Nurses' judgment as they care for persons who exhibit impaired judgment: a phenomenological study

The purpose of this phenomenological study was to discover the process by which psychiatric nurses make judgments as they care for persons who exhibit impaired judgment. Data were collected from six experienced psychiatric nurses in a private room and were audiotaped. These data were analyzed using Spiegelberg's (1976) phenomenological method. The data yielded an overarching theme: all the nurses presented judgment as a personal responsibility. Within this overarching theme, were four major themes: (1) closeness to the clinical data; (2) critical reflection; (3) respect for one's knowledge and ignorance; and (4) existential nature of judgment. Categories within theme (1) closeness to the clinical data were nurse as knower and focus on the patient; within theme (2), critical reflection were experience and understanding; within theme (3), respect for one's knowledge and ignorance were self-consciousness and expectation of self; and within theme (4), existential nature of judgment were alone facing the unknown and "Eureka! I've got it!" Essentially, judgment occurred privately within the mind of the nurse, making it both the creation and responsibility of the nurse. For these nurses judgment was the pivotal event in nursing inquiry beginning in the desire to know, proceeding through understanding and presentation of a nursing problem and then determining the question, "What is it?" in a "Eureka!" moment. With this experience of "I've got it!" the nurse crossed from the unknown to the known. Judgment which began in the desire to know began again with a new question.