Clinical Nursing Judgement
Clinical Nursing Judgement
Clinical Nursing Judgement
Ashley Gladd
March 2, 2020
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The concept of clinical nursing judgement is often hard to define, as this concept is often
integrated with critical thinking. Although a nurse must possess the ability to think critically to
carry out clinical judgement, the two concepts are completely separate.
There is not a simple definition that can completely define the concept of clinical nursing
judgement, but through extensive research on this topic, a basic understanding of this concept
Manetti (2019) discusses multiple factors within the definition of nursing clinical
judgement. Clinical judgement includes interpreting a patient’s needs and health problems and
the action the nurse takes or chooses not to take in regards to their findings (p 103). It is easy to
imply that the two concepts, critical thinking and clinical judgement, as one, but in a broader
sense clinical judgement is the actions a nurse takes after implementing their critical thinking
skills.
Throughout nursing school, students are tested and evaluated on their ability to think
critically, but not evaluated enough on their ability to use clinical judgement. Anderson &
Cazzell (2016) state, “In current nursing education research on simulation, much of the focus is
on evaluating improvements in CT post simulation, ran than CJ” (p 83). Nursing students need to
be educated and evaluated on clinical judgement, because once a basic understanding of this
concept is achieved, they can begin to understand how important this concept is to implement
When a nurse attains the ability to use clinical judgement, they are able to assist patients
with more positive outcomes. Manetti (2019) states, “For patients, sound clinical judgement
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results in improved outcomes due to early detection of problems, quality nursing care, and
A nurse with this ability can recognize when the needs of their patients change and take
action to accommodate these changes. For example, a nurse who has good clinical judgement
will recognize that their post-op patients wound has worsened by changes in the patient’s vital
signs and appearance and take necessary action to contact the provider and stabilize the patient,
which leads to a better outcome for the patient. A nurse who does not inhibit good clinical
judgement, may not recognize these early changes and attribute it to the wound. This nurse may
only see that the wound is worsening when they directly look at the wound or when a negative
outcome has taken place, such as infection leading to septic shock. Dalvandi et al. (2017)
reinforces this by stating, “Clinical judgement and decision making skills in solving clinical
problems is the most important factor in preventing such injuries” (p 1). Patient outcomes are
greatly reflected on the care the patient receives by nursing staff. It is important for nurses to
understand and use good clinical judgement in their every day practice, so positive outcomes for
nursing students do not have as much clinical judgement as expected when graduating” (p 1).
This is likely due to the concept of critical thinking and clinical judgement being merged into
one concept, rather than two separate concepts. As discussed previously, clinical judgement is a
very important skill for a nurse to understand and implement, and nursing school should be the
place that this understanding begins. As a nursing student who will be graduating in just a few
months, I feel that my nursing educators have taken the time to educate me on this concept. I feel
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that I have a basic understanding of clinical nursing judgement and would like to discuss a time
During my preceptorship I took care of an elderly diabetic patient who had just returned
from a five-hour treatment of dialysis. Upon his return, he was exhibiting signs of confusion
which were different from his baseline documented neuro assessment. Due to these offset signs
of confusion I quickly performed a neuro assessment of my own. I looked at his chart thereafter
and found that he was not given anything to eat while at dialysis and was given his insulin as
ordered. I proceeded to retrieve the blood glucose monitor and test his blood glucose, which
came back at a level of 50. I immediately notified my preceptor of my findings and the blood
sugar protocol was implemented. The patient was given a turkey sandwich, peanut butter
crackers, orange juice and IV Dextrose. Along with implementing the blood glucose protocol, we
held his evening dose of insulin as ordered and monitored his blood glucose according to
protocol over the next couple of hours. I feel that I implemented good clinical judgment and in
return my patient had a positive outcome. In this same situation, if a nurse did not have the
understanding and ability to use clinical judgement, they may have attributed his confusion to
sundowning, which could have led to a negative positive outcome. As Manetti (2019) stated,
“Bedside nurses must notice subtle cues and changes in a patient’s condition to prevent
In conclusion, nursing clinical judgment is a quality that every nurse should be able to
implement. Good clinical nursing judgement leads to better outcomes for the patient and
maintaining positive patient outcomes is something every nurse should strive for daily.
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References
Anderson, M., & Cazzell, M. (2016). The impact of critical thinking on clinical judgment during
simulation with senior nursing students. National League for Nursing, 37(2), 83-90.
https://doi.org/10.5480/15-1553
Dalvandi, A., Ebadi, A., Khankeh, H., & Pouralizadeh, M. (2017). Factors influencing nursing
https://doi.org/10.7860/JCDR/2017/25753.9822
Manetti, W. (2019). Sound clinical judgement in nursing: a concept analysis. Nursing Forum,