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Monagle J, Jessee MA, Nielsen A, Gonzalez L, Lasater K. Observed Use of Clinical Judgment Among New Graduate Nurses. J Contin Educ Nurs 2024:1-8. [PMID: 38466730 DOI: 10.3928/00220124-20240301-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Despite the efforts of academic nursing educators to prepare students to make sound clinical judgments, the literature suggests new graduate nurse (NGN) competence with this critical skill continues to decline. This study sought to identify how practicing nurses describe their observations of the use and outcomes of clinical judgment by NGNs in nursing practice. METHOD A multisite, cross-sectional survey using multiple-choice, Likert scale, and open response items to identify participants' observations of NGN clinical judgment was sent with snowball sampling and resulted in a sample of 314 participants from 19 U.S. states. RESULTS Practice partners identified a wide discrepancy between how they expect NGNs to use clinical judgment and what they actually see NGNs do, with resultant negative effects on patients and NGNs. CONCLUSION These results provide a beginning understanding of NGNs' specific challenges with clinical judgment. Efforts to improve clinical judgment across nursing education and practice are needed. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].
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Lasater K, Nielsen A. The Lasater Clinical Judgment Rubric: 17 Years Later. J Nurs Educ 2024; 63:149-155. [PMID: 38442394 DOI: 10.3928/01484834-20240108-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Nearly 17 years ago, the Lasater Clinical Judgment Rubric (LCJR) was published to provide a common language and trajectory of students' development to think like a nurse. METHOD This article traces the uses of the LCJR from creation to the present and cites lessons learned from its use. RESULTS During the intervening years, the LCJR has been used effectively as a debriefing guide in simulation and as a research instrument, as well as for formative assessment. The LCJR has been translated or is in process in 19 languages besides English. CONCLUSION This article provides evidence of the efficacy of the LCJR and discusses important lessons learned. [J Nurs Educ. 2024;63(3):149-155.].
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Gonzalez L, Nielsen A. An integrative review of teaching strategies to support clinical judgment development in clinical education for nurses. NURSE EDUCATION TODAY 2024; 133:106047. [PMID: 38039885 DOI: 10.1016/j.nedt.2023.106047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
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.
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Affiliation(s)
- Lisa Gonzalez
- College of Southern Maryland, Center for Health Sciences, 6105 Foster Ln, Hughesville, MD 20637, United States of America.
| | - Ann Nielsen
- Oregon Health & Science University School of Nursing, 3455 SW US Veteran's Road, Portland, OR 97239-2941, United States of America
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Deschênes MF, Maheu-Cadotte MA, Fontaine G, Dionne É. Scoring Methods in Script Concordance Tests: An Exploratory Psychometric Study. J Nurs Educ 2023; 62:549-555. [PMID: 37812827 DOI: 10.3928/01484834-20230815-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods. METHOD An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods. RESULTS The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods. CONCLUSION Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549-555.].
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Calcagni L, Lindell D, Weaver A, Jackson M. Clinical Judgment Development and Assessment in Clinical Nursing Education. Nurse Educ 2023; 48:175-181. [PMID: 36728083 DOI: 10.1097/nne.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is a gap in evidence for effective clinical teaching strategies to promote nursing students' development of clinical judgment (CJ). PURPOSE This study examined the effect of active learning strategies (ALSs) during clinical postconference sessions on the CJ of undergraduate nursing students. METHODS This quasi-experimental study of ALSs or standard postconferences used the Lasater Clinical Judgment Rubric (LCJR) to rate CJ at 3 time points. All faculty members and students were trained on use of the LCJR. Ratings were done by both faculty and students. RESULTS All ratings of CJ improved over time ( P < .001). Ratings of CJ varied between the control and intervention groups. CONCLUSIONS The findings of this study contribute to knowledge regarding the effectiveness of clinical teaching strategies for CJ and preparation for entry to nursing practice.
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Affiliation(s)
- Laura Calcagni
- Assistant Professor (Dr Calcagni) and Associate Professor (Dr Weaver), Centofanti School of Nursing, Youngstown State University, Youngstown, Ohio; Professor (Dr Lindell) and Assistant Professor (Dr Jackson), Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Delle JM, Cross L, Weaver A, Jessee MA. Evolving the Assessment of Clinical Judgment: An Individual or Collective Competency? Nurse Educ 2023; 48:76-81. [PMID: 36731092 DOI: 10.1097/nne.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nurses make decisions about care individually and as part of a team. Collective competence, the effective team management of patient care situations, is partially dependent on nurses' individual confidence and clinical judgment competence. PURPOSE To describe individual and team-based facilitators and barriers to collective competence in teams of senior baccalaureate-level prelicensure nursing students during a team-based simulation. METHODS With a cross-sectional design, the study used a 26-item survey based on the National Council of State Boards of Nursing (NCSBN)-Clinical Judgment Measurement Model (CJMM) (α= .86) to assess individual student confidence and perceptions of clinical judgment competence while observation of team dynamics and task completion assessed collective competence. RESULTS Closed-loop communication and role assignment were facilitators of collective competence when present and barriers when absent. Additional barriers were lack of student confidence and perceived competence with Layers 3 and 4 of the NCSBN-CJMM. CONCLUSIONS Team-based simulation strategies can be effectively used to assess collective clinical judgment competence.
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Affiliation(s)
- Janelle M Delle
- Assistant Professor of Nursing (Dr Delle), Instructor (Mss Cross and Weaver), and Assistant Dean for Academics, Generalist Nursing Practice (Dr Jessee), Vanderbilt University School of Nursing, Nashville, Tennessee
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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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Edwards A, Froude E, Dark L, Carding P. Factors that influence success when training videofluoroscopic swallowing study analysts. SPEECH, LANGUAGE AND HEARING 2023. [DOI: 10.1080/2050571x.2023.2171952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Ann Edwards
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Leigha Dark
- School of Allied Health, Australian Catholic University, North Sydney, Australia
- School of Health Sciences, University of Western Sydney, Sydney, Australia
| | - Paul Carding
- School of Allied Health, Australian Catholic University, Virginia, Australia
- OxINMAHR, Oxford Brookes University, Oxford, UK
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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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Bryan V, Corcoran L, Dewart G, Thirsk LM, Bowers E. Clinical learning during the pandemic: Experiences of LPN-BN undergraduate nursing students. J Prof Nurs 2022; 42:301-307. [PMID: 36150874 PMCID: PMC9368157 DOI: 10.1016/j.profnurs.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/01/2022]
Abstract
Background When the COVID-19 pandemic was declared in March 2020, nursing programs made rapid decisions regarding clinical placement experiences for students. In many nursing programs, this meant ending clinical placements early, delaying clinical courses, and moving clinical courses to simulation. Purpose The purpose of this study was to explore LPN-BN students' experiences in clinical courses during the COVID-19 pandemic. Method A qualitative descriptive approach was employed in this study. Fifteen semi-structured conversational interviews with nursing students and recent graduates were conducted. Inductive content analysis was used to analyse the data. Results Four main concepts were identified: (1) logistics of learning; (2) shifts in clinical learning; (3) mental health matters; (4) readiness to practice. Conclusion It is important to understand the experience of nursing students as this is an inordinately stressful and impressionable time for them. Insight into the student experience, will inform educators in the areas of curriculum and competency-based evaluation as well as supports for student mental health and well-being.
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Hosseinzadeh T, Norouzi Tabrizi K, Fallahi-Khoshknab M, Khankeh H, Shokooh F. Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study. Nurs Forum 2022; 57:860-868. [PMID: 35701998 DOI: 10.1111/nuf.12762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills. AIM The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU. DESIGN A qualitative design was used. METHODS This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring. RESULTS The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively. CONCLUSION This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.
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Affiliation(s)
- Touba Hosseinzadeh
- Department of Nursing, University of Social Welfare and Rehabilitation (USWR), Tehran, Iran
| | - Kian Norouzi Tabrizi
- Department of Nursing, University of Social Welfare and Rehabilitation (USWR), Tehran, Iran
| | | | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Forozan Shokooh
- Education Development center (EDC), University of Social Welfare and Rehabilitation (USWR), Tehran, Iran
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Anderson M, Hills-Meyer PR, Stamm JM, Brown K. Integrating Clinical Reasoning Skills in a Pre-professional Undergraduate Human Anatomy Course. ANATOMICAL SCIENCES EDUCATION 2022; 15:304-316. [PMID: 33387378 DOI: 10.1002/ase.2050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
Clinically integrated curricula in health science education has been shown to promote the development of problem-solving schema and positively impact knowledge acquisition. Despite its' purported benefits, this type of curricula can impose a high cognitive load, which may negatively impact novice learners' knowledge acquisition and problem-solving schema development. Introducing explicit clinical reasoning instruction within pre-professional undergraduate basic science courses may limit factors that increase cognitive load, enhance knowledge acquisition, and foster developing clinical problem-solving skills. This study, conducted over the Fall and Spring semesters of the 2018-2019 school year, sought to evaluate whether the implementation of a clinical reasoning instructional intervention within a clinically integrated pre-professional undergraduate general human anatomy course influenced students' acquisition of anatomical knowledge and development of clinical problem-solving skills. Results of the study were mixed regarding the acquisition of anatomical knowledge. Both the intervention and comparison groups performed similarly on multiple choice examinations of anatomical knowledge. However, the clinical reasoning intervention positively impacted students' ability to apply clinical reasoning skills to anatomically based clinical case studies. Results from M\mixed between-within subjects analysis of variance comparing scores on Written Clinical Reasoning Assessments revealed a significant interaction between time and group affiliation, with the groups receiving the interventions outperforming the comparison groups: Fall, P < 0.001; Spring, P < 0.001. The results of this study may imply that explicit clinical reasoning instruction within a clinically integrated undergraduate Human Anatomy course could hold potential for fostering students' early clinical reasoning skills.
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Affiliation(s)
- Margene Anderson
- Department of Academic Technology, University of Wisconsin, Madison, Wisconsin
| | | | - Julie M Stamm
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin
| | - Kirsten Brown
- Doctoral Program in Educational Leadership Policy Studies, School of Education, Edgewood College, Madison, Wisconsin
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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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Abstract
BACKGROUND Safe patient care relies on the ability of nurses to make timely, sound clinical judgments, yet new nurse graduates are underprepared. Nurse educators must take action with teaching to develop students' clinical reasoning skills and ultimately their clinical judgment. One first step is to consider strategies that integrate clinical judgment and clinical reasoning skills into nursing curriculum. METHOD The literature was reviewed to uncover what is known about teaching strategies that intentionally teach clinical reasoning skills and are focused on the development of students' clinical judgment. RESULTS Although not exhaustive, this guide for faculty discusses first steps when considering integrating clinical reasoning and judgment into nursing curriculum, presents teaching strategies, and provides ideas for implementation within nursing curriculum. CONCLUSION Teaching clinical reasoning skills, using a framework, and incorporating teaching strategies such as concept-learning, high-order questioning, and reflection focused on developing clinical reasoning skills may prove useful in developing students' clinical judgment. [J Nurs Educ. 2021;60(9):485-493.].
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Kawase Y, Miyashita M, Okayasu M, Hirai Y. Development of a Clinical Judgment Scale for Japanese Nurses. J Contin Educ Nurs 2021; 52:383-391. [PMID: 34324379 DOI: 10.3928/00220124-20210714-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to develop a scale to assess the clinical judgment of nurses based on the clinical judgment process. METHOD Based on a qualitative analysis of interviews with specialized and certified nurses and extant literature, a scale comprising 44 question items was created. A questionnaire survey was conducted with 1,444 nurses working in 28 general hospitals, psychiatric wards, cardiac care units, and intensive care units in Japan. RESULTS Valid responses were obtained from 610 nurses. Exploratory factor analysis was performed on the 23 items extracted by item analysis, and two factors, "theoretical and practical reasoning" and "grasping the condition by observation," were extracted. Confirmatory factor analysis revealed the fit of the model. Cronbach's alpha confidence factor was 0.943 for the first factor and 0.924 for the second factor. CONCLUSION These results support the factor validity and reliability of the clinical judgment scale. [J Contin Educ Nurs. 2021;52(8):383-391.].
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Pillay T, Pillay M. Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e12. [PMID: 34342487 PMCID: PMC8335787 DOI: 10.4102/sajcd.v68i1.832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022] Open
Abstract
Background This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment. Objectives This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation. Method A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years. Results Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation. Conclusion The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.
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Affiliation(s)
- Thiani Pillay
- Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Mohammadi-Shahboulaghi F, Khankeh H, HosseinZadeh T. Clinical reasoning in nursing students: A concept analysis. Nurs Forum 2021; 56:1008-1014. [PMID: 34228356 DOI: 10.1111/nuf.12628] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/23/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of this analysis is to clarify the concept of clinical reasoning in nursing students. BACKGROUND Sound clinical reasoning is the most important skill required in professional nursing and understanding of this concept is emphasized as a basis for clinical reasoning development in nursing education curricula. DESIGN Rodgers' concept analysis method was used to achieve a clear and understandable definition. DATA SOURCE Resources published from 2000 to 2020 were identified via electronic databases. REVIEW METHODS A review of the literature was completed, and the data were analyzed to identify the Surrogate and related terms, attributes, antecedents and consequences of the concept. RESULTS This concept is a holistic and recursive cognitive process that has a dynamic and flexible nature to perceive the patient's condition, select the best practice to respond to the situation, and learn from the situation. Clinical reasoning in nursing students emerges despite professional standards; discipline-specific knowledge, cognitive perception, critical thinking, learning experiences, and intuitive ability, and the requirements of the professional system affect its establishment in the nursing discipline. Clinical reasoning is the cognitive process underlying clinical judgment, appropriate decision making, improvement of nursing quality, metacognitive awareness, and professional competence in nursing, whose achievement, generally, paves the way for nursing professionalization and development that are important steps toward independence in the nursing profession. CONCLUSIONS The present concept analysis clarifies the concept of clinical reasoning as a complex thinking process that should be considered as a fundamental thinking skill in nursing program.
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Affiliation(s)
- Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Touba HosseinZadeh
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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McNelis AM, Dreifuerst KT, Beebe S, Spurlock D. Types, Frequency, and Depth of Direct Patient Care Experiences of Family Nurse Practitioner Students in the United States. JOURNAL OF NURSING REGULATION 2021. [DOI: 10.1016/s2155-8256(21)00021-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Script Concordance and the Think-Aloud Approach Through the Lens of Cognitive Apprenticeship Theory. Nurse Educ 2021; 46:E193-E197. [PMID: 33793451 DOI: 10.1097/nne.0000000000001008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Script concordance (SC) and the think-aloud (TA) approach informed by cognitive apprenticeship theory can promote clinical reasoning. PURPOSE The purpose of this study was to determine whether SC with the TA approach based on the tenets of cognitive apprenticeship theory facilitated clinical reasoning in senior-level prelicensure nursing students in a baccalaureate program. METHODS This study was executed in a didactic pediatric nursing course using a quantitative, nonexperimental design. Creation of the SC/TA learning activity was grounded in cognitive apprenticeship theory and based on the SC testing/TA testing method. RESULTS Repeated-measures analysis of variance revealed a difference (P = .001 and .003) between earlier and later SC scores for the fall 2018 cohort. CONCLUSION The SC/TA teaching/learning activity informed by cognitive apprenticeship theory offers a leveled approach to foster clinical reasoning in prelicensure nursing education.
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Wyatt T, Baich VA, Buoni CA, Watson AE, Yurisic VE. Clinical Reasoning: Adapting Teaching Methods During the COVID-19 Pandemic to Meet Student Learning Outcomes. J Nurs Educ 2021; 60:48-51. [PMID: 33400809 DOI: 10.3928/01484834-20201217-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The COVID-19 pandemic impacted all aspects of health care, including nursing education. Senior nursing students saw the elimination of in-person clinical opportunities in the final months prior to graduation as health care facilities restricted access to essential personnel in an effort to minimize transmission of the virus and conserve personal protective equipment. METHOD To fulfill course requirements, faculty created a COVID-19 assignment that implored students to research the most current infection control recommendations for COVID-19 and to describe the impacts of the virus on nursing care, patients, families, interdisciplinary collaboration, and public safety. RESULTS The COVID-19 assignment fostered clinical reasoning and encouraged personal reflection with application to practice. Students reported that the assignment greatly enhanced knowledge and awareness of COVID-19. CONCLUSION This assignment was beneficial for transition to practice in the midst of a pandemic, and it can be easily replicated for any future emerging health care topic that may affect nursing education. [J Nurs Educ. 2021;60(1):48-51.].
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Markey K. Moral reasoning as a catalyst for cultural competence and culturally responsive care. Nurs Philos 2020; 22:e12337. [PMID: 33155425 DOI: 10.1111/nup.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 11/28/2022]
Abstract
The importance of developing cultural competence among healthcare professionals is well recognized. However, the widespread reports of insensitivity and deficiencies in care for culturally diverse patients illuminate the need to review how cultural competence development is taught, learnt and applied in practice. Unless we can alter the 'hearts and minds' of practising nurses to provide the care that they know they should, culturally insensitive care will continue operating in subtle ways. This paper explores the ideas behind nurses' actions and omissions when caring for culturally diverse patients and proposes the need to examine cultural competence development through a moral reasoning lens. Examining cultural competence development through a moral reasoning lens can help empower nurses, whilst nurturing commitment and courage to providing quality care that meets the needs of culturally diverse patients. The model of morality provides a framework that explores how moral motivation and behaviour occur and can provide a vehicle for critically examining the knowledge, skills and attitudes required to provide culturally responsive care.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Science Institute, University of Limerick, Limerick, Ireland
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Elvén M, Hochwälder J, Dean E, Söderlund A. Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students. Phys Ther 2019; 99:964-976. [PMID: 30869789 PMCID: PMC6665874 DOI: 10.1093/ptj/pzz044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/03/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. OBJECTIVE This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-à-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. DESIGN This study used an exploratory cross-sectional design. METHODS The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. RESULTS All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R2 = 0.04; SBC change in R2 = 0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. LIMITATIONS The limitations of this study are that it was cross-sectional. CONCLUSIONS Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden,Address all correspondence to Ms Elvén at:
| | - Jacek Hochwälder
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University
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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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