Evaluating the Importance of Clinical Judgment in Entry-Level Nursing.

BACKGROUND: This study investigated the extent to which clinical judgment is important in entry-level nursing practice. METHOD: A task analysis linkage study methodology based on a large-scale, comprehensive practice analysis was used for the study. The practice analysis validated more than 200 entry-level nursing tasks, and the linkage study sought to evaluate the importance of clinical judgment overall and for each specific task expectation. RESULTS: The results provide confirmatory evidence of the importance of clinical judgment. In addition, the work provides a comprehensive list of entry-level tasks and their associated clinical judgment importance. CONCLUSION: Clinical judgment is a vital skill at entry into the profession and is expected to grow over time. This study offers insights on the extent to which clinical judgment is a necessary skill and provides direct evidence of its importance for specific entry-level tasks. [J Nurs Educ. 2024;63(3):156-162.].

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.

Integrating the National Council of State Boards of Nursing Clinical Judgment Model Into Nursing Educational Frameworks.

BACKGROUND: Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents the National Council of State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) and discusses the use of the model. METHOD: A multidisciplinary team conducted a qualitative comparative analysis of the relationships between the NCSBN-CJM and the three leading frameworks for providing clinical judgment education to entry-level nurses. RESULTS: The NCSBN-CJM aligns with the Information-Processing Model and the Intuitive-Humanistic Model. The NCSBN-CJM also can be used to assess the Dual Process Reasoning Theory. CONCLUSION: The NCSBN-CJM can assist nurse educators in designing effective tools for assessing clinical judgment by helping them target specific cognitive operations. This flexible model expresses the complexities associated with decision making in a simplified manner to enable better measurement of clinical judgment. [J Nurs Educ. 2019;58(2):72-78.].

Projection-Based Stopping Rules for Computerized Adaptive Testing in Licensure Testing.

The confidence interval (CI) stopping rule is commonly used in licensure settings to make classification decisions with fewer items in computerized adaptive testing (CAT). However, it tends to be less efficient in the near-cut regions of the θ scale, as the CI often fails to be narrow enough for an early termination decision prior to reaching the maximum test length. To solve this problem, this study proposed the projection-based stopping rules that base the termination decisions on the algorithmically projected range of the final θ estimate at the hypothetical completion of the CAT. A simulation study and an empirical study were conducted to show the advantages of the projection-based rules over the CI rule, in which the projection-based rules reduced the test length without jeopardizing critical psychometric qualities of the test, such as the θ and classification precision. Operationally, these rules do not require additional regularization parameters, because the projection is simply a hypothetical extension of the current test within the existing CAT environment. Because these new rules are specifically designed to address the decreased efficiency in the near-cut regions as opposed to for the entire scale, the authors recommend using them in conjunction with the CI rule in practice.

Program accreditation effect on paramedic credentialing examination success rate.

OBJECTIVES: Program accreditation is used to ensure the delivery of quality education and training for allied health providers. However, accreditation is not mandated for paramedic education programs. This study examined if there is a relationship between completion of an accredited paramedic education program and achieving a passing score on the National Registry Paramedic Certification Examination. METHODS: We used data from the National Registry Paramedic Certification Examination for calendar year 2002. Successful completion (passing) of the examination was defined as correctly answering a minimum of 126 out of 180 (70%) of the questions and meeting or exceeding the individual subtest passing scores. Accredited paramedic training programs were certified by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) on or before January 1, 2002. Candidates reported demographic characteristics including age, gender, self-reported race and ethnicity, education, and employer type. We examined the relationship between passing the examination and attendance at an accredited paramedic training program. RESULTS: A total of 12,773 students completed the examination. Students who attended an accredited program were more likely to pass the examination (OR = 1.65, 95% CI: 1.51-1.81). Attendance at an accredited training program was independently associated with passing the examination (OR = 1.58, 95% CI = 1.43-1.74) even after accounting for confounding demographic factors. CONCLUSION: Students who attended an accredited paramedic program were more likely to achieve a passing score on a national paramedic credentialing examination. Additional studies are needed to identify the aspects of program accreditation that lead to improved examination success.

Behavioral health risk factors of United States emergency medical technicians: the LEADS Project.

OBJECTIVE: Personal risk behaviors are modifiable. This report describes the 2002 national baseline of behavioral health risk factors of US emergency medical technicians (EMTs) that can guide policy and program development in improving EMT well-being. METHODS: A 19-item Health Behavioral Risk Survey (Appendix) was added to the 2002 Longitudinal Emergency Medical Technician Demographic Study mail survey. Risk survey questions covering physical activity, tobacco use, and alcohol use were modeled after the Centers for Disease Control and Prevention 2002 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. Personal, non-work related seatbelt use and motor vehicle driving questions were adopted from the 2002 US National Highway Traffic Safety Administration (NHTSA) Motor Vehicle Occupant Safety Survey (MVOSS). Post-stratification adjustment factors were used to allow comparisons with BRFSS and MVOSS national estimates. RESULTS: A total of 1,919 EMT respondents were compared with 239,866 BRFSS and 5,220 MVOSS respondents. These comparisons indicate that EMT-Basics drove more slowly than paramedics; male EMTs drove faster, drank more, and wore their seatbelts less often than did female EMTs; female EMTs smoked more and engaged in vigorous exercise less than males. Those EMTs who reported to be in fair or poor health, smoked more and exercised less than those who reported to be in good or excellent health. Regardless of gender, age, or race, EMTs, on average, wore their seatbelts less often, drove faster than, and were less likely to engage in moderate physical exercise, compared to US adults. CONCLUSION: Stereotypical gender differences in risk behaviors exist among EMTs. An EMT's self-reported health positively correlates with smoking and exercising. Compared to US national estimates, except for smoking and vigorous exercise, EMTs have increased risk behaviors.

Longitudinal Emergency Medical Technician Attribute and Demographic Study (LEADS): an interim report.

OBJECTIVES: This ten-year longitudinal study examines various attributes and demographic characteristics of emergency medical technicians (EMTs) and paramedics to identify factors that influence their careers, to identify trends in emergency medical services (EMS), and to provide data on why individuals report leaving the EMS career field. METHODS: A 46-item core survey and a 16-item cross-sectional survey were administered to EMT-basics and EMT-paramedics who were randomly selected and placed in cohort groups stratified by duration of continuous registration at each level and by race. The core survey focused on five broad areas of attributes and demographics, including general, professional, educational, personal, and financial. Case weights were calculated for respondents in each stratum, reflecting the individual's probability of selection. These case weights were adjusted, within strata, for nonresponse. The survey will be administered annually. The cross-sectional survey focused on EMS education. RESULTS: This interim report is descriptive of the overall responses of EMT-basics and EMT-paramedics to core survey items. The demographic characteristics of EMT-basics and EMT-paramedics are described as well as a description of their work activities, working conditions, and job satisfaction CONCLUSIONS: The initial EMT and paramedic attribute and demographic data have been collected, analyzed, and reported. The longitudinal nature of this study requires further data collection and analysis to accurately present trends in EMS, as well as correlations and associations between identified attributes and other factors that influence the careers of EMTs and paramedics. Further reports of the findings will be necessary.