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Clinical Nursing Judgement

Victoria Coppola

Nursing Department, Youngstown State University

NURS 4850 Nursing Capstone

Dr. Heasley

March 1, 2024
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As a nurse, the ability to assess a patient and notice slight changes in the patient’s

progress and come up with a logical reason is not something that is taught. When you notice a

decline in a patient’s status you make informed decisions and apply critical thinking to improve

patient outcomes. Clinical judgement is a nurse’s intuition or “gut feeling” that is acquired over

time from the accumulation of knowledge and skills. It is important to pay attention to any new

information or situations, such as lab values, as you never know when applying the information

will be useful. This accumulation enhances the nurse’s ability to observe the patient’s

presentation, objective data, subjective data, and implement evidence-based nursing

interventions to improve the patient’s outcomes and quality of life. According to (Connor et al.,

2022) “… nurses are recognized as key decision-makers, progressively required to provide safe

and effective nursing care in multi-layered healthcare environments that demand higher

cognitive and clinical skills than in previous decades.” Being the key decision-maker, it is vital

that nurses acquire clinical nursing judgement to their practice. The Tanner Model of Clinical

Judgement is a guide that assists in the understanding of clinical judgement and guides nurses to

make effective decisions. According to (Son, 2023) “… based on the Clinical Judgement Model

proposed by Tanner is to strengthen nursing students’ clinical reasoning ability as a conceptual

framework for teaching and evaluate this as regular undergraduate nursing curriculum.” In this

model, there are four components to focus on to succeed at gaining a nurse’s intuition. The steps

include noticing, interpreting, responding, and reflecting. To apply the model to acquire clinical

judgement you first, recognize cues or changes in a patient’s condition, followed by analyzing

and evaluating the collected data, then prioritize interventions and communicate the findings, to

finally evaluate the outcomes.

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An essential component of nursing is clinical judgement, as a nurse’s decision could

directly affect patient outcomes. In order to acquire and improve clinical judgement, one must

engage in real life situations and moments when quick thinking is needed, to develop and

enhance situational awareness and knowledge towards critical situations. According to (Yang,

2021) “…studies mention that nursing students are not developing the complex reasoning skills

and clinical judgement abilities to function effectively on graduation because of knowledge

deficiency and lack of opportunity to practice in the ever-changing healthcare environment.” It is

necessary to focus and improve upon clinical judgement from the start of one’s nursing career, as

early as nursing school. Improving clinical judgement will also correlate with improvement in

time management and assessment skills, which will decrease chances of errors in treatment. Lack

of judgement can lead to medication errors, hospital acquired injuries, or even death. Clinical

judgement is the primary prevention of errors and critical mistakes in young nurses and older

nurses alike. New nurses are considered beginners and will do things by way of rules and

guidelines, when sometimes a situation requires outside the box thinking and the answer may not

be clear cut. Case studies, simulation labs, and clinical hours are all ways to practice and enforce

clinical judgement. The responsibility from the nurse to the patient is the primary focus and must

be treated with importance and in a swift manner.

One particular night shift working as a student nurse tech, I remember a situation where I

applied clinical nursing judgement. It was the middle of the night, and as a nurse assistant it was

my role to turn the patients every two hours. The assistant I was working with that night agreed

that we would go together to turn our patients who required a two person assist to turn first, then

we would separate, and turn our one person assist patients on our own. As we walked into this

particular patient’s room, we both noticed there was tan liquid all over the patient’s sheets and
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blanket. We then noticed there was a pudding cup on the patient’s bedside table and assumed the

patient must have thrown up. After realizing the patient had thrown up, we decided we would

clean him up, turn him, and go on to our next room. While looking at the patient closer I had a

feeling it wasn’t throw up, his position in the bed was flat and he wasn’t responding to us or

stimuli. I had this “gut feeling” that he had aspirated and immediately elevated the head of his

bed and checked inside of his mouth. When inspecting his mouth, it was full of tan liquid and he

was still unresponsive. We then called for a rapid response team and applied a pulse oximeter to

his finger and began to suction his mouth. The patient had a significant desaturation of oxygen,

stating between sixty and seventy. While stabilizing the patient, the nurse called for an

ambulance to transport him to the emergency department. That “gut feeling” that he didn’t just

throw up was my clinical nursing judgement. While assessing the patient and observing that the

bed was flat and not elevated was the key decision that he had aspirated. If we had just treated

the patient as if he had just thrown up and cleaned him, turned him, and left he would have

continued to desaturate and may have not of made it to the emergency department that night.

Having the ability to notice a slight change or decline in a patient and come up with a logical

reason and nursing intervention is clinical judgement, which could make all the difference

between life and death for a patient.

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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, 32(13–14), 3328–3340.
https://doi.org/10.1111/jocn.16469

Son, H. K. (2023). Effects of simulation with problem-based learning (S-PBL) on nursing

students’ clinical reasoning ability: Based on tanner’s clinical judgment model. Effects of
Simulation with Problem-Based Learning (S-PBL) on Nursing Students’ Clinical
Reasoning Ability: Based on Tanner’s Clinical Judgment Model.
https://doi.org/10.21203/rs.3.rs-2803260/v1

Yang, S. (2021). Effectiveness of neonatal emergency nursing education through simulation

training: Flipped learning based on Tanner’s Clinical Judgement Model. Nursing
Open, 8(3), 1314–1324. https://doi.org/10.1002/nop2.748