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.].

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.

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.

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.

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.

Transcultural Translation and Validation of Lasater Clinical Judgment Rubric© / Tradução e Validação Transcultural da Lasater Clinical Judgment Rubric© / Traducción Transcultural y Validación de la Lasater Clinical Judgment Rubric©

ABSTRACT 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.

RESUMO Objetivos: traduzir e validar transculturalmente o instrumento Lasater Clinical Judgment Rubric© (LCJR©) para estudantes de Enfermagem. Métodos: a aplicação do LCJR-PT© foi precedida por tradução linguística ao português, baseando-se no método de traduçãoretradução. Este estudo psicométrico envolveu 32 estudantes de Enfermagem de um programa em Portugal. Os dados foram recolhidos mediante observações de dois observadores independentes durante o desempenho das práticas desenvolvidas pelos estudantes por meio dos cenários validados por peritos em simulação de alta e média fidelidade. Resultados: das 64 observações das práticas de estudantes de Enfermagem, o valor das correlações por intraclasse nos quatro aspectos do instrumento ultrapassou os 0,792. Identificou-se um alfa de Cronbach global na LCJR-PT© de 0,921 e 0,876 nos observadores 1 e 2, respectivamente, com um nível de concordância estatisticamente significante. Conclusões: a LCJR-PT© é um instrumento válido e confiável, demonstrando um alto potencial para seu uso na educação clínica e pesquisa em enfermagem.

RESUMEN Objetivos: traducir y validar transculturalmente el instrumento Lasater Clinical Judgment Rubric© (LCJR©) para estudiantes de Enfermería. Métodos: aplicación del LCJR-PT© precedida por traducción lingüística al portugués, basándose en el método de traducción y retraducción. Estudio psicométrico involucró 32 estudiantes de Enfermería de un programa en Portugal. Datos recolectados mediante observaciones de dos observadores independientes durante el desempeño de prácticas desarrolladas por estudiantes mediante los escenarios validados por peritos en simulado de alta y mediana fidelidad. Resultados: de las 64 observaciones de prácticas de estudiantes de Enfermería, el valor de correlaciones por intraclase en los cuatro aspectos del instrumento sobrepasó 0,792. Identificado un alfa de Cronbach global en el LCJR-PT© de 0,921 y 0,876 en los observadores 1 y 2, respectivamente, con un nivel de concordancia estadísticamente significante. Conclusiones: el LCJR-PT© es un instrumento válido y confiable, demostrando un alto potencial para su uso en educación clínica e investigación en enfermería.

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.

Clinical judgment and diagnostic reasoning of nursing students in clinical simulation.

OBJECTIVES: to determine the degree of association between clinical judgment and diagnostic reasoning of nursing students in clinical simulation. METHODS: this is a correlational research design using a quantitative approach. The sample consisted of 41 nursing students who assisted a patient with vaso-occlusive crisis in a high-fidelity clinical simulation setting. The instruments used included the Lasater Clinical Judgment Rubric - Brazilian Version and the Diagnostic Thinking Inventory. RESULTS: clinical judgment was associated with diagnostic reasoning (r=0.313; p=0.046), as well as the "noticing" aspect of clinical judgment with diagnostic reasoning (r=0.312; p=0.047). CONCLUSIONS: the results show that skills to interpret patient data are associated with diagnostic reasoning skills. Teaching clinical judgment skills is necessary to develop the diagnostic reasoning of nursing students.

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.

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.

Clinical judgment and diagnostic reasoning of nursing students in clinical simulation / Juicio clínico y razonamiento diagnóstico de estudiantes de enfermería en simulación clínica / Julgamento clínico e raciocínio diagnóstico de estudantes de enfermagem em simulação clínica

ABSTRACT Objectives: to determine the degree of association between clinical judgment and diagnostic reasoning of nursing students in clinical simulation. Methods: this is a correlational research design using a quantitative approach. The sample consisted of 41 nursing students who assisted a patient with vaso-occlusive crisis in a high-fidelity clinical simulation setting. The instruments used included the Lasater Clinical Judgment Rubric - Brazilian Version and the Diagnostic Thinking Inventory. Results: clinical judgment was associated with diagnostic reasoning (r=0.313; p=0.046), as well as the "noticing" aspect of clinical judgment with diagnostic reasoning (r=0.312; p=0.047). Conclusions: the results show that skills to interpret patient data are associated with diagnostic reasoning skills. Teaching clinical judgment skills is necessary to develop the diagnostic reasoning of nursing students.

RESUMEN Objetivos: conocer el grado de asociación entre el juicio clínico y el razonamiento diagnóstico de estudiantes de enfermería en simulación clínica. Métodos: estudio correlacional con enfoque cuantitativo. La muestra consistió en 41 estudiantes de enfermería, que atendieron a pacientes en una crisis vasooclusiva, en un escenario de simulación clínica de alta fidelidad. Los instrumentos utilizados incluyeron la rúbrica Lasater Clinical Judgment Rubric - Brazilian Version y el Inventario de Razonamiento Diagnóstico. Resultados: el juicio clínico se asoció con el razonamiento diagnóstico (r=0.313; p=0.046), así como el aspecto de "reconocimiento del juicio clínico" con el razonamiento diagnóstico (r=0.312; p=0.047). Conclusiones: los resultados muestran que las habilidades para interpretar los datos del paciente están asociadas con las habilidades de razonamiento diagnóstico. La enseñanza de habilidades de juicio clínico es necesaria para el desarrollo del razonamiento diagnóstico de los estudiantes de enfermería.

RESUMO Objetivos: conhecer o grau de associação entre o julgamento clínico e o raciocínio diagnóstico de estudantes de enfermagem em simulação clínica. Métodos: estudo correlacional de abordagem quantitativa. A amostra foi composta por 41 estudantes de enfermagem, que realizaram atendimento a paciente em crise vaso-oclusiva, em cenário de simulação clínica de alta fidelidade. Os instrumentos utilizados compreenderam o Lasater Clinical Judgment Rubric - Brazilian Version e o Inventário de Raciocínio Diagnóstico. Resultados: o julgamento clínico apresentou associação com o raciocínio diagnóstico (r=0,313; p=0,046), bem como o aspecto "reconhecimento do julgamento clínico" com o raciocínio diagnóstico (r=0,312; p=0,047). Conclusões: os resultados evidenciam que as habilidades para interpretar os dados do paciente estão associadas às habilidades de raciocínio diagnóstico. O ensino das habilidades de julgamento clínico é necessário para o desenvolvimento do raciocínio diagnóstico dos estudantes de enfermagem.

Student nurses' attitudes to social justice and poverty: An international comparison.

BACKGROUND: In both the United Kingdom (UK) and the United States (US), health inequities are proving resistant to improvement. Nurses are ideally placed to advocate for social justice. It is therefore important that nurse education encourages awareness of the social determinants of health and equips students to act to address health inequity. However, little is known about student nurses' attitudes to social justice and poverty and the impact of pedagogical strategies used to teach the determinants and patterns of health inequities. OBJECTIVES: To assess and compare UK and US student nurses' attitudes towards social justice and poverty before and after learning about social determinants of health and health inequities. DESIGN: Cross-sectional study with embedded before and after design using validated measures. SETTING: Two universities: one urban UK university and one US university with urban and rural campuses. PARTICIPANTS: 230 student nurses in the UK (n = 143) and US (n = 87) enrolled in courses teaching content including health inequities and social determinants of health. RESULTS: Student nurses generally disagreed with stigmatizing statements about people living in poverty and mostly agreed with statements promoting social justice. However, US students were significantly more likely to have positive attitudes towards both social justice (p = 0.001) and poverty (p < 0.001). In multiple regression analyses, engagement in social justice-promoting activities, activism and higher levels of education were associated with positive attitudes to social justice and poverty. Statistically significant positive changes in attitudes to poverty and social justice after their courses were observed only among US student nurses. CONCLUSION: UK and US student nurses' attitudes to poverty and social justice were generally positive. Education around social determinants of health and health inequity had a different effect in the UK and the US. There is a need to explore further what specific components of educational programmes lead to positive changes in attitudes.

Do prelicensure nursing students' backgrounds impact what they notice and interpret about patients?

BACKGROUND: Academic educators are challenged to foster the development of clinical judgment in diverse learners. The impact of nursing students' backgrounds on clinical judgment has not previously been studied. AIMS: SAMPLE: Prelicensure/preregistration students, representing three international English-speaking programs in 3 countries, comprised the sample (N = 532). All were enrolled in the first course in which perioperative content was taught. DATA COLLECTION: An online learning activity was designed to elicit responses to a simulated case study of an expert nurse role model caring for an older adult patient experiencing delirium several days post-operatively. DATA ANALYSIS: Dyads of coders did three rounds of coding. Logistic and multinomial logistic regression models used background variables to look for patterns in student responses. FINDINGS: The data strongly suggest that background variables impact clinical judgment, however, not in interpretable patterns. CONCLUSION: Nurse educators must acknowledge that prelicensure students' backgrounds impact their clinical judgment and assist them to learn to think like nurses.

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.].