Running Head: CLIINICAL NURSING JUDGEMENT 1

Nursing and Clinical Judgement

Tramaine Tillis

Youngstown State University

Nursing Capstone

Dr. Ballone

March 19, 2018

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Nursing and Clinical Judgement

Clinical thinking is important element of nursing. Clinical judgement is the way nurses

use critical thinking to fulfill the needs of patients. It allows nurses to make decisions while

ensuring patient safety. Making clinical decisions are based on nurses analyzing the situation,

observation and reflection of the patient. As a nursing student, students are expected to develop

clinical judgement skills by graduation. When looking at clinical judgment, Tanner (2006)

defined it as “Clinical judgment to means an interpretation or conclusion about a patient’s needs,

concerns, or health problems, decision to take action, use or modify standard approaches, or

improvise new ones as deemed appropriate by the patient’s response” ( p 204).

When looking at Clinical Judgement, Tanner review nearly 200 studies and noted that

there are five conclusion that can be drawn. In the first conclusions of Tanner “ Clinical

judgments are more influenced by what nurses bring to the situation than the objective data about

the situation at hand” (Tanner, 2006 p.204). Secondly of Tanner conclusion “Sound clinical

judgment rests to some degree on knowing the patient and his or her typical pattern of responses,

as well as an engagement with the patient and his or her concerns” ( Tanner , 2006 p.204). Third,

“Clinical judgments are influenced by the context in which the situation occurs and the culture of

the nursing care unit” (Tanner, 2006 p.204). Fourth, “Nurses use a variety of reasoning patterns

alone or in combination” (Tanner, 2006 p.204). Fifth, “Reflection on practice is often triggered

by a breakdown in clinical judgment and is critical for the development of clinical knowledge

and improvement in clinical reasoning” (Tanner, 2006 p.205). After reviewing Tanner’s five

conclusion of clinical judgment it is based on the nurse and patient interaction. Its takes the

nurse listening to the patient and then analyzing the situations. It’s not all about the objective
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data but subjective as well. Nurses have to realize that patients do not respond the same way to

treatments and also diseases. Nurses have to be flexible when it comes to clinical judgement.

Making good clinical judgment requires flexibility and the ability to recognize the aspects of an

undefined clinical situation, interpret their meanings, and respond appropriately. Understanding

the pathophysiological and diagnostic aspects of a patient’s clinical presentation, illness

experience of the patient and family will aide in making clinical nursing judgement. Clinical

judgments require various types of knowledge that are abstract, generalizable, and applicable.

According to Tanner, new nurse must reason things through analytically, must learn how to

recognize a situation in apply and begin to develop a practical knowledge that allows refinement,

extensions, and adjustment of textbook knowledge. Before a nurse graduate, it is the Educational

practices job to help students engage with patients and help them think critical in situations.

When it comes to clinical nursing judgment, nurses that have experience gained it through

practice. Some may say that old nurses make better clinical judgment than new nurse. I believe if

a nurse keep practicing with clinical judgment than they will get better at it.

In healthcare Nurses are significant decision makers (Thompson, Aitken, Doran,

Dowding, 2013). As a nurse, everything you think is important. In order to fulfill patient’s needs,

we must think with a purpose. We are usually the first healthcare staff to see the patient, so our

information we gather and in our interpretation have to be exact. As nurses we have to be

knowledgeable to form clinical nursing judgment. We also have to be observant when it comes

to clinical nursing judgment. It is important that as nurses we make good clinical nursing

judgment because the situation could be life or death. “Clinical judgment includes using opinions

to make nursing decisions for patients based on experience and knowledge in a real clinical

environment” (Kyung Oh, 2016 p.305). Research provided by Kyung Oh (2016), conducted to
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evaluate the effects of a debriefing process that utilized a clinical judgment rubric on nursing

students’ clinical judgment, communication, and skill performance. Having a structured clinical

judgement rubric debriefing is a useful teaching mechanism that helps with clinical judgment,

communication, and skill performance which is essential to new nursing students. Clinical

judgement is based on decisions that improves patient care, responses, and standard nursing

practices and also related to making a conclusion about the patient. As I look back, starting with

sophomore year to now when we had stimulation, I never really understood why we needed to

have the stimulation. Today I get it. It was to help us think critical and aide in making clinical

nursing judgement. The stimulation made us think fast to save the patient life. As graduation is

approaching, it’s starting to hit me. The stuff we did in stimulation soon will be stuff I will be

doing as a nurse. The only difference is it will be a real patient and the clinical judgment I make

is important.

Finally, a time where I had to make clinical nursing judgment was the very first time I

had to precept. The nurse and I received patient report from the midnight nurse. I was assigned to

two patients and I had to decide which one to see first. I decided to see the patient whose glucose

was running low. Before starting the assessment, I notice the patient speech was slow and

slurred. I notice the bed was wet. At first I thought the patient wet the bed but that was not the

case. The Iv of Dextrose 50 had come out and ran all over the bed. The next thing I did was

check the patient glucose and the reading was less than 40. I told the nurse that I think it would

be smart if I administer glucagon orally while she inserted an IV. So we did. It took two bottles

of glucagon to raise his blood sugar levels which came up to 65. The dextrose was running and

we continue to watch the patient. I continue to do my assessment as well to make sure the patient

was in stable condition. Apparently, at 5am lab came to draw blood sugar levels and failed to
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tell nursing of the results. The results were only 12. Lab finally called at 10:30am to notify

nursing. We had to fill out a safe care on lab because they were required to notify us on abnormal

result. Through that process it was my clinical nursing judgment that help me provide the right

care to the patient. Clinical judgment is important part of nursing.

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References

Kyung oh, H. (2016). Effects on Nursing Students’ Clinical Judgement, Communication, and

Skill Performance Following Debriefing using a Clinical judgement Rubric. International

Journal of Bio-Science and Bio-Technology, Vol.8, No.1. Retrieved from https://

www.sersc.org/journals/IJBSBT/vo18_no1/27.pdf

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

Journal of Nursing Education, 45(4), 204- 208

Thompson, C., Aitken, L., Doran D., & Dowding D. (2013). “An Agenda for Clinical Decision

Making and Judgment in Nursing Research and Education. “ International Journal of

Nursing Studies, 50(12): 1720-1726. Dos: 10.1016/j.ijnurstu.2013.05.003