1
NURSING PROCESS TO CLINICAL JUDGEMENTS
The Nursing Process, Clinical Thinking, and Clinical Judgments
Brooke Bond
Dixie State University
2
NURSING PROCESS TO CLINICAL JUDGEMENTS
The nursing process plays an important part of total patient care. Whether a nurse
specializes in pediatrics, oncology, or home health the nursing process is the same across the
continuum. It is a crucial link that ties nurses together no matter what area of health care the
nurse chooses to work in. The nursing process is an essential foundation for the registered
nurse to bring to the table in order for patients to receive patient-centered care. When the
nursing process is combined with critical thinking and clinical judgments, the patient receives
comprehensive, quality care.
The Nursing Process
The nursing process consists of a stepwise approach that concentrates on getting the
patient back to health using a mechanism of checks and balances. The process consists of
assessment, diagnosis, planning, implementation, and evaluation of the patient.
The assessment of a patient consists of the gathering of information and data that can
be objective or subjective. The nurse obtains this information through a series of interviews,
questions, physical examinations and observations. All information needs to be gathered in
order to provide the nurse with a complete picture of the patient.
The diagnosis step requires the nurse to use clinical judgments and analyze the patient’s
actual or possible health problems. Using critical thinking skills, the nurse addresses not only
the condition of the patient but also identifies potential problems that could arise and create
more complications.
3
NURSING PROCESS TO CLINICAL JUDGEMENTS
The third step is the planning step of care. The nurse and patient set goals based on
importance, meaning that the most critical needs of the patient should be addressed first.
These goals should be both specific and measurable and consist of short and long term targets.
Implementation is the next step in the nursing process and requires action from the
nurse. The nurse puts into place the plans and goals that were addressed earlier. This step
consists of performing medical duties, monitoring the patient, and educating the patient so that
favorable outcomes are achieved.
Evaluation is the final step. Here the nurse determines if all interventions and outcomes
were achieved. If the patient has not improved or if health goals were not met, the plan of care
is revisited and new goals are implemented and the process begins again.
Critical Thinking and the Nursing Process
In order for the nursing process to be successful, the nurse must incorporate critical
thinking into the plan of care for the patient. Critical thinking is, “Knowing how to learn,
reason, think creatively, generate and evaluate ideas, see things in the mind’s eye, make
decisions, and solve problems,” (Snyder, 2012, 206). It is a process of accurate, purposeful
thought processes that allow the nurse and those who work with her to make sound judgments
and create safe practices.
Critical thinking goes above and beyond the traditional way of thinking. It takes the care
of the patient to the next level. It questions why and how things are being done and decides
4
NURSING PROCESS TO CLINICAL JUDGEMENTS
what information is relevant or not. It addresses problem solving by looking for patterns or
relationships within signs/symptoms and lab values. It applies knowledge that is learned
through education and experience. And finally, it makes and evaluates decisions based on
evidence-based practice.
Critical thinking is not intended to replace the nursing process, rather it provides the
nurse with the means to make informed decisions about their patients and their care. It is a
tool for the nurse to use when assessing, diagnosing, and setting goals for the patient as well as
creating outcomes that are both positive and achievable.
Critical Thinking and Clinical Judgment
Critical thinking leads or advances into clinical judgments. It is what differentiates the
professional nurse from her colleagues that are merely there for technical roles (Gordon, 2006,
p. 3). Clinical judgments goes beyond the why’s and how’s, beyond the patterns and trends,
and beyond the differential of possibilities. Clinical judgments seeks out information, makes
sense of the patterns using experience and research, and recognizes the larger context of
objective and subjective data. It is a crucial component of total patient-centered care.
When clinical judgments are effective they lead to positive patient outcomes, effectual
teaching and education of the patient, evidence-based practice in treating the patient, and
trusted nurse-patient relationships. If clinical judgments are non-effective the consequences of
such actions leads to a breakdown of all components of the nursing process. These negative
5
NURSING PROCESS TO CLINICAL JUDGEMENTS
outcomes can lead to unsafe nursing practices, a breach in standards and conduct, and noncommunication or ineffective communication with the patient and their families.
Conclusion
Critical thinking and clinical judgments are an intricate part of the nursing process. This
procedure is an important part of nursing that ties all nurses together. All steps from the
assessment through the evaluation should be accurate and complete in order for nurses to
provide quality care. Critical thinking skills help the nurse make informed and important
decisions concerning their patients and the care they receive. Clinical judgments go beyond the
nursing process and critical thinking. It requires the nurse to actively search for solutions to
problems and is a key component in patient centered care. Nurses who exhibit these skills are
able to bring about new ideas, express those ideas, and are fluid in moving between various
ideas, interventions, and evaluations both quickly and efficiently in order for their patient to
receive positive outcomes (Rural Connection 2007).
6
NURSING PROCESS TO CLINICAL JUDGEMENTS
References
Gordon, S. ( 2006 ). What do nurses really do? Topics in Advanced Nursing eJournal, 6(1).
Rural Connection. (2007). Critical thinking and clinical judgments. Retrieved from http:// nursesas
teachers.org/residency_program/documents/Module3-CriticalThinkingClinicalJudgement.pdf
Snyder, M. (2012). Critical thinking: A foundation for consumer-focused care. The Journal of Continued
Education in Nursing, 24(5), 206-210.