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UNIT 1 How Nurses Think
Toward Evidence-Based Practice Manetti,W. (2018). Evaluating the clinical judgment of prelicensure nursing students in the clinical setting. Nurse Educator, 43 (5), 272–276. https://doi.org/10.1097/ NNE.0000000000000489 This study used the Lasater Clinical Judgment Rubric (LCJR) to measure the clinical judgment of junior and senior baccalaureate nursing students, using the scales of beginning, developing, accomplished, and exemplary to describe Tanner’s performance levels. Findings revealed that junior nursing students demonstrated a clinical judgment performance level of accomplished on all 11 dimensions. In contrast, senior nursing students demonstrated an exemplary performance level in all areas, except for interpreting, which was at the accomplished level. In addition, students who had previous knowledge and experience in healthcare environments had higher total clinical judgment scores.The latter is consistent with the finding by Sterner et al. (2021) that students with previous experience in healthcare before nursing education were better able to prioritize interventions. Dix, S., Morphet, J., Jones,T., Kiprillisa, N., O’Hallorana, M., Piperac, K., & Innes, K. (2021). Perceptions of final year nursing students transfer to clinical judgment skills from simulation to clinical practice:A qualitative study. Nurse Educator in Practice, 56 (2021), 103218. https://doi.org/10.1016/ j.nepr.2021.103218 Researchers investigated the transfer of clinical judgment skills into clinical practice. Undergraduate students in their final clinical course participated in two simulated clinical scenarios, followed by 160 hours of clinical practice.The findings indicated that students transferred learning from simulation to clinical practice. In addition, students with a solid knowledge of normal values and anatomy and physiology displayed good clinical judgment.Although sound foundational knowledge is essential for understanding and interpreting data and using those data to make decisions, the volume of data in acute situations can be overwhelming to novice nurses who are not exposed to making complex clinical decisions as students. refine clinical reasoning include the use of algorithms, reflective journaling, thinking aloud (Victor-Chmil, 2013), simulation, and case studies. The practice of professional nursing requires strong clinical reasoning skills because of the rapidly changing healthcare environment, technological advances, the complexity of client problems, and shortened hospital stays. Research has indicated that ineffective clinical reasoning is a major factor in the failure of nurses to respond appropriately to deteriorating client conditions (Liaw et al., 2018). Each client presents with a different problem and background, different contextual factors, and different needs and goals. You will need to use your
Sterner,A., Ramstrand, N., Palmér, L., & Hagiwara, M.A. (2021).A study of factors that predict novice nurses’ per- ceived ability to provide care in acute care situations. Nursing Open, 8 (4), 1958–1969. https://doi.org/10.1002/nop2.871 Working in acute care facilities can be intimidating and fearful for novice nurses because their level of competence is perceived as unequal to that of experienced nurses.This study investigated factors that influenced the novice nurses’ perception of readiness to provide safe, quality patient care.The findings revealed the following regarding novice nurses: ■ Trust in their abilities was influenced by experience in acute care facilities during nursing education. ■ Their ability to exercise clinical judgment (noticing, interpreting, responding) in acute situations was positively associated with experience during nursing education, postgraduate experience in acute care, and duration of experience. ■ Their ability to prioritize interventions was associated with experience in healthcare before nursing education, duration of work experience, and acute care experience. ■ Their ability to act independently was influenced by duration of work experience. ■ Their ability to determine the most appropriate intervention was associated with a longer duration of work experience and postgraduation experience in acute situations. This study identifies several factors important to the development of clinical judgment. 1. What do the studies reveal about the knowledge, level, and experience of nursing students and the development of clinical judgment? 2. What is the importance of clinical rotations as a student nurse and in postgraduate experience? 3. What is the role of simulation in nursing education?
knowledge and experience to assess the client and make decisions on the treatment plan or the need to obtain additional information. Clinical reasoning skills are important for safe client care. It is necessary to detect and appropriately respond to a client’s worsening con- dition. Your clinical faculty will help you to focus your learning experiences and client assignments to enhance
your clinical reasoning skills. Knowledge Check 2-4 ■ Define clinical reasoning .
■ Why is clinical reasoning important in nursing practice? ■ What evidence exists that Jan used clinical reasoning?
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