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Clinical Nursing Judgement 1

Clinical Nursing Judgement

Carly Greenwood

NURS4852 – Serroka

January 30, 2018


Clinical Nursing Judgement 2

In the health care system, there are a variety of different professionals who are involved

in the care of one individual. A health care team could consist of, but is not limited to,

physicians, residents, nurses, dieticians, physical therapists and respiratory therapists. Although

each health care professional has a different task at hand during their care, they each have a

common goal: improving the health of their patient. It is because of this common goal that the

team collaborates their work while completing their individual job to provide holistic care for the

patient. Nurses spend a vast majority of their time caring for their patients within the hospital;

they are responsible for completing assessments, implementing doctor’s orders and initiating

proper interventions, making clinical nursing judgement an important quality to have. Clinical

nursing judgement can be a hard concept to understand, as it is an important process gained with

experience that nurses use every day to decide what is best for their patient during that time.

Bussard defines clinical judgment as “the ability of a nurse (or nursing student) to gather

patient data, make sense of that data and then evaluate both the patient’s and one’s own actions.

Self – reflection has been identified as a key component to developing clinical judgment and

should be incorporated throughout the curriculum.” (Bussard, 2017, p.1). Nurses use clinical

judgment to provide proper and safe care to their patients while they are in the hospital by

prioritizing what is most important and then implementing the proper interventions. They look at

what data they have available such as the patient’s chart, their assessments and the patient’s

appearance to identify what the problem is and then what they can do to fix it. As a quick

example, imagine a nurse walking into her patient’s room to administer his morning medications

and she notices that his oxygen stats are down to 85% when they are typically in the mid 90’s.

Interpreting the data she has available, she knows that the patient is most likely having difficulty

breathing. She could raise the head of the bed, apply oxygenation, check the pulse oximeter and
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assess his heart and lungs before administering any medications, since the patient’s airway is of

higher priority.

Clinical nursing judgment is something that is developed with personal experience,

making it important for nursing students to gain enough experience to have this skill developed

upon licensure. There was a study completed in one nursing school to determine whether there is

progression in clinical judgment using high-fidelity simulations measured by the Lasater Clinical

Judgment Rubric. Seventy students were included in the four simulations and at the end of the

first scenario, the mean score was 24.10 compare to the mean score of 40.17 at the end of the

fourth scenario which signified that there was progression in clinical judgment (Bussard, 2017,

p.2). In addition to this theory, Benner had created a hierarchy in nursing starting with a novice

nurse, which would be a new grad, to an expert nurse, one with more than five years of

experience. He concluded that the novice nurse would have very limited knowledge and

experience which would make clinical judgment more difficult, but the expert nurse has more

experience, self-confidence and better intuition which develops better clinical judgment (as cited

in Phaneuf, 2008, p. 4). While both studies prove that clinical judgement is something that is

gained with more experience, it doesn’t explain it’s importance and how it pertains to nursing.

Clinical nursing judgement is an important tool for nurses in order to provide the safest

and most effective care for patients. By using clinical judgement, nurses gather vital information

and assessment data to prioritize patients based on their severity and come up with proper

nursing interventions. It is also a way to reflect upon previous situations and improve on what

could be done differently so that there could be a better outcome. The best way to understand

clinical judgement’s importance is to have a real-life situation as an example to show how it is

used to keep a patient safe and provide proper care.


Clinical Nursing Judgement 4

A patient arrives at the ER with symptoms of dehydration, shortness of breath weakness,

fatigue, excessive thirst and urination; he tells the nurse he is a type 1 diabetic and recently

started to feel very sick. Considering that the patient has type 1 diabetes and is showing signs of

hyperglycemia, the first thing the nurse did was take a blood sugar. While taking the patient’s

glucose and touching his arm, she noticed that his skin was very dry and dehydrated. The result

of his blood sugar was 565, he is becoming less oriented since first arriving and his respirations

are at 26 per minute and labored. Using clinical nursing judgement, the nurse would anticipate a

doctor to place orders for 0.9% NaCl and an insulin drip as first priority, since the patient is

presenting signs of diabetic ketoacidosis. The patient would need to have cardiac monitoring

since there is IV insulin running, glucose would need checked hourly along with urinary output

and level of consciousness. This scenario shows that by gathering all of the information possible

quickly, the nurse can determine what is best for the patient and how important it is to provide

proper nursing care.

In conclusion, as a student nurse who is about to graduate from nursing school, I have

come to learn the importance of clinical nursing judgment and how to implement the process.

Since I have now completed multiple clinicals, simulations and also my preceptorship I have had

different experiences to help contribute to my formation of clinical judgement. Nurses are with

the patient’s the most throughout the day and by assessing their patients they can determine the

abnormal findings and significant changes in data to determine their current health status and

interventions that could implement to help their patient. This interpretation of data and the

interventions used is the process of clinical nursing judgement which is important to providing

safe and proper care and is the kind of care every patient has the right to have.
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Work Cited

Bussard, M.E. (2017). Evaluation of Clinical Judgment in Prelicensure Nursing Students. Nurse
Educator. 00(0), 1-3.
McNiesh, S. (2007). Preceptors Perceptions of New Graduate Nurses. Holistic Clinical
Judgment. 72-78.
Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession.
Retrieved from
http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement%E2%80%
93An_Essential_Tool_in_the_Nursing_Profession.pdf

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