1

Clinical Nursing Judgment

Reagan Todd

Department of Nursing, Youngstown State University

NURS 4850: Capstone

Dr. Randi Heasley

1 March 2024
 2

Clinical Nursing Judgment

As one of the key attributes of professional nursing, clinical judgment is a concept by

which nurses make decisions based on their knowledge. This knowledge includes items such as

evidence, theories, ways, or patterns of knowing critical thinking, and critical reasoning as stated

in the article, Clinical Judgment Concept Tool Kit (Cantrell, 2022). The nursing process is the

foundation of clinical judgment. However, clinical judgment is a more comprehensive, action-

oriented, philosophy of client safety. Clinical judgment is important in nursing because it

accumulates knowledge and skills over time. These skills contribute 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 (Embler, 2021). For nursing

students to learn to manage complex clinical scenarios effectively, it is essential to understand

the process and steps of clinical reasoning. Clinical judgment in nursing students was defined in

Uppor’s article, A Concept Analysis of Clinical Judgment in Undergraduate Nursing Students,

stating, that judgment in nursing students is defined as the cognitive process exhibited via a

nursing action by observation, patient assessment, interpreting, and prioritizing data that leads to

a response while using the appropriate nursing practice with the patient (Uppor, 2022). While

students may learn their clinical judgment based on observing experienced nurses' practice, the

best practices for nursing faculty to foster clinical judgment come from things such as safe

opportunities to challenge critical analysis skills, providing reflective debriefing opportunities,

and emphasizing the need for preparation. Patient presentations and objective and subjective data

can be presented quickly in the clinical setting. According to the article, Imparting Clinical

Judgment Leading to Sound Clinical Decision-making and Patient Advocacy, the use of case

studies in the didactic setting and engaging simulation or skills lab beyond repetitive
 3

demonstrations are two ways to integrate critical analysis into a curriculum. Practicing in these

types of settings allows students a safe environment to discuss what went right and wrong and

more importantly, what went wrong can contribute significantly to student confidence which

feeds into clinical judgment and decision-making.

My clinical nursing judgment was tested during a complex care clinical in the medical

intensive care unit. The patient assigned was a 66-year-old female who had suffered from a

cardiac arrest. She had a previous history of cardiac arrest, along with diabetes, COPD, and

asthma. After CPR, the first line of treatment was done for this patient, a defibrillator was used,

and she was then put on an assist-control setting ventilator for life-support.

During her plan of treatment, the physicians discovered her kidneys, liver, and brain

were beginning to decline in function. The patient then remained on continuous dialysis (CRRT)

and had a feeding tube placed, a fecal management system, and multiple cardiac drips running,

along with many other medications ordered. According to the article, Initiation of Continuous

Renal Replacement Therapy versus Intermittent Hemodialysis in Critically Ill Patients, a major

advantage of continuous dialysis therapy is the slower rate of solute or fluid removal per unit of

time (Wald, 2023). Thus, it has significant utility in hemodynamically unstable patients who

cannot tolerate conventional intermittent hemodialysis (Wald, 2023). Her fecal management

system was beneficial during the care because it prevented an increased infection in her already

opened sacral wound. During a neurological examination, the patient’s left pupil was fixed and

dilated. It was nonreactive to light, and a corneal reflex test was conducted to see any brain

activity present. My clinical nursing judgment came into place during these assessments because

I had to observe the patient, conduct an assessment, and interpret the data findings. This then

allowed me to prioritize data and discover what needed to be addressed first. The organization
 4

and prioritization of the patient findings were established early on with the help of the registered

nurse assigned to this patient,

Clinical nursing judgment is an ever-changing process in healthcare. With clinical

experiences, critical thinking ability, an extensive knowledge base, and the capacity to integrate

and incorporate evidence-based research into practice they become necessary to assist in any

decision-making process. Nursing is always changing due to the advancements in technology,

changing disease patterns, discoveries for treatment, and the aging populations, both in the

patients and nurses, hence why clinical judgment is an evolution. It is an essential portion of the

practice to learn from the experience because it will help us gain our nursing judgment and

provide quality patient care and outcomes. Nurses who are more specialized in their setting tend

to use a more holistic approach to making decisions compared to less experienced nurses who

use a task-and-action-oriented approach. However, high-quality, safe patient care is dependent

upon the healthcare provider’s ability to reason, think, and make judgments about the care.

Novice nurses are challenged with overcoming a knowledge gap, leading to less effective

decisions and actions compared to experienced nurses who are challenged with traditional

thinking. Overall, successful critical reasoning and decision-making require a balance of

intuition and evidence-based thinking to make effective clinical decisions. All things considered;

clinical nursing judgment differs between the nurse’s experience, their level of thinking, and the

practice they had away from differing clinical settings. It is vital to practice this judgment away

from patients as well as on patients due to the risk of making mistakes, which is why students

benefit from simulation experiences and debriefing. The best practices nurses can utilize in

clinical judgment are those involving assessment, observation, interpretation, and decision-

making, which can all be practiced in a variety of settings on a diverse patient population.
 5

References

Cantrell, M. (2022) Clinical Judgment Concept Tool Kit. American Association of Colleges of

Nursing. The Voice of Academic Nursing.

https://www.aacnnursing.org/essentials/database/kit/i/c_cj_wg_xls

Embler, P. (2021). Imparting Clinical Judgment Leading to Sound Clinical Decision-making and

Patient Advocacy. Wolters Kluwer.

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

Maffucci, J., Vaderzwan, K., Burt, L. (2023). Evaluating a Shared Reflective Practice to Develop

Nursing Student Clinical Judgment. Lippincott Williams and Wilkins. Nurse Educator.

https://web-p-ebscohost-com.eps.cc.ysu.edu/ehost/detail/detail?vid=5&sid=9b57edf6-

b765-4c08-8d1c fbc8dc9b1c3a

%40redis&bdata=JkF1dGhUeXBlPWlwLHVpZCZzaXRlPWVob3N0LWxpdmUmc2Nvc

GU9c2l0ZQ%3d%3d#AN=38108376&db=cmedm

Uppor, W., Klunkin, A., Viseskul, N. (2022). A Concept Analysis of Clinical Judgment in

Undergraduate Nursing Students. Nursing Fortum (Vol. 57).

 6

https://web-p-ebscohost-com.eps.cc.ysu.edu/ehost/detail/detail?vid=6&sid=8358abec-

0c9c-4003-9873 55bb0a555b5c

%40redis&bdata=JkF1dGhUeXBlPWlwLHVpZCZzaXRlPWVob3N0LWxpdmUmc2Nvc

GU9c2l0ZQ%3d%3d#AN=35671387&db=cmedm

Wald, R., Gaudry, S., Adhikari, NKJ. (2023). Initiation of Continuous Renal Replacement

Therapy Versus Intermittent Hemodialysis in Critically Ill Patients with Severe Acute

Kidney Injury: A Secondary Analysis of STARRT-AKI Trial. Intensive Care Medicine,

(Vol. 49). Division of Nephrology.

https://web-p-ebscohost-com.eps.cc.ysu.edu/ehost/detail/detail?vid=5&sid=d836df58-

dec0-43a5-95bc-9567fd57c61e

%40redis&bdata=JkF1dGhUeXBlPWlwLHVpZCZzaXRlPWVob3N0LWxpdmUmc2Nvc

GU9c2l0ZQ%3d%3d#AN=37815560&db=cmedm