Running Head: CLINICAL NURSING JUDGMENT 1

Scholarly Paper: Clinical Nursing Judgment

Makayla Violette

Centofanti School of Nursing Youngstown State University

NURS. 4852 Senior Capstone Seminar

Kimerly Barone and Randi Heasley

February 28, 2023

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Scholarly Paper: Clinical Nursing Judgment

The clinical nursing judgment is a concept that is a strong foundation of every nurse's

performance at any patient care level. Whether it is outpatient or inpatient, in a hospital or

doctors office, a nurse is always using clinical judgment to give the utmost care for their patients.

Nurses use critical thinking, knowledge, and problem-solving techniques to provide the best

care. According to the concept analysis “Clinical Judgment in Nursing” located in the Journal of

Clinical Nursing, “Clinical judgment is a key attribute of professional practice (Seidi et al., 2015;

Tanner, 2006), and its application is vital to the nursing process, effective clinical decision-

making, problem-solving and the overall consequence of safe and quality patient care (Seidi et

al., 2015)” (Massey PhD et al, 2022.) This concept analysis was performed by healthcare

professionals who were composing a concrete definition of clinical nursing judgment. The

journal explains how through the evolution of nursing there has been clinical nursing judgment

shown throughout decades.

The article mentioned how in World War I nurses were treated wounded warriors and

they had to triage using their knowledge and problem-solving techniques. The researchers

highlighted how “Health care is becoming more complex (Kuipers et al., 2014), and nurses are

recognised as key decision-makers, progressively required to provide safe and effective nursing

care in multi-layered healthcare environments that demand higher cognitive and clinical skills

than in previous decades (Clemett & Raleigh, 2021)” (Massey PhD et al, 2022.) It is evident that

nursing clinical judgment is a very important concept that is used in everyday practices. It allows

the nurse to use her intelligence and observations to be able to treat patients with optimal care

and treatments. Us, as nurses, have to be able to use our education and quick thinking so that we

can treat all of the patients equally and quickly to prevent further complications.
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Using nursing clinical judgment is very important for nurses to use. According to

concept analysis “Clinical Deterioration: a concept analysis,” in the Journal of Clinical Nursing,

“Literature has demonstrated that inpatients who suffer cardiopulmonary arrest can show signs of

physiological decay 24 hr prior to arrest and an estimated 23,000 cases of in-hospital arrest can

be avoidable with better care” (Padilla & Mayo, 2017.) The analysis study explains how patients

with future conditions/problems can possibly be avoided with the use of nursing clinical

judgment. Diagnoses like a stroke, myocardial infarction, and cardiac arrest are all detrimental

situations that can cause lifelong effects. Using clinical judgment, nurses are able to look at

different situations and try to prevent further issues from occurring. Nurses can use their

knowledge, observation skills, and problem solving abilities to be able to identify and work

quickly.

A personal experience that I used nursing clinical judgment is when a patient had gone

into hypoglycemic reaction. She was a 78 year old woman and had been admitted post op from a

hip replacement. It was lunch time and as the lunch trays were being served she began to be

extremely fatigued, confused, and lethargic. She was not able to stay awake and kept falling

asleep. Thinking about her medical history, she was a Type 1 Diabetic. “Type 1 diabetes is a

chronic autoimmune disease characterized by insulin deficiency and resultant hyperglycaemia”

(Lancet, 2018.) Thus meaning that the body is not able to produce insulin, which helps control

and regulate the body’s blood glucose (sugar) levels, resulting in high levels of blood glucose.

With this consideration from her medical history the first intervention we had to do was check

her blood sugar. When her sugar was checked, her blood glucose was 35 mg/dL. Which is

extremely low considering the normal range is 80 mg/dL - 100 mg/dL. Immediately she was

given orange juice and sugar packets to try and bring the sugar within normal range. Slowly her
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sugar started to rise just enough for her to wake up and become more alert and oriented. It was

difficult giving her the juice because she was having a difficult time staying awake. Inorder to

prevent aspiration, we would lift her head up, wake her up, and instruct her to drink. She

followed orders very well and was able to cooperate with us to the best of her ability.

Using Clinical Judgment in the experience listed above, I was able to identify the

problem with signs and symptoms displayed by the patient. She had been showing signs that

could have fallen under any category of diseases or problems, these were broad symptoms that

could have been anything. However, by using the knowledge we had already known about her

medical history, I was able to use critical thinking and act quickly and check her blood sugar for

any drops or elevations. This situation could have been detrimental if it was not taken care of

immediately. Having low blood sugar can lead to hypoglycemia ketoacidosis which can be very

life threatening. Having knowledge about this kind of situation was important in this situation in

order to prevent further issues from occurring. We did not want the blood sugar to drop any

lower than it already had so we had to be educated and know that we do not give insulin, we

would give them a sugary drink like orange juice or apple juice. Sometimes sugar packets are put

into the juices, in this certain situation we did add packets, to help raise that sugar even more. By

using clinical nursing judgment, I was able to solve the situation and prevent further issues for

this patient. There are many cases when patients come in for one diagnosis and have something

happen that is completely unrelated to the original problem. When this happens it can be very

difficult to figure out what the root cause of the situation is. However, if we use knowledge and

critical thinking, we are able to think quickly and treat the situation as needed.
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Citations

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018, June 16). Type 1 diabetes. Lancet

(London, England). Retrieved March 9, 2023, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661119/

Padilla , R. M., & Mayo, A. M. (2017, December 21). Clinical deterioration: A concept analysis

- wiley online library. Clinical deterioration: A concept analysis . Retrieved March 9,

2023, from https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.14238

Phil , J. C. M., Flenday , T., Massey , D., & Dwyer, T. (2022, July 25). An evolutionary concept

analysis - wiley online library. Clinical judgment in nursing - An evolutionary concept

analysis . Retrieved March 9, 2023, from

https://onlinelibrary.wiley.com/doi/10.1111/jocn.16469