Clinical Judgment 1

Nursing Judgment

Kaitlyn Kalicatzaros

Dr. Ballone and Mrs. Thomas

Capstone 4852

March 19, 2018

Introduction

Throughout nursing school we have been instructed to “think like a nurse,” but

what exactly does this mean? Beginning in our first semester we are taught the nursing

process; to assess, diagnose, plan, implement, and evaluate. In this problem solving

process, the nurse collects both objective and subjective assessment data, infers

nursing diagnoses, and plans, implements and evaluates client care (Cappelletti, Engel,

J. K., & Prentice, 2004). Following this framework allowed us to think systematically

and process vital information about our patients. When implementing these steps we

are enhancing our critical thinking. However, the process cannot stop there. We must

take this practice a step further and apply it to making clinical judgments. Although

the two terms are often used interchangeably, “critical thinking” and “clinical

judgment” can be defined differently (Tanner, 2006). “Critical thinking” is the thought

process by which nurses solve and draws conclusions based on a patient’s problems.

(Papathanasiou, Kleisiaris, Fradelos, Kakou & Kourkouta, 2014). Clinical judgment is

not limited to identifying a problem; it also involves making a decision that may

determine a patient outcome. According to Margot Phaneuf, “Clinical judgment allows

the nurse to associate pieces of information, to review them, to establish relationships

with known facts, and to analyze and interpret the data at hand from both a critical and

rational perspective” (Phaneuf, 2008). Clinical judgment is an essential element of a

nurse's decision-making process and has long been considered to be the hallmark of

professional nursing (Cappelletti, Engel, J. K., & Prentice, 2004). Clinical nursing

judgment, not only guides the actions and decisions of the nurse, but also of physicians
 Clinical Judgment 3

and other care providers as well (Phaneuf, 2008). It is therefore viewed as an essential

skill for nurses in order to make educated and responsible decisions.

The Body

Nurses play a huge role in the care of patients. As a previously “task-oriented

profession,” nursing is making the transition to more of a knowledge-based practice,

which uses knowledge and critical thinking as the foundation for decision-making

about patient care (Evans & Donnelly, 2006). A nurse’s clinical judgment can affect

health promotion, prevention of complications, decreased length of stay, and even

make a difference in life or death (Cappelletti, Engel, J. K., & Prentice, 2004). The

expanding role of the nurse has brought about greater responsibility and

accountability. Clinical judgments require various types of knowledge: that which is

abstract, generalizable, and applicable in many situations and is derived from science

and theory (Tanner, 2006). This range of knowledge grows with experience. For an

experienced nurse encountering a familiar situation, the necessary knowledge is

readily available; the nurse is able to respond intuitively, based on an immediate

clinical grasp and just “knowing what to do” (Phaneuf, 2008). However, the novice

nurse must reason things through analytically; he or she must learn how to recognize a

situation in which a particular aspect of theoretical knowledge applies and begin to

develop a practical knowledge that allows refinement, extensions, and adjustment of

textbook knowledge (Phaneuf, 2008).

Throughout nursing school we have been challenged to think critically and

apply the information we were taught in class in practice. As we have advanced

through the program I have already began to see myself transition as a nurse. We
 Clinical Judgment 4

began this program feeling timid, and scared. When a problem arose, we responded,

“I’ll go find your nurse,” or “let me ask my instructor.” Now as we are in our final

semester, finishing up our precepting hours, we’ve come to the realization that we are

now the nurses. It is time for us implement all we have learned and take on full

responsibility of patient care.

In my time as a student I‘ve had so many awesome experiences that have helped

me grow as a nurse. Precepting has pushed me to take responsibility. Rather than

relying on my nurse or instructor, I am forced to use my own clinical judgment when

caring for patients. This semester my preceptor was on the Medical Intensive Care

Unit, Downtown Mercy. The patients on this floor are extremely complex. It can be a

challenge to apply the knowledge we learned in class because they have multiple

disease processes. Multiple conditions and treatments can counteract each other. In

most cases, clinical judgment must be utilized to weigh the “risk versus benefit.” I’ve

had many opportunities to observe my nurse’s clinical judgment and begin to use my

own. One of the best experiences I had with clinical judgment was during a code on the

floor. Obviously this wasn’t a decision I made on my own, but it was a really good

example of clinical judgment. My patient came on to the floor with a saturation of 80%

and his pressure was dropping. He was maxed out on most pressors in the emergency

room so they had limited options. He was going in and out of Ventricular Tachycardia,

without a pulse. We had to do compressions and shock him three times. One thing I

really like about the ICU is the teamwork amongst all of the nurses, physicians, and

other health care professionals. As the patient was continuing to decrease saturation

and pressure, everyone began discussing our options. There was a Rotaprone bed in
 Clinical Judgment 5

the hallway that was brought up for the patient prior to him coding. We decided the

best call was to try and get him on the Rotaprone bed before he coded again. I honestly

doubted that it would work, I didn’t believe t the patient wouldn’t stay stable long

enough to not only transfer him to another bed, but also have to strap him all in, and

quickly turn the bed so he was prone. We all worked as team moving the patient and in

the end, it worked. It was really interesting experience to see how that decision most

likely saved this man’s life.

Conclusion

Critical thinking and clinical judgment are both important skills we will utilize

throughout our career as nurses. Just as our ability to critically think has grown

throughout our time as students, our clinical judgment is not a skill we will achieve

over night. With practice and experience we will be able to analyze and rationalize

patient information more quickly to come up with the best solutions for our patients.

Margot Phaneuf described Clinical judgment, “as an essential path to acquiring the

effective ability and knowledge to understand the condition and needs of the patient,”-

this how we “think like a nurse.” (Phaneuf, 2008)

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References

Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment

and reasoning in nursing. Journal of Nursing Education, 53(8), 453-458.

http://eps.cc.ysu.edu

Evans, R. J., & Donnelly, G. W. (2006). A model to describe the relationship between

knowledge, skill, and judgment in nursing practice. Nursing Forum, 41(4), 150-

7. https://eps.cc.ysu.edu

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014).

Critical Thinking: The Development of an Essential Skill for Nursing Students.

Acta Informatica Medica, 22(4), 283–286.

http://doi.org/10.5455/aim.2014.22.283-286

Tanner, C. (2006). Thinking like a nurse: a research-based model of clinical judgment

in nursing. Journal Of Nursing Education, 45(6), 204-211.

Phaneuf, M., R.N., Ph.D. (2008, November/December). Clinical Judgement – An

Essential Tool in the Nursing Profession. Retrieved March 14, 2018, from

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

–An_Essential_Tool_in_the_Nursing_Profession.pdf