Clinical Nursing Judgement

Hannah McKinley

Youngstown State University

Clinical Nursing Judgement

Nursing judgement is a crucial part of nursing. Many decisions that are made by the

nurse are based on their clinical reasoning and judgement. These decisions directly affect the

patient, their care and overall health. These decisions also ultimately effect the patients family.

One of the most common problems patients have is pain. How seriously the complaint of pain

is taken, and the steps used to relieve pain are both dependent on the nurse and their clinical

judgement.

According to an article by Dorothy Del Bueno (n.d.), only thirty five percent of new

graduates meet the entry expectations for clinical judgement. The majority of new graduate

nurses are unable or have considerable difficulty translating knowledge and theory into

practice. Nursing judgement and critical thinking are not things that can necessarily be taught.

Both are a process and way of thinking, which are better developed over time.

Nursing judgement is necessary because it leads to appropriate nursing diagnoses,

clinical decision making, and health promotion. Nursing judgement is based on the nurses

knowledge, experience, reasoning, intuition, clinical thinking, and evidence based practice.

(Seidi, Alhani, Salsali, 2015). Errors in clinical judgement and decision making are said to

account for more than half of adverse clinical events. Nurses are responsible for their actions

and nursing judgement and action or inaction at all times. The speed of which a nurse makes a

clinical decision is based on their experience and intuition. Nurses are lifelong learners.

Knowledge is maintained and accumulated through experience and classes throughout nursing

careers.
NURSING JUDGEMENT 3

As a nursing student at Youngstown State University, instructors are very clear that we

are always to believe the patients complaint of pain. If the patient reports they have a pain of

ten on a pain scale of zero to ten, the patients rating is believed and treated as such. However,

many nurses have misconceptions that affect pain treatment include disbelief of patient pain

reports, exaggerated risk of opioid addiction, and concerns about patient tolerance (Sherwood

& McNeil, 2017). One thing, making pain treatment very difficult is the fact that every person

responds to pain differently. How a person is raised, different religions, cultures, values and

comorbidities all influence how a person responds to pain. For example, a person in pain from

the Amish community remains stoic and calm, even among children. While, Arab Americans

tend to exaggerate and emphasize pain. The nurse must be compassionate, and consider the

patients background and their response to pain. (Richardson, 2012).

Elderly patients tend to have chronic pain, and tend to underrate the amount of pain

they are in. Persistent pain, pain lasting longer than three months, affects about seventy six

million Americans. (Keen, Embree, Lancaster, Bartlett Ellis, 2017). In order to maintain optimal

pain management, nurses must be knowledgeable about both pharmacological and

nonpharmacological pain management.

As a nursing assistant on a long term care unit, working very closely with the nurses I

have been able to see both good and bad nursing judgement. Many residents complain of pain

but it is never treated by the nurses. This is very frustrating to nursing assistants, families but

most of all the resident who is suffering.

While working, there have been many times that I have had to use nursing judgement.

Many residents can not communicate on the unit I work on, making the job of the staff and
NURSING JUDGEMENT 4

their judgement even more important. Most of the residents have trouble and need help

feeding themselves and performing activities important to everyday life. There have been

many times that I have been feeding a resident and had to stop because they have become

tired and stopped chewing their food, in order to prevent aspiration, I stop feeding the patient.

One of my patients during clinical suddenly started coughing after taking a drink of

water. Her face became red, and the coughing became worse. I was able to raise the head of

the bed, and put the patient on SpO2 monitoring. The patient was maintaining their stats.

Thankfully the patient’s coughing subsided. After this, the nurse was able to order a swallow

study, which the patient failed. They were put on thickened liquids.

While many nursing schools focus on strengthening critical thinking skills, nursing

judgement is formed through knowledge, experience and critical thinking. There are many

classes for nurses that help critical thinking.

Nursing judgement is a crucial part of nursing. It helps determine the nurses identity,

not just personally as a nurse, but also their reputation as a nurse. The decisions that nurses

make related to a patients care, based on their personal experience and knowledge, affect the

patients health and healing. Nurses are patient advocates, part of nursing judgement is

knowing when to advocate for their patient.

References:

Del Bueno, Deb. (n.d.). A Crisis in Critical Thinking. Cinhal. http://dx.doi.org/15365026

Keen, A., Embree, J., Lancaster, S., Bartlett Ellis, R.J. (June, 2017). Feasibility of Using

Mixed Media Vignettes to Enhance Nursing Knowledge and Attitudes About Pain

Management. The Journal of Continuing Education in Nursing.

http://dx.doi.org/10.3928/00220124-20170517-10

Richardson, G. (2012). Pain Expression in Different Cultures; A qualitative study of the

analysis for the cues of pain in different cultures. NOVIA.

https://www.theseus.fi/bitstream/handle/10024/43628/GraceRichardson.pdf?

sequence=1

Seidi, J., Alhani, F., & Salsali, M. (September 17, 2015). Nurses’ Clinical Judgement

Development: A Qualitative Research in Iran. Iranian Red Crescent Medical

Journal. http://dx.doi.org/10.5812/ircmj.20596

Sherwood, G., McNeill, J. (May, 2017). Refelective Practice: Providing Safe Quality

Patient Centered Pain Management. ProQuest. http://dx.doi.org/10.2217/pmt-

2016-0053