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.

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.

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.

Adaptação para cultura brasileira do instrumento Lasater Clinical Judgment Rubric / Adaptation of the Lasater Clinical Judgment Rubric to the brazilian culture / Adaptación del instrumento Lasater Clinical Judgment Rubric a la cultura brasileña

Objetivo: adaptar à cultura brasileira o instrumento Lasater Clinical Judgment Rubric. Método: estudometodológico que utilizou o modelo de adaptação transcultural de Beaton e colaboradores. Ainda, testou-se aestabilidade do instrumento em versão brasileira (índice de concordância intra e interobservadores).Resultados: o processo de adaptação transcultural mostrou-se adequado para manter as equivalênciassemântica, idiomática, experiencial e conceitual entre o instrumento original e o instrumento adaptado àcultura brasileira, resultando na Lasater Clinical Judgment Rubric – Brazilian Version. Os dados dasconcordâncias intra e interobservadores foram considerados aceitáveis. Conclusão: a pesquisa contribuiu parao desenvolvimento de instrumento culturalmente apropriado para caracterizar os aspectos do julgamentoclínico de estudantes de enfermagem brasileiros em simulação clínica.(AU)

Objective: to adapt the Lasater Clinical Judgment Rubric to the Brazilian culture. Method: methodological study that used the model for transcultural adaptation by Beaton et al. The stability of the instrument in the Brazilian version was also tested (intra- and inter-observer agreement index). Results: the transcultural adaptation process was adequate to maintain the semantic, idiomatic, experiential and conceptual equivalences between the original rubric and the rubric adapted to the Brazilian culture, resulting in the Lasater Clinical Judgment Rubric ­ Brazilian Version. Intra- and inter-observer agreement data were considered acceptable. Conclusion: the research contributed to the provision of a culturally appropriate tool to characterize the clinical judgment aspects of Brazilian nursing students in a clinical simulation.(AU)

Objetivo: adaptar la Lasater Clinical Judgment Rubric a la cultura brasileña. Método: estudio metodológico que utilizó el modelo de adaptación transcultural de Beaton y colaboradores. Además, la estabilidad del instrumento en su versión brasileña fue testada (índice de concordancia intra e interobservadores). Resultados: el proceso de adaptación transcultural se mostró adecuado para mantener las equivalencias semántica, idiomática, experiencial y conceptual, resultando en la Lasater Clinical Judgment Rubric ­ Versión Brasileña. Los datos de las concordancias intra e interobservadores fueron considerados aceptables. Conclusión: la investigación contribuyó al desarrollo de un instrumento culturalmente apropiado para caracterizar los aspectos del juzgamiento clínico de estudiantes brasileños de enfermería en simulación clínica.(AU)

An Interprofessional Approach to Reducing the Risk of Falls Through Enhanced Collaborative Practice.

Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This article describes a project that engaged an interprofessional teaching team to support interprofessional clinical teams to reduce fall risk in older adults by implementing the AGS/BGS guidelines. Twenty-five interprofessional clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long-term care, hospital, and home health settings for a structured intervention: a 4-hour training workshop plus coaching for implementation for 1 year. The workshop focused on evidence-based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatic blood pressure, and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected using chart reviews, coaching plans and field notes, and postintervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long-term care facilities were more likely to address environmental concerns and add tai chi classes, and ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long-term care settings.

Learning activities to enhance research literacy in a CAM college curriculum.

As complementary and alternative medicine (CAM) therapies become increasingly accepted healthcare options, it is of major importance for CAM institutions to enhance research literacy and an evidence-based perspective in their curricula. A research education program for students and faculty at the Oregon College of Oriental Medicine (OCOM), developed in collaboration with the Oregon Health & Science University School of Nursing, has been supported by an R25 award from the National Center for Complementary and Alternative Medicine (NCCAM). A key initiative of OCOM's grant is the design of learning activities that infuse a research perspective into nonresearch courses in both the traditional Chinese medicine and biomedicine curricula. This approach was pilot-tested in course sequences chosen from each of the 3 years of the master's degree program. Learner-centered activities included Infusing Evidence and Reflection Into Introductory Qigong Classes (Year 1: Qigong), Using Evidence to Inform Acupuncture Point Selection (Year 2: Point Actions and Indications), and Media and Research in Western Clinical Medicine (Year 3: Western Clinical Diagnosis). Among the lessons learned are the need to infuse learning activities into the curriculum in a manner that minimizes interactivity redundancy and reinforces learning, the importance for faculty to communicate to students the rationale for introducing the learning activities, and the value of creating a learning activity design template to guide faculty recognition of essential elements in design and evaluation and to provide sustainable overviews of the learning activities.

Research scholars program: a faculty development initiative at the Oregon College of Oriental Medicine.

BACKGROUND: The Research Scholars Program (RSP) was created at the Oregon College of Oriental Medicine (OCOM) to provide faculty development in research literacy, research-informed clinical practice, and research participation skills. The RSP is part of a broad effort, funded by a National Institutes of Health/National Center for Complementary and Alternative Medicine R25 education grant, to infuse an evidence-based perspective into the curriculum at schools of complementary and alternative medicine. The RSP arose from the realization that this curriculum reform would first necessitate faculty training in both research appreciation and pedagogy. OCOM's grant, Acupuncture Practitioner Research Education Enhancement, is a partnership with the Oregon Health & Science University School of Nursing (OHSU SON). DESIGN: The RSP was developed initially as a collaborative effort among the OCOM Dean of Research (R.H.), OCOM Director of Research Education (S.F.), and an OHSU SON education specialist (K.L.). The 9-month, 8 hours per month seminar-style RSP provides the opportunity for a cohort of OCOM faculty and staff to explore research-related concepts and content as well as pedagogical practices that emphasize interactive, learner-centered teaching. The RSP adheres to a competency-based approach as developed by the Education Committee of the grant. As a tangible outcome, each Research Scholar designs a sustainable learning activity that infuses a research perspective into their courses, clinic supervision, or other sphere of influence at the college. In this paper, we describe the creative process and the lessons learned during the planning and initial implementation of the RSP. CONCLUSIONS: We view the early successes of the RSP as encouraging signs that research literacy and an evidence-based perspective are becoming increasingly accepted as needed skill sets for present-day practitioners of acupuncture and Oriental medicine.

High-fidelity simulation and the development of clinical judgment: students' experiences.

Nursing education programs across the country are making major capital investments in alternative learning strategies, such as human patient simulators; yet, little research exists to affirm this new innovation. At the same time, nursing programs must become even more effective in the development of students' clinical judgment to better prepare graduates to take on increasingly complex care management. This qualitative study examined the experiences of students in one nursing program's first term of using high-fidelity simulation as part of its regular curriculum. On the basis of these experiences, it seems that high-fidelity simulation has potential to support and affect the development of clinical judgment in nursing students and to serve as a value-added adjunct to their clinical practica.