Senior Capstone: A Perspective on Clinical Nursing Judgment 1

Senior Capstone: A Perspective on Clinical Nursing Judgment

Brent C. Skall

Youngstown State University

Senior Capstone: A Perspective on Clinical Nursing Judgment 2

Abstract

Clinical nursing judgment as defined by Tanner (2006) is the interpretation of a patient’s

health-related needs, concerns, or problems, as well as the decisions regarding

interventions to address these. The concept of clinical nursing judgment is vague in

nature and needs simplified so that it can be understood. Often, terms are used

interchangeably to describe clinical nursing judgment and this can result in confusion.

The purpose of this paper is to explore the topic of clinical nursing judgment and get a

better understanding. Sound judgment is the foundation of quality nursing care and serves

to guide nurses with decisions in regards to clinical practice. These decisions have a

major impact on patient outcomes and can be the difference between life and death.

Everyday nurses are tasked with organizing, prioritizing, and critical thinking. There is

concern that novice nurses do not have the sound clinical judgment skills required for

clinical practice. Through research and education, there is hope that novice nurses will be

better equipped to practice in the clinical setting. The main goal of nursing is to provide

holistic care to all patients regardless of cultural, ethnic, or religious background. Clinical

nursing judgment will continue to play a key role in nursing practice in years to come.

Keywords: Clinical, Nursing, Judgment

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Senior Capstone: A Perspective on Clinical Nursing Judgment

The intent of this paper is to analyze the concept of clinical nursing judgment. Tanner

(2006) defined the term as the interpretation of a patient’s health-related needs, concerns,

or problems, as well as the decisions regarding interventions to address these . Manetti

(2018) believes that sound clinical judgment is essential in nursing because decisions

made influence patient outcomes. On a daily basis, nurses must make decisions in clinical

practice that call for careful thought. Clinical practice is very demanding and often

requires a nurse to multitask and make important judgments while also providing care.

Ebright (2018) called this complex cognitive work, “stacking” which involves

organizing, prioritizing, and decision-making about patient care delivery in the context in

which that care is delivered while remaining open and flexible to changes in the plan of

care as needed. There is much concern that stacking is difficult for novice nurses because

they do not have the sound clinical judgment skills required upon entry into clinical

practice. Furthermore, novice nurses are not well rehearsed in coming to conclusions

about a patient’s needs, concerns, health problems, and the decision to take action,

modify approaches, or make new ones based on patient’s responses. In contrast to the

novice nurse, experienced nurses have the ability to notice, interpret, respond, and reflect

on patient care. In order to better prepare nurses, both new and old techniques must be

incorporated into nursing school curriculums.

One of the most important concepts that a nursing student should know in order to

develop greater clinical nursing judgment is an understanding of the nursing process.

Huckabay (2009) explains the nursing process as a “conceptual framework that enables

the student or practicing nurse to think systematically and process pertinent information
Senior Capstone: A Perspective on Clinical Nursing Judgment 4

about the patient. More specifically, it enables the nurse to gather objective and

subjective data about the patient, make a nursing diagnosis based on the data, plan the

care, implement the care, evaluate the care, and revise the care based on the results of the

evaluation.” To understand the purpose of the nursing process, one must also be able to

think critically. As a student or nurse acquires critical thinking skills they are better able

to analyze data, come to conclusions, make interpretations, and make implications in

patient care. Most of these critical thinking skills are obtained through clinical practice

and clinical instructors. It is imperative that instructors are knowledgeable to facilitate

student-learning experiences and to help them develop sound clinical nursing judgment.

This has been an ongoing issue for the past few years. Due to the shortage of nurses

nationwide, nursing schools continue to hire apprentice nurse educators. Research has

shown that these novice clinical teachers often rely on their nursing practice experience,

or the way they learned as students themselves, teaching the way they were taught

(Gardner, 2014). This may result in a disregard to essential course requirements, and

impact the quality of student learning experiences. The key to success of both the

students and novice faculty is mentoring by experienced nurses. Because clinical

instructors are the main source of teaching students to “think like a nurse” it is important

that they are well rehearsed in the concept of clinical nursing judgment themselves. As

students, educators, and nurses continue to integrate the nursing process into care, they

will become better clinical decision-makers and have the ability to make sound

professional judgments.

On a personal level, I try my best to adhere to the nursing process in order to

better my clinical nursing judgment. I have had many experiences in which I had to use
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my judgment to the best of my ability. One prime example of this would be during my

critical care rotation on the surgical intensive care unit at St. Elizabeth’s hospital in

Youngstown, Ohio. My served as a crucial aspect to my learning and was able to help

shape my clinical reasoning and judgment because of her extensive critical care

experience. I remember one situation in particular where I really had to think critically

and use the nursing process in order to provide the best care as possible. The situation

was as follows: my patient was intubated and had suffered serious injuries from a car

crash. The patient had multiple IV drips, a ventriculostomy, an internal cooling catheter,

halo brace and intense neurological and cardiac monitoring. Because of this, I was tasked

with helping the patient maintain homeostasis and an ICP less than 15. In order to

provide exceptional care to this patient, I needed to think like a nurse, and process

information. I prioritized care by first completing the most crucial tasks followed by

some of the more basic ones. After that, I proceeded to gather objective and subjective

data about the patient (by referring to patient’s chart and making observations), made a

nursing diagnosis based on the data (risk for ineffective air clearance r/t patient being

intubated and unconscious), planned the care (what interventions needed to be done),

implemented the care (by completing tasks), and revised care when necessary. By

following the nursing process, I ensured that I was providing the patient with the best

care possible. My clinical nursing judgment skills also continued to advance because I

analyzed data, derived a diagnosis, made interventions, and evaluated the effectiveness of

my care throughout the day.

In conclusion, nurses must continue to advance clinical nursing judgment in

practice and competent when caring for the patient. As a collaborate, nurses must also
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improve their analysis of data, deriving of diagnoses, implementation of interventions,

and evaluation of care, as it will continue to play a key role in care. If all nurses take the

time to improve clinical nursing judgment skills, patient outcomes will be much better. In

sum, it is important to remember that patients’ are human beings and must be treated with

care. Nurses must continue to advocate for the patient and promote a therapeutic and

healing environment.
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References

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

Process. Nursing Forum, 44(2), 72+. Retrieved from
http://link.galegroup.com/apps/doc/A199426314/PPNU?u=ohlink104&sid=PPNU
&xid=a8e7fba6

Manetti, W. (2019, January-March). Sound clinical judgment in nursing: A concept

analysis. Nursing Forum, 54(1), 102+. Retrieved from
http://link.galegroup.com/apps/doc/A573435946/PPNU?u=ohlink104&sid=PPNU
&xid=782eba6e

Rodger, K. (2019). Learning to Think Like a Clinical Teacher. Teaching and Learning in
Nursing, 14(1), 1. Retrieved from
http://link.galegroup.com/apps/doc/A569566134/PPNU?u=ohlink104&sid=PPNU
&xid=03795b57