Running Head: CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Danielle McMinn

Youngstown State University

3/16/2018

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Running Head: CLINICAL NURSING JUDGEMENT

Nursing is a practice-based profession and everything we as nurses do affects the health

and well-being of others. Nursing practice needs to be safe and effective in promoting health and

recovery from illness. Thus, nursing practice and actions needs to be well reasoned, responsive

to individual’s needs, and to have outcomes that benefit the patient. According to Standing

(2017), clinical nursing judgement is an informed opinion that relates observation and

assessment of patients to identifying and evaluating alternative nursing options. When I think of

the words ‘clinical nursing judgement’, I think intelligence and assessment. First, one must have

the knowledge to pay attention to the patient’s condition. Then, one gathers information

regarding the actual problem, using critical thinking skills. Lastly, one must resort to logical

deduction to identify the problem. Nurses’ judgements and decisions have the potential to help

healthcare systems allocate resources efficiently, promote health gain and patient benefit and

prevent harm (Thompson, C., Aitken, L., Doran, D., & Dowding, D., 2013).

Without observation, patient-centered clinical judgement and decision making is not

quite possible. Collaborative decision making relies on good observation. We as nurses must be

attentive to what the patient is telling us. It is vital for us to develop effective observation skills,

which comes with experience. Observation is simply using our senses, mainly our eyes to see

what is happening with our patient and environment. The significance of observation needs to be

understood to decide which action needs to be taken to resolve the problem.

My experience with clinical nursing judgement is going from a quite simple situation to a

more in-depth situation. I have observed my nurse that I precept with for countless hours and I

am slowly developing my critical thinking skills just by watching her. Nurses are primarily

responsible for safe medication administration. Nurses draw from their foundational knowledge

of patient conditions and use clinical reasoning that supports safe medication practice

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(Rohde, E., & Domm, E., 2017). For example, as I am passing meds on my 4 patients one

morning with my nurse, I noticed that one of our patients had 3 different blood pressure/heart

rate control medications. Using my critical thinking skills back from day one in Professional 1, I

think to myself, even though the aide got vitals thirty minutes ago on this patient, I should

probably get my own set of vital signs, especially blood pressure and pulse before giving these

medications. As I grab my stethoscope and blood pressure cuff to get a more accurate reading,

my nurse was very pleased that I did this FIRST. At this point, the blood pressure reading was

110/70, and pulse was 60. Using my nursing clinical judgement, I looked at my nurse and told

her, I will not give these blood pressure medications at this time. Instead, I will reassess her

blood pressure and pulse shortly. Thirty minutes went by, and her blood pressure was higher;

136/76. At this point, I gave the blood pressure medications, knowing that these meds will help

to bring the blood pressure down. My nurse was very proud of me at this point, because she

didn’t even have to tell me anything before I already know what I needed to do.

Another good example with clinical judgment and myself was that I had a patient who

was in for multiple falls and a small subarachnoid hemorrhage that the doctors weren’t doing

anything about, due to it being so small. The patient was intermittently confused; he would go in

and out of confusion, however was very alert during our first morning assessment. During my

assessment, I noticed that the patient had small tremors. At this point, I wanted to investigate the

chart under history and see if there were any underlying causes to these tremors and I found

nothing in the chart. As the day went on, these tremors got worse, and the confusion got worse.

The kind patient during my morning assessment was no longer kind during the next assessment

four hours later. He began to get aggressive and shaking uncontrollably. At this point, I knew

there was a problem. Using critical thinking, I right away called the doctor and reported these

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symptoms, as well as calling the POA- which was his wife and getting a little more information.

The wife had told me that he is a functioning alcoholic and this all made sense as to why he was

having bad tremors; he was going through alcohol withdrawal symptoms. I released this

information to the doctor and new orders were placed at this time. Due to the in depth care that

this patient needed and more observation, the patient was transferred to the Medical Intensive

Care Unit. I was very proud of myself for noticing this and calling the doctor for the first time

ever! I was very nervous to talk to the doctor, but it went very smooth. My nurse made a

comment that I probably saved this guys life by noticing the confusion, tremors and change in

LOC.

In conclusion, beyond observation, clinical nursing judgement allows the nurse to

associate pieces of information, to review them, to establish relationships with known facts, and

to analyze and interpret the data at hand from both a critical and rational perspective. Using

clinical judgement allows the nurse to identify, associate and interpret the signs or symptoms of a

given condition. Clinical nursing judgement comes with experience and time. Judgement is

necessary because it leads to appropriate nursing diagnoses, clinical decision-making, and health

promotion.

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References

Rohde, E., & Domm, E. (2017). Nurses’ clinical reasoning practices that support safe medication
administration: An integrative review of the literature. Journal of Clinical Nursing, 27(3-
4). doi:10.1111/jocn.14077

Standing, M. (2017). Clinical judgement and decision making in nursing. Los Angeles:
Sage/Learning Matters.

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