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Connor Dennison

Nursing Capstone

March 3rd, 2018

Clinical Nursing Judgement

Clinical nursing judgement is a very important part of not only nursing but any health

professional because of the importance of how it is used in the importance in patient care and

how to prepare the best type of care for the patient to gain the most effective care for the patient

that promotes optimum health. Each area of nursing uses clinical nursing judgements that are

used appropriately to help the patient in that area of nursing whether it be mental health nursing

or it be an ICU nurse taking care of a critical patient. I will tell about how I think about the

different areas of clinical nursing judgement and how the different articles I have gathered view

their different ideas of nursing judgement and how they define what it is.

As said by Thompson (2013) “Nurses’ judgements and decisions have the potential to

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

and prevent harm” (p. 1). Their idea of nursing judgement from this statement is saying how

much of an impact nurses really have in the healthcare industry and how they can make a change

in the hospital for a few reasons. One thought is that most nurses are with patients every day that

they are working and this allows them to see how what they implement for someone can affect

them directly. This allows them to make the right decisions based on the situation that the patient

is in because of how direct their care is and also allows them to use the different types of

technology that is available to them to help the patient safely and effectively. Since they are

using all these different pieces of equipment, nurses are able to voice their opinion of how these

instruments either aide or cause a detriment to the patient. With this knowledge, they are able to
see a patient in certain situation and really understand what would be the best method of

treatment would be for the patient. Even if they aren’t able to make orders like the doctor can, it

does not mean that any nurse can make a suggestion for the care plan of the patient to the doctor

or any other professionals that might be working with the patient. Another idea that this

statement might mean is that nurses also have the ability to actually research different treatment

methods or interactions with the patients or mostly anything else within their scope of practice

and make that research into a complete study. This allows nurses to really delve deep into a

certain topic about the healthcare field and can be able to gather the most information about the

topic they can. This allows future researchers and nurses to look at their information gathered

and make a clinical judgement on what the outcome of the topic might have been whether it was

good or bad and allow them to make changes in that area of care if it is more beneficial to the

patient.

Another great part about clinical nursing judgement is that the seasoned nurse is able to

use his/her years of knowledge to make decisions much more efficiently than a newer nurse.

In the article by Phaneuf, R.N., Ph.D. she states:

The concept of clinical judgement is difficult to put into practice. Perhaps this partly

explains why nurses experience difficulty mastering this essential skill. Another obstacle

is the lack of importance granted to clinical judgement in certain forms of training as well

as in certain departments in which technological and administrative skills are

emphasized. The intellectual elements are thus often superseded by the more technical

aspects of the profession. (p. 3)


What I can gather from this paragraph is that she is saying how clinical nursing judgement is not

an easy thing to not only learn but to master as well; this being very evident from the fact of the

difference in care that a more experienced nurse provides to a patient than a newer nurse might

provide. Now this is not saying that the new nurse is providing care that is not as good as the

experienced nurse but there is a more apparent idea of how the veteran nurse can come to a

conclusion about what the best method of care for the patient is and how they can look at a

certain situation the patient might be experiencing and decide the most appropriate intervention

and promote the best outcome and maintain optimum health for the patient. As a student myself,

I will need many more years to be very efficient in my clinical nursing judgement but it does not

mean I am not able to come to a decision for my patient throughout the time in my clinical

experience.

I have been in nursing school for four years now and can say with confidence that my

ability to clinically think in the hospital setting has increased and allows me to be more confident

in my patient care.

According to Dowding (2011):

Education also has to render visible how decisions are made so that, together, curriculum

design and practice facilitation offer students a clinical decision-making framework that

can be understood and applied in any unique real-world situation across the clinical

landscape. (p. 351)

To me this is saying how a student needs to make the most of their time in not only the school

setting but the hospital setting as well. Also states that when you use the skills and knowledge

you have gathered in the school setting then you can have the confidence to make those clinical
decisions in the real world. An example of when I had made a clinical nursing judgement is

during my time as being a nurse’s aide actually. My scope of practice is different when I am

working as an aide but I still use my clinical nursing judgements to help the nurses as best I can.

During one of my shifts, I was sitting at the nurse’s station charting on my patients and heard one

of the patients Spo2 monitor alarms going off (this patient was on a continuous monitor that

alarmed whenever it dropped below a certain level) and didn’t think too much of it because the

alarms go off all the time and its usually because the patient is moving or adjusting their nasal

cannula. However this patient was on a high flow nasal cannula at fifteen liters as well as a

rebreather mask which was also on fifteen liters so this patient was receiving 30 liters of oxygen

total which is significantly higher than most patients receive. Since I knew how much the patient

was receiving and the alarm was going off for about a minute now without it turning off, I go in

to check out the patient because the nurse was busy and see that their Spo2 was down to 64%. I

immediately looked at the patient and made sure both of their oxygen devices were on them

which they were and there were no tubing kinks and the monitor was connected directly to the

patient without any connection issue. I was also able to see that the patient was in great distress

with how shallow they were breathing and their excessive use of their accessory muscles to try to

increase ventilation as well as the purple discoloration in the extremities even after I raised the

head of the bed to try to improve ventilation. I immediately got the nurse and she was able to call

the rapid response team who were in the room within a minute to help the patient by giving

different medications to improve their ventilation and allow them to breathe easier and after the

patient was stabilized they were transferred to another unit for closer monitoring and the patient

ended up recovering from the situation. I was pleased with myself for the fact that I was able to
identify the situation and act appropriately for what was best for the patient and help them to

attain recovery from their deteriorating situation.

Clinical nursing judgement is something nurses will use now and forever. It is a great

method of determining the most effective care plan for any patient no matter the situation. Even

if you are not able to determine the best treatment for a patient, you are always working with

other nurses who have years of knowledge and are able to put their minds to together in any high

stress situation.
References

Dowding, D., Gurbutt, R., Murphy, M., Lascelles, M., Pearman, A. and Summers, B.

(2018). Conceptualising decision making in nursing education. [online]

journals.sagepub.com. Available at:

http://journals.sagepub.com/doi/pdf/10.1177/1744987112449963 [Accessed 9 Mar.

2018].

Phaneuf, M. (2018). Clinical Judgement – An Essential Tool in the Nursing Profession. [online]

Infiressources.ca. Available at:

http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement%E2%80%

93An_Essential_Tool_in_the_Nursing_Profession.pdf [Accessed 9 Mar. 2018].

Thompson, C., Aitken, L., Doran, D. and Dowding, D. (2018). An agenda for clinical decision

making and judgement in nursing research and education. [online] International Journal

of Nursing Studies. Available at: http://www.journalofnursingstudies.com/article/S0020-

7489(13)00144-2/fulltext [Accessed 9 Mar. 2018].

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