Running head: CLINICAL JUDGEMENT AND ITS ROLE IN NURSING 1

Clinical Judgement and its Role in Nursing

Amanda Verterano

Youngstown State University

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Abstract

Clinical judgement is a core concept of nursing care. In this paper I explored nursing journals

which explored other nurses views of what clinical judgement is, as well as what clinical

judgement actually is and how it can be applied to the nursing field. Clinical judgement is a

multi-step process through which a conclusion is reached to tell a nurse what she should do next

in caring for a patient. Assessment, observation and critical thinking are all very important in

making a clinical judgement. The way a nurse makes associations between problems and

solutions differs from nurse to nurse. So clinical judgement differs among nurses. However, at

the center of each nurse’s clinical judgement is what they feel will best serve this patient and aid

them in their recovery process. A nurse is that patient’s advocate and always has to act as so for

that patient’s safety.

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Clinical Judgement and its Role in Nursing

Clinical judgement is a nurses ability to make judgements and decisions for their patients

as to what interventions they need in their care at any point in time, while understanding how to

perform them and why these interventions are necessary. A solid, well-developed knowledge

base is necessary in the nursing profession, but without the ability to think critically and apply

this knowledge to their intervention plans, nurses would not be successful in care giving. In order

to make a clinical judgement a nurse must first assess and observe the patient situation. From

here a nurse must be able to make the connections and identify relationships between conditions

and problems. After analyzing the data a nurse must use what he/she knows about what is going

on to reach a conclusion of how he/she should intervene. “It is almost impossible to imagine a

health care professional practicing without being capable of exercising this kind of judgement.

Such an individual would quickly be deemed incompetent and unfit for working with patients

and dealing with their problems. As for all health care professionals, clinical judgement is also

essential in nursing” (Phaneuf, 2008).

“Some people associate nursing with the physical tasks concerned with keeping

the sick person safe, comfortable, nourished and clean. Some view nursing as assisting the doctor

by carrying out tasks associated with medical treatment. These descriptions are indeed part of

nursing practice today” (van Graan, Williams & Koen, 2016). True, these descriptions are

important in nursing practice, but clinical judgement is even more important. It is important

when speaking about clinical judgement and its role in nursing that we acknowledge many

people do not think of this when they think of nurses. There is such a loose understanding of a

nurse’s role in the public and more often than not this role isn’t seen as being a decision maker or

critical thinker. Most people believe that a nurse is someone who just blindly carries out any
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order placed by a doctor. While it is a nurse’s role to carry out those orders that a physician puts

in, it is also the nurse’s job to think in doing so if this order is appropriate and to question it if her

knowledge of the patient’s condition tells her to. Let’s face it, a nurse spends far more time in the

room providing care to a patient than any doctor will. The nurse see’s the patient’s condition

over time a lot more and notices any changes in it a lot sooner. Sometimes a doctor see’s a

patient in the morning at 0800 while all is well and by 1700 at the time he has an order placed,

the condition has seriously changed and that order may no longer be appropriate. A nurse serves

as the last line of defense for that patient and must always advocate in that patient’s best interest.

In their study van Graan, Williams & Koen found that participants (nurses) described

clinical judgement as, “‘Love and passion for the work; ...integrity; ...work to my best ability;

...decision to pull through... do the best for the patient... to walk the extra mile for your patient;

...identify a problem; ...have to listen; ...assessment of what is going on and what there is to do or

manage in another way; ...use your brain to do the observations; ...use your intellect …stop to

learn according the book; theory and practice needs to meet; ...experience ...excellent care comes

with experience; this patient has expectations... holistic approach” (2016). While it seems that

some of the participants got clinical judgment’s meaning and personal characteristics confused,

there were some important parts of clinical judgement identified. These include “do the best for

the patient,” “assessment of what is going on and what there is to do or manage in another way,”

and “theory and practice needs to meet.” Nursing really comes down to thinking of that patient

as one of your loved ones and taking care of them as so, to make the best decisions for them.

That patient is someone else’s family and they want a nurse who is going to make judgements

for that patients best recovery, not someone who does what the books or doctors or such say that

they should without taking this patients personal case and condition in that moment into account.
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“Human judgement involves managing uncertainty about problems encountered,

alternative solutions available, and a person’s ability to cope. ‘The response to one’s uncertainty

has always been to seek more information’ and decision theory describes different ways of

accessing, processing, applying and validating information” (Standing, 2008). Everyone’s

judgement of certain situations may vary, but in nursing most judgements come back to a pretty

cut and paste solution. A nurse has to be able to assess and observe what is available to her right

there and seek out more information for herself. It is also important that a nurse never fears

asking for a second opinion or someone else’s help if she is unsure. Just as in life you work to

find answers for anything that makes you uncertain, a nurse must do so in her job. Just because a

nurse has finished school and graduated and started practicing will never put her above a new

opportunity to learn more or to pull out that old medication book. As a nurse there is no harm to

your pride in seeking out any help you can receive to make the best judgement for your patient.

In conclusion I believe that Phaneuf put it best in saying that, “Clinical judgement

is the conclusion or enlightened opinion at which a nurse arrives following a process of

observation, reflection and analysis of observable or available information or data” (2008). One

nurse’s interpretation of a patient’s situation may not be the same as the next completely, but

every nurse has his or her own reasoning for the conclusions they reach and each nurse should be

thinking what is going to produce the best outcome in that patient. Like I said before, the nurse is

the last line of defense in that patient’s care and it is important to always think things through

before following orders blindly. While it may seem intimidating to be the nurse questioning a

physician, it needs to be done sometimes and that is an unwritten role of the nurse. A nurse’s

clinical judgement is their key to effective and morally correct care.

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References

Phaneuf, M., R.N., Ph. D. (2008). Clinical Judgement- An Essential Tool in the Nursing

Profession. Retrieved February 25, 2019, from

http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement–

An_Essential_Tool_in_the_Nursing_Profession.pdf

Standing M. (2008). Clinical judgement and decision-making in nursing – nine modes of practice

in a revised cognitive continuum. Journal of Advanced Nursing 62(1), 124–134. doi:

10.1111/j.1365-2648.2007.04583.x

Van Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses' understanding of

clinical judgement: A contextual inquiry. Health SA Gesondheid 21, 280-293. Retrieved

February 25, 2019.