Clinical Judgment

Clinical Judgment: Critical Thinking in Nursing

Amanda R. Doran

Youngstown State University

Clinical Judgment: Critical Thinking in Nursing

Nursing is a passion that we are called to. A passion that is built upon caring and practice.

Nurses go through several years of schooling and upon graduation find out that what is learned is

just the tip of the iceberg. Academics give nurses the background of their field, but practical

wisdom gives way to critical thinking and clinical judgment.

Defining Clinical Judgment

Clinical judgment can be defined as “the process of applying knowledge and expertise to

a clinical situation to develop a solution.” (Quinn-O'Neil, B., Kilgallen, M., & Terlizzi, J. (2011) p. 47)

This is not something that can be learned through any textbook or lecture. It is developed over

time through experience. It is important to understand the nursing process to analyze and assess

the situation before coming to an immediate resolution. Knowledge is the basis of patient needs

and determines the action to meet said needs. This is the ultimate problem-solving puzzle.

Nursing demands higher cognitive skills that many newly registered nurses lack.

Developing Nursing Judgment

Nursing curriculum attempts to prepare graduate nurses for their new role and what is to

be expected. This transition from student to professional is challenging, taking what was learned

and shifting into practice. Nurses must recall on past experience and knowledge to foster clinical

judgment. This can be difficult with the limited experience new nurses have. Clinical experiences

with faculty and experienced medical professionals can both help and hinder the journey of

developing nursing judgment. It is imperative that good role-modeling in the clinical setting is

evident. Student and new graduate nurses often look to someone who is experienced and how

they would handle critical situations. Veteran nurses know what to look for in a deteriorating

patient, while a novice nurse may focus on a particular situation. This is where knowledge and
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experience can meld to improve client outcomes. This is the basis of learning to critically think, a

necessary skill in nursing practice.

Thankfully, many medical facilities offer new nurse orientation and additional precepting

opportunities giving enhanced experience in an ever-changing field. Orientation fosters graduate

nurses to develop sound nursing judgment by offering an understanding of practice and a smooth

transition from student to professional.

Personal Development of Clinical Judgment

In my experience, I have been to multiple facilities and several departments during

clinical rotations. I have seen firsthand the many shapes of nursing, each leaving an imprint on

my career. I have learned how critical concepts can be interpreted differently. Part of developing

clinical judgment is learning how to think reflectively and link existing knowledge with the

given situation. I have been in such a situation that facilitated my learning by looking a patient

holistically rather than a single diagnosis. While in my critical care rotation in the ICU, I was

assigned a patient suffering from alcohol withdrawal with respiratory failure. This patient was

sedated, chemically paralyzed, and mechanically ventilated. With an objective stance, I

witnessed the nurse care for this patient with respect and dignity. I learned what protocols are in

place for withdrawal assessment (CIWA protocol) and how these protocols are in place for better

patient outcomes. Abstinence from alcohol after prolonged use can result in autonomic

hyperactivity which is why this patient was sedated. While researching effects of alcohol, I was

also able to piece together how lab values are affected with long term use. This patient had a

critically low potassium along with low protein and elevated liver enzymes particularly due to

liver disease and malnutrition secondary to alcoholism. Throughout my shift, we were able to

wean sedation and mechanical ventilation. The paralytic was discontinued as well. We were able
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to promote communication with effective hand grasps and explain all procedures before they

were initiated. This experience showed me that while a complicated case, to look at the patient as

a whole rather than focusing on individual tasks. I also saw how many aspects of medical care

come together for the benefit of the patient with respiratory therapy, physicians, physical therapy,

and nursing. This experience showed me the big picture.

Conclusion

Nursing is a highly complex profession that requires attention to detail. It requires the

ability to critically think, something that cannot be taught, but must be learned. Throughout

nursing education, it is important to learn to be an independent, knowledgeable, safe clinician

with clinical judgment skills. Something can be learned from every single experience. These

experiences will help with the future of a nursing and collective patient care.
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