AN ADVANCEMENT IN CLINICAL NURSING JUDGMENT

An Advancement Of Clinical Nursing Judgment

Paige Strobel

Youngstown State University

4852 Senior Capstone Seminar

Dr. Ballone and Mrs. Heasley

February 20 , 2023
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An Advancement in Clinical Nursing Judgment

As nursing has progressed over the years, so has the way nurses use their clinical

judgment. Nursing clinical judgment is defined as how nurses make a decision based on their

knowledge and extensive background information. This can be from schooling, years of work, or

extensive experience. There are many components that go into nursing clinical judgment such as

problem solving, critical thinking, and decision making. Putting all these together can be

challenging and take a long time to master but it is for the best outcome of the patient. According

to Embler, 2021 :

Clinical judgment is the accumulation of knowledge and skills over time, which

contributes to the nurse’s ability to analyze and synthesize the patient presentation,

objective and subjective data, and then provide evidence-based nursing interventions to

improve patient outcomes; clinical decision making. (p.1)

The primary goal is to provide high end care for our patients and provide them the care they

deserve. Each patient has a different set of needs and a different diagnosis than every other

patient. To increase your clinical judgment skill, having different levels of care for patients helps

you improve your skill and better understand how to individualize your care for each and every

patient you are assigned to. Once you gain the experience and see all types of patients and know

how to care for them and know what needs to be done, your clinical judgment improves.

It is important to gain good clinical judgment to help you prepare for situations where

you are forced to think critically. For example, if your patient has a blood pressure of 80/40 , a

pulse rate of 38, a respiratory rate of 7. A good nursing clinical judgment of the situation would

be to call an RRT for your patient rather than trying to do other things when there are signs your
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patient is crashing. This would give you more help early on and would provide a better outcome

for your patient which is the ultimate goal of the nursing practice. The dynamic and changing

conditions of nurses’ work environment, along with the uncertain and changing situation of

clients, require them to be competent decision-makers and to be able to combine their technical

skills and professional knowledge to make accurate and appropriate clinical judgments about

patients’ health status ( Abbaszadeh et al., 2021). With the ever changing world of nursing, and

how advanced the profession is becoming it is important to improve our clinical judgment skills

and maintain our focus for the best patient outcome.

During my time here at Youngstown State university and pursuing my Bachelor of

Nursing degree, using clinical judgment has made a huge impact on how I go about my day to

day care at clinical to achieve my patients best outcome.All of our clinical staff spends countless

hours trying to prepare us to be the best nurses possible and learn essential skills needed to be a

nurse.I have gained this experience through countless hours at the hospital at clinical,

precepting , and many hours of lectures have given me a lot of insight on how to think critically

and make my own judgments. One certain time sticks out to me when it comes to nursing

clinical judgment. For our professional three clinical on a telemetry unit, I had a patient who was

prescribed Metoprolol for his high blood pressure. During the morning I collected my vital signs

before the morning med pass. My patient's blood pressure was 85/60 and the metoprolol was due

at that time. During this time it was essential to use my clinical judgment to hold the medication

because of the blood pressure being too low and the Metoprolol would drop it even more. During

this time I was using my critical thinking skills like they have taught us in our time in nursing

school.
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Another great experience to enhance our clinical judgment as students is the use of our

sim lab. We use our sim lab for each course we are required to take as students. For each clinical

we have a whole day set up to be a scenario to help us enhance our judgment. For example,

during our Women’s Health clinical we have a special mannequin in our lab that acts like it gives

birth. During this clinical experience our instructors make up a scenario and we have to go in and

treat the patient and figure out what is going on. While we do this there is a microphone in

another room where our instructor can speak to us through it and act like the patient or give

feedback as we are going through the simulations. Going through all these scenarios during our 4

years in the nursing program helps us develop a feel for how having our own patient would feel

like. It also helps improve our critical thinking skills preparing us for real world scenarios and

the NCLEX. Clinical scenarios can be used to teach clinical judgment. Using prompts,

instructors can deliberately lead students through the steps of recognizing cues, analyzing cues,

prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes ( Billings et

al., 2020). This study shows that more students feel more comfortable in the field with having

experience in a sim lab learning basic nursing skills and practicing them first.

My time here at Youngstown State University has provided me with endless

opportunities to learn and many ways to enhance my practice for when I become a nurse. All the

professors have provided me with good learning experience and have shown me countless ways

on how to perfect my nursing clinical judgment and have provided me with a foundation on

which I feel comfortable and ready to excel as a nurse myself. I hope to continue my growth and

learn new things when I become a nurse. Clinical judgment is a lifelong process that can always

continue to be built upon and there are always new things to learn in the nursing world.
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References

Borhani F, Abbaszadeh A, Bahrampour A, Ameri GF, Aryaeenezhad A. Role of judgment

in promoting nurses' decisions and ethical behavior. J Educ Health Promot. 2021

1111111 Mar 31;10:88. doi: 10.4103/jehp.jehp_875_20.

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical

Decision-making and patient advocacy.Wolters Kluwer, Retrieved March 1, 2023, from

https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement

Hensel, Desirée PhD, RN, PNCS-BC, CNE, CHSE; Billings, Diane M. EdD, RN, FAAN, ANEF.

Strategies to Teach the National Council of State Boards of Nursing Clinical Judgment

Model. Nurse Educator 45(3):p 128-132, 5/6 2020. | DOI:

10.1097/NNE.0000000000000773