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Determining Clinical Judgment Among Emergency Nurses During a Complex Simulation. J Emerg Nurs 2023; 49:222-235. [PMID: 36572599 DOI: 10.1016/j.jen.2022.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Clinical judgment is imperative for the emergency nurse caring for the acutely ill patients often seen in the emergency department. Without optimal clinical judgment in the emergency department, patients are at risk of medical errors and a failure to rescue. METHODS A descriptive observational approach using the Lasater Clinical Judgment Rubric evaluated nurses during a task that required recognition of clinical signs of deterioration and appropriate clinical care for simulated patients. RESULTS A total of 18 practicing emergency nurses completed only 44.6% of the patient assessments leading to low levels of clinical judgment throughout the simulation. Nurses expressed 4 levels of clinical judgment: exemplary (n = 1), accomplishing (n = 6), developing (n = 9), and beginning (n = 2). On average, nurses completed 69% of required tasks. DISCUSSION Assessments were completed less than half the time, demonstrating a breakdown in the noticing phase of clinical judgment. The nurses shifted to task completion focus with minimal use of clinical judgment. As the nurses remained task oriented, several medication and medical errors were noted while caring for the simulated patients. Experience and education did not influence observed clinical judgment among the participants. Given the extreme demands placed on the emergency nurse, it cannot be assumed that nurses have developed or can use clinical judgment when caring for their patients. Time and training targeting clinical judgment are essential for emergency nurse development.
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Abstract
AIM This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment. BACKGROUND Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used. METHOD A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models. RESULTS Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation. CONCLUSION Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.
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Scaffolding questions to foster higher order thinking. TEACHING AND LEARNING IN NURSING 2023. [DOI: 10.1016/j.teln.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Yeh CH, Huang HM, Kuo CL, Huang CY, Cheng SF. Effectiveness of e-STORY App in clinical reasoning competency and self-directed learning among students in associate nursing program: A quasi experimental study. Nurse Educ Pract 2022; 64:103456. [PMID: 36162302 DOI: 10.1016/j.nepr.2022.103456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
AIM The purpose of this study was to promote students' clinical reasoning (CR) and self-directed learning (SDL). The specific aims were: (1) to examine effectiveness of the e-STORY App in promoting nursing students' CR and SDL; and (2) to explore the relationships between levels of learning motivation and suitability of the e-STORY App. BACKGROUND CR and SDL are core competencies for nursing students. However, new graduates tend to be in adequately prepared in these competencies. Humanoid diagram uses diagrams to guide students in gaining a comprehensive view of the patient issues, which may promote attainment of these competencies. The Z generation students favor learning through smart devices for the feature of no time and spatial limitations. The e-STORY App was developed to overcome the setbacks of creating hard-copy drawings to promote learning effectiveness. DESIGN This quasi-experimental study used two-group repeated measure design with a convenience sample. METHODS A total of 77 students from two sections of the "Seminar for Clinical Case Studies" course participated in the study (experimental group: 39 students; control group: 38 students). Data were collected before, one week after and four weeks after the teaching intervention. The instruments used were demographic information sheet, Huang et al.'s (in press) Clinical reasoning scale and Cheng et al. (2010) Self-directed learning instrument. RESULTS There were no significant differences in the CR and SDL scores between the experimental and control groups one week after the intervention (p>.05). Analyses of the delay effects four weeks after the intervention found significantly higher CR scores in the experimental group than the control group (p < .05). However, there were no significant differences in the SDL scores between groups (p>.05). Analysis of the findings from the experimental group found that students with moderate and low learning motivation showed significantly higher CR scores on the posttest and follow-up test (p < .05). CONCLUSIONS Application of the e-STORY App as a supplementary teaching strategy promoted nursing students' CR ability, especially in students with moderate or low learning motivation. It is recommended to use the App in students with moderate or low learning motivation to promote learning effectiveness.
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Affiliation(s)
- Chia-Han Yeh
- Department of Nursing, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei City 11217, Taiwan, ROC.
| | - Hui-Man Huang
- Department of Nursing, Tzu Chi University of Science and Technology, No. 880, Sec. 2, Jianguo Rd., Hualien 970, Taiwan, ROC.
| | - Chien-Lin Kuo
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd, Beitou District, Taipei City 11219, Taiwan, ROC.
| | - Chu-Yu Huang
- School of Nursing, Cedarville University, 251 N. Main St., Cedarville, OH 45314, USA.
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd, Beitou District, Taipei City 11219, Taiwan, ROC.
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Seibert SA. Validated instructional resource to engage nursing students in critical thinking. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The impact of a clinical coaching education on faculty's coaching behavior. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jessee MA. An Update on Clinical Judgment in Nursing and Implications for Education, Practice, and Regulation. JOURNAL OF NURSING REGULATION 2021. [DOI: 10.1016/s2155-8256(21)00116-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Renn BN, Areán PA, Raue PJ, Aisenberg E, Friedman EC, Popović Z. Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept. RESEARCH ON SOCIAL WORK PRACTICE 2021; 31:90-100. [PMID: 34321858 PMCID: PMC8315227 DOI: 10.1177/1049731520964854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies. METHODS We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays. We also examined time spent using ITS and relation with competency. RESULTS The majority of students (81.8%) in Wave 1 and all of the students who submitted role-plays in Wave 2 passed the clinical skills role-play. Students advancing through the ITS more quickly had better tCBT competency ratings than those progressing more slowly. DISCUSSION One of the most challenging aspects of training is how to competently deliver evidence-based practices. ITS has the potential to streamline and scale such training.
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Affiliation(s)
- Brenna N. Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J. Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Eugene Aisenberg
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Emily C. Friedman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Zoran Popović
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
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Vierula J, Hupli M, Talman K, Haavisto E. Identifying reasoning skills for the selection of undergraduate nursing students: a focus group study. Contemp Nurse 2020; 56:120-131. [DOI: 10.1080/10376178.2020.1743732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jonna Vierula
- Department of Nursing Science, University of Turku, Turku 20014, Finland
| | - Maija Hupli
- Department of Nursing Science, University of Turku, Turku 20014, Finland
| | - Kirsi Talman
- Department of Nursing Science, University of Turku, Turku 20014, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Hospital District of Satakunta, Turku 20014, Finland
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Lasater K, Holloway K, Lapkin S, Kelly M, McGrath B, Nielsen A, Stoyles S, Dieckmann NF, Campbell M. Do prelicensure nursing students' backgrounds impact what they notice and interpret about patients? NURSE EDUCATION TODAY 2019; 78:37-43. [PMID: 31035101 DOI: 10.1016/j.nedt.2019.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/12/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Academic educators are challenged to foster the development of clinical judgment in diverse learners. The impact of nursing students' backgrounds on clinical judgment has not previously been studied. AIMS SAMPLE: Prelicensure/preregistration students, representing three international English-speaking programs in 3 countries, comprised the sample (N = 532). All were enrolled in the first course in which perioperative content was taught. DATA COLLECTION An online learning activity was designed to elicit responses to a simulated case study of an expert nurse role model caring for an older adult patient experiencing delirium several days post-operatively. DATA ANALYSIS Dyads of coders did three rounds of coding. Logistic and multinomial logistic regression models used background variables to look for patterns in student responses. FINDINGS The data strongly suggest that background variables impact clinical judgment, however, not in interpretable patterns. CONCLUSION Nurse educators must acknowledge that prelicensure students' backgrounds impact their clinical judgment and assist them to learn to think like nurses.
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Affiliation(s)
- Kathie Lasater
- Oregon Health & Science University, 3455 SW Veterans' Hospital Rd., Portland, OR 97239, USA.
| | - Kathy Holloway
- Victoria University of Wellington, Level 7, Clinical Services Block, Wellington Hospital, 6242, New Zealand.
| | - Samuel Lapkin
- Faculty of Science Medicine & Health, School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, Perth, Australia.
| | - Belinda McGrath
- School of Health, Whitireia Polytechic, Porirua, New Zealand.
| | - Ann Nielsen
- Oregon Health & Science University, 3455 SW Veterans' Hospital Rd., Portland, OR 97239, USA.
| | - Sydnee Stoyles
- Oregon Health & Science University, 3455 SW Veterans' Hospital Rd., Portland, OR 97239, USA.
| | - Nathan F Dieckmann
- Oregon Health & Science University, 3455 SW Veterans' Hospital Rd., Portland, OR 97239, USA.
| | - Molly Campbell
- Oregon Health & Science University, 3455 SW Veterans' Hospital Rd., Portland, OR 97239, USA.
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Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric. Nurse Educ Pract 2019; 38:14-20. [DOI: 10.1016/j.nepr.2019.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 04/11/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022]
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Jessee MA. Teaching Prioritization: “Who, What, & Why?”. J Nurs Educ 2019; 58:302-305. [DOI: 10.3928/01484834-20190422-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
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Brown Tyo M, McCurry MK. An Integrative Review of Clinical Reasoning Teaching Strategies and Outcome Evaluation in Nursing Education. Nurs Educ Perspect 2019; 40:11-17. [PMID: 30095730 DOI: 10.1097/01.nep.0000000000000375] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND This study explored teaching strategies used to promote clinical reasoning in nursing education and identify outcomes used to evaluate effectiveness. METHOD The integrative review framework by Whittemore and Knafl (2005) was used in this study. RESULTS Strategies included simulation (n = 10); active learning strategies such as case studies, reflection, journaling, and collaborative learning (n = 13); teaching strategies such as think aloud or case studies with simulation (n = 12); and experiential or clinical experiences (n = 2). Although most studies used exams, worksheets (n = 19), or observations by clinical instructors (n = 2) to measure effectiveness, some studies (n = 8) also used surveys to measure student satisfaction, engagement, or perception; three studies measured the student's ability to use the instrument. CONCLUSION Improving clinical thinking requires development of innovative, effective teaching strategies. Instruments that can accurately evaluate teaching and learning strategies are needed to advance this educational initiative and improve quality of care.
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Affiliation(s)
- Mirinda Brown Tyo
- About the Authors Mirinda Brown Tyo, MSN, TCRN, is a PhD student, University of Massachusetts Dartmouth College of Nursing, Dartmouth, Massachusetts. Mary K. McCurry, PhD, RNC, ANP, ACNP, is an associate professor and adult gerontology PCNP track coordinator, University of Massachusetts Dartmouth College of Nursing. For more information, contact Mirinda Brown Tyo at or
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Georg C, Karlgren K, Ulfvarson J, Jirwe M, Welin E. A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients. J Nurs Educ 2018; 57:408-415. [DOI: 10.3928/01484834-20180618-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/06/2018] [Indexed: 11/20/2022]
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Jessee MA. Pursuing Improvement in Clinical Reasoning: The Integrated Clinical Education Theory. J Nurs Educ 2018; 57:7-13. [DOI: 10.3928/01484834-20180102-03] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/02/2017] [Indexed: 11/20/2022]
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