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Running Header: THE DEFINITION AND IMPORTANCE OF NURSING JUDGMENT 1

The Definition and Importance of Clinical Nursing Judgment

Rey Xavier Colon

Youngstown State University


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The Definition and Importance of Clinical Nursing Judgment

Critical thinking is about being able to effectively solve a problem, reason logically, and

analyze information before forming conclusions (Lee, 2017). Critical thinking, in the context of

nursing practice, is described as the process of purposeful thinking and reflective reasoning

where practitioners examine ideas, assumptions, principles, conclusions, beliefs and actions

(Lee, 2017). This thought process is essential in maintaining the patient’s safety as well as

reaching their nursing goals. Thinking like a nurse or nurse’s clinical judgment is an

interpretation or conclusion about a patient’s needs, concerns, or health problems and/or the

decision to take action use or modify standard approaches, or improvise new ones as deemed

appropriate by the patient’s response (Ward, Morris, 2016). There is no question that clinical

judgment is not only important in the nursing field but in all medical fields because it can be the

difference between life and death.

The importance of clinical nursing judgment cannot be overstated. Medications can save

lives or cause death depending on the rate, concentration, and timing of the administration.

That’s why it is so important for nurses to understand what they are doing and to think critically

while fundamentally understanding how the care they provide affects their patient. Clinical

nursing judgment cannot only help catch mistakes that the nurse might make but it can also help

prevent a mistake other medical professionals might make as well. It is also imperative not to

rely on technology and fly on autopilot because technology is there to help and is not a full proof

safety net. Bar code technology is powerless to prevent errors that occur from incomplete or

incorrect assessment data. For example, if a patient’s medication history isn’t assessed and
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properly documented during the admission process, including when the last dose of each

medication was taken before admission, a patient could inadvertently receive a medication too

early or too late, or even miss an important dose for an entire day (Ayello, 2015).

The process of clinical nursing judgment should be instilled into the early curriculum of

nursing students. This way the students may build upon their clinical nursing judgment through

their tenure at their university and their clinicals/preceptorships. The professors at YSU have

instilled in me a sense of clinical nursing judgment even before I have graduated by constantly

asking questions pertaining to my patient’s status and how it correlates with their assessments

and labs. Every clinical, I’ve had nursing professors probe my mind and make me explain the

thought processes of my assessments and the care that I was providing. This forced me to not

only think critically about my assessments and care, but also think critically about how my care

can affect their goals and outcomes. Just recently I was assessing a DKA patient who was not

alert or oriented and on an insulin drip. I noticed that his response to pain was in all extremities

except for his right arm. This led me to believe that the patient may be suffering from more than

just DKA, but he may have had a stroke that is inhibiting movement of that arm. This analysis is

important because the patient in not alert and oriented and cannot communicate with the nurse to

describe how they are feeling exactly. This simple assessment of a flaccid arm can help cascade

the thought process and provide better focused care for that patient. It provoked more thought

from the physicians who ordered more tests be done to try and obtain a more accurate diagnosis.

It was an epiphany during clinical and an example of how a student nurse can be taught through

their curriculum to build upon their clinical nursing judgment even before they have graduated.

However, essential nursing concepts that facilitate critical thinking among beginning nursing
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students are often lost in the large amount of content needed to build nursing knowledge. Faculty

often times give conflicting messages regarding which concepts are essential. When students

cannot determine which concepts in a course are fundamental and which are less important,

efforts to learn are undetermined by a lack of focus (Ward, Morris, 2016). If nurses are to deal

effectively in today’s increasingly complex and demanding healthcare environment, they are

required to cultivate stronger critical thinking skills that will make them an expert in

individualized, contextual-specific problem solving (Lee, 2017).


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References:

Ayello, E. A., Cohen M. R., , D’Arcy, Y., Day, M. W., Funnell, M. M., Gray-Vickrey, P.,

Heavey, E., Held-Warmkessel, J., Myers III, F. E., Pruitt, B., Sensmeier, J., Simmons, S., Smith,

L. S., Starr, K. T.S., & Strickler, J., (2015). Technology is no substitute for nursing judgment.

Nursing 2015 Wolters Kluwer Health, Inc.. Letters.

Lee, D. S. K, Abdullah, K. L., Subramanian, P., Bachmann, R. T., & Ong, S. L.,. (2017). An

integrated review of the correlation between critical thinking ability and clinical decision-making

in nursing. J Clin Nurs. ;26: 4065–4079

Pouralizadeh, M., Khankeh, H. R., Ebadi, A., & Dalvandi, A. (2017). Concept analysis of

clinical judgment in nursing students: A hybrid model. Iran Red Crescent Med J.; 19(5);

Strickland, H. P., Cheshire, M. H., & March, A. L., (2017). Clinical judgment during

simulation: A comparison of student and faculty scores. Nursing Education Perspectives; 38(2);

85-86

Ward, T. D., & Morris, T., (2016). Think like a nurse: A critical thinking initiative. The ABNF

Journal