CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Jenna Henshaw

Youngstown State University

February 27th, 2018

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Critical nursing judgement, also called critical thinking is one of the most important and

highly researched topic in the nursing field. Critical thinking (CI) has been defined as the ability

to identify a problem, select pertinent information needed to solve the problem, recognize stated

and unstated assumptions, select relevant hypotheses, draw valid conclusions, and justify the

validity of inferences (Kaddoura, M. 2013). This is what sets experienced nurses apart from

students and new graduates. During school we are constantly trying to develop this elusive

concept of critical thinking, we understand what it means but it is an entirely different thing to

actually apply it. The thing I find interesting though is that for me it kind just clicked one day

what it actually meant to use clinical nursing judgement. This experience happened during

professional 3 clinical at Trumbull Memorial Hospital, and it is a day that I'll never forget.

Our day started out pretty standard with the usual paperwork and early morning

grogginess, my patient had been in the hospital for about a week at this point. She had just been

diagnosed with Crohns disease and was there for an exacerbation and her physician had

performed surgery twice in this timeframe. She had a new colostomy that of course had teaching

and education to go along with it, but thats not what kicked in my critical thinking. Over the

course of the day she had been having very bloody and what seemed like formed stool, which

because she had a colostomy seemed strange to me. Especially considering that she was going

frequently, at some point during my day I got kind of discouraged and I'll admit a bit annoyed

that my cover nurse wasn't coming to look at what I was concerned with. With me being a

student I was thinking I shouldn't overstep my boundaries but I had had enough.

I went directly to the surgical nurse on the floor, knowing that my patient had had two

surgeries over the course of a week and was on heparin. I explained to her that my patient was
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having very large amounts of bloody watery and formed stool and she just looks at me for a

minute. She asks me if I had informed her nurse and I told yes but that I was really concerned

because she shouldn't be bleeding this much or having formed stools in the amount she was.

Within 10 minutes the surgical nurse was in my patients room and had gathered at least 5

residents and their overseeing physician. Turns out my patients was supposed to be off the

heparin at this point in time and that she wasn't passing stool but very large blood clots from her

colon. Needless to say I am glad I listened to my gut that something wasn't right and sought out

the proper people who could help and see what I was seeing.

It took me a lot of courage to do this though because I felt I was being disrespectful in

seeking help, but in fact I was using my judgement that something needed to be done as soon as

possible. In this particular instance I had to break away from my faculty as well as my cover

nurse to get something done for my patient, it was scary and I felt like I had done something

wrong when I saw all those people in my patients room. This in a sense is what it means to use

your judgement, sometimes you may not know if what you're thinking or seeing is right. Critical

thinking makes you question things and seek what needs to be done for your patient. This is why

it is so important to start cultivating this skill as soon as nursing school starts, you don't just gain

sudden insight and knowledge the day you pass the NLEX. This is also why it is being

researched what method of teaching or activities best help foster clinical nursing judgement.

In one study performed at Kasem Bundit University in Thailand, they did a study

assessing the structural equation model of critical thinking among nursing students by sending

out questionnaires. They used cluster random sampling to select 549 first year nursing students,

25% of which were from a private higher education institute. They found that the 25% from
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these private higher education institutes scored higher on the assessment questionnaires then

those who weren't. According to their data though the Self Efficiency (SE), Emotional

Intelligence (EI), and Learning Style (LS) variables had a positively direct effect on critical

thinking. They also found that the Internal Locus of Control (ILC) variable had a negatively

direct effect on critical thinking (SRISAWAD, K., RATANA-OLARN, T., & KIDDEE, K. 2017).

So even with all the education a person can get before becoming a nurse, critical thinking is very

dependent on the person themselves.

The second study I looked at was researching whether or not concept mapping actually

improves critical thinking. They randomly divided a group of 4th year nursing students in half,

one of which went to a one conference on concept mapping. Their conclusion being, Overall, it

can be concluded that concept mapping based on nursing process is effective in the improvement

of critical thinking skills and habits of mind (Moattari, M., Soleimani, S., Moghaddam, N. J., &

Mehbodi, F. 2014). Which unfortunately for us means even though we moan and groan about

having to do a concept map, they truly help in developing clinical nursing judgement. Looking

back on completing a concept map, it makes you think what would I do in a specific situation.

This is the basic foundation of critical thinking, asking yourself what do I need to do.

Critical thinking has been around far longer then any of us students, it is a proven skill

that is essential to the nursing profession. Through the skills we have been taught, we are now

able to tip toe into the realm of being on our own. We have the basic foundation to start building

our knowledge further with experiences good and bad. The road of learning is by no means a

smooth uphill walk, it is full of valleys and obstacles that we can now with some confidence

navigate. Critical thinking is where nursing starts and is where it continues to grow.
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References

Kaddoura, M. (2013). New Graduate Nurses' Perceived Definition of Critical Thinking During

Their First Nursing Experience. Educational Research Quarterly, 36(3), 3-21.

Moattari, M., Soleimani, S., Moghaddam, N. J., & Mehbodi, F. (2014). Clinical concept

mapping: Does it improve discipline-based critical thinking of nursing students?. Iranian

Journal Of Nursing & Midwifery Research, 19(1), 70-76.

SRISAWAD, K., RATANA-OLARN, T., & KIDDEE, K. (2017). The Development of Structural

Equation Model of Critical Thinking among Nursing Students. Walailak Journal Of

Science & Technology, 14(1), 65-73.