Assessing Clinical Judgment and AACN Domains in Self-Reflection of Video Recorded High-Fidelity Simulation Scenarios.

BACKGROUND: Clinical judgment is the hallmark of safe patient care. Nurse educators continue to explore best practices to assist prelicensure nursing students in developing clinical judgment. PURPOSE: The 3-part purpose of this study was to identify what students learned about themselves related to clinical judgment after viewing their video-recorded high-fidelity simulation scenarios, to assess if video recording is an effective post-debriefing teaching strategy, and to evaluate if the 2021 American Association of Colleges of Nursing (AACN) Domains can be assessed longitudinally. METHODS: Qualitative interpretive description study of 37 prelicensure nursing students. RESULTS: Ten codes were derived from 314 excerpts: communication, body language, confidence in self, putting data together, collaboration, leadership, safety, skillfulness, areas of improvement, and growth. CONCLUSIONS: Longitudinal data showcased the development of clinical judgment, effectiveness of self-evaluation of video recorded simulations as a teaching strategy, and assessment of 5 AACN Domains.

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.

Relaxation as an Educational Strategy for Stress Management and Resiliency.

BACKGROUND: Prelicensure nursing students experience higher levels of stress, anxiety, and depression than the remainder of the student body. PURPOSE: The purpose of this study was to identify whether implementation of Stress Management and Resiliency Training (SMART) and a relaxation room decreased perceived stress levels in prelicensure nursing students. METHODS: This quasi-experimental pre- and posttest interventional study used a within-subjects design. Nursing students were asked to use a relaxation room for 15 minutes following a discussion on stress management and resiliency strategies. The students evaluated their stress level at baseline and at the conclusion of using the relaxation room. RESULTS: The self-reported stress levels decreased for nearly 90% of the participants following the use of the interventions. CONCLUSIONS: Stress management and resiliency interventions during academic hours decreased the reported stress levels of nursing students. The strategies are beneficial options to reduce stress and improve resiliency skills among prelicensure nursing students.

Public Health in the Public Eye: Experiences of Ohio's Public Health Workforce During COVID-19.

The COVID-19 pandemic was uniquely challenging for public health workers charged with enforcing recommendations. In the United States, media reports highlight frequent outbursts and threats from community members and elected officials regarding masking protocols, vaccine mandates, and other public health measures such as isolation/quarantining recommendations. Given this backdrop, the purpose of this study was to better understand the lived experiences of this critical workforce in the context of COVID-19. We conducted in-depth phone interviews with public health workers in Ohio (N = 11). Questions were designed to illicit workers' experiences and sense-making of the pandemic experience. We analyzed results using the techniques of interpretive phenomenological analysis. Five major themes focused on how workers experienced public perceptions of COVID-19 and the public health response. Three themes highlight the role of media and social media in polarizing public perceptions. These we note as: Dealing with Deadlock, Feeling Misunderstood and Misrepresented, and The Rollercoaster of Public Opinion. Getting on With the Work reveals strategies used to navigate public perceptions and misperceptions. This ranged from aggressive education and information sharing, to setting boundaries around the controversial or disputed aspects of the pandemic. Finally, After the Dust Settles comments on hopes for postpandemic transformations of public health and public perceptions thereof. These results can inform new pathways for public health. Paramount among these are effective strategies that address public knowledge, values, and worldviews. Such messaging must promote nuanced understanding and customized approaches for local realities, rather than relying on rigid dichotomies that further polarization and distrust.

Satisfactory Completion of End-of-Course Outcomes Using Simulation.

BACKGROUND: Simulation is replacing clinical hours in prelicensure nursing programs, and students must be evaluated to ensure that the end-of-course outcomes are met. The purpose of this study was to identify what an average score (or cutoff score) for high-fidelity simulation is for successful and satisfactory completion of end-of-course outcomes in a medical-surgical nursing course using the Lasater Clinical Judgment Rubric. METHOD: A retrospective, descriptive, quantitative study was performed using a convenience sample of 143 RN diploma nursing students. Data were collected from 2013 to 2017. RESULTS: A cutoff score of 28 was identified indicating satisfactory and successful completion of end-of-course outcomes in a medical-surgical nursing course. CONCLUSION: Ensuring that students meet end-of-course outcomes and participating in simulated patient scenarios is essential in meeting board of nursing regulations. [J Nurs Educ. 2018;57(8):489-492.].

Evaluation of Clinical Judgment in Prelicensure Nursing Students.

Clinical judgment is an essential end-of-program outcome for prelicensure nursing students. Evaluating progression of clinical judgment when students participate in simulated patient experiences is essential in ensuring that end-of-program and course outcomes are achieved. The purpose of this study was to identify if progression in clinical judgment is evident after students participate in 4 simulated patient experiences as measured by the Lasater Clinical Judgment Rubric.

Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment.

BACKGROUND: Nurse educators are increasingly using high-fidelity simulators to improve prelicensure nursing students' ability to develop clinical judgment. Traditionally, oral debriefing sessions have immediately followed the simulation scenarios as a method for students to connect theory to practice and therefore develop clinical judgment. Recently, video recording of the simulation scenarios is being incorporated. METHOD: This qualitative, interpretive description study was conducted to identify whether self-reflection on video-recorded high-fidelity simulation (HFS) scenarios helped prelicensure nursing students to develop clinical judgment. Tanner's clinical judgment model was the framework for this study. RESULTS: Four themes emerged from this study: Confidence, Communication, Decision Making, and Change in Clinical Practice. CONCLUSION: This study indicated that self-reflection of video-recorded HFS scenarios is beneficial for prelicensure nursing students to develop clinical judgment. [J Nurs Educ. 2016;55(9):522-527.].

The Nature of Clinical Judgment Development in Reflective Journals.

BACKGROUND: Evaluating the development of clinical judgment after high-fidelity simulation (HFS) scenarios is essential for nurse educators to ensure that prelicensure nursing students are meeting course and curriculum outcomes. METHOD: This qualitative, interpretive description study reviewed the reflective journals of 30 prelicensure nursing students who participated in four progressive HFS scenarios during a medical-surgical nursing course to determine their levels of clinical judgment, using Lasater's Clinical Judgment Rubric (LCJR). RESULTS: Within journal one, 172 comments were identified as either beginning or developing in clinical judgment, whereas 52 comments were identified as such within journal four. In journal one, 65 comments were identified as accomplished or exemplary in clinical judgment, whereas 170 comments were identified as such within journal four. CONCLUSION: This study indicated that evaluating reflective journals using the LCJR is an effective method for ensuring that course and curriculum outcomes are met after prelicensure nursing students participate in HFS scenarios.

Clinical judgment in reflective journals of prelicensure nursing students.

Clinical judgment is an essential skill needed by RNs. Employers expect new graduate nurses to enter the work-force with established clinical judgment skills. Therefore, nurse educators must ensure that prelicensure nursing students develop clinical judgment before graduation. This qualitative, interpretive description study reviewed the reflective journals of 30 prelicensure nursing students who participated in four progressive high-fidelity simulation (HFS) scenarios during a medical-surgical nursing course. Eight themes were identified in the reflective journals: (a) expectations about the patient, (b) recognition of a focused assessment, (c) interpretation of medications, laboratory data, and diagnostics, (d) communication with the patient, (e) collaboration and interprofessionalism, (f) prioritizing interventions, (g) skillfulness with interventions, and (h) incorporation of skills and information into real patient situations. This study indicated that reflective journaling following progressive HFS scenarios may be an effective teaching-learning strategy to assist prelicensure nursing students in the development of clinical judgment.

Reteplase: nursing implications for catheter-directed thrombolytic therapy for peripheral vascular occlusions.

Several studies since 1998 have shown the efficacy of catheter-directed thrombolytic therapy with reteplase. Reteplase is a plasminogen activator that penetrates the thrombus and causes lysis. This catheter-directed approach has been used to treat both arterial and venous occlusions, with a success rate of 72% to 88%. The most serious complication associated with thrombolytic therapy is intracranial hemorrhage. Patients should be admitted to the intensive care unit for monitoring of neurological status, vital signs, laboratory values (hematocrit, hemoglobin level, activated partial thromboplastin time, and fibrinogen concentration), and bleeding or oozing at puncture sites. Staff nurses in the intensive care unit must be aware of this important thrombolytic therapy, its indications, and its implications for nursing interventions.