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Thinking Like a Nurse: Clinical Judgement

Clinical judgment is an essential concept in healthcare and, more specifically, in nursing. It is a process that involves collecting client data, interpreting the data, making diagnoses, and identifying proper steps. Essential components of the process are critical thinking, decision making, and problem-solving. Clinical judgment is required for somewhat ambiguous situations. Good clinical judgment requires knowledge and information to address the nuances that may exist in undefined circumstances.

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Clinical judgment hinges on many factors, such as knowledge and experience. According to Tanner (2006), clinical judgment is a complex subject used for ambiguous, under-determined circumstances laden with conflict from entities with competing interests. For this reason, good clinical judgment requires a nuanced and flexible ability to identify critical aspects of under-defined clinical situations, interpret them correctly and provide a proper response (Tanner, 2006). Nursing is generally complex, and individualized care is but one factor adding to this intricacy. In one of the literature reviewed, terms such as the rule of thumb and heuristics are applied to the decision-making process; this indicates that humans are generally poor in informal statistics (Tanner, 2006). There would be no better application of experience than in such circumstances.

Experience is the process of filling gaps in theoretical abstractions with practice. Tanner, 2006 reviewed many works of literature where one of the conclusions was that clinical judgment depends more on the nurse’s contributions than it does on objective data. Conducting clinical judgment requires scientific knowledge that is abstract, applicable in situations, and generalizable. To be able to fill these abstractions is a nuanced process that involves practice, hence, experience. Knowledge is vital in clinical judgments as experienced nurses can easily access what they know confidently. This is not the case with a novice nurse who must analytically reason out things. They must also recognize where theoretical knowledge applies and adopt practical knowledge that permits extrapolations, refinement, and adjustment of theory.

One of the most critical aspects of clinical judgment in nursing is philosophy. A nurse’s inclination toward a specific treatment method relies heavily on their philosophy on the same. Moral philosophy is about what is good and wrong, and nurses will get into the practice with a foundational disposition. According to Tanner (2006), some areas where philosophy plays a part in clinical judgment include the ability to humanize care, disclosure to patients and their families, and comfort under extreme suffering. For example, a nurse who undertreats pain is informed by their attitude towards pain and the importance of comfort (Tanner, 2006). Conversely, Tanner (2006) concluded that proper clinical judgment depends on knowing a patient and their typical response patterns. This is identified as subtle ‘knowing’ that the nurse cannot even describe formally.

Intuition is the process of making decisions subconsciously without explicit evidence. Intuition is a controversial subject as nursing is a profession based on science. However, with knowledge and experience, professionals have applied intuition in their daily practice. According to Tanner (2006), reasoning patterns used by nurses are analytic process, intuition, and narrative thinking. In many studies, intuition is described as sudden apprehension of a clinical situation and is primarily a function of experience; this apprehension is associated with pattern recognition. The concept of intuition receives mixed reviews from various scholars, but nurses have expressed their love for the idea and confessed to using it in clinical judgment (Melin-Johansson et al., 2017). It has been revealed that nurses are reluctant to share anecdotes of using intuition with their colleagues because of fear of being judged.

Intuition involves experiencing clinical situations as a whole and making decisions without factual data. Linguistically, intuition relates to terms such as gut feeling, discovering similarities, pattern recognition, common sense, tacit knowledge, and skill to know how. When I think about how I would apply intuition in clinical situations, experience comes to mind. As a new nurse, I would most likely avoid using intuition; as a matter of fact, I would not even be aware that I am avoiding it, as a new nurse would probably lack confidence. However, I can have enough knowledge and experience to apply pattern recognition with time.

Clinical judgment is an indispensable part of all healthcare professions; nurses, physicians, anesthesiologists, dentists, and clinical officers must make situation-specific decisions. One lingering question surrounding clinical judgment is the factors it depends on, such as knowledge and experience. Clinical judgment is the decision-making process in situations that are under-determined and ambiguous. Knowledge is critical in identifying these underdefined situations, interpreting them, and deciding on a clinical path. Studies have shown that clinical judgment involves the filling of theoretical abstractions with practical knowledge. Automatically, filling these abstractions takes time as one reconciles what they studied in nursing education to practice. Intuition is a controversial subject in clinical judgment as it involves deciding without information. However, the concept is valued by nurses and relates to experience as it involves pattern recognition. Clinical judgment is a critical subject in nursing that is subtle and nuanced, requiring in-depth examination.

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Melin-Johansson, C., Palmqvist, R., & Rönnberg, L. (2017). Clinical intuition in the nursing process and decision-making-A mixed-studies review. Journal of Clinical Nursing, 26(23–24), 3936–3949. Web.

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211. Web.

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