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Nursing Clinical Judgment

Vladislav Neboga

Senior Capstone

NURS 4852

Professor Heasley & Ballone

3/12/23
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Nursing Clinical Judgment

Since the rise of modern medicine and nursing, nurses have been engaging in the

decision-making process of patients. This includes clinical judgment, ethical reasoning,

organization, and patient data collection to improve interventions. However, nursing judgment is

viewed as the most valuable dynamic in the clinical setting due to their assistance in defining the

core problems and shaping the appropriate interventions for the patient. This is a logical process

that requires a nurse to review relevant data and assessments, followed up by a reflection on the

possible outcomes of interventions.

However, clinical judgment is complex and sound clinical judgment is said to be the

“Foundation of quality nursing care..” (Connor et al, 2022). Nurses are expected to notice cues

and changes within a patient's condition, regardless of how subtle they are so that they may be

proactive in the prevention of further deterioration. A study by Justine Connor, identified 3

themes as precursors for clinical judgment to occur, “The three themes are classified as knowing

your subject, knowing your situation, and knowing the nursing process” (Connor et al, 2022).

Several factors play a part in these themes as well. For example, knowing your subject is heavily

dependent on the level of education the nurse has received, years of experience they have

attributed, or years of care in specialized fields which allows for quicker pattern recognition.

Knowing your situation refers to the relationship you must build with your patient and colleagues

to create a cohesive interdisciplinary team free of confusion or missed data. The application of

the nursing process, ADPIE, is an explicit precursor to clinical judgment. This involves taking in

your assessment, objective data, and subjective data, to consider a plan and implementing it at

the appropriate times.

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A key skill for all nurses to have is that they must be able to reflect upon critical care

situations such as RRTs and code blues, specifically debriefing after the situation has occurred.

A study conducted by Przednowek found that , “Regular debriefing has been associated with

improved resource utilization and measurable improvements in team performance in crisis

situations” (Przednowek et al, 2021). Although already well established in other high-stakes

industries, such as the military or aviation, it is not provided as a standard in the healthcare field.

The act of debriefing would drastically improve the clinical judgment of a nurse by allowing

them to reflect upon the situations play-by-play. They may realize that their compressions were

too soft, they may realize that they waited too long to call a code blue, or they may have realized

they should not be putting in the IV. Debriefing also supplements what the nurse may already

know about the patient, patients in similar situations, and other relevant treatments that may have

occurred, the act of reflection expands and refines background knowledge for clinical care.

Nurses are at the front of patient care and have the most frequent contact with them. That

is why clinical judgment, and the nursing process is so important for a nurse to have. From the

very first baseline assessment that they conduct at the beginning of their shift, till the end of the

12 hours they are looking for complications and any acute changes that may be signs of

deterioration in a patient. They must then communicate these changes to the physician which

influences the decision and treatment. Diagnostic errors or clinical decision-making mistakes can

be detrimental to the patient's health. “Clinical judgment goes beyond the NCLEX, and there can

be no substitute for years of experience in the field.” (Schoessler et al, 2012) The education

nurses receive prior to their degrees created a strong foundation for clinical judgment, but it is

ultimately up to the individual nurse themselves to be an active learner when they are still new to

continue building their expertise and skills.

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An experience that occurred to me when I had to use my clinical judgment was with a

nursing home patient being transferred up from the ED. She was an older lady who presented

due to the facility's nurses saying that her oxygen saturation was plummeting. The nurse and I

admitted the patient together, she was alert and slightly oriented but could not provide the correct

year or month. As we went about our day, I went to grab our vital signs for 4 o'clock. I had

noticed she was very hard to arouse, her blood pressure became much softer, and had labored

breathing. I immediately decided to listen to her lungs, clear but diminished, recorded her

respiratory rate which had also increased since the baseline vitals, checked the pulse oximeter

which was still normal, and attempted to arouse her one more time prior to getting my nurse.

From here we decided to perfectly serve the doctor to let him know about the patient's current

situation as well as notifying him that we will be drawing ABGs. As we go in to draw the labs,

the RT happens to walk by and we also confirm with her that this is definitely a change from her

previous status. Once the ABGs had resulted we saw that her CO2 was high and her pH was low,

Respiratory acidosis. The RT came in and puts her on a BiPAP, and we continued to monitor her

throughout the day with ABGs and physical assessments.

Patient safety and quality care is a cornerstones in health care, and nurses play a large

part within the ecosystem. That is why clinical judgment ultimately starts and ends with nurses,

however, they may have not had the appropriate training or adequate amount of time as a nurse

to care for specific patients. Continuing education is a must for all new-graduate and even

seasoned nurses, because healthcare is ever-changing with new technology, interventions, and

medications.
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References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing – An

evolutionary concept analysis. Journal of Clinical Nursing, 00, 1– 13.

https://doi.org/10.1111/jocn.16469

Przednowek, T., Stacey, C., Baird, K., Nolan, R., Kellar, J., & Corser, W. D. (2021)

Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community

Emergency Department Setting. Spartan medical research journal, 6(1), 21376.

https://doi.org/10.51894/001c.21376

Schoessler, M., Brady, M., Engelmann, L., Larson, J., Perkins, I., & Shultz, C. (2012). Nursing

Judgment: Educating Nurses to Make Decisions in Practice. Nursing Education Perspective

(National League for Nursing), 33(6), 422.

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