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The Importance of Clinical Nursing Judgement in Practice

Marauka Santucci

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Dr. Ballone, Ms. Heasley

February 26, 2023

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The Importance of Clinical Nursing Judgement in Practice

Clinical nursing judgement refers to the process by which nurses make decisions based

on nursing knowledge, evidence, theories, critical thinking, and reasoning. Clinical judgement is

developed through practice, experience, and the continual building of knowledge. During the

clinical judgement process, nurses will collect data, interpret the data, arrive at a nursing

diagnosis, and identify appropriate nursing interventions to implement. This process requires

problem solving, decision making, and critical thinking by the nurse. Health care is becoming

more complex and patient safety is reliant on the safe, accurate, and time sensitive decisions of

nurses. With nurses being recognized as crucial decision-makers in health care, and as they are

progressively required to provide safe and effective care, there is a demand for higher cognitive

and clinical skills than ever before.

According to Clinical judgement in nursing – An evolutionary concept analysis, clinical

judgement is viewed as an essential skill for nurses that has continually evolved, rather than

being discovered or invented. Improving the quality of nursing care and patient outcomes is

dependent on nursing and the development of proper decision-making skills. Clinical judgment

also contributes to the nurse’s ability to respond to changes in patient presentations with

appropriate clinical decision-making and patient advocacy. Clinical judgment requires numerous

types of knowledge that are abstract and applicable in many situations and is derived from

science and theory, which grows with experience.

The article Thinking Like a Nurse: A Research-Based Model of Clinical Judgement in

Nursing writes about Florence Nightingale establishing the idea that observations, and the

interpretation of those observations, were the highlights of trained nursing practice. The article

states that clinical judgement is tremendously complex, and that good clinical judgement
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requires the ability to recognize aspects of a clinical situation, the ability to interpret meanings

and to respond appropriately. In addition, good clinical judgement demands the understanding of

pathophysiological and diagnostic aspects of a patients clinical presentation and disease, as well

as the physical, emotional, social strengths and coping resources for both the patient and the

family. On an acute care unit, nurses often have five or more patients and are responsible for

making judgements about priorities among competing and challenging patient needs. Nurses also

must manage highly complicated processes that include resolving conflicting patient or family

and care provider information, managing patient placement to suitable levels of care, and

coordinating complex admissions and discharges. As previously stated, health care is becoming

more complex and patient safety is reliant on the safe, accurate, and time sensitive decisions of

nurses. It is crucial that nurses learn and build on clinical judgement early on.

To learn clinical judgement takes a lot of consistent practice and continued learning

through experience and the building of knowledge as a nurse. The process of building clinical

judgement begins in nursing school along with building cognitive skills. Clinical decision

making is built when students can integrate scientific knowledge, experiences, and clinical

judgement in specific situations through clinical rotations. These opportunities can guide nursing

students to deeper understandings of the situation and allow them to progress. In addition to

consistent practice and the building of knowledge, a good way to build clinical judgement and

cognitive skills is to emphasize preparation and pre-clinical assessment, and to provide feedback

from peers and instructors during clinical exercises. Feedback can be given to nursing students

through ways of discussing simulations, debriefing, discussions of case studies, and reflection on

clinical practice. The article Professional nurses' understanding of clinical judgement: A

contextual inquiry, explains that students should be guided to understand patient needs, and be
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able to develop appropriate responses as well as adjust care plans based on clinical judgement.

Nursing students should be able to go beyond the protocols, standards, and formal rules to

promote safe patient care.

As a nursing student, I have worked continuously on building and growing my clinical

judgement skills by using the tools and opportunities provided to me during clinical rotations,

time spent in skills labs, and in challenging courses. One specific tool that has aided the growth

of my clinical judgement is the time I have spent in simulation labs. Simulation labs have helped

me to be more comfortable in my skills and ability to react to unexpected situations in a

controlled environment. What I appreciate most about simulation labs are debriefing we do

afterwards. I feel this really helps me to understand the situation from an outside viewpoint as I

discuss the appropriate actions that I took during simulations and actions that I may have missed

and could be reminded of for future simulations. I was able to strengthen my clinical judgement

skills during a recent simulation about a patient case involving cardiac arrest. In this situation, I,

as the main nurse, needed to recall information I learned about EKG’s and be able to recognize

the waveform to know what was happening with my patient. From there I needed to recall all of

the information about that dysrhythmia to know how to treat it. During the simulation, my

patient’s waveform went from ventricular fibrillation to asystole and I had to respond

accordingly. During debriefing, we discussed every step taken during simulation and whether

they were appropriate decisions to make for that patient at that time. Another personal

experience I have that helped me to build my clinical judgement skills was during a clinical

rotation. On this unit I was assigned a patient with a traumatic brain injury and increased

intracranial pressure. Using what I learned in lectures, I was able to perform an accurate

assessment of my patient and monitor them for unexpected changes. I was able to review labs
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and vital signs with the nurse to know whether the interventions being done for this patient were

effective.

Overall, I am eager to continue building and growing my foundation of clinical nursing

judgement as I finish out my nursing program at Youngstown State, and as a nurse in the future.

Christine A. Tanner states that “educational practices must, therefore, help students engage with

patients and act on a responsible vision for excellent care of those patients and with a deep

concern for the patients’ and families’ well-being” (p. 209-210). I believe that the faculty and

educators have helped to prepare me to successfully be an advocate for patients and families by

using the information I have learned throughout this program. As Tanner states, “
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References

Cadavero Jr., A. A., & Oermann, M. H. (2020, October 27). Seven tips for teaching clinical
judgment through cases. Back to top. Retrieved March 9, 2023, from
https://www.wolterskluwer.com/en/expert-insights/teaching-clinical-judgment-through-
cases.

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing – an
evolutionary concept analysis. Journal of Clinical Nursing.
https://doi.org/10.1111/jocn.16469

Graan, A. C. van, Williams, M. J. S., & Koen, M. P. (2017, January 31). Professional nurses'
understanding of clinical judgement: A contextual inquiry. Health SA Gesondheid.
Retrieved March 9, 2023, from https://www.ajol.info/index.php/hsa/article/view/150788.

Meijer, S. (2022, November 8). 5 ways to boost clinical judgment skills in nursing education.
Kaplan Test Prep. Retrieved March 9, 2023, from https://www.kaptest.com/blogs/nursing-
educators/post/5-ways-to-boost-clinical-judgment-skills-in-nursing-education.

Tanner, C. A. (2006, June). Thinking like a nurse: A research-based model of clinical judgment
in Nursing. Thinking Like a Nurse: A Research-Based Model of Clinical Judgement in
Nursing. Retrieved March 7, 2023, from
https://www.mccc.edu/nursing/documents/Thinking_Like_A_Nurse_Tanner.pdf.