Clinical Nursing Judgment

Hannah Hassett

Youngstown State University

4850: Nursing Capstone

Dr. Heasley

February 26, 2024

 Clinical Nursing Judgment

Clinical Nursing Judgment is a concept everyone in the nursing field has heard but, what

really does this judgment really entail. Nursing judgment would most likely be described by my

fellow peers similar to the following: our ability to make informed decisions as a nurse to help

shape the best patient outcomes as possible. Some questions still arise, such as, in what ways did

we develop this knowledge, how is it standardized, and are new nurses able to form safe nursing

judgments.

In the article ‘Clinical judgment in nursing – An evolutionary concept analysis’, clinical

nursing judgment is described as a “reflective and reasoning process that draws upon all

available data, is informed by an extensive knowledge base and results in the formation of a

clinical conclusion.” (Connor et al.2023). This is a broad definition that serves as an umbrella

term to cover all the realities of the situations that encompass nursing judgment. Within this

same article the nursing process itself was mentioned. This process has multiple names and

various corresponding labels of steps, but this process stands as a guide about how to approach

ambiguous situations without an obvious course of direction. The generalized understood steps

of the nursing process are as follows: assessment, diagnosis, planning, intervention, and

evaluation. As nurses we use the nursing process daily to decide what patient signs and

symptoms are concerning even if we are not directly treating the patient for those corelating

conditions. The nursing process is a continuum that spans the whole nurse patient interaction and

relationship, and nurses constantly must use their judgment to analyze the nursing process steps

necessary to provide safe patient care. As stated in the ‘Nursing Diagnosis Manual: Planning,

Individualizing & Documenting Client Care (7th Edition)’

 “Although we use the terms assessment, diagnosis, planning, implementation, and

evaluation as separate, progressive steps, in reality they are interrelated. Together

these steps form a continuous circle of thought and action that recycles throughout

the clients contact with the healthcare system.” (Doenges et al. 2022, pg 4).

This again emphasizes that this process is used to enhance nursing judgment and is a continuum

and not a definite set of finite steps.

Nurses overall are trained to be problems solvers. Nurses are taught to anticipate patients’

needs and responses to treatments, then respond appropriately and efficiently. During a

baccalaureate-based nurse training, training nurses spend years practicing various activities and

methods to develop and enhance our clinical nursing judgment. The concept of nursing judgment

is an ever-changing idea, it is imperative that this concept stays evolving throughout time,

especially as technology used in patient care is ever changing. The idea that nurses never stop

learning is absolutely a fact -even after new nurse’s graduate, it is the truth. As nurses there will

always be more to learn, and skills to be improved upon. As treatments evolve, technology

evolves so it is only to be expected that a nurse’s knowledge and judgment continues to evolve

as well. As nurses grow and gain clinical experience over their career, they become more flexible

and understanding of the clinical judgment ideals. We build our knowledge on experience, thus

the more experience a nurse has the more knowledge toward clinical nursing judgment they hold.

A personal experience that involves clinical judgment that I hold, took place before I

even started my nursing curriculum. During the beginning of college before my acceptance to the

nursing program I worked at a nursing home and rehabilitation center. This shift I was working

on the rehab side and had an older female patient who was confused, nonverbal, and receiving

therapy for a surgically fixed fractured hip. During my rounds I needed to get a weight on this
patient and noticed she had about a 15lb weight gain since her last weight. I sat the patient down

after reweighing her multiple times to ensure an accurate weight. When I sat this patient down, I

asked if she had any pain, she did not verbally respond, so I began an inspection. I rolled up her

sweatpants leg to reveal her ankle to assess for edema, and it was abundantly evident that her left

leg was significantly more swollen and warm than the other. This patient’s leg had increase in

size to about twice its normal size. Being the novice I was, I was not positive what the diagnosis

would be but knew enough not to walk her more until I had a nurse assess her extremities. The

nurse confirmed that the patient had a surgical complication which was confirmed by a leg

ultrasound, to be a deep vein thrombosis.

As I progress in my career, working in the field as an STNA, preparing to graduate

nursing school, completing my clinical rotations and my practicum I am continuing to build a

foundation of nursing judgment. My curriculum throughout college has implemented multiple

learning tools to help my judgment development. One of the most common learning tools I have

used to develop my judgment is real patient scenarios in the form of case studies/simulations.

Case studies give students the opportunity to look at a real nurse/patient interaction, look at all

the patient symptoms and pertinent details, and come to conclusions based on such. Since these

are real scenarios, it is understood that there were certain indicated correct courses of action

taken within the study/simulation. As a student participating in such study, we are enabled to

track whether or not we were able to correctly identify what actions were imperative in order to

achieve optimal patient outcomes. The best part about case studies is that students get to think

about a patient situation and make inferences at their own pace or in conjunction with other

students and compare them to what was actually completed in the study- without potentially

negatively effecting patient outcomes. Seeing what was done for a patient by the nurse within a
case study helps the student to see how a more experienced nurse or other care team members

compute clinical nursing judgment. The article titled ‘Mapping critical Thinking, Critical

Reasoning, and Clinical Judgment Across the Curriculum’, touches on the importance and

benefits of actually having students act out case studies through role play/simulation to enhance

their learning (Noll et. Al 2023). Acting out case scenarios through simulation really impacted

my learning and judgment. I believe there is something to be said about working with peers at

about the same level of understanding, that helps each student develop their critical thinking

skills as well as their nursing judgment.

To close, clinical nursing judgment is about how we as nurses use all the information

about a situation as well as the nursing process in order to come to an appropriate conclusion.

Throughout training to become a competent nurse there are many different tools implemented to

facilitate the development of such judgment, all of which build on each other. After finishing

nursing school new nurses have the tools to begin a career that uses clinical nursing judgment but

should always be open to learning as experience is gained. Critical thinking within the nursing

profession allows nurses to draw upon their experiences, along with heir nursing judgment in a

way that may impact their future actions in similar situations. Nursing judgment is not a finite

concept, but rather an ever-evolving spectrum.

 References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2023, July). Clinical judgement in nursing -
an evolutionary concept analysis. Journal of clinical nursing.
https://pubmed.ncbi.nlm.nih.gov/35880251/

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2022). Nursing diagnosis manual: Planning,
individualizing, and documenting client care. F. A. Davis Company.

Noll, K., Hunt, C., & Jones, M. (2023). Mapping critical thinking, clinical reasoning, and clinical
judgment across the Curriculum. Nurse Educator, 48(5), 282–286.
https://doi.org/10.1097/nne.0000000000001413