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

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.].

Observed Use of Clinical Judgment Among New Graduate Nurses

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. 2024;55(8):399-406.].

The Lasater Clinical Judgment Rubric: 17 Years Later

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.].

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review

OBJECTIVE

To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice.

DESIGN

Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment.

METHODS

Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics.

RESULTS

Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study.

CONCLUSION

In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

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.