CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Kayle Augustine
Youngstown State University
Dr. Kim Ballone
Senior Capstone
March 2018
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Clinical Nursing Judgement

With health care constantly changing with new research, discoveries and

with a more and more complex environment, clinical nursing judgement is a big

key factor in order to grow, adapt and implement care or a task quickly with the

best outcome in the least costly way. The health care environment is constantly

changing due to the increase of chronic illnesses, the increased ratio of patient to

nurse new found research and how shorter and shorter hospital stays are. A nurse

is required to think effectively with the best outcome in mind for countless

situations that are presented in ill patients who come to the hospital everyday

(Potgieter, 2012:4).

Nursing is not just keeping a patient clean, fed and comfortable. Each

individual who presents themselves into a hospital cannot go under absolutely one

step by step treatment plan in order to effectively cure/treat their diagnosis. Like

Pongmarutai says, just following a process and analyzing data like a computer will

not always solve a patient’s problem. This why many new qualified nurses do not

actually meet the entry level of clinical judgment that is required of them

(Pongarutai, 2010:1). Experience plays a huge whole in adapting and

implementing fast and correct care for a vast possibility of illnesses, diseases and

problems.
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A vital skill to determine the right nursing interventions is clinical nursing

judgement, especially when dealing patients that can deteriorate quickly. Fast

decisions with the right care implemented is crucial and why much research goes

into clinical judgement and how to constantly improve the health field. These

changing demands bring uncertainty, but nurses are still required to give the most

effective care possible (Lindsey & Jenkins, 2013:64)

In order to increase skills in students, hands on experience and real-life

scenarios can help raise clinical nursing judgment. According to Tanner (2006) it

is inefficient to keep the time the student has with the teacher/instructor with only

preforming tasks and assessments in a controlled environment that is meant to

keep the student safe. Getting the most experience possible has a student can help

them rely on past personal experiences; the basis for clinical decision making

(Tanner, 2006:205). This allows the student to begin at the entry level of clinical

judgement they should have as a beginning entry nurse.

Still a nursing student, I have a lot to learn and a lot of experience to still

gain. My clinical experience and judgment is not up to par as nurses who have

been in the field of multiple years. When it comes to nursing judgement, I can

recall one specific important situation I got stuck in while at clinical in an

intermediate floor. This specific day I was following a nurse who had 3 patients

with a new admission of a man with history of uncontrolled diabetes. He already

had both legs amputated but came in due to diaphoresis, stomach pain and
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vomiting. His blood pressure was around 160/100. The floor he was admitted on

previously had diagnosed him with pancreatitis. He was alert and oriented when

coming in but was still vomiting. The nurse and I administered a medication to

bring his blood pressure down (I can’t recall which medication) and continued to

monitor him. Once he was stable, the nurse and I went to check on other patients

in order to make our rounds. The call light for our diabetic man went on and he

admitted to having chest pain. I asked him to explain and describe the pain, how

much pain, where exactly it was. This is when I went to the charge nurse and

describe the situation. This is when the RRT was called. I got a new blood sugar

from the patient because his previously blood sugar was taken 3 hours ago and

was in the 400’s or so. Though I was student in a very serious situation, I tried my

best to help and use correct clinical judgement in a situation that was well above

my knowledge at the time.

Stable patients can be stable and become unstable with no obvious reason.

It is the nurses job to find that reason, implement treatment and care for our

patients who cannot care for themselves.

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References

Tanner, C.A (2006). Thinking like a nurse: a research-based model of clinical

judgement in nursing Retrieved from Journal of Nursing Education, 45 (6) (2006),
pp. 204-211

Potgieter, E (2012). Clinical teaching: developing critical thinking in student nurses

Retrieved from Professional Nurse Today, 16 pp. 4-8.

Pongmarutai, T. (2010). Application of a judgement model toward measurement of

clinical judgement in senior nursing students. Dissertation 2010.

Lindsey P.L, Jenkins, S (2013). Nursing Students’ clinical judgement regarding rapid
response: the influence of a clinical simulation education intervention. Nursing
Forum, 48 (1), pp. 61-70