Clinical Judgment Scripts as a Strategy to Foster Clinical Judgments

Rolling Through the Complications With the Clinical Judgment Model

BACKGROUND

Nurse educators have been challenged to creatively implement the clinical judgment model (CJM) across the curriculum. Opportunities exist to utilize rich patient data in clinical debriefing.

METHOD

Rolling Through the Complications with the CJM, a scripted clinical debriefing tool, was created to help students think beyond the clinical day and apply clinical judgment to potential complications. In a pilot study, five medical-surgical clinical instructors implemented the clinical debriefing tool.

RESULTS

Survey responses from 29 students following the clinical debriefing expressed the activity was a positive experience encouraging focused analysis beyond typical post-conference discussions. Comments focused on critical thinking, collaborative learning, application to future practice, and holistic care.

CONCLUSION

Clinical post-conferences offer excellent opportunities to implement scripted debriefing encompassing the CJM. [J Nurs Educ. 2024;63(X):XXX-XXX.].

An integrative review of teaching strategies to support clinical judgment development in clinical education for nurses

OBJECTIVES

Historically, emphasis on task-completion and lack of intentional approaches that develop students' thinking skills have dominated clinical education. One contributing factor may be the limited literature about teaching to develop clinical reasoning and clinical judgment in the clinical environment. This integrative review accessed available literature to answer the question, What strategies are used to develop clinical judgment in the clinical education environment?

DESIGN

The Whittemore and Knafl approach framed the integrative review. The framework includes the following steps 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation.

DATASOURCES

The data bases CINAHL Plus with Full Text, OVID, and ProQuest were searched through the period of January 2000 through July of 2022.

REVIEW METHODS

The PRISMA protocol informed review and screening of the literature. Authors assessed articles for eligibility via first screening by abstract review, followed by review of the full text. Both authors reviewed the articles, assessing qualification for inclusion and evaluating the content. Data from eligible articles were analyzed and synthesized to answer the research question.

RESULTS

Of the initial 427 articles, a total of 20 articles met inclusion criteria for final analysis. Five general themes emerged for clinical judgment during clinical education. The findings identified the teaching strategies nurse educators use. Many of the teaching methods include deliberateness and intentionality in planning and implementing the strategies. In addition to evaluating clinical judgment, nurse educators guided and mentored student thinking. Finally, this review identified reported outcomes and results of the teaching strategies and methods.

CONCLUSIONS

A limited number of articles describing teaching for clinical judgment in clinical environment were found. The articles analyzed found that nurse educators used a variety of teaching strategies for the purpose of developing students' clinical judgment. More research is needed to guide best-practices in clinical education. We must move the science forward to transform and leverage clinical education more deliberately to teach thinking in practice and decision-making about patient care.

The implementation of Tanner's Clinical Judgment Model and the Indonesian version of the Lasater Clinical Judgment Rubric in the clinical setting

A critical component for nurses to provide safe and quality care with strong patient outcomes is clinical judgment. This study aimed to identify the difference in the clinical judgment score in newly graduated nurses by implementing Tanner's Clinical Judgment Model. This study followed an experimental design with a pretest-posttest and involved thirty-two newly graduated nurses from three private hospitals in Indonesia. The intervention group had a scheduled post-conference with their preceptors using Tanner's Clinical Judgment Model's guidelines with high-level, open-ended questions for two consecutive weeks. Independent samples t-test was used to compare pre-and post-test scores utilizing the valid and reliable Indonesia version of the Lasater Clinical Judgment Rubric. There was no significant difference between the pre-test results of the intervention and control groups, with a significance value of 0.647. The results indicated a significant difference in the mean clinical judgment scores between the intervention and control groups after two weeks of intervention, where the intervention group's scores were higher than the control group's with a significance value of <0.001 with a mean difference of 6.75 and CI of 95 % (4.18-9.31). Tanner's Clinical Judgment Model showed a significant impact in increasing clinical judgment scores. The Indonesia version of the Lasater Clinical Judgment Rubric is a valuable tool for assessing and evaluating the development of clinical judgment and provides detailed targeted areas needing improvement. Preceptors and nursing leaders in the clinical setting should continue to use this model and tools to assist newly graduated nurses in developing clinical judgment skills during their transition period.

Assessment of Clinical Reasoning While Attending Critical Care Postsimulation Reflective Learning Conversation: A Scoping Review

BACKGROUND

The critical care environment is characterized with a high level of workload, complexity, and risk of committing practice mistakes. To avoid clinical errors, health care professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, health care professionals should get the chance to practice and be exposed to different patient experiences. To minimize safety risks to patients and health care professionals, clinical reasoning with a focus on reflective learning conversation opportunities can be practiced in simulated settings.

OBJECTIVES

To explore the most valid and reliable tools to assess clinical reasoning while attending adult critical care-related simulation-based courses in which reflective learning conversations are used.

METHODS

A scoping review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews. Eight electronic databases were searched, and full-text review was completed for 26 articles.

RESULTS

The search resulted in no studies conducted to measure clinical reasoning while attending adult critical care-related, simulation-based courses in which the reflective learning conversation method was embedded.

DISCUSSION

This highlights the need to evaluate current available clinical reasoning tools or develop new tools within the context of adult critical care simulation where reflective learning forms a key part of the simulation procedures.

Cultivating Clinical Judgment in Pharmacological Decision-Making Through Reflection on Practice

BACKGROUND

Competent clinical judgment about pharmacological therapies by nurses is essential for safe medication outcomes. This study examined the impact of postclinical pharmacology-focused reflective debriefing sessions on clinical judgment in prelicensure senior nursing students.

METHOD

A nonrandomized repeated measures design was used to compare clinical judgment of students who participated in an additional learning activity with students who did not. Data were collected using Lasater's Clinical Judgment Rubric.

RESULTS

Within-groups analysis of variance demonstrated statistically significant increases in clinical judgment scores at mid- and late-semester timepoints for the entire cohort of participants (n = 128). However, analysis of covariance showed no statistically significant differences in the clinical judgment scores for the intervention (n = 62) and control (n = 66) groups.

CONCLUSION

Clinical experiences provide opportunities for prelicensure students to develop clinical judgment about pharmacological therapies. Nurse educators must implement and evaluate strategies to foster this process. [J Nurs Educ. 2022;61(3):143-146.].

The Use of Guided Reflection in Simulation-Based Education With Prelicensure Nursing Students: An Integrative Review

BACKGROUND

This integrative review synthesized the findings of studies to determine the uses and outcomes of guided reflection in simulation-based education (SBE) with prelicensure nursing students.

METHOD

A search of Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Education Resources Information Center (ERIC), Education Research Complete (ERC), and PsychINFO using the key words reflection, guided reflection, simulation (nursing education or nursing student), traditional, and baccalaureate identified 18 articles.

RESULTS

Findings suggest facilitation of guided reflection in SBE has a positive effect on leadership development, clinical judgment, student satisfaction, and critical thought. Development of a tool to accurately measure guided reflection is warranted.

CONCLUSION

Current evidence on the use of guided reflection in SBE calls for a major paradigm shift in higher education. Guided SBE experiences enhance participant knowledge, and guided reflection should be used as an innovative teaching strategy in SBE. [J Nurs Educ. 2022;61(2):73-79.].

Reclaiming magical incantation in graduate medical education

Critical thinking relies upon conceptualization (what is the possible pathophysiology?), analysis (how do I relate an aberration in physiology to the lived experience of illness?), and synthesizing (how do I best intervene?). These cognitive skills are subsumed in the category of reflective competencies and are necessary for developing a differential diagnosis or a plan of care. A vulnerability of teaching medicine through the filter of heuristics is that it may simply recapitulate the teacher's style of cognitive shortcuts. Poorly calibrated heuristics may culminate in systematic errors of judgment. If the aim is to teach critical reasoning in the arena of clinical education, then a new paradigm is called for. Teaching critical reasoning as it applies to medical decision-making begins with recognizing decision scripts.Key Points• Medical heuristics are high-stakes endeavors.• The process of examining the choice of heuristics employed in any given clinical scenario is a meta-reasoning strategy.• Debiasing reduces cognitive errors due to motivated reasoning.