Clinical Nursing Judgement 1

Clinical Nursing Judgement

Genevieve Smith

Bitonte College of Health and Human Services, Youngstown State University

NURS 4850 Senior Capstone Seminar

Dr. Heasley

2/26/2024
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What is Clinical Judgment in Nursing?

Clinical Judgment is not something that can be taught, it is something that is learned

through experiences. In the journal, Imparting clinical judgment leading to sound clinical

decision-making and patient advocacy, Embler writes "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." I define clinical judgment as using knowledge and

past experiences to determine how to care for a patient's physical, emotional, and psychological

needs but there is no concrete definition.

Commonly, if a nurse has had a patient with the same diagnosis in the past, then they

know what to expect during care, but a new nurse with no experience with the same diagnosis

may not know how to react if the patient's condition does not go as anticipated. In nursing

school, it is ingrained in the clinical setting and lecture to assess patients and use the assessment

findings and diagnosis to create nursing diagnoses, and goals to implement during care and

evaluate the outcome. This model is a good baseline but doesn't prepare for real-life scenarios as

patients can deteriorate spontaneously which requires a quick response. "Decision-making by

nurses is usually a fluent, quick action, guided by pertinent subjective and objective data

available and often made under labored conditions and in uncertain environments" (Phil, et al,

2022.) This quote further validates that clinical judgment is typically used in high-stakes

situations that do not allow time for step-by-step methods. Clinical judgment skills progress as

experience is gained but isn't something new nurses generally possess.

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Why is Clinical Judgement important?

Clinical Judgement is an important part of nursing as it helps maintain and promote

patient outcomes and safety. "Additionally, poor patient outcomes have been linked to poor

nursing decision-making…" (Poston, Brunette, Ciccone, 2023) This quote helps further explain

that if nursing judgment is poor, then patients' overall outcomes will be poor as nurses are the

front line of care. If a nurse cannot timely recognize subtle cues in a patient's condition and

respond quickly then the patient's health and safety are at risk.

For example, a patient with diabetes mellitus is admitted to the medical-surgical floor

from the emergency department complaining of sweating and anxiety but assumes it is from the

temperature of the room and being admitted to the hospital. Instead of using clinical judgment

and checking the patient's blood sugar, the nurse turns the temperature down in the room and

continues doing rounds on other patients. When the nurse comes back to the patient's room to

give medications, they find the patient unconscious in bed due to hypoglycemia. This patient's

outcome would have been different if the nurse used clinical judgment and realized the patient's

sugar was low due to being NPO in the emergency room for hours, recognizing the symptoms of

anxiety and sweating, and ultimately avoiding the outcome of the patient becoming unconscious.

Personal Experience Using Clinical Judgement

Although there are many experiences I have using clinical judgment, the one I decided

was the most personal and relevant was during one of my nightshift precepting shifts on the

medical surgical floor. My nurse and I had a patient who was admitted to the floor with a small

bowel obstruction, and she had a nasogastric tube placed in the emergency room before arriving
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on the floor that was connected to low intermittent suction. During the shift report, the day shift

nurse told us that the patient had a bowel movement and was passing flatus, so the surgical team

discontinued the order for the NG tube to be connected to suction and the patient was not

experiencing any symptoms of nausea or vomiting and denied these symptoms when asked at the

bedside. While I was grabbing another patient a blanket from the linen closet, I saw the patient's

call light was on and entered the room. She stated that she felt slightly nauseous and thought it

was because the tube was touching the back of her throat. I told the nurse I was working with,

and we decided to give the patient the ordered PRN Zofran and connect her NG tube back to the

suction just in case. Before turning the suction on, we did the ordered NG tube maintenance

which includes flushing the tube with at least 30 mL of water and adding 30 mL of air to prevent

the tube from sitting on the stomach lining. During this time, we also checked the NG tube

placement by comparing the initial placement measurement with the measurement it was at then.

About 100 mL (including the maintenance fluid) drained from the NG tube into the canister, so

we figured the nausea was just the tube irritating her throat. A couple hours later the PCA on the

floor came and informed us that the patient was vomiting over the trashcan. We went into the

room and the canister was still empty. I decided to inspect the NG tube and placement. I realized

that the tube was slightly pulled on causing it to not be in the correct place to suction the stomach

contents out, which was causing the patient to be nauseous and vomit. We advanced the tubing

and got an X-ray to confirm placement. When we got the all-clear, I connected the tube to

suction and the canister started to rapidly fill with dark green stomach contents. I used my

clinical judgment to check the NG tubing to make sure it was in the correct placement so the

suction would work to decompress the stomach and relieve the patient's nausea and vomiting.
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References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022, July 25). Clinical judgement in

nursing – an evolutionary concept ... Wiley Online Library.

https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.16469

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

decision-making and patient advocacy. Wolters Kluwer.

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

Poston, K., Brunette, G., & Ciccone, J. (2023, March 5). Collaborative strategies to

improve clinical judgement and address bedside care challenges. ScienceDirect.

https://www.sciencedirect.com/science/article/pii/S1557308723000239?casa_token=wLpvkBK4

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