Running Head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment

Shavon Johnson

Youngstown State University

Abstract
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Caring for a patient in any type of health-care setting requires the provider to have well

developed clinical nursing judgment skills to take adequate care of the patient. Taking care of

patients is a huge responsibility for nurses because they are the ones that are constantly with the

patient and their family, unlike the physicians and other core care members on their team. We, as

nurses need to have the adequate knowledge to be able to know what is good for our patients and

what is not. In this paper on Clinical Nursing Judgment, I discuss some main points of the

definition patient advocacy, and correct concepts nurses need to have in order to give the best

care possible.
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Clinical Nursing Judgment can have a variety of definitions, but Manetti (2018) defined it

as “a cognitive or thinking process used for analyzing data, deriving diagnoses, deciding on

interventions and evaluating care” (p. 103). This definition that she uses in Sound Clinical

Judgment in Nursing is the best definition I’ve seen thus far for the term. I feel as if the nursing

judgment is the basis for nurses to focus on the care they give their patients and how they go

about their decision making. Judgment itself, reflects that the nurse needs to have the skills and

knowledge to be able to make choices based on previous learned things and when you add

nursing to that it just sums up that the nurse is doing the best thing for his/her patient that they

can possibly do.

All nurses should have good nursing judgment in my eyes. The better your judgment, the

better the outcome of your patients will be. Having good clinical judgment is an important factor

being in the health-care field and will determine the quality of patient care. Patient advocacy and

being aware of negligence are two main factors in my viewing of having proper nursing

judgment skills. Lachman (2014) states, “The definition of objection in health care involves the

rejection of some action by a provider, primarily because the action would violate some deeply

held moral or ethical value about the right or wrong” (p. 196). With this being said, if you are

one of those nurses who object to something that the patient wishes or does not carry out what
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they want done then you are somebody who does not have the patients thoughts in mind.

Whether we as nurses think it is right or not, the patient gets to make their own decisions at the

end of the day as long as they are competent to do so. With good nursing skills, this differentiates

a good nurse from one who does not respect patients wishes as much.

Patient advocacy is something that comes learned with the term clinical nursing

judgment. Advocating for your patients is huge and without the correct skills and knowing what

is right from wrong, being that good patient advocate won’t be as effective. Patient advocacy is

defined as “nurses practice to protect a patient’s rights and beliefs” (Toda, Sakamoto, Tagaya,

Takahashi, & Davis, 2015). “It is distinguished from paternalism as the advocate respects the

patients values stated explicitly or discerned through the nurses interaction with the patient”

(Toda et al., 2015). In order to be there for your patient, whether it be from other family

members, other healthcare providers or even their medications, you have to know what normal

standards are be able to have the competency to stand up for what you believe is right.

Clinical nursing judgment comes from experience and trial and error. You don’t know

how to be a good nurse until somebody shows you how or until you go through things that build

your nursing knowledge for the better. In order to have good judgment skills in critical

situations, you have to be in critical situations often and get used to what it feels like. I believe

that over time I will have that outstanding clinical judgment that my fellow professors and

clinical instructors have, but until then I will continue to build my judgment skills as a new

nurse. Just because that experience isn’t here yet, does not mean that I still can’t advocate for my

patient and be able to know when something is wrong with them. Going through a nursing

program and getting my bachelors degree has helped me tremendously in building up good

judgment skills to carry on to my future job and be an excellent nurse.

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This past month I noticed myself developing good clinical nursing judgment skills

without even noticing it because the situation was dangerous was all happening so fast. A couple

of weeks ago I was at my second or third precepting shift with my nurse at Trumbull memorial

hospital when it happened. I precept on a basic Medical-Surgical floor and each nurse usually

has around five patients. Since I am getting more comfortable being on the floor, I take my own

patients from my nurses assignment and go from there. I chose a couple patients that I have

previously had that prior day so I can be a little bit more familiarized with what was going on

with them and why they were there.

One of my older woman patients was there for generalized weakness, and hypoxia. She

was on 12 liters of high flow oxygen on the unit and we could not wean her down. On this day of

care, she went down for dialysis from 7 am-12:30 pm. When my patient got back from dialysis

she was starving and kept asking me for a tray, which is normal since she hasn’t eaten yet at all

that day. Since she was in the hospital for weakness and hypoxia she was often confused and

since she was a much older adult it would be a little bit tricky to define if something was wrong

with her regarding confusion. Regardless, I brought her a tray of food and then all of a sudden

she did not want it and kept complaining of nausea. Nausea was normal for my patient on her

stay here which I was aware of because she had been my patient for a couple of days. I went and

got my preceptor so we can give her her PRN Zofran, and my nurse came in the room with me so

she could observe me pass her afternoon meds. I asked the woman for her name and she would

not answer me, at this point she looked very confused and like her body was shutting down. I

relayed to my nurse that something was seriously wrong with our patient. I started talking really

loud in this woman’s ear because she was also hard of hearing but all I got in return was this

weary gaze in her eyes. She was not responding to voice at all. My nurse came and I started to
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worry, so I ran out of the room called for help and got a vitals machine. My patient was still on

her 12 liters but her pulse ox was reading 48!

Upon seeing such a low SpO2, we rechecked on her ear and were still getting the same

reading. My nurse checked to make sure her oxygen was properly in her nose because something

was just not adding up. After tracing the oxygen tubing to the wall, we realized that transport

hooked her oxygen back up to the wrong port and she was not receiving oxygen for 10 minutes

straight. She was breathing on her own for those ten minutes and that was the reason for the

weary eyes, and the no response to voice. Fortunately, we put a mask on her and got her

breathing back up in time and she was okay but without me noticing that she wasn’t the same

lady from the day before she could have died in minutes! I knew my patient and I knew that

something was wrong enough that I needed to go get help. I noticed that the symptoms weren’t

adding up and that her vitals were bottoming out, and with this good nursing judgement we put

together the pieces of why this woman was so hypoxic. I learned a lot from the clinical nursing

judgment definition and I plan to carry these skills on with me in the future and be able to

analyze data, determine diagnoses, and determine adequate patient outcomes.

References

Lachman, V. D. (2014). Conscientious Objection in Nursing: Definition and Criteria for

Acceptance. MEDSURG NURSING, 23(3), 196-198.

https://www.ncbi.nlm.nih.gov/pubmed/25137800

Manetti, W. (2018). Sound Clinical Judgement in Nursing: A Concept Analysis. Nursing Forum,

54, 102-110. https://www.ncbi.nlm.nih.gov/pubmed/30380153

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Toda, Y., Sakamoto, M., Tagaya, A., Takahashi, M., & Davis, A. J. (2015). Patient advocacy:

Japanese psychiatric nurses recognizing necessity for intervention. Nursing Ethics, 22(7),

765-777. https://www.ncbi.nlm.nih.gov/pubmed/25244919