Running head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment

Mackenzie Stanley

Youngstown State University

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Nurses are faced with many challenging decisions throughout their careers that can define

the outcome for their patients. Because of this, clinical nursing judgement is of importance for

every nurse. Through the use of academic research and my own experiences in a nursing setting,

I will examine clinical nursing judgement and its impact for my own nursing practice.

Clinical nursing judgment is a widely used term that can be defined as “an interpretation

or conclusion about patient’s needs, concerns, or health problems and/or the decision to take

action, use or modify standard approaches, or improvise new ones as deemed appropriate by the

patient’s response” (Benner, 2005, p 204). The term “clinical judgment” is often interchanged

with other terms such as problem solving, decision making, and critical thinking. The concept of

clinical judgment is a complex topic that requires sound understanding of the problem at hand, as

well as the ability to interpret it and respond appropriately. Within nursing practice, there are

several complicating factors, including the number of patients the nurse is responsible for and the

prioritization of care based on the patient’s condition and needs.

In the article, “Clinical judgment and decision-making in nursing – nine modes of

practice in a revised cognitive continuum” the concept of clinical nursing judgment is evaluated

by identifying revisions required for the application of judgment within nursing. Standing

(2008) states that the use of clinical judgement indicates that, “in addition to knowing why an

intervention is needed and how to perform it competently, nurses have a professional

responsibility to ‘justify, explain and defend judgements and decisions” (p 125). The cognitive

continuum theory was used to relate different challenges faced with different ways of thinking

and responding to them. This theory demonstrated how tasks are related to different thought

processes and how identifying these can help optimize decision making. A revised version of this

continuum was developed to outline the nature and variety of patient-centered judgment tasks
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and decisions within nursing and how to use this to identify the best way to provide safe and

effective care (Standing, 2008).

According to the article “Nursing Judgment: Educating Nurses to Make Decisions in

Practice” nurses have taken part in decision making since the rise of nursing. These decisions can

range from clinical judgement, to ethical concerns to organization and leadership. This article

states that clinical judgment starts when the nurses first realize the problem at hand. The nurse

analyzes the situation and responds based on their own knowledge of the patient’s condition.

Reflection is a critical part of clinical judgement. During the reflection phase, the nurse is able to

expand and refine background knowledge from their clinical practice. Clinical judgment is

something that can be taught but is an ever-changing concept throughout a nurse’s career

(Schoessler et all, 2012).

“Clinical Reasoned Judgment and the Nursing Process” identifies a model that integrates

the nursing process with a conceptual model of critical thinking to help nurses develop better

critical thinking skills, reason accurately, and make appropriate decisions based on the patient’s

response. Eight different elements were identified to provide a structure of thought processes and

were applied to each step of the nursing process. These included: clarity, accuracy, precision,

relevance, depth, breadth, and logic. This article states that critical thinking is an acquired

behavior that can be integrated into nursing practice by helping to assess, diagnose, plan and

implement, evaluate and revise patient care as needed. This, in turn, will help nurses become

better at making clinical decisions along with more accurate professional judgements (Huckabay,

2009).
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During my past 3 years of nursing school, there were many instances where I was

required to use clinical nursing judgment in order to provide the best care possible for my

patients. During my critical care rotation in the Surgical Intensive Care Unit, many of my

patients required complex levels of care which helped me develop better nursing judgment.

Many of the patients within this unit required mechanical ventilation along with hourly care. Due

to the severity of these cases, it is important to closely monitor patients and identify any

abnormal findings that may warrant further interventions. An example of this included

monitoring patient’s oxygenation status and deciding the best treatment option depending on the

patient’s situation. Some of the possible treatments included checking all ventilator connecting,

repositioning, increasing the Fi02, or suctioning the patient. It was very important for me to use

clinical judgement when assessing my patients so that I could correctly improve my patient’s

status.

Clinical nursing judgment is a very complex component of nursing care that can help to

provide patients with the best care possible. The concept of clinical judgment is a very complex

topic that requires sound understanding of the problem at hand, as well as the ability to interpret

it and respond appropriately. Clinical judgment can be interpreted in several different ways.
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References

Benner, P. 2005 Using the Dreyfus Model of Skill Acquisition to describe and interpret skill

acquisition and clinical judgment in nursing practice and education. The Bulletin of

Science, Technology and Society Special Issue: Human Expertise in the Age of the

Computer. Vol. 24 (3) 188-199.

Huckabay, L. M. (2009). Clinical Reasoned Judgment and the Nursing Process. Nursing Forum,

44 (2), 72-78.

doi:10.1111/J.1744-6198.2009.00130.X

Schoessler, M., Brady M., Engelmann, L., Larson, J., Perkins, I., & Shultz, C. (2012). Nursing

judgment: Educating nurses to make decisions in practice. Nursing Education

Perspectives (National League for Nursing), 33 (6), 422.

Standing, M. (2008). Clinical judgement and decision-making in nursing – nine modes of

practice in a revised cognitive continuum. Journal of Advanced Nursing, 62 (1), 124-134.

doi:10.1111/J.1365-2648.2007.04583.X