Clinical Judgment in Nursing

Significant Influences on Clinical Judgment 

Clinical judgment is an essential skill for every medical practitioner and is the precipice upon which nursing decisions are made. It entails the various considerations that a medical practitioner makes when making decisions concerning patients. The relevant authorities make these decisions based on either experience, knowledges, or a combination of both. According to Tanner (2006), the application of either one of these elements is relative to numerous other material sub-factors relating to the situation and the parties involved. The conflict, therefore, comes up in disparities and disagreements about which situational influence is applicable in what context. 

There are several factors to consider in the classification of clinical judgment as sound, including the right balance of skills and knowledge. Studies have suggested that where experience is the preferred basis, reliance is emphasized on what the nurse has to offer rather than the objective data that is presented. Due to the delicate nature of the parties directly affected by these decisions, clinical judgments require various types of knowledge. These extend beyond the traditional sense and takes on abstract, generalizable, and directly applicable forms. Seasoned nurses apply this knowledge to varied needs over time, consequently honing their skills considerably. 

An experienced nurse would intuitively know what to do if they were exposed to a familiar situation, almost like using a well-exercised muscle would ease. However, a new nurse is still prone to errors in the face of uncertainty and would, therefore, apply thorough analytical analysis supported by their training. Sound clinical judgment also depends on knowing the patient on an intrapersonal level, preferably from previous interaction. This implies that the practitioner is aware of the patterns of responses the patient possesses, the patient's concerns, and challenges that may impede the patient's ability to express their concerns or wishes. 

Clinical judgment is also influenced by the environment of occurrence and the nursing culture present. Practical operation during working hours depends on the routine of the workplace, the knowledge of the workplace, and the various priorities assigned to patients. The symbiotic relationship among the various personnel, coupled with the narrative of accounts offered on issues, weighs in on the clinical judgment exercised. Furthermore, the existing power dynamics between nurses and physicians come into play when the former make certain decisions, such as when they lack the authority to proceed in a specific direction. Certain socioeconomic elements also come into play, such as the patient's status, nurses may choose not to proceed with certain courses of treatment if the patient cannot cover them. Both experience and training are critical building blocks in forming clinical judgments. Nurses rarely use one pattern of reasoning absolutely. Instead, with experience, they apply a combination of both based on their grasp of the situation, demands of the situation, and the goals of the practice (Tanner, 2006). The model uses three approaches; applying analytical processes is common where prior knowledge is insufficient, there is a disparity between the actual and expected results or when one is weighing several options. Intuition is approached with caution and apprehension but is practiced by some practitioners. The final approach applies some narrative thinking to clinical reasoning, which could either be through propositional argument or through the communication of stories. These patterns are especially popular with experienced nurses. While both experience and knowledge are important, the latter seems to take precedence in succeeding years of most professionals. 

In order to achieve a reasonably healthy balance between reasoning and experience as bases for judgment, Tanner proposes a four-step framework. The first step is noticing and involves identifying the most relevant data and why it is important. The second step, interpreting, entails analyzing the implications of this data and its significance. The response stage is where actions are taken if necessary, while the final step of reflection serves to strengthen and improve clinical judgment practically. 

Intuition in Clinical Judgment 

Several attempts have been made to integrate intuition into the nursing profession but have failed due to the lack of sufficient research to validate the practice. Intuition is known by the practitioner's innate ability for knowing or doing without adequate reasons (Hassani, Abdi & Jalali, 2016). Despite the reservations, the wide array of quality and accurate intuitive judgements have led researchers to believe that there may be some unexplainable rational basis driving the basis. Introducing intuition into various nursing teaching models is on the increase, with numerous practitioners insisting that its contribution to the medical field might be too important to ignore. Intuition has been linked to several cases of increased nursing ethical practices; however, due to the limited amount of information available on the practice in nursing, the majority of medical professionals are skeptical about applying it on a large scale. 

Nursing intuition is developed and reinforced through experience and practice. It essentially involves trusting one's judgment without proper evidence to justify the resulting actions. Therefore, for not only the nurse but also the patient and the relevant authorities to be confident of the level of service provided, a satisfactory foundation of the relevant knowledge must be built. The nurse should also be reasonably familiar with the patient; this helps to monitor their progress against their usual patterns, a fairly reasonable starting point for analyzing the issue. Although the practice has numerous potential benefits when correctly applied, more training is required before this stage, as well as a larger library of research on the matter. 

References 

Hassani, P., Abdi, A., & Jalali, R. State of Science, “Intuition in Nursing Practice”: A 

Systematic Review Study. Journal of Clinical Diagnostic Research . 10(2): pp. 7–11. 

doi: 10.7860/JCDR/2016/17385.7260 

Tanner, C. A. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in 

Nursing . Journal of Nursing Education, 45(6):204-11. Retrieved from: 

https://www.researchgate.net/publication/7003793_Thinking_like_a_nurse_A_research- 

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