As part of our Gordon Scholar series and our July focus on Clinical Judgment, Dr. Rita Gengo explores how nursing’s disciplinary knowledge, theories, and standardized nursing language provide the foundation for sound clinical judgment and person-centered care.
Grounding Clinical Judgment in Nursing’s Disciplinary Knowledge
Clinical judgment is at the heart of every nursing decision. Whether recognizing subtle changes in a person’s condition, determining priorities for care, or evaluating outcomes, nurses rely on clinical judgment to provide safe, person-centered care. But what makes nursing clinical judgment distinctly nursing? The answer lies in the discipline’s own body of knowledge.
Nursing clinical judgment should be grounded in nursing’s unique disciplinary knowledge and informed by the ways nurses come to know the person, family, groups, or communities. This knowledge shapes how nurses recognize practice situations, interpret their significance, and respond to address human responses to health and illness. In this blog, we explore how nursing theories, discipline-specific frameworks and classifications, and the patterns of knowing inform the clinical judgment process.
Nursing Theory Provides the Foundation for Clinical Judgment
Nursing theories provide the disciplinary foundation for practice. Developed within the discipline of nursing to explain nursing phenomena and guide nursing practice, they distinguish nursing’s unique perspective from theories originating in other disciplines. Examples include Theory of Human Caring, Nursing as Caring, and Roy Adaptation Model. Nursing theories influence how nurses understand the person, conceptualize health, interpret the environment, and define the role of nursing.
As nursing roles continue to evolve, nurses increasingly integrate knowledge from multiple disciplines to address complex health needs. This interdisciplinary knowledge is essential. However, it does not replace nursing’s disciplinary foundation. When nursing practice is guided exclusively by theories and models from other disciplines, patients miss the unique perspective that nursing brings to understanding their experiences, responses, strengths, values, and goals.
Regardless of role or level of practice, nursing theories shape the thinking that underlies clinical judgment by influencing what nurses attend to, how they interpret patient situations, what they consider priorities, and how they determine the most appropriate nursing response. Grounding clinical judgment in nursing theory helps ensure that patients experience care that is distinctly nursing.
The Clinical Judgment Process
The National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model describes six interconnected cognitive operations that nurses use during decision-making:
- Recognize cues
- Analyze cues
- Prioritize hypotheses
- Generate solutions
- Take action
- Evaluate outcomes
Although these stages are often presented sequentially, clinical judgment is dynamic and iterative. New information continually reshapes assessment, priorities, and interventions throughout the care process.
What transforms these cognitive operations into nursing practice is the use of nursing-specific frameworks and standardized language. Each stage of the clinical judgment process is strengthened by nursing’s disciplinary knowledge.
Recognizing Cues
Cue recognition is the first cognitive operation in clinical judgment. Nurses begin by identifying information that is relevant to understanding the person’s health situation.
While some cues emerge intuitively, nurses cannot rely on intuition alone. A systematic assessment helps ensure that important information is not overlooked. Gordon’s Functional Health Patterns provide a nursing-specific framework that guides comprehensive assessment by directing attention to the person’s health behaviors, functional status, values, relationships, coping, nutrition, elimination, activity, sleep, cognition, self-perception, roles, sexuality, and other dimensions of health. Rather than focusing solely on disease or physiological findings, this framework supports a holistic understanding of human responses to health and illness.
Analyzing Cues
Recognizing cues is only the beginning. Nurses must determine what those cues mean for the person, family, group, or community. This interpretive process is enriched by the integration of multiple ways of knowing.
Empirical knowing supports the interpretation of assessment findings through scientific evidence, clinical knowledge, and observable data. Personal knowing deepens understanding of the person’s unique experiences, values, and goals through authentic therapeutic relationships. Aesthetic knowing enables nurses to perceive the whole situation, recognizing meaning and connections that may not be immediately apparent. Ethical knowing ensures that interpretation reflects respect for dignity, autonomy, and what ought to be done. Emancipatory knowing broadens understanding by considering the social, cultural, economic, and structural factors that influence health and healthcare. Unknowing encourages nurses to suspend assumptions, remain open to the person’s perspective, and avoid premature conclusions.
Prioritizing Hypotheses
After analyzing assessment findings, nurses determine which human responses require immediate attention and which can be addressed as care progresses. This is where standardized nursing language becomes essential.
The NANDA® Nursing Diagnosis Classification provides a taxonomy of nursing phenomena for which nurses are accountable to identify, diagnose, and manage. Rather than asking, “What disease does this person have?” the classification helps nurses ask, “What human responses require nursing care?” This distinction ensures that clinical judgment remains grounded in nursing’s unique scope of practice.
Because Gordon’s Functional Health Patterns and the NANDA Nursing Diagnosis Classification are conceptually aligned, nurses can move naturally from assessment findings to diagnostic reasoning. Standardized nursing diagnoses also provide a shared language that improves communication among nurses while supporting individualized care planning.
Generating Solutions
Once nursing priorities have been established, nurses collaborate with the person, family, groups, or communities, whenever possible, to determine the desired outcomes of care and identify the nursing interventions most likely to achieve those outcomes.
Resources such as NANDA 360, or the NANDA-I nursing diagnosis classification combined with the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC), support this process by helping nurses develop consistent, measurable, and individualized plans of care while connecting diagnoses, outcomes, interventions, and the evidence that underpins clinical decision-making.
Generating solutions requires more than matching diagnoses to outcomes and interventions. Nurses integrate the person’s goals with the best available evidence, clinical expertise, and available resources to determine the most appropriate course of action. Throughout this process, multiple ways of knowing continue to inform sound clinical judgment.
Taking Action
Taking action is not simply carrying out predetermined interventions. Nurses continuously observe, interpret, and respond to the person’s changing condition, adapting care as new information becomes available. It is an expression of caring enacted through competent, intentional, and person-centered practice.
Depending on the practice situation, implementation may involve rapid, intuitive responses developed through experience or deliberate analytical reasoning when situations are complex or uncertain.
Evaluating Outcomes
Evaluation is not the end of clinical judgment but the beginning of a new cycle of assessment and decision-making. Nurses continuously evaluate whether expected outcomes have been achieved, whether nursing diagnoses remain accurate, and whether the plan of care should be revised.
Throughout evaluation, nurses continue to draw upon multiple ways of knowing to determine whether outcomes are meaningful for the person, family, group, or community. Empirical knowing supports the evaluation of measurable outcomes and the effectiveness of interventions, while personal, aesthetic, ethical, emancipatory knowing, and unknowing help nurses interpret the significance of those outcomes within the person’s unique context and evolving health experience.
Nursing theories continue to guide evaluation by shaping what nurses consider meaningful change and how they interpret the person’s responses to care. Standardized nursing language further strengthens this process by providing consistent ways to document changes in human responses, measure outcomes, and communicate clinical decisions across care settings.
Final Thoughts
As healthcare grows increasingly complex, nurses will continue to integrate knowledge from many disciplines. However, nursing’s disciplinary knowledge remains the foundation for clinical judgment as an expression of caring in nursing. Nursing theories, assessment frameworks, and standardized nursing language ensure that clinical judgment remains distinctly nursing.
By grounding clinical judgment in nursing theory, standardized nursing language, and the multiple ways of knowing, nurses preserve nursing’s unique perspective while delivering care that is scientifically rigorous, person-centered, and distinctly nursing.
References
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004
Chinn, P. L., Canty, L., & Mkandawire-Valhmu, L. (2026). Knowledge development in nursing: Theory and process (12th ed.). Elsevier.
Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing clinical judgment model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72–78. https://doi.org/10.3928/01484834-20190122-03
Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024–2026 (13th ed.). Thieme.
International Nursing Knowledge Association. (n.d.). NANDA 360. https://nanda.org/nanda-360/
Moorhead, S., Swanson, E., Johnson, M., & Maas, M. L. (2023). Nursing outcomes classification (NOC): Measurement of health outcomes (7th ed.). Elsevier.
Smith, M. C. (2025). Nursing theories and nursing practice (6th ed.). F. A. Davis.
Wagner, C. M., Butcher, H. K., Clarke, M. F., & Dochterman, J. M. (Eds.). (2023). Nursing interventions classification (NIC) (8th ed.). Elsevier.
About the Author
Rita Gengo, PhD, MSN, MSc, RN, FNI, is an Assistant Professor at Florida Atlantic University Christine E. Lynn College of Nursing in the USA and a member of the current cohort of Gordon Scholars in The Marjory Gordon Program for Knowledge Development, Clinical Reasoning & Decision Making. Through this international program, a collaboration between the International Nursing Knowledge Association and the Boston College Connell School of Nursing, Gordon Scholars work with mentors and colleagues from around the world to advance assessment-driven, diagnosis-centered nursing knowledge and clinical reasoning, and NANDA 360. The Gordon Scholars’ work has informed practice, scholarship, policy, and instruction worldwide. Rita Gengo’s current work focuses on symptom science, nursing classifications, and development and testing of complex interventions, with particular interest in cardiovascular conditions. Her scholarly interests also include clinical reasoning and its role in supporting high-quality nursing care.
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