Clinical Nursing Judgement

Putting it to use

Kristen Johnston

3/19/2018
 As a Registered Nurse we are the ones who do the hands on care with the patients.

Nurses are the ones giving the medicines, putting in Foley catheters, wound dressing changes

and any other patient care. That is why clinical nursing judgement is so important. Nursing

Clinical judgement is the most important factor that helps decrease the incidence of injury to a

patient (Pouralizadeh, Khankeh, Ebadi, Dalvandi, 2017). Through-out nursing school we are

told that clinical judgement is one of the most important parts of being a nurse. Each semester

since our sophomore spring year we have had clinicals each semester and we were always told

use your clinical judgement; which I did not feel like we could do as a nursing student! We

always had an instructor go with us into a patient’s room to give medicine or do a dressing

change, or insert a Foley Catheter; we were never really by ourselves to be able to use clinical

judgement. Since we are doing our preceptorship we are given more freedom to be able to make

clinical judgement decisions. Clinical judgement is a very important part of the nursing process.

Research has shown that there are five factors that influence nursing student clinical

judgement “thoughtful behavior, professional ethics, use of evidence based care and context of

learning environment and individual and professional features of clinical teachers”

(Pouralizadeh, Khankeh, Ebadi & Dalvandi, 2017). All of these things we learn in nursing

school; we learned them at the beginning or our journey.

When we first heard of concept maps we all decided immediately that we hated them and

we did not understand why they were making us do this. According research making concept

maps are one way to build critical judgement skills (Gerdeman, Lux, Jacko, 2017). Concept

mapping; everyone loved to complain about them! Even though we did not like them; they truly
did help us develop critical judgement. They helped us understand if this is a problem what can

we do to try and help this problem. Looking back now I wish I would have just tried a little

harder when working with them; when we did them I just thought they were away for the

professors to just give us busy work. Concept maps help us nursing students make better clinical

decisions and help improve our clinical judgement.

This semester we are all working side by side with our preceptor; which allows us to us

our clinical judgement that we have developed throughout our class career. One way that I

showed my clinical judgement was on my 5 day of doing my preceptorship. I had a patient who

was 58 years old; was admitted for nausea and vomiting. The patient had a history of diabetes

mellitus, hypertension, GERD, congested heart failure, and depression. This patient was to be

given Lantus, metformin, aspirin, Humalog, protonics, lovenox, and Lasix. At the beginning of

our shift the patient’s blood sugar was 70, the night nurse gave her crackers and a juice to drink,

and said she should check it again before we gave her any of her medicines. The patient was

asymptotic so it wasn’t an emergency situation. My preceptor gave me all of her medicines and

told me to go give her the medication and do my assessment on the patient. Before I gave her the

medicines a re-checked her blood sugar; which was 82. After I did that I went to talk to my

preceptor.

With my patient’s blood sugar being so low I did not think it was a good idea to give her

all of these blood glucose medicines. Her blood glucose was already on the low side and I did

not want it to drop any more than it already had. When I told my preceptor we decided to hold all

of her medicines and call the attending physician to see what they wanted us to do. We both
know that that was too much blood glucose medicine. My preceptor said we need to talk to the

charge nurse and get her opinion on what we should do. She agreed with us that was too much

medicine for her blood glucose. This patient has been there for two days before me and Latosha

had her as a patient. We had to make a call out to the doctor and explain that her blood glucose

was kind of low and we did not think it was a good idea to give her all the blood glucose

medicine. In the end the doctor told us to give the metformin, and hold everything else. We

used our clinical judgement skills when dealing with this patients low blood glucose levels and

the amount of diabetic medicine she was on. Later in the day our patient’s blood glucose went to

120 around lunch time. My preceptor told me that she see things like this happening all the time;

which is sad.

This is just one example of when I had to use clinical judgement. As nursing

students we have studied ways in using clinical judgement but until now some of us having got

to use what clinical judgement skills we learned. As we become registered nurses we will get to

use this skill more. Clinical judgement is something that we learned and when we apply it we can

do great things, and help save lives. Our classes teach us about diseases, how they happen and

what’s going on inside the body; what medications should be given to a person with this disease

process, and how to pass the NCLEX, but learning about it is one thing; but actually getting to

put it to use (everything we have learned so far) is truly amazing.

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 & Diagnostic Research, 11(5), 1-4.

doi:10.7860/JCDR/2017/25753.9822

Gerdeman, J. L., Lux, K., & Jacko, J. (2013). Using concept mapping to build clinical judgement

skills. Capital University , 13(1), 11-17. Retrieved March 117, 2018, from

http://www.nurseeducationinpractice.com/article/S1471-5953(12)00104-7/pdf

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 & Diagnostic Research, 11(5), 1-4.

doi:10.7860/JCDR/2017/25753.9822