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Exploration In Clinical Nursing Judgement

Emily Testa
Department of Nursing, Youngstown State University
NURS 4850: Nursing Capstone
Dr. Randi Heasley
March 1, 2024
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Exploration In clinical Nursing Judgement

Clinical judgement is practiced every day in the healthcare world, it is practiced by

doctors, nurses, technicians, etc. The practice is vital to make decisions revolving patient care

and safety. Many nurses use clinical judgement every day and may not even realize they are

using clinical judgement, due to the thought process. Nurses use clinical judgement skills to

assess the patient and the environment surrounding them. Interpretation of the data collected

information in order identify and fulfill patient needs. This process results in the establishment of

nursing diagnoses, effective clinical decision-making, problem solving and the improvement of

care quality. (Seidi et al., 2015, p.15) The concept of clinical judgement was not invented, rather

an evolution of the idea and theory. Clinical judegment may have been around, since the birth of

nursing and healthcare, but current conditions have been an essential tool for nurses judgement

skills. Clinical judgement skills are developed through gained experience and accumulation of

knowledge throughout their time in healthcare.

The importance of the use of clinical judgement is essential in the patient care and safety.

Florence Nightingale reformed healthcare in the 19th and 20th centuries due to her use of clinical

judgement in the quality of care of patients. Nightingale’s reforms significantly impacted how

nurses work and use their skills today. In Thinking Like a Nurse: A Research-Based Model of

Clinical Judgment in Nursing, Christine Tanner discusses the importance of this skill, “Nurses’

noticing, and initial grasp of the clinical situation trigger one or more reasoning patterns, all

which support nurses’ interpreting the meaning of the data and determining an appropriate course

of action.” (Tanner, 2006, p.206) Clinical Judgement is important to the thought process of a

nurse and contributes to the appropriate implementation of care in the patients specific situation
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and diagnosis. Skills improve over time and with gained experience. Clinical judgement is one of

the weakest areas for new grad nurses, contributing to their lack of experience in the healthcare

setting. Many universities and nursing programs are working to improve this gap by lectures;

however, I believe student learn best by hands on experience in clinical.

In my clinical experience I have seen nurses use their clinical judgement to improve their

patient outcomes. Many nurses use their judgement and have their theory verified by the

physician or healthcare team. During my preceptorship at the Cleveland clinic, my nurse

encourages me to use my clinical judgement with our patients. Once at during my shift, my

patient had gone down to CAT scan and was off the unit for 3 hours, my patient maintained an

NPO status till he returned. This patient was a diabetic and had not eaten in several hours due to

his procedure. I completed blood glucose checks every four hours, the results at 7am and 11am

did not require an insulin injection per his sliding scale. Upon returning to the unit after his

procedure, we rechecked his blood sugar and gave him a meal tray. The results for his blood

sugar were slightly elevated but did not require any insulin. My preceptor asked me what we

should do in this situation, implying for me to use my clinical judgement. Through my

knowledge in my clinical experiences, I believed that we should follow the sliding scale,

withholding the insulin, and recheck the blood sugar after the patient had finished his meal tray.

Upon rechecking his blood sugar, the patients results were elevated requiring multiple units of

insulin. We gave the dose of insulin, updated the physician on the patients condition and

continued to monitor the patient for any complications. I completed another blood glucose check

about an hour later to see if the problem was still ongoing, however the patient returned to a

normal baseline glucose level. This experience proved to show my clinical judgement skills and
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got me to think like a nurse in this situation. Through these experiences I will have better

knowledge on treating my diabetic patients and monitoring their parameters.

The clinical judgement model is a resource that should be available to all healthcare

professionals to improve their patient outcomes. For nursing students research found factors

influencing their experience with clinical judgment, “In this study, researchers classified the

factors influencing nursing students’ clinical judgment into five main themes including

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

environment and individual and professional characteristics of clinical teachers.” (Pouralizadeh,

et al., 2017, p.111) All these factors are taught through lecture and clinical experience. The basis

of clinical judgement is getting to know your patient in depth, their history, what has worked for

them previously, and getting their opinion on their health status. With getting to know your

patient comes the previous clinical knowledge and judgement for their plan of care.

The main aspect in teaching clinical judgement is for nursing teachers develop student’s

clinical judgment skills by providing a secure psychological environment, proper training

conditions, using instructional strategies to reinforce deep thinking processes, education of

professional ethics and applying scientific evidence and principles. In my experience I believe

my preceptor is fostering the correct environment to develop my clinical judgement and

knowledge. It is up to nursing instructors to introduce this skill to their students, and for students

to incorporate their skills in the clinical setting. These skills do not develop overnight, they come

with time and experience and the opportunity to make these decisions. If instructors do not allow

their students to think on their own these strategies will never develop fully.
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References

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

Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses' Clinical Judgment Development: A Qualitative
Research in Iran. Iranian Red Crescent medical journal, 17(9), e20596.
https://doi.org/10.5812/ircmj.20596

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in

nursing. Journal of nursing education, 45(6), 204-211.