Running Head: CLINICAL JUDGEMENT 1

The Use of Clinical Judgement in Nursing

Jasmine Smith

Youngstown State University

Nursing Capstone

Dr. Ballone

03/19/2018
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The Use of Clinical Judgement in Nursing

Nursing clinical judgement is use d to maintain the health of a patient, provide patient

safety and to improve the patients overall quality of life while providing the best quality of care.

In a clinical environment nurses exercise the use of making clinical judgements and decisions

based on the patients unique situation. Nurses play a key role in overcoming the main challenges

within the healthcare systems. For example the ageing populations, the rise within healthcare

costs, promoting the health of the population, reducing discriminations within the healthcare

setting and applying evidence based practice to create the best patient outcomes in the most

efficient and acceptable manner possible. Health systems require nurses whose use their clinical

judgements to make the best decisions to provide the greatest care for patients.

When it comes to nursing judgement and decision making, it is essential to understand

what happens when nurses vary in their decision making. Variation in healthcare practices is to

be expected and can end in positive or negative outcomes. The patients’ preferences for care and

treatment differ, and in healthcare we may not know which treatments are the most effective.

Variation becomes a problem however when the nurse knows which interventions are clinically

effective and is valued by the patients, but makes an irrational decision. Significant variations

exist in the decisions that nurses’ make when intervening to improve functional impairment,

pain, nausea, dyspnea, fatigue, and pressure ulcers (Doran et al., 2006). A number of studies

have highlighted that when given the same information, and undertaking the same decisions,

nurses will make consistently different judgements and decisions (Thompson et al., 2008a,

Thompson et al., 2008b, Thompson and Yang, 2009). If it is understood why these variations

occur and in what areas they can be identified, then the variations between the impact on patient
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care be acknowledged when determining the different aspects of complex interventions

(Anderson, 2008) required to improve health practices.

A number of studies have described how nurses make judgements and decisions in practice.

These studies generally examine nurses’ clinical reasoning, often categorizing processes such as

deductive reasoning, identifying how nurses make sense of the information surrounding

decisions. Without some idea of the basis for differences then discerning the quality of

judgements and decisions is difficult. One measure of the quality of a decision is its internal

logic or “coherence” (Dowding and Thompson, 2003).

Nurses identify the important information needed in order to make clinical judgements

(Lewis, 2011). Better structured judgements stem from situations in which there is, relevant

information, time is not constrained, expertise is limited, and a well-planned, rational-analytical

approach is used. For those situations where time is limited, information is perceptual or sensory

and the nurse has some perceived expertise it is appropriate to use intuition as the basis for

judgement. The key to successful reasoning is to adapt reasoning to the demands of the task

(Thompson et al., 2008a, Thompson et al., 2008b). Human reasoning involves two parallel forms

of processing. System one is a fast, intuitive, relatively automatic form of reasoning. System one

stems either from instinct, cognitive processes or from highly practiced, repetitive behaviors

(Brehaut et al., 2007). System two is a slower, rational, premeditated form of reasoning. Brehaut

et al. (2007) noted that organizing our knowledge in ways that allow for fast, intuitive reasoning

is a central component in the development of medical expertise. For beginners, every decision

involves premeditated consideration of relevant signs and symptoms, while experts often appear

to make decisions effortlessly (Brehaut et al., 2007).

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As a student I have not yet been placed in a situation where I had to make my own

decisions when deciding the proper care needed to take care of a patient. During a simulation, I

was given the role of the secondary nurse in a situation where the patient was suffering from

postpartum hemorrhage. The patient was a postpartum women on the maternity floor after

having her first child. Upon doing an assessment, I noticed that the patient was bleeding severely

when checking the amount of lochia. The first thought that came to mind, was to massage her

fundus. A fundal massage will help the uterus to contract and return back to its original size,

which will reduce the bleeding. I assisted the head nurse taking turns as we figured out the next

step to take. I noticed that her blood pressure was significantly low and from the substantial

amount of blood lost, I knew the reason why. As everyone scrambled to give this women

medicine and stop the bleeding, I was thinking of how low her blood pressure had become

because of the blood loss. I thought to myself that we would need to replace the blood she lost, to

bring her blood pressure back up to a normal level. I discussed this with the head nurse and we

decided to notify the physician, who informed us to administer one unit of packed red blood

cells. At the end of the simulation my clinical judgement is what saved our patient. The patient

would not have survived without receiving a blood transfusion because of the hemorrhage. The

use of clinical judgement is definitely an important quality for a nurse to have and can also be

life saving for the patients in which care is provided.

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References

R. Anderson New MRC guidance on evaluating complex interventions

British Medical Journal, 337 (2008), p. a1937

Brehaut et al., 2007 J. Brehaut, R. Hamm, S. Majumdar, F. Papa, A. Lott, E. Lang

Cognitive and social issues in emergency medicine knowledge translation: a research

agenda Academic Emergency Medicine, 14 (2007), pp. 984-990

D. Doran, M.B. Harrison, H. Laschinger, J. Hirdes, E. Rukholm, S. Sidani, L.M. Hall, A.E.

Tourangeau, L. CranleyRelationship between nursing interventions and outcome

achievement in acute care settings Research in Nursing & Health, 29 (1) (2006)

D. Dowding, C. Thompson Measuring the quality of judgement and decision-making in nursing

Journal of Advanced Nursing, 44 (1) (2003), pp. 49-57

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision

making and judgement in nursing research and education. International Journal of Nursing

Studies, 50(12), 1720-1726. DOI: 10.1016/j.ijnurstu.2013.05.003