Running head: CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Alyssa Grimm

Youngstown State University

March 13, 2017

Kimberly Ballone & Bonnie Thompson

As a nursing student, I learned the skills and gained the knowledge necessary to be a

competent nurse. I learned how to properly assess a patient and the meanings of my findings. I
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learned the pathophysiology of countless medical conditions and how they connected to the

patients symptoms. I learned normal lab value ranges and the consequences of these values not

being within normal limits for a patient. I learned how to communicate with patients in a

therapeutic way. I learned that in order to have good clinical judgement, I needed more than

assessment skills and the knowledge to understand lab values. Clinical judgement involves

looking at the patient as a whole instead of fragmented pieces of information. How are these lab

values correlated to the patients diagnosis? What medications should this patient be receiving if

they are not already? What is the patients emotional response to their experiences with their

condition and hospitalization? I not only need to treat the patients present ailments; I also need

to focus on how I can educate the patient, treat symptoms, and assist in achieving his or her

highest level of functioning.

Benner, Tanner, and Chelsa (2009, p. 199) have found:

Experienced nurses reach an understanding of a persons experience with an illness, and

hence their response to it through knowing the particular patient, his typical pattern of

responses, his story and the way in which illness has constituted his story, and through

advanced clinical knowledge, which is gained from experience with many persons in

similar situations. This experientially gained clinical knowledge sensitizes the nurse to

possible issues and concerns in particular situations.

Therefore, clinical judgement involves looking at the patient in every aspect. It is

necessary to determine how the patient is responding to his or her medical diagnosis. The

pathophysiology of conditions shows that those with a specific condition are likely to show the

same symptoms from one patient to another. Thus, many see the nursing diagnosis and assume

the symptoms of the patient. However, it is important to use clinical judgement to determine
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which symptoms are presenting themselves in order to properly treat the patient. Is a specific

issue related to the diagnosis itself, or is there another factor in play, such as an abnormal lab

value? Is the patient displaying symptoms of depression or is he or she showing emotional

symptoms of hypothyroidism? While making decisions for an on behalf of the patient, it is

crucial to truly see the bigger picture to understand the interventions that he or she requires as an

individual.

There are different forms of clinical judgement, including: causal judgement, descriptive

judgement, evaluative judgement, and predictive judgement. Causal judgement is using

assessment data to determine the causes of presenting issues. Descriptive judgement is

describing the patients condition (such as stable) based on observations of the patient and

information found from other sources, such as blood or urine cultures, arterial blood gases, or

images obtained radiographically. Evaluative judgement is determining changes in the patients

condition, including deterioration or improvements. Predictive judgement is evaluating the

course the patient will take. (Thompson, Aitken, Doran, & Dowding, 2013) Will the patient have

lifelong issues related to their illness? Will the patient need acute rehab to enable them to

perform their activities of daily living and thrive outside the hospital?

The key to successful reasoning is to adapt reasoning of the task. (Thompson et al.,

2013, p. 1722) A patients condition is everchanging and the nurse needs to stay adaptive to

these changes. Has the patient improved or worsened? Have goals been met or not met? If goals

have not been met, what further interventions can be taken to attempt to remedy this situation?

Nurses need to determine not only the needs of the patient, but also address the issues that the

patient discusses. Objective information is not the only important factors in a patients condition,

it is also highly important to attend to subjective data provided by the patient.

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Per The Queensland Nurse (2009, p. 16):

Professional nursing judgement is a process which requires decision making based on

critical reflection, evaluation and clinical expertise in order to resolve issues, problems

and dilemmas. When you exercise your professional judgement you are advocating for

your patients and keeping yourself and them safe.

When discussing clinical nursing judgement, the first thought to come to mind may be

critical thinking and assessing the situation. However, nursing judgement also involves

implementation. Evaluate dilemmas, determine appropriate interventions, and then perform these

interventions to resolve these issues.

Overall, clinical nursing judgement involves a variety of factors. Causal, descriptive,

evaluative, and predictive judgements must be involved to have a proficient nursing judgement.

Nurses must choose appropriate interventions and target them towards individual patients that

will benefit from them. Communication is key in order to properly receive and deliver

information to patients, family members, and other healthcare professionals. It is also vital to

assess the situation to determine whether the interventions are successfully aiding the patient.

(Thompson et al., 2013) Competent nurses use their clinical judgement to advocate for and on

behalf of patients to address physical, psychological, and spiritual needs.

References
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Benner, P., Tanner, C. A., & Chesla, C. A. (2009). Chapter 7: Clinical Judgment. In Expertise in

nursing practice: caring, clinical judgment and ethics (2nd ed.). New York: Springer.

The Queensland Nurse. (2009). Professional nursing judgement--keeping the system safe. RANF

QLD. Branch Union of Employees, 28(6), 14-17. Retrieved March 8, 2017.

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. Retrieved March 8, 2017.