CLINICAL NURSING JUDGEMENT

Michelle Vidale
Clinical Nursing Judgement
Senior Capstone
March 19, 2018

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Higher cognitive skills are essential competencies for nurses joining the technologically

and increasingly complex health care environment to provide safe and effective nursing care

(Van Graan, Williams & Koen, 2016). Nursing care viewed by the layman is something as

simple as taking care of a sick person, making sure they are comfortable, clean, fed and safe.

Some see it as an assistance to the doctor who does all the thinking and the nurses just follow

through on their orders. Little do they know there is so much more to nursing than that. Nurses

need to be the total eyes and ears to know what may be going on with a patient so that correct

information could be passed on to the doctor. Nurses must assess, diagnose, plan, implement and

evaluate. This is what makes up, in a nutshell, the clinical judgement that is necessary for the

care of the patient so that their needs are met in an appropriate and efficient manner.

The nursing environment is constantly changing and becoming more and more essentially

in need of the acute cognitive skills of the nurse. Nursing has become very complex with the

need for quick action, quick turnover and even quicker discharges, hence the need for the nurse

to be critically evaluating each patient. Not only does the nurse need to do the basic assessment

of the patient by making sure the airway is clear, patient is safe, patient is not losing profuse

blood and patient is comfortable. But he/she needs to assess what else may be going on with a

patient to cause them to have something else going on and what can be done about it. This is

where clinical judgment steps in. The nurse needs to creatively think, observe and interpret any

signs that may lead to something other than the obvious.

Being a novice nurse may make this action difficult to carry out. It takes practice and time to be

like the experienced nurse who can rely on her intuition to be able to assess a problem and act

swiftly to carry out an action. It may mean the difference between life and death. As lifelong

learners, nurses are constantly accumulating more knowledge, expertise and experience, and it’s

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a rare nurse indeed who chooses not to apply his or her mind towards the goal of constant

learning and professional growth (BMJ, 2017).

This takes me to my experience where I got the opportunity to practice clinical nursing

judgement. I am working alongside a nurse in the PACU at the pediatric hospital. When I first

started, I would carefully observe the nurses and how they would care for the children as they

were brought out of their various surgeries. On the one occasion when I felt I was a little more

seasoned, I was asked to assess this teen that had just come out of surgery on his knee. She was

awake, flushed red on her face, feeling nauseous and vomiting and was very combative towards

anyone who was trying to help her. The nurse asked what I would do to help this patient who

clearly felt that she did not need help. She was receiving blow-by oxygen as her SPO2 was

below 95%, it was at 88% so the blow-by at was helping to increase it to 98%. The patient being

combative was due to the effects of the anesthesia and her having a negative effect of coming out

of it. The nursing and surgical staff was trying to keep her calm by speaking to her to try to

orient her to where she was. My nurse counterpart turned to me and asked what she thought I

would do to help with the nausea and vomiting. I thought about it and knew that nothing could

be given by mouth due to her vomiting. Looking at the monitor, her heart rate was fine, her

SPO2 was up and her respiratory rate was a bit elevated due to the fact she was being combative.

She still had her IV in from the surgery and I knew we had to calm her down but the vomiting

also needed to stop. I thought about it and told the nurse, “Why not ask the anesthesiologist to

put in an order for Zofran via IV”! The nurse had already done her assessment of the situation

and knew what was needed to be done, but she wanting to help me to apply my critical nursing

skills to make an appropriate nursing judgement. She commended me on thinking so fast on my

feet.

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It is often difficult to come up with an appropriate solution to a problem. Clinical judgement in

itself encompasses a cycle of sensory activities which begins with perceptions and which is

followed by cognitive functions associated with the intellectual processing of information

through the mental operations of reasoning and judgement, (Phaneuf, 2008). It is through

experience that one can acknowledge the clinical judgement of a situation. Observation,

reasoning, critical thinking, and being knowledgeable of complex situations that one has

experienced over the years, makes clinical judgement something that is easy to summarize.

Paying attention to a patient’s condition and gathering information about the problem makes it

easy to utilize the reasoning abilities to think about the facts and to come to a clinical judgement

solution.

As a professional one must be able to be knowledgeable of the specific situation at hand. They

must be able to use it with the sensory and intellectual abilities to come up with an appropriate

solution. Going through the stages of being a novice to become an expert takes time, training and

a lot of intuition. This is the reality of nursing in this present time. The goal for me is to continue

with my intense observations and analyzing them to become as proficient as my seasoned

counterparts with their ability to make clinical judgements.

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References

McCartney, M. (2017). Nurses must be allowed to exercise professional judgement. BMJ

2017;356:j1548. https://doi.org/10.1136/bmj.j1548 (published 28 March 2017).

Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession.

December 17, 2008.

Van Graan, A. et al (2016). Professional Nurses’ understanding of clinical judgement: A

Contextual Inquiry. Health SA Gesondheid. Volume 21, December 2016, pages

280-293.