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The Importance of Clinical Judgment in Nursing

Tara Williams

Centofanti School of Nursing, Youngstown State University

NURS 4850

Dr. Randi Heasley

March 1st, 2024

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Clinical judgment is a concept used every day in regards to nursing for the safety and

well-being of patients and the healthcare team. This is a professional attribute in nursing defined

as “the process by which nurses make decisions based on nursing knowledge, other disciplinary

knowledge, critical thinking, and clinical reasoning.” (“Clinical Judgment”, 2024) This is not an

element of nursing that can be learned overnight. It takes time and experience to become well-

rounded in clinical judgment and it starts in nursing school and grows throughout one’s career.

Throughout nursing school, one is expected to become familiar with the concept of

clinical judgment. Because of the surge of nursing shortage, new graduate nurses are held to a

higher expectation. This ultimately is leading to a rise of seemingly unqualified nurses that are

faced with difficulty in making decisions pn the health of patients which can lead to harm and

decrease in quality of care (Pouralizadeh et al,2017). This is a dilemma many face and therefore,

is where the importance of education comes into place. It has motivated the educational system

to improve itself and prepare students for an environment where they can feel confident going

into situation where this is needed, but according to research many of the graduating students

lack this crucial aspect (Pouralizadeh et al, 2017). It is important for universities and facilities to

prepare student adequately by practicing practical skills and participating in an interactive

environment that simulates circumstances where clinical judgment is needed.

In the research of “Factors Influencing Nursing Students’ Clinical Judgment: A

Qualitative Directed Content Analysis in an Iranian Context” (Pouralizadeh et al, 2017), a

qualitative study was done that named five factors that influences clinical judgement which are,

thoughtful behavior, professional ethics, use of evidence based care, context of learning

environment and individual and professional characteristics of clinical teachers. It was found that

personal moral principles have an impact on professional ethics. This is important because
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people have different perceptions of right and wrong and therefore influences how they can

approach difficult situations.

Clinical judgment is necessary for nurses to be able to make decisions effectively and

safely. In the study of “A concept analysis of clinical judgment in undergraduate nursing

student” (Uppor et al, 2022), it focusses on the understanding, definition, attributes and

consequences of nursing student using their clinical judgment in healthcare settings. This looks

at clinical reasoning, clinical decision-making, and clinical reasoning and how they are

interchangeably used yet can cause uncertainty if definitions are not understood. The purpose is

to find clarity within these concepts so that it helps further the development of nursing students

clinical judgment. An American researcher defined this as “the process where healthcare

professionals specify the methods, reasoning, and data used in clinical decisions when lacking

any formally identified design and evaluation methods” (Uppor et al, 2022). Meaning there is a

logical idea behind clinical judgment.

Though one uses their past knowledge and experiences to make decisions, there should

be a logical approach that goes into handling patient’s diagnosis. Nursing judgment is a cognitive

process that includes, thinking and analyzing data to problem solve. When newly graduates go

on into their careers, clinical judgment helps them in their plan of care to form appropriate

nursing diagnosis and outcomes according to Justine Conner BN,RN (2022). There is an

expectation of healthcare professionals to be able to put this concept into use no matter the

complexity of the situation.

A personal experience dealing with clinical judgment comes from working in the

hospital. As a nursing student, it is hard to make sound decisions in a quick manner because

there is less experience. When working on labor and delivery one does not only have to care for
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the mother but also the unborn newborn. There was a mother who was preparing birth for her

second child, previously having birthing complications with her first. She did was an active labor

and adamant that she did not want to have a caesarean section. She was going on thirty minutes

of laboring and was not making much progress. It seemed like an ideal option to prepare for a C-

section based on the lack of progress. This however became the last option and the nurses on the

unit thought of all different positions she could try to push in to get the baby to move down. Here

is where nursing judgment comes into play because as the nurse one has to understand the effects

of a prolonged labor, however you still have to put the patient’s wishes as a priority as well. We

helped her into multiple positions that ultimately did not help. A caesarean section looked like

the best option at this point, yet before that a vacuum extraction delivery was discussed. This was

not a C-section but not entirely a vaginal birth unassisted. The options had to be weighed quickly

amongst the healthcare team and the family to determine if this was safe and would give the best

outcome. This option was decided. Throughout this process it seemed to go by in a quick manner

because everyone had to know what to do or what her options were going forth in labor. If one

has not had experience in a difficult situation and not know and fully understand all the options

and the consequences that could come with it, that can set up a situation where all alternatives

are not exhausted and the most invasive one could be executed first when it may not have to.

Clinical nursing judgment is an essential part of nursing. Though knowing basic nursing

skills and providing patient care is highly important, one also has to have the understanding to

make safe decisions in a reasonable time frame. This is a concept that starts in nursing school

and it is up to the education system to prepare students and give them tools to be able to think

critically and put that skills to use.

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References

“Clinical Judgment” (2024) The Essentials. American Association of Colleges of Nursing.

www.aacnnursing.org/essentials/tool-kit/domains-concepts/clinical-

judgement#:~:text=As%20one%20of%20the%20key,critical%20thinking%2C%20and%

20clinical%20reasoning.

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2023). Clinical judgement in nursing – An

evolutionary concept analysis. Journal of Clinical Nursing (John Wiley & Sons,

Inc.), 32(13/14), 3328–3340. https://doi-org.eps.cc.ysu.edu/10.1111/jocn.16469

Pouralizadeh, M., Khankeh, H., Ebadi, A., & Dalvandi, A. (2017). Factors Influencing Nursing

Students' Clinical Judgment: A Qualitative Directed Content Analysis in an Iranian

Context. Journal of clinical and diagnostic research : JCDR, 11(5), JC01–JC04.

https://doi.org/10.7860/JCDR/2017/25753.9822

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

judgment in undergraduate nursing students. Nursing Forum, 57(5), 932–937. https://doi-

org.eps.cc.ysu.edu/10.1111/nuf.12757