Nursing and Midwifery Practice: Clinical Judgement and the Care Process
What you must understand
Clinical questions test whether you can apply the nursing process (assess, diagnose/identify need, plan, implement, evaluate) and the ABC/ABCDE prioritisation framework. Know the difference between dependent interventions (requiring a prescription, e.g. administering a drug), interdependent (collaborative, e.g. wound care protocol) and autonomous nursing actions (positioning, health education, pressure-area care). Understand evidence-based practice: best evidence, clinical expertise and patient preference together. Be able to describe informed consent elements, documentation standards (contemporaneous, factual, signed), and record-keeping as a professional duty rather than an optional extra.
Traps in questions
- 'First action' vs 'best action': the first action is usually assessment or safety (e.g. stop, check, call for help), not a treatment.
- Distractors that sound caring but are unsafe: giving a drug before checking identity/allergy, or reassuring a deteriorating patient instead of escalating.
- Confusing accountability (you are answerable for your actions) with responsibility (task assigned).
- Assuming a doctor's order overrides a safety concern: you must question and escalate.
- Ignoring the evaluation step: if the plan is not working, reassess rather than repeat.
Rule of thumb
Assess → Prioritise by threat to airway/breathing/circulation → Act within your competence → Escalate/reassess → Document. If a patient is deteriorating, the answer is almost always call for senior help early and stay with the patient, not a lone intervention.
Worked example
A post-operative patient is drowsy, RR 8/min, SpO2 91% on air. Option A: give prescribed analgesia. Option B: reposition, open airway, call for urgent review, stay with patient. B is correct: airway/breathing threat outranks pain; you escalate and never leave a deteriorating patient alone.