1

An Exploration on Clinical Nursing Judgment

Alissa L. Sipus

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Dr. Ballone & Ms. Heasley

February 26, 2023

 2

An Exploration on Clinical Nursing Judgment

Clinical nursing judgment is an important skill that each nurse should have. It is a

concept that is used throughout many healthcare facilities, and that also causes the meaning of

clinical nursing judgment to vary among those individuals. When it comes to building clinical

nursing judgement in nurses it begins in student’s undergraduate programs, with the help of the

educators. According to Uppor et al., 2022 the most citied author in relation to clinical nursing

judgment describes it as “when one interprets or concludes the patients’ needs, concerns or

health problems and decides to take action (or not), make any modification to the standard

approach or improvise a novel approach that suits the response of the patient” (p. 933). To be

able to use clinical nursing judgment correctly nurses need to not only know what is going on

with their patients but also need to really comprehend and understand it to make decisions for the

patient.

Before nurses make a clinical nursing judgment, they need to take into consideration a lot

of things such as, observation of their patients, assessments of their patient, interpreting and

prioritizing data about their patient, and then responding to what they find using clinical nursing

judgment. Nurses then need to reflect on their patient’s outcome to the intervention, which then

is turns help build on nurse’s clinical judgment. These steps need to be taught and prioritized

during nurses schooling because it will only help improve clinical nurse judgment in new nurses

when they start to have to make decision on their own. To ensure that new nurses understand and

use clinical judgment correctly the earlier is it established and talked about in undergrade

education the more competent the nurses will be before entering the nursing practice (Uppor et

al., 2022).

Importance of Clinical Nursing Judgment

 3

Clinical nursing judgment is important for many reasons, but it really is important for the

care of patients. It ensures they are getting the correct and best provided care. Nurses use clinical

judgement to interpret and conclude about what the patient needs, concerns, and health problems

are and then nurses decide what the best action is to care, treat or be there for the patient. It is

first important for nurses to be able to critically think and clinically reason because clinical

judgment is the decision and outcome made by the nurse using those skills (Borgmann et al.,

2020). These are important to the care and treatment of a patient.

The researched based model of clinical judgment is a tool that helps not only new nurses,

but experienced nurse better make accurate clinical judgment decisions about their patient. The

model includes four aspects, the first being noticing. Nurses need to notice if there is something

abnormal or a change in their patient’s status and be able to recognize it, but that stems off doing

a thorough assessment of the patient initially. The second aspect is interpreting, the nurse needs

to understand the data that is presenting to be abnormal and why it is occurring. For example,

abnormal labs, finding a wound, and a patient falling, the nurses need to take into consideration

all the information and determine why and how something is occurring. The nurse then needs to

respond, which includes deciding the right course of action that is correct for the situation,

sometimes that may be no action at all. Then the nurse reflects, this includes the outcomes of the

action given to the patient and an overall reflection of the nurses noticing, interpreting, and

action taken (Tanner, 2006). This allows the nurse to clinically learn and improve on the clinical

judgment, which in turns allows better care and treatment of patients. Nurses need to know how

to use clinical judgment because it can be a life-or-death decision for their patient. The better the

understanding of clinical nursing judgment the better outcome for patients.

Personal Experience: Clinical Nursing Judgment

 4

When it comes to personal experience using nursing clinical judgement, an experience

comes to mind. While precepting on the Neuro/ Spine floor with my nurse we had a patient that

got admitted to the floor post spine surgery. After doing all the patients admitting paperwork, we

then did our initial head to toe assessment which included obtaining vital signs. When getting her

blood pressure, the reading was lower. But we knew from reviewing her medications that she

normally has high blood pressure because she was ordered lisinopril and her chart had

hypertension listed under her history of chronic illness. We make a clinical judgment to not give

her ordered medication because her blood pressure was already low. In addition, we knew that

she would continue to take morphine for pain and that has the capability to lower the patients

blood pressure as well. We used nursing judgment by noticing the blood pressure, we then

interpreted the data by understanding the clinical reasoning for her low blood pressure. Then we

responded by taking appropriate action to not lower her blood pressure anymore because we

know that can cause even more problems for the patient. The outcome showed that her blood

pressure didn’t decrease anymore after holding her medication and giving her pain medications.

We then reflected and talked about why those decisions were made and how they in turn helped

the patient. This was just one example of how I used clinical nursing judgment, it can be used for

a varying of different scenarios, from more emergent to minor situations.

Overall clinical nursing judgment is a crucial and important part of nursing. Nurses need

to begin to learn and truly understand clinical nursing judgment and how to use it. The four

aspects of clinical nursing judgment; noticing, interpreting, responding, and reflecting if used

correctly can help not only take care of patients but possibly save them. It begins with educating

nursing student early on and continuing that education and use of clinical nursing judgment.
 5

With more experience and patients’ nurses will use and make even better clinical nursing

judgments.
 6

References

Borgmann-Klenke, L., Cantrell, M. A., & Mariani, B. (2020). Nurse educators’ guide to clinical

judgment: A review of conceptualization, measurement, and development. Nurs Educ

Perspect ,41(4), 215-221. https://doi.org/10.1097/01.nep.0000000000000669

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in

nursing. J Nurs Educ., 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04

Uppor, W., Klunklin, A., Viseskul, N., & Skulphan, S. (2022). A concept analysis of clinical

judgment in undergraduate nursing students. Nurs Forum, 57(5), 932-937.

https://doi.org/10.1111/nuf.12757