after I stopped the flush, I was able to manipulate the tip of the catheter allowing for

a better blood return and was actually able to bypass the area that was once swollen, in order to
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get the amount of blood needed. One more experience I will like to mention is about a patient I

had in the coronary care unit, who upon purposeful hourly rounding, was found to have his right

IJ cordis line dressing being tugged away from his neck. As the nurse, it is my responsibility to

deliver quality care to the patient while keeping the patient’s safety above all. I used clinical

judgment and with my preceptors “okay” and assistance, we removed his IJ line instead of re-

securing a new dressing on top of the site. The reason behind why we went ahead and removed

the line was due to the increased risk for infection with prolonged time the line has been in, it

was caught to his gown and pulling/ tugging on it, and even though he was on 20ml of 0.9% NS,

it had been passed the mandatory time the doctor ordered the fluid to be infused after surgery, so

instead of having to hook up the saline drip to a different IV site, we discontinued the fluid all

together.

Back to education and why it is so important for nurses, and nursing students

alike, to have a good understanding of what it means to use sound clinical nursing judgment

while providing patient care. There is an article titled, “Clinical Judgment in Nursing Students

After Observation of In-Class Simulations”, that studied the relationship between nursing

students and their clinical judgment skills before and after in-class simulations. The article

mentions “clinical judgment is significantly underdeveloped among graduate nurses”. The article

also mentioned that “The National Council of State Boards of Nursing (NCSBN) acknowledged

that errors that occur in acute care, inpatient settings may be preventable if decisions are made

by nurses with sound clinical judgment (NCSBN, 2017). Educational strategies must focus less

on simple recall and more on experiential learning, so nursing student graduates are able to apply

knowledge in real-life practice (AdairBreault & Breault, 2014)”. So in conclusion, “observation

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of in-class interprofessional simulation and being in the primary nurse role may improve clinical

judgment skills”.

Another article titled “An Innovative Clinical Concept Map to

Promote Clinical Judgment in Nursing Students”, written by Nancy Eisenmann, followed a study

that found a new approach to creating concept maps whose results claimed “student feedback is

positive, pointing to increased ability to prioritize nursing care and simplifying a significant

amount of complex information and improved critical thinking and clinical judgment”. The

article reiterates “clinical judgment is an essential component of nursing education and a

necessary skill for entry-level nurses”. The concept map mentioned in the article can be a helpful

and important tool for students that “increases clinical judgment by assimilating and

analyzing clinical information and integrating it into the nursing process” (Eisenmann, 2021).

The last article I will mention is titled, “Effects of an Experiential Learning Simulation

Design on Clinical Nursing Judgment Development”. This study “applied a model of

experiential learning to design a simulation experience, examined how this design

affected clinical nursing judgment development, and described the relationship

between clinical nursing judgment development and student performance when using the

experiential learning design”. This study’s findings suggest that “using an experiential learning

simulation design results in more highly developed nursing judgment and competency in

simulation performance”. This information is helpful to know so prelicensure programs can

utilize the findings and in return, have more positive outcomes when it comes to new nursing

graduates and their ability to use sound clinical nursing judgment when providing care for their

patients.
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References

Chmil, J. V., Turk, M. F., Adamson, K., & Larew, C. (2015). Effects of an Experiential

Learning Simulation Design on Clinical Nursing Judgment Development. Nurse

Educator, 40(5), 228–232. https://doi-org.eps.cc.ysu.edu/10.1097/NNE.0000000000000159

Eisenmann, N. (2021). An Innovative Clinical Concept Map to Promote Clinical Judgment

in Nursing Students. Journal of Nursing Education, 60(3), 143–149. https://doi-

org.eps.cc.ysu.edu/10.3928/01484834-20210222-04

Klenke-Borgmann, L., Cantrell, M. A., & Mariani, B. (2021). Clinical Judgment in

Nursing Students After Observation of In-Class Simulations. Clinical Simulation in Nursing, 51,

19-27. doi:10.1016/J.ECNS.2020.11.006

Risk management tools & resources. (n.d.). Retrieved March 15, 2021, from

https://www.medpro.com/clinical-judgment cah#:~:text=Clinical%20judgment%20refers%20to

%20the%20thought%20process%20%28clinical,on%20objective%20and%20subjective

%20information%20about%20a%20patient.
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