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Clinical Nursing Judgment

Olivia Engle

Youngstown State University

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As a registered nurse, it is critical to be able to use assessments and patient

data in order to provide care for patients. When developing a plan of care for a

patient, nurses use clinical nursing judgment. Clinical nursing judgment is the way

in which nurses use critical thinking in order to make decisions about patient care.

Several research studies have been conducted on clinical nursing judgment and its

process. It is important for nurse educators to be able to help with the development

of nursing judgment in students as it is a tool that will be used every day in their

nursing career.

Tanner defined clinical nursing judgment as “an interpretation or conclusion

about a patient’s needs, concerns or health problems, and/or the decision to take

action (or not), use or modify standard approaches, or improvise new ones as

deemed appropriate by the patient’s response” (Manetti, 2017, p. 1). Clinical nursing

judgment is something that is used every day in nursing practice and is essential in

providing patient care. In Tanner’s clinical judgment model there are four steps to

clinical judgment: noticing, interpreting, responding and reflecting. It is important

for all nurses to have good clinical judgment in order to provide safe patient care.

In the article “The Impact of Critical Thinking on Clinical Judgment During

Simulation with Senior Nursing Students” the ideas of critical thinking and clinical

judgment are explored. It is important to state that there is a difference between

critical thinking and clinical judgment. Critical thinking is defined in this article as

“making decisions based on judgment”(Cazzell and Anderson, 2016, p. 1). The

purpose of this study was to evaluate whether or not senior nursing students were

using clinical judgment during their simulations. It also looked at the impact that
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critical thinking has on clinical judgment. The Lasater Clinical Judgment Rubric

(LCJR) was used to measure the clinical judgment of the students. The study

determined that clinical judgment needs a separate definition and educational

pathway from critical thinking.

In a second article also focused around students, “Evaluating the Clinical

judgment of pre-licensure nursing students in the clinical setting”, the level of

clinical judgment present in junior and senior nursing students was assessed. Unlike

other studies that focus on the clinical judgment of students, this study was done in

the clinical setting. The article focuses on the importance of clinical nursing

judgment in nursing practice. It states, “sound clinical judgment is essential to the

delivery of high-quality, safe nursing care” (Manetti, 2017, p. 1). Once again the

Lasater Clinical Judgment Rubric was used in this study in order to evaluate the

students in their clinical. Not surprisingly, it was found that senior students have a

significantly higher level of clinical judgment than junior students.

Gail Clack in “Decision making in nursing practice: a case review” discusses

clinical nursing judgment based off of the specific example of an assessment of a

child with asthma. The assessment occurred in nurse-led asthma clinic, and the

article discusses the importance of good clinical judgment especially because this is

a nurse-led clinic. This article also discusses Tanner’s theory stating “clinical

judgments are more influenced by what the nurse brings to the situation than by the

objective data to hand” (Clack, 2009, p. 24). The nurse in this study did a full history

and physical on a child with asthma, and used this information to make decisions

about treatment. Not only does clinical nursing judgment focus on the treatment of
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the disease, but can also focus on how the disease affects the lives of the patient and

family. In the example given in this article, the nurse is aware that the child’s asthma

is affecting his social life because of missing school. Tanner states that it is

important that when a nurse is using clinical judgment they do not just focus on the

pathophysiology of the disease, but also how it affects the patient and there family

(Clack, 2009, p. 24).

As stated previously, it is important that nursing students begin to develop

clinical nursing judgment while in nursing school. From my own clinical experiences

I believe that my clinical nursing judgment developed the most while in the Surgical

Intensive Care Unit during the fall semester of 2017. These patients were critically

ill, most on ventilators, and many of them could have drastic changes in their

medical status within minutes. It was important for me to use good clinical

judgment when assessing and treating these patients. An example of this is with

mechanically ventilated patients with tracheostomies. It is critical for nurses to have

a good understanding of all ventilator settings and alarms so that these patients can

be cared for properly. For example, if a patient’s oxygen saturation is low and their

lung sounds are not clear, this may indicate a need for suctioning of the

tracheostomy in order to improve airway clearance. It is also important that these

patients are assessed often in order to determine any status changes and treat them

immediately.

Clinical nursing judgment is critical to providing competent patient care.

Much like the Manetti and Cazzell & Anderson articles, my schooling has helped me

develop a clinical nursing judgment. I know that this is something that will continue
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to develop with time throughout my nursing career. It is important that clinical

nursing judgment is used in all aspects of patient care, including patient and family

centered care as mentioned in the Clack article.

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References

Cazzell, M., & Anderson, M. (2016). The Impact of Critical Thinking on Clinical

Judgment During Simulation With Senior Nursing Students. Nursing

Education Perspectives (National League For Nursing), 37(2), 83-90.

doi:10.5480/15-1553

Clack, G. (2009). Decision making in nursing practice: a case review. Paediatric

Nursing, 21(5), 24-27.

Manetti, W. (2017). Evaluating the Clinical Judgment of Prelicensure Nursing

Students in the Clinical Setting. Nurse Educator, 1-5.

doi:10.1097/nne.0000000000000489