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.

Nursing Students' Cue Recognition in Educational Simulation: A Scoping Review.

BACKGROUND: New nurses often struggle with recognizing cues and applying clinical judgment. Nurse educators develop educational simulation scenarios to support students in developing clinical judgment, which includes the foundational step of recognizing cues. PURPOSE: A scoping review on undergraduate nursing students' cue recognition during simulation was conducted to systematically map the existing research and identify knowledge gaps. METHODS: From initial identification of 228 studies published between 2010 and 2020, a total of 17 quantitative or qualitative studies were independently appraised using the Joanna Briggs Institute scoping review process and PRISMA-ScR reporting guidelines. RESULTS: Cues were missed with varying levels of frequency. Participants frequently failed to recognize respiratory rates and physical assessment changes as salient cues to patient deterioration. Verbal cues from simulated patients were often missed or resulted in distancing behaviors. CONCLUSION: Research is needed to determine the most effective methods for helping learners develop skills in cue recognition and analysis.