Clinical judgement (medical profession)

Clinical judgement is used to describe a nurse's informed medical opinion that is derived directly from interacting with a patient. The term is generally used to refer to the trained judgement of nurses, although it may be used in context with any medical professional in which direct communication with the patient occurs in a clinical setting. When providing a clinical judgement, a nurse is expected to use their observations about the patient's condition to decide what questions should be asked, and then form tentative assessments about the patient's health needs. While the clinical judgement of a nurse is not necessarily intended to be the definitive answer for patients seeking medical solutions, it nonetheless can be an important asset that has the potential to allocate health care resources more effectively so that a resolution can be found quickly. Clinical judgements require critical thinking, decision-making, and problem-solving abilities.

Overview

An informed clinical judgement requires that the nurse properly uses his or her training and intuition to establish a viable opinion about how to act. This typically involves following a protocol that requires observation, reflection, and analysis. Observation involves examining the patient's physical signs of injury or recognizing the presentation of symptoms. Reflection requires that the nurse assess the potential risks and benefits of possible treatments. During this phase, nurses are asked to consider various alternate treatments. Finally, analysis is the application of the nurse's intuition and knowledge to fashion a treatment plan that best meets the health needs and best overall interests of the patient.

Oftentimes, a clinical judgement may require quick decisions, such as in cases of emergency. In such scenarios, nurses will likely rely more on instinct and training than reflection or detailed analysis. An intuitive clinical judgement is one of five types of clinical judgement. In addition to emergency-driven intuitive clinical judgements, there are also reflective, patient and peer-aided, system-aided, and critical clinical judgements. When there is more time available to research treatment options, more resources may be used to come to a fuller diagnosis and treatment plan.

For instance, in cases requiring a reflective clinical judgement, a quick decision is still required, although more time is available to formulate a course of action. An example of a medical situation requiring a reflective clinical judgement might include cases wherein a patient has torn open a set of stitches. The nurse will recognize quickly that the wound needs to be closed immediately, although the situation does not demand the intuitive response a choking patient would require. As such, a reflective clinical decision allows a nurse to rely more on observation and reflection than a completely emergency-driven intuitive clinical judgement would require. Similarly, a patient and peer-aided clinical judgement means that there is enough time to allow for consultation with both the patient and on-premises medical staff. Many clinical judgements are of this type. In a system-aided clinical judgement, medical professionals from other institutions may be consulted. In cases where the symptoms do not point to an obvious cause of illness, this form of clinical judgement may be more beneficial. Finally, when there is even more time available, a review of medical journals and studies may present more viable treatment options. Chronic or long-term illnesses may be best served by critical clinical judgement.

Bibliography

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