Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

Clinical Judgment in Nursing School, the Workplace and its Importance

Brooke M. Culler

Youngstown State University

Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

Abstract

This paper explores three published articles that explain the importance of clinical

judgment in nursing. One of the articles explains the difference between clinical thinking

and clinical judgment and its importance, while another one is a simulation between

nursing students to show how it works in full effect. The last article I chose was one that

interviews’ nursing students and clinical faculty to get their insight on how they believe

clinical judgment is obtained. All three of these articles show clinical judgment in a

different way in order to help the reader understand the concept from different points of

view.
Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

Clinical Judgment in Nursing School, the Workplace and its Importance

Nurses have one of the most critical thinking jobs out there. They must decide

within a split second what they need to do next or else a patient may die. This can be a

life or death situation, making it crucial for nurses to be on their game everyday. As one

article stated, “Nursing is a practice based discipline and one of the basic objectives of

nursing education is to achieve clinical judgment. Clinical judgment is essential for

decision making and is considered an inseparable part of high quality nursing care

(Khankeh).” So how do we know at graduation if nurses are competent enough to make

these decisions? Through research, I found a few articles that put nurses and nursing

student critical thinking and judgment to the test.

In my first article, “Factors Influencing Nursing Students’ Clinical Judgment,” they

interviewed students, teachers, and clinical instructors to explore there input on clinical

judgment. The study was performed in the School of Nursing and Educational Hospitals

of Guilan University. Through the interviewing process the study used “prolonged

engagement methods to ensure the collection and analysis of participants actual

experiences (Khankeh).” The results showed five categories that they believe influenced

clinical judgment. These factors were, thought behavior, professional ethics, use of

evidence-based care, the context of learning environment, and individual and professional

features of clinical teachers. Through this process students and teachers need to work

together to promote review of topics, and a non-threatening environment. Students

explained that when teachers were more understanding and helpful they became more

open to learning. Students also explained, “teachers follow up questions encourage us to

investigate to develop more sense of our critical thinking (Khankeh).’” As a result it has
Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

been recognized that the clinical learning environment plays an important role in the

success and development of the process of clinical thinking and judgment. “Teachers

need to create an appropriate educational conditions and a safe psychological atmosphere,

and use instructional strategies to strengthen and deepen there thought process

(Khankeh).”

In my next research article that I found, it explored the difference between critical

thinking and clinical judgment and which of them nurse educators should be focusing

more on. So what are the differences between these two similar concepts? As explained

in the article “The Impact of Critical Thinking on Clinical Judgment,” critical thinking is

making decisions based on reflections. Clinical thinking was so vital that in the early

years of nursing it was labeled as the most vital part of being a successful professional

nurse. In order to be a good critical thinker it was simple, all that was needed was years

of experience. “Oermann reported that critical thinking in nursing students is acquired

over time as a cumulative effect of many different clinical experiences (Cazzell).” On the

other side of the spectrum, Clinical Judgment that was not brought about until years later

explained understanding something and then when a problem arose, responding

accurately to this problem. The purpose of the study of the article was to see the impact

that critical thinking had on clinical judgment and how much they went hand in hand. To

evaluate this, nursing student’s demonstrated a pediatric medication administration for

the first time without their instructors. Results showed that critical thinking and clinical

judgment should be defined as separate areas. Some areas of studies with students may

need more help such as gender differences and also ethnicity. In the article it stated, “to
Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

get the gist of something, advanced reasoning must occur; it is influenced more by the

value of a situation than the precise details (Cazzell).”

My last article was a study that showed a process able to measure clinical

decision-making. They believed that human- patient simulation was the best way to

evaluate this process. “This simulation is used in teaching to develop and refine clinical

skills, advanced knowledge and clarify understanding, and evaluate the antecedent and

consequences of clinical decision-making (Shelestak).” In other words, this article

believed to evaluate a students understanding of clinical decision making it is vital for

students to take what they learned in class and apply it to their patients through there

symptoms and complaints. Results showed about fifty percent answered the simulation

correctly and fifty percent answered incorrectly. The article stated, “Students who

incorrectly identified cues were more likely to make incorrect judgments (Shelestak).” I

liked this article the best because just because we read about something in a book does

not mean we truly understand it and would act the correct way when being tested. In

nursing school we do theses simulations about once or twice a semester. I feel as though I

learn the most from them because I am actually getting involved and doing them. Our

skills are also put to the test when we are out in clinical and have to make split second

decisions.

A split decision I had to make as a nursing student will always stick in my mind

as a day I will never forget. I was in my first year of the nursing program and we had just

started our first clinical in the hospital. All of us were so nervous because we finally had

to put what we had been learning the whole year to the test. Our instructor always told us

to answer call lights and help the nurses as much as possible. She explained this would
Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

give us the best experience. A call light went off in a room I knew nothing about; it was

the bathroom call light so I figured she needed help getting back to her bed. When I

arrived she was having a seizure, or at least what looked like one to me at the time. I

knew to protect her so I bear hugged her so that she would not hit her head on anything. I

then began to yell for help. Everyone flooded into the room and shortly later a rapid

response was called. I soon got out of the way to let the doctors do what they needed to

do. My instructor was super proud of me because she had realized I remembered the

important things of what t do if a seizure arose and that was protect the patient. Now that

I am a senior nursing student and about to graduate in a few short weeks, I know that I

did do a very good job but there are a couple things I would change. The first thing I

would change is that I would have pulled the call light again or let it keep going off

because then someone else may have made it to the room also. Knowing what I would do

different now if the situation occurred just show me how much better clinical judgment I

have. I really do believe with all of these articles that clinical judgment takes time an

years of practice. I can’t wait to see a couple years in what other decision I will be

making. Also I will think back to that experience I had a few years back and maybe there

is more I would have changed about the situation. In nursing there is always room to

grow and improve, but studies will always prove that without clinical judgment,
Running Head: THE IMPORTANCE OF CLINICAL JUDGEMENT IN NURSING

References

Cazzell, M., & Anderson, M. (2016). The Impact of

Critical Thinking on Clinical Judgment During Simulation with Senior Nursing Students.

Retrieved March 18, 2018, from

http://eps.cc.ysu.edu:2085/ehost/pdfviewer/pdfviewer?vid=2&sid=8183012e-8636-4d0b-

a718-7c31b6c14458%40sessionmgr120

Khankeh, H., Dr. (2017, May). Factors Influencing

Nursing Students’ Clinical Judgment: A Qualitative Directed Content Analysis in an

Iranian Context. Retrieved March 18, 2018, from

http://eps.cc.ysu.edu:2085/ehost/pdfviewer/pdfviewer?vid=1&sid=8183012e-8636-4d0b-

a718-7c31b6c14458@sessionmgr120

Shelestak, D. S., Meyers, T. W., Jarembak, J. M.,

& Bradley, E. (n.d.) A Process to Assess Clinical Decision- Making During Human

Patient Simulation: A Pilot Study. Retrieved March 18, 2018, from

http://eps.cc.ysu.edu:2085/ehost/pdfviewer/pdfviewer?vid=4&sid=8183012e-8636-4d0b-

a718-7c31b6c14458%40sessionmgr120