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.

Investigating clinical decision-making in bleeding complications among nursing students: A longitudinal mixed-methods study.

AIM: To describe undergraduate nursing students' clinical decision-making in post-procedural bleeding scenarios and explore the changes from the first to the final year of their program. BACKGROUND: Bleeding is a common complication following invasive procedures and its effective management requires nurses to develop strong clinical decision-making competencies. Although nursing education programs typically address bleeding complications, there is a gap in understanding how nursing students make clinical decisions regarding these scenarios. Additionally, little is known about how their approach to bleeding management evolves over the course of their education. DESIGN: Longitudinal mixed-methods study based on the Recognition-Primed Decision Model. METHODS: A total of 59 undergraduate students recorded their responses to two clinical decision-making vignettes depicting patients with signs of bleeding post-hip surgery (first year) and cardiac catheterization (final year). Their responses were analyzed using content analysis. The resulting categories capture the cues students noticed, the goals they aimed to achieve, the actions they proposed and their expectations for how the bleeding situations might unfold. Code frequencies showing the most variation between the first and final years were analyzed to explore changes in students' clinical decision-making. RESULTS: Nearly all students focused on two primary categories: 'Bleeding' and 'Instability and Shock.' Fewer students addressed six secondary categories: 'Stress and Concern,' 'Pain,' 'Lifestyle and Social History,' 'Wound Infection,' 'Arrhythmia,' and 'Generalities in Surgery.' Students often concentrated on actions to manage bleeding without further assessing its causes. Changes from the first to the final year included a more focused assessment of instability and shifts in preferred actions. CONCLUSIONS: This study reveals that nursing students often prioritize immediate actions to stop bleeding while sometimes overlooking the assessment of underlying causes or broader care goals. It suggests that concept-based learning and reflection on long-term outcomes could improve clinical decision-making in post-procedural care.

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.

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.

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.].

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.].

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.