Learning Clinical Judgments With a Lens of Inclusivity.

ABSTRACT: To prepare practice-ready graduates and promote NCLEX® success, many schools of nursing have adopted a clinical judgment model (CJM) to provide a framework for their curriculum and teaching strategies. Missing from most CJMs are clear principles of justice, equity, diversity, and inclusion (JEDI), imperative to prepare a nursing workforce to care holistically for diverse populations. This article describes the curriculum integration of an adapted model with added JEDI principles. By intentionally integrating the language and understanding of a CJM with JEDI principles, nurse educators can promote the clinical judgment development necessary to prepare graduates to care for diverse populations.

A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula.

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.

Case Studies of Interprofessional Education Initiatives From Five Countries.

BACKGROUND: Although teamwork and interprofessional collaboration are critical to patient safety, nursing, medical, and allied health graduates often feel ill-prepared to confidently communicate and collaborate with other team members. While interprofessional education (IPE) has been advocated as a way of addressing this issue, there are multiple barriers to its systematic and sustained integration in undergraduate healthcare programs. Despite these challenges, examples of effective IPE initiatives have emerged. INNOVATION: This article profiles seven case studies of innovative interprofessional education activities that have been successfully implemented across five countries, for a variety of learners, using different delivery modalities, and with evaluation results attesting to their success. CONCLUSIONS: The case studies demonstrate innovative ideas that have the potential to overcome some of the barriers to IPE through the use of creative and targeted approaches. This article provides a wealth of ideas for the successful design and implementation of IPE initiatives and will be of benefit to educators wishing to expand their repertoire of teaching approaches. CLINICAL RELEVANCE: A body of research attests to the relationship between interprofessional communication, teamwork, and patient outcomes. IPE is imperative for facilitating the development of nursing graduates' communication and teamwork skills; however, innovative approaches are needed to overcome the perceived and actual impediments to its implementation.

New Graduate Nurse Experiences in Clinical Judgment: What Academic and Practice Educators Need to Know.

AIM: The aim of the study was to determine if use of a structured reflection exercise using a clinical judgment framework would result in more practice-ready new graduate nurses (NGNs). BACKGROUND: Clinical judgment is a critical skill for all nurses, yet it is identified as a deficit in NGNs. METHOD: Seventy-four NGNs in two groups participated in this mixed-methods study in their first year in practice. Scores from two quantitative measures were collected for all participants. The Lasater Clinical Judgment Rubric framed the structured intervention. RESULTS: Although the quantitative data showed no significant differences between the groups, use of the reflection exercise indicated a positive impact on NGNs. Qualitative data revealed four themes that present challenges for preparation of NGNs: enhancing communication, finding interprofessional support, responding to complexity of care, and appreciating the role of the nurse. CONCLUSION: Implications provide guidance for academic and practice educators to smooth the transition into practice.

Falls prevention education: Interprofessional training to enhance collaborative practice.

The gap between the complex health care needs of older adults and the availability of geriatrics-trained health care professionals is widening. Interprofessional education offers an opportunity to engage multiple professions in interactive learning and clinically relevant problem solving to achieve high-quality patient-centered care. This article describes a project that engaged an interprofessional teaching team to support interprofessional practice teams to reduce falls in older adults via implementation of evidence-based practice guidelines. Ninety-five participants from 25 teams were trained on multiple strategies to decrease the risk of falls in older adults. The intervention facilitated increases in knowledge, confidence in skill performance, and team commitment to change practice patterns to support the health and safety of older adults. Findings suggest that community-based practices can successfully support the training of interprofessional teams and that training may lead to improved care processes and outcomes for older adults.

Reducing incivility in the workplace: results of a three-part educational intervention.

BACKGROUND: Incivility among nursing staff has a negative impact on the workplace environment. The purpose of this study was to determine whether a three-part educational intervention improved the work environment in two units of a major health sciences hospital. METHOD: Staff (N = 94) participated in assessments of the intervention at designated time points postintervention. Interviews of eight volunteer participants followed the intervention. RESULTS: Perceived acts of incivility decreased significantly for both units. Self-efficacy increased for both units, whereas collective efficacy decreased for one unit and increased for the second unit. Qualitative data supported the positive impact but identified that participants were not confident their units could effectively combat incivility without refresher sessions. CONCLUSION: A three-part educational intervention was effective in decreasing incidences of perceived incivility and increasing self-efficacy. Collective efficacy might be improved and sustained with unit refresher sessions or regular discussion.

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.].

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. 202x;5x(x):xx-xx.].

Current Practices for Teaching Clinical Judgment: Results From a National Survey.

BACKGROUND: Safe patient care is closely linked to clinical judgment. Concerns about inadequate practice readiness and the impending inclusion of clinical judgment items on the NextGen NCLEX have resulted in increasing interest and publications about teaching clinical judgment. However, little is known about actual current practices for teaching this skill. PURPOSE: This research describes findings about current strategies to teach clinical judgment used in US prelicensure nursing programs. METHODS: Cross-sectional methodology was used to survey program deans and directors across the United States. RESULTS: Programs are using multiple strategies to teach clinical judgment. The most common strategies used include case studies and simulation. Participants believed strategies have a positive impact on student thinking, practice readiness, and program outcomes. They described insights into implementation of teaching for clinical judgment. CONCLUSION: The results of this research provide foundational data to inform current teaching practices and further research for this essential skill.

Competencies and standards in nurse education: The irresolvable tensions.

This paper explores the inherent contradiction between the purpose of nurse education - to produce critical thinking, autonomous and accountable future nurses - and the prescription of standards and competencies to realize this goal. Drawing on examples from the United Kingdom's Nursing and Midwifery Council's (NMC) 'Future Nurse' standards, we argue that standards and competencies offer little more than a veneer of protection to the public and that, fundamentally, educational approaches based on 'dot point' formulations are antithetical to conditions in which genuinely critical-thinking, autonomous and accountable practitioners can develop. The purpose of this paper is to raise debate about the hegemony of competencies and standards. For the sake of academic health and the future of the nursing profession, the ubiquity of competency-based education must be critiqued and challenged.

Geriatrics in simulation: role modeling and clinical judgment effect.

Clinical judgment development is critical to preparing students to safely meet the needs of an aging population. Evidence linking manikin-based simulation and clinical judgment is sparse.The purpose of this quasi-experimental international study was to determine the effect of expert role modeling on nursing students' clinical judgment in the care of a simulated geriatric hip fracture client. Students from five diverse schools (n = 275) participated in an unfolding simulation. Students were assigned to treatment or control groups.Treatment groups viewed an expert role model video.Trained observers rated student clinical judgment from selected video recordings using the Lasater Clinical Judgment Rubric (n = 94). Significant group differences (p = .000) were found for the clinical judgment dimensions of noticing, interpreting, and responding. Findings provide support for combining expert role modeling with clinical simulation to improve students' clinical judgment in the care of older adults.

Assessing the reliability, validity, and use of the Lasater Clinical Judgment Rubric: three approaches.

The purpose of this article is to summarize the methods and findings from three different approaches examining the reliability and validity of data from the Lasater Clinical Judgment Rubric (LCJR) using human patient simulation. The first study, by Adamson, assessed the interrater reliability of data produced using the LCJR using intraclass correlation (2,1). Interrater reliability was calculated to be 0.889. The second study, by Gubrud-Howe, used the percent agreement strategy for assessing interrater reliability. Results ranged from 92% to 96%. The third study, by Sideras, used level of agreement for reliability analyses. Results ranged from 57% to 100%. Findings from each of these studies provided evidence supporting the validity of the LCJR for assessing clinical judgment during simulated patient care scenarios. This article provides extensive information about psychometrics and appropriate use of the LCJR and concludes with recommendations for further psychometric assessment and use of the LCJR.

A digital toolkit to implement and manage a multisite study.

Calls for multisite studies are increasing in nursing education. However, the challenge of implementing consistent protocols and maintaining rigorous standards across sites can be daunting. One purpose of a recent multisite, collaborative, simulation study was to evaluate a digital toolkit's effectiveness for managing a multisite study. We describe the digital toolkit composed of Web-based technologies used to manage a study involving five sites including one United Kingdom site. The digital toolkit included a wiki, a project Web site to coordinate the protocols and study materials, software to organize study materials, and a secure location for sharing data. Most of these are familiar tools; however, combined as a toolkit, they became a useful management system. Web-based communication strategies and coordinated technical support served as key adjuncts to foster collaboration. This article also offers practical implications and recommendations for using a digital toolkit in other multisite studies.

Transcultural Translation and Validation of Lasater Clinical Judgment Rubric©.

OBJECTIVES: to translate and cross-culturally validate the Lasater Clinical Judgment Rubric© (LCJR©) instrument for nursing students. METHODS: the application of LCJR-PT© was preceded by a linguistic translation into Portuguese, based on the translation-back-translation method. This psychometric study involved 32 nursing students from a program in Portugal. Data were collected through observations of two independent observers during the performance of the practices developed by the students, through the scenarios validated by experts of high and of medium-fidelity simulation. RESULTS: of the 64 observations obtained from the practices of nursing students, the value of intra-class correlations in the 4 aspects of the instrument exceeded 0.792. There was a global Cronbach's alpha of LCJR-PT© of 0.921 and 0.876 in Observers 1 and 2 respectively, with a statistically significant level of agreement. CONCLUSIONS: the LCJR-PT© is a valid and reliable instrument, demonstrating a high potential for its use in clinical education and nursing research.

Developing Students' Clinical Reasoning Skills: A Faculty Guide.

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.].

Context, complexity and cross-pollination: Nursing leaders' views of the role of the voluntary and community sector in nurse education.

BACKGROUND: Placements in voluntary and community sector (VCS) organisations have long played an important part in student nurses' education in several countries. New standards for nurse education published by the Nursing and Midwifery Council in the United Kingdom include significant changes to practice supervision arrangements that enable students to spend more time in VCS organisations. OBJECTIVES: To assess nursing leaders' views on the role of the VCS in nursing education and benefits of VCS placements for students and organisations. DESIGN: Qualitative interview study. PARTICIPANTS: Twenty-four nursing leaders from academic (n=15), practice (n=4) and regulatory (n=5) sectors. METHODS: Semi-structured interviews were conducted face-to-face (n=21), by telephone (n=2) or Skype (n=1). Interviews were transcribed and analysed, using interview questions as structural themes, followed by inductive thematic analysis. RESULTS: Nursing leaders identified three key roles for the VCS in nursing education: (1) determining knowledge needs; (2) developing curricula; (3) providing placements. Five key benefits of VCS placements for students were shared: (1) understanding the contribution of the VCS to care; (2) seeing the context and complexity of people's lives; (3) challenging attitudes and perceptions; (4) gaining confidence, knowledge and skills; and (5) supporting career decisions. Three benefits for VCS organisations were found: (1) cross-pollinating knowledge, skills and networks; (2) changing organisational cultures; (3) promoting careers in the VCS. CONCLUSIONS: Changes to practice supervision models enabling closer relationships with the VCS were welcomed. Nursing leaders thought that VCS placements had potential to cross-pollinate ideas and harness the role of student nurses as knowledge brokers in increasingly integrated health and social care systems. Nurse educators should embrace opportunities offered through collaboration with the VCS for student learning and deeper partnerships across health and social care settings to enable students to gain deeper insight into the context and complexity of people's lives.

Effects of a Complex Case Study and High-Fidelity Simulation on Mechanical Ventilation on Knowledge and Clinical Judgment of Undergraduate Nursing Students.

BACKGROUND: Improving nursing students' knowledge and clinical judgment related to mechanical ventilation (MV) is paramount, considering the heightened need for MV due to the current COVID-19 (coronavirus disease 2019) pandemic. High-fidelity simulation (HFS) provides students with real-life clinical experiences that they would rarely confront in clinical training, especially complex case scenarios (such as a patient needing MV). PURPOSE: This study assessed students' clinical knowledge and judgment after including HFS involving MV in an undergraduate nursing program. METHODS: This was a quasi-experimental design with a convenience sample of 151 nursing students using the Lasater Clinical Judgment Rubric. RESULTS: There were significant differences between the intervention and control groups in knowledge (t = 20.42; P = .001) and total clinical judgment scores (t = 19.55; P < .001) post-HFS. CONCLUSIONS: Including a complex case study using MV and HFS significantly improved students' clinical decision-making, clinical knowledge, and self-confidence and enhanced their critical thinking, noticing, interpreting, reflecting, and responding capabilities.

Academic Activities Abroad: One Nurse Educator's Fulbright Experience.

BACKGROUND: Nursing students need an understanding of global health concepts in the 21st century. Patients and/or populations may come from anywhere in the world, some of whom may be seeking refuge from conflict and/or war. In addition, nurses may be employed in other countries. PROBLEM: Nurse educators may not have international experiences or know about global opportunities or how to navigate them. APPROACH: Fulbright Scholar Awards are one way for nursing educators to experience academic opportunities in another country, working with international colleagues and/or students. OUTCOMES: One nurse educator describes her experience from successful application through the postaward period. CONCLUSIONS: Fulbright offers opportunities for academics to engage in teaching and/or research, work with international colleagues, and be immersed in other cultures. Such experiences can equip nurse educators with more comprehensive global perspectives for preparing future nurses.

Population health as a 'platform' for nurse education: A qualitative study of nursing leaders.

BACKGROUND: Challenges to the sustainability of global healthcare systems are prompting a shift towards more population-focused models of care. Nurse educators need to develop courses that prepare students for population health practice. However, the educational approaches that can support this shift are poorly understood. Publication of new standards for nurse education by the United Kingdom's (UK) Nursing and Midwifery Council that place greater emphasis on population health presented an opportunity to seek nursing leaders' views on population health in nurse education. OBJECTIVES: To assess the views of nursing leaders within a Scottish context on the connection between nurse education and population health for all students, evaluate what student nurses need to know to support population health practice, and draw insights from the UK for pre-registration programmes internationally. DESIGN: Qualitative interview study. PARTICIPANTS: Twenty-four nursing leaders from academic (n = 15), practice (n = 4) and regulatory (n = 5) sectors. METHODS: Semi-structured interviews were conducted face-to-face (n = 21), by telephone (n = 2) or Skype (n = 1). Interviews were transcribed and analysed, using interview questions as structural themes, followed by thematic and content analyses. RESULTS: Nursing leaders encouraged rebalancing nurse education towards population health, suggesting that population health concepts should sit at the core of spiral curricula to enable students to (re)view learning through a population health lens. Seven outcomes were identified to equip student nurses for practice in any setting. These formed the mnemonic FULCRUM: Find and interpret evidence; Understand the psychology of behavior and change; Link epidemiology to population health; Consider others and themselves in context; Recognise social determinants of health; Understand the impact of policy and politics on health; Motivate to encourage behaviour change. CONCLUSIONS: FULCRUM can guide nurse educators globally to support preparation of graduate nurses for the significant shifts in healthcare delivery and service organisation towards improving population outcomes.