Clinical Nursing Judgment

THE ESSENCE OF CLINICAL NURSING JUDGMENT

The Essence of Clinical Nursing Judgment Madison Evans Youngstown State University

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Abstract Clinical nursing judgment is a continually developing attribute in the scope of the nurse’s professional practice. A myriad of factors can potentially affect the degree to which a nurse can critically think in all situations, including immediate and life-threatening instances. Moreover, a few quasi-experimental and qualitative studies have yielded results that have shown how clinical nursing judgment is a skill that progressively develops over time. Conclusions can be drawn from Yuan et. al’s quasi-experimental study, Saidi et. al’s qualitative study, and Shelestak et. al’s quantitative study relative to the concept of clinical nursing judgment. Furthermore, pertinent minutiae will be discussed from each study as it pertains to exactly what clinical nursing judgment is, the importance of clinical nursing judgment in professional practice, and I will share a personal experience where my own nursing judgment essentially saved the life of a patient.

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Practicing as a professional nurse and possessing adequate clinical nursing judgment can ultimately be a life saving moment for a patient. One critical decision can pose long-term and short-term affects for a patient. Everything we do as nurses impacts our patients in some way. In order to promote patient wellness and have the ability to make immediate decisions when necessary, nurses need to be able to think and operate at a high level. Part of achieving this high level of thinking involves an attribute every nurse needs: Clinical nursing judgment. I will be discussing what is meant by “clinical nursing judgment,” its essence in professional nursing practice, and how this ability to think rapidly and intuitively, helped me to ultimately save a patient’s life. As established in an article, “Clinical judgment is a prerequisite for establishing professional identity, and is mainly based on nurse’s knowledge and experience as well as their reasoning, intuition, clinical thinking, and evidence-based practice skills” (Seidi, Alhani, & Salsali, 2015, para. 6). Being able to interpret data, assess a patient’s change in status and react quickly, and develop nursing diagnoses is all very unlikely to happen without the appropriate judgment. Furthermore, as nurses we are continually evaluating and assessing, and having the ability to think critically leads to patients’ wellbeing and productive outcomes. I will discuss two different studies that are both simulation based and reflect the importance being able to think and operate clinically as a nurse. The importance of clinical nursing judgment in nursing practice can be demonstrated in a myriad of ways. One important way in particular is to measure its effects in a simulation based scenario. In a particular study, “Nursing Students’ Clinical Judgment in High-Fidelity Simulation Based Learning (Yuan, Williams, & Man, 2014),”

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a total of 113 baccalaureate nursing students participated in five different simulation exercises within a 36-hour period. Among these students, 49 were in their second year of college, and 64 were in their third year. The results exemplify how previous experiences had positively impacted the students’ ability to make clinical decisions. Consequently, when comparing the very first session to the very last session, the students had significantly improved each time with interpreting the proper cues and making the correct judgments. As one nursing student explained, “The patient coughs frequently and complains of severe wound pain while we are doing wound dressing for the patient after the operation. We protect the wound with sterile gauze first ... as well as check the vital signs and the repertory sound, then we discuss the potentials of the patient’s condition and made a decision” (Yuan et al., 2014, p.13). In this specific situation, the student nurse was changing a wound dressing while assessing the patient’s presentation and expression, and as a consequence then knew to check the patient’s vital signs for any irregularities. Furthermore, appropriate clinical nursing judgment is critical for not only maintaining a patient’s status, but also delivering the appropriate care when there is a significant change in patient status from their baseline assessments. Also, in a second study based on human patient simulation, 49% of the participants were able to correctly identify the patient’s situation in the first trial and 71% correctly recognized specific cues to the patient’s condition during the second trial (Shelestak, Meyers, Jarzembak, & Bradley, 2015). Critical thinking plays an integral part in clinical nursing judgment because although a nurse can identify a situation at hand, he or she may not know what appropriate actions to take in order to react a given situation. Effective critical thinking involves recognizing and reacting to patient needs.

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As I am nearing the end of my nursing undergraduate education, I have worked in several situations in which nursing judgment has played a vital role in providing the best care possible to my patients. After having experienced different situations in the emergency department, the NICU, the PICU, the labor and delivery unit, and postpartum unit, a telemetry unit, an orthopedic unit, a psych unit, and an oncology unit, one particular situation, out of many, comes to mind first. It was my first day not only at the emergency department at Akron Children’s Hospital, but my first time at any emergency department in general. A mother had brought her infant in for symptoms of a cough, nasal congestion, a high fever, and difficulty breathing. The patient was initially put on Vapotherm, a type of noninvasive respiratory support device. After having evaluated its effectiveness on the patient’s condition for a few hours, the RN and I came to the conclusion that this patient’s condition was not improving. The Vapotherm was put on the highest setting and the infant’s respiratory rate was in the mid eighties with evident substernal and intercostal retractions, and each minute at this point was vital. I was in the room by myself because I had stopped to check in real quick, and I noticed the sustained and elevated respiratory rate and noted how much distress this infant appeared to be in, and I told the RN immediately. She then made a phone call to the doctor for a possible intubation as a short-term emergency measure. As a result of our collaborative ability to evaluate and use our clinical judgment, we were able to do what was best for our patient in that situation and prevent a possible negative outcome. As evidenced in my personal situations and in research-based conclusions, it is quite imperative for nursing students to begin developing essential clinical nursing judgment skills early and throughout the course of education through not only simulated

THE ESSENCE OF CLINICAL NURSING JUDGMENT experiences, but also in clinical situations. Being a registered nurse is a never-ending learning process, and as a current student nurse, every day I endeavor to strengthen my clinical judgment skills in order to deliver the highest quality of care possible to my patients. In conclusion, the importance of effective clinical nursing judgment is significant for patient care, and is ultimately the foundation for which effective nursing care was built.

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References Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses’ clinical judgment development: A qualitative research in Iran. Iranian Red Crescent Medical Journal. doi: 10.5812/ircmj.20596 Shelestak, D. S., Meyers, T. W., Jarzembak, J. M., & Bradley, E. et al. (2015). A process to assess clinical decision-making during human patient simulation: A pilot study. Nursing Education Perspectives. doi: 10.5480/13-1107.1 Yuan, H., Williams, B., & Man, C. (2014). Nursing students’ clinical judgment in highfidelity simulation based learning: a quasi-experimental study. Journal of Nursing Education and Practice. doi: 10.5430/jnep.v4n5p7