Running head: Clinical Nursing Judgment 1

Clinical Nursing Judgment Scholarly Paper

Brandon Reyes

Youngstown State University

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Clinical Nursing Judgment

This paper is focusing on how us nurses make, “clinical nursing judgment” in the

clinical field of practice. To define clinical nursing judgment means, “the process by

which the nurse decides on data to be collected about a client, makes an interpretation of

the data, arrives at a nursing diagnoses, and identifies appropriate nursing actions; this

involves problem solving, decision making, and critical thinking” (“Miller-Keane,”

2003). As a nurse, it is our priority to make logical, rational decisions and determine

whether a given action is right or wrong. Clinical nursing judgment is applied while the

patient is still alive, and the critical decisions are made based on scientific observations,

along with the added skill provided by a long understanding due to similar experiences.

“The distinction of nursing care by professional nurses lies in the clinical

judgment inherent in the processes of assessment, diagnosis, implementation and

evaluation.” (“Van Graan,” 2016). It is important to have critical thinking and clinical

judgment as necessary skills when caring for a patient in an everyday nursing practice.

Without clinical practice, we would have limited exposure to real life scenarios. This

would negatively benefit us in accomplishing the part of developing the “role taking”

skill as a nurse in different patient scenarios. Having such opportunities will give us

nursing students a deeper understanding of the clinical situation and ethical values for
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care. The nursing process has dominated nursing education since the 1960's as theorists

tried to link their theories with the clinical judgment process and to link nursing theory

with clinical practice (“Williams,”).

The personal experience I would like to share where all medical personnel’s used

clinical judgment, including nurses, was my first patient code. I was in the Medical

Intensive Care Unit (MICU) at downtown St. E’s for an offsite clinical last semester for

critical care class. I was helping admit a patient who coded on a previous unit while

receiving dialysis. He was very unstable and this was the second time he coded within 4

hours. Another nurse and I were hooking him up to an EKG, drawing blood from a

femoral line, and the next thing you know, he starts to seize and his blood pressure drops!

Respirations are decreasing with each breath and then no pulse! The nurse hit the code

button on the wall and a code team of about 14 medical personnel’s rushed in. It caught

me off guard and I was in complete shock. I stood off to the side and watched these

heroes do everything they can to save this person’s life. It was amazing to see how each

department had their own required task in bringing this guy back to life. He was a full

code patient. Nurses were doing chest compressions and helping the doctors by pushing

the medications like Atropine to raise the patient’s heart rate. Respiratory watched vitals

and bagged the patient, while the doctors were giving instruction by telling everyone

what to do/look for, etc. Seeing how everyone used clinical judgment in such an intense

moment made everything come together on the outlook of medical professionals by how

they used problem solving, decision-making, and critical thinking in this specific
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scenario. It became reality when the one male nurse demanded me to hop in and due

chest compressions on the patient. I was completely caught off-guard and hesitated for a

brief second before taking action. In that moment, my heart was beating out of my chest

and I had to make clinical judgment on remembering the proper technique of giving chest

compressions by hand placement, locking the arms, exerting pressure by using body

weight, and pressing hard enough to penetrate 2 inches into the chest wall at a rate of 100

compressions a minute. After about 5 minutes into the code and while I was doing chest

compressions, the nurse exclaimed, “We have a pulse!” I was in complete relief and the

adrenaline rush I experienced was amazing. After this experience is when I knew the

Intensive Care Unit was where I wanted to specialize in the field of nursing.

In conclusion, “The focus of the nurse clinical judgment has to be on quality

evidence based care delivery, therefore, observational and reasoning skills will result in

sound, reliable, clinical judgments. Clinical judgment, a concept which is critical to the

nursing can be complex, because the nurse is required to use observation skills, identify

relevant information, to identify the relationships among given elements through

reasoning and judgment” (“McCartney,” 2017). Nursing school, along with the clinical

experience, definitely helps us nursing students develop clinical judgment and critical

thinking skills in the time of need. I am pleased to have chosen nursing as my career and

profession. Everything I have learned and will continue to learn will only further benefit

the people around me and myself. Having the knowledge and clinical experience of being

able to help save a patients life is the most rewarding gift of all!
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Reference Page

Clinical judgment. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine,

Nursing, and Allied Health, Seventh Edition. (2003). Retrieved March 14 2018

from

https://medical-dictionary.thefreedictionary.com/clinical+judgment

McCartney, M. (Ed.). (2017, March 28). Margaret mccartney: Nurses must be allowed to

exercise professional judgment. Retrieved March 18, 2018 from

http://www.bmj.com/content/356/bmj.j1548/rr-0

Van Graan, A. C., Williams, M. J.S., & Koen, M. P. (Eds.). (2016, December).

Professional nurses' understanding of clinical judgement: A contextual inquiry.

Retrieved March 18, 2018 from

https://www.sciencedirect.com/science/article/pii/S1025984816300047