CLINICAL NURSING JUDGMENT: A SYNAPOSIS

Clinical Nursing Judgment: A Synopsis

Catherine Garcia

Youngstown State University

 CLINICAL NURSING JUDGMENT: A SYNAPOSIS

Clinical Nursing Judgment: A Synopsis

The field of nursing is one that requires great skill, extensive training, and sound

judgment of its members. Nurses are often called upon to provide life-saving care and make

split-second medical decisions, often relying upon past training and experience to guide them in

doing so. While many procedures and situational decisions can be ascribed to textbooks and

nursing manuals, many of them cannot, and it is the latter - defined as a nurse's clinical nursing

judgment - that is often required to provide effective medical care.

While no standardized definition of clinical nursing judgment presently exists, it can

perhaps be best defined conceptually as a nurse's ability to exercise judgment, observation,

critical thinking and "soft skills" to complement traditional medical care. It often results in the

satisfaction of a patient's physical, emotional and spiritual needs; medically speaking, it can

result in the identification and interpretation of symptoms, the planning of care to alleviate

symptoms, and in hospice scenarios, a nurse's ability to assist a patient in their passing with

dignity (Phaneuf, 2008). Empathy is often a required skill when it is applied practically, as

critical nursing judgment often entails a nurse making performing care a patient would seek if

the patient had sufficient medical training, and as critical nursing judgment on an emotional

level may also manifest itself as a nurse providing soothing words and other affirmations during

a patient's period of great distress and uncertainty (Phaneuf, 2008).

Clinical nursing judgment is also accepted to be a skill that must be developed and

evolved with experience; one is not simply endowed with it. It is commonly believed that it a

nurse requires 5 years of practical nursing experience to fully develop this skill (Phaneuf, 2008);
 CLINICAL NURSING JUDGMENT: A SYNAPOSIS

in Tanner's (2006) article, it is suggested that developing this skill entails an evolution of four

different functions: noticing (obtaining knowledge from the senses), interpreting

(understanding knowledge arising from these observations), responding (taking action from

these interpretations), and reflecting (learning from outcomes of actions) (Tanner, 2006, p.

208) . When these cognitive skills are fully developed over time, they effectively complement a

nurse's experience allowing the nurse to make sound decisions pertaining to a patient's medical

care, given the contextual, ad-hoc information about the patient's situation.

Applied within the correctional nursing environment, clinical nursing judgment is an

invaluable asset that allows a nurse to provide appropriate care in difficult circumstances.

Nurses are often tasked with providing care to individuals accused of the most heinous

offenses, and those who have sustained severe injuries or wounds resulting from the

commission of their criminal acts, or their attempts to elude law enforcement. Within this

context, nurses are often tasked with suspending their judgment of the patient's criminal acts

while administering care – which is often quite difficult to do, particularly if the act affects the

nurse on a personal level – and respecting that all patients are entitled to respect, dignity and

compassion, regardless of the criminal accusations pending against them (Williams and Heavey,

2014).

Clinical nursing judgment is often required and of value when nurses are tasked with

functioning in a forensic capacity, which can present challenges as the law enforcement

community's interest in obtaining evidence from a patient often conflicts with a nurse's interest

in providing effective medical care. Finally, clinical nursing judgment in this context often

entails bearing a calm demeanor in the presence of law enforcement personnel and criminals
 CLINICAL NURSING JUDGMENT: A SYNAPOSIS

or those accused of criminal activity; whereas law enforcement personnel often depend upon

intimidation and a stern demeanor to exert control over the individuals trusted to their

custody, and as those in custody can often exhibit belligerent behavior when confronted or

questioned, presenting a calm demeanor allows the nurse to perform their duties in a

professional and efficient manner despite the hostilities and tension in the environment

surrounding them (Williams and Heavey, 2014).

My own experience exercising clinical nursing judgment occurred within the correctional

nursing context: while serving a rotation within the SICU, I was assigned to a suspected criminal

who bore gunshot wounds to the neck and pharynx, resulting from his attempts to elude law

enforcement; these wounds warranted treatment within a level 1 trauma facility. The patient's

criminal actions required the patient to be accompanied by law enforcement personnel on a

24-hour basis, and the personnel assigned to these duties were exacerbating the patient's

mental state by provoking him, unplugging his television and making unpleasant and

derogatory statements towards him.

As the patient's medical history included documented incidents of belligerence towards

medical personnel, I disregarded this information and exercised clinical medical judgment by

voluntarily assisting the patient with his personal hygiene regimen; while doing so, I soothed his

emotional unrest by providing companionship to the patient, conversing with him as if he were

a human being entitled to dignity and respect. My actions resulted in the patient's ceasing of

his belligerent behavior, allowing other medical personnel to treat the patient in a more

pleasant environment than they otherwise would have.

 CLINICAL NURSING JUDGMENT: A SYNAPOSIS

Clinical nursing judgment certainly cannot replace the medical training required of a

nurse, but it effectively complements a nurse's "toolbox" of skills by enhancing the nurse's

ability to make sound decisions in the context of a patient's circumstances. Further, it can allow

a nurse to satisfy a patient's needs that traditional medical care would not otherwise address,

such as their emotional and spiritual needs; addressing these needs often makes the

administration of traditional medical care more efficient and pleasant. It is an invaluable skill

that would produce dividends to every nurse who concerns themselves to invest in developing

it for themselves.
 CLINICAL NURSING JUDGMENT: A SYNAPOSIS

References

Phaneuf, M. (2008, December 17). Clinical Judgement – An Essential Tool in the Nursing ...

Retrieved March 9, 2018, from

http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement–

An_Essential_Tool_in_the_Nursing_Profession.pdf

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

nursing. Journal of nursing education, 45(6).

Williams, T., RN, & Heavey, E., PhD, RN. (n.d.). How To Meet The Challenges Of Correctional

Nursing(1st ed., Vol. 44). Wolters Kluwer Health.

doi:10.1097/01.NURSE.0000438716.50840.04