Clinical Judgment Article - How to Teach Clinical Judgment

HOW

to teach Clinical Judgment and prepare students for the Next Gen NCLEX ® with Davis Advantage

Before “How,” we need to know “What” Before we discuss how to best use Clinical Judgment in your classes, it helps to have a basic understanding of what exactly Clinical Judgment is and how Davis Advantage can help.

Clinical Judgment is an ongoing process that is the “observed outcome of critical-thinking and decision-making”. Nurses must use their knowledge and experience to assess and interpret the problems of their patients, synthesize and prioritize relevant information to identify priorities, and respond in an evidence-based, safe and effective way. This has always been an important skill that students and new nurses struggle to develop.

Research shows that:

65% 50% 20%

of nursing errors result from poor clinical decision-making of novice nurses are involved in those errors of nursing care

96 % of instructors said they would recommend Davis Advantage

of employers are satisfied with clinical decision-making skills of novice nurses

How Davis Advantage can help

Promotes a Consistent, Easy-To-Use Approach The Davis Advantage online platform uses a Learn-Apply-Assess model in a scaffolded structure, with Clinical Judgment comprising the “Apply” component of the model. Clinical Judgment is designed to help students employ their learning in ways that develop and strengthen their clinical-thinking skills. For each textbook that includes the Davis Advantage platform, the Clinical Judgment assignments contain six or twelve clinical case studies, each with six questions. These case studies reflect the latest health care practices. Each case begins with an introduction to the patient, and displays a chart with tabs for History and Physical Assessment, Nurses’ Notes, Vital Signs, and Laboratory Results. As the case progresses, the chart expands and populates with additional data.

96% of instructors said Davis Advantage is easy to use

94% of instructors said Davis Advantage helped their students make the connections

90% of instructors said Davis Advantage improved student scores

Each case study is based on the six key areas for assessing clinical judgment and decision-making as determined by the NCSBN’s Clinical Judgment Measurement Model. These six areas are the ability to recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes. Each question in the Clinical Judgment case studies is mapped to one or more of the six key areas, so students gain experience with these specific, identifiable skills. Feedback with comprehensive rationales and assessment data about the student’s performance is also provided to both instructors and students. Features Next Gen NCLEX ® Cases and Questions The questions in the Clinical Judgment assignments use the same five, new formats as the Next Gen NCLEX®: Extended Multiple Response, Extended Drag-and-Drop, Cloze (Drop-Down), Enhanced Hot Spot (Highlighting) and Grid/Matrix. Each of the five question types is found at least one time in each Clinical Judgment case study, exposing students to these more difficult questions and building their confidence. We know through our teaching that it takes time for students to not only learn information, but also to develop the skills they need to correctly analyze and answer such diverse question types. Integrates Clinical Judgment into the Learning Process From my perspective as a teacher, asking students to integrate evolving patient information is one of the most efficient ways to help students make relevant connections in patient care. Patient care is not based solely on memorizing several disease characteristics, but rather patient care is multidimensional in nature. When we complete a case study, such as the ones found in Clinical Judgment, students can see the multiple factors that exist in a patient scenario. As an added benefit, I also feel confident that my students are getting the targeted practice they need to succeed in the future.

HHHHH “Utilizing the new F.A. Davis resources in our

nursing courses has been an excellent addition to our

program! They are easy to use, enhance student learning, promote clinical reasoning & adaptable for any course! I would highly recommend!”

– Rebecca H., Instructor at College of the Ozarks

The “How” is Easy

As a teacher, you know one of the more daunting tasks is to either create a new course or change an existing course and curriculum. What seems so easy on the surface can take hours of planning, organizing, and fixing logistical snafus. Thus, it is understandable when you hear about a new product, such as Clinical Judgment in Davis Advantage, that your first response may be hesitancy. But, I want to assure you that the “how” of integrating Clinical Judgment into your existing class could not be easier. Of course, no single “right” or “wrong” way exists to incorporate Clinical Judgment. However, one option for integration available to you is simple, direct, and only requires a single “click” in your course set-up within Davis Advantage.

As an instructor, you do not want extraneous items that you some- how have to “fit” into your class. Clinical Judgment case studies only appear for those topics you select to include in your course. I would also recommend that you schedule the Clinical Judgment cases in alignment with the other material for that subject. The benefit of Davis Advantage is

that you have the freedom, with ease, to select the amount and type of content that you want your students to use. As teachers, we are always mindful of the time and energy involved in each step of our classes. In con- sideration of this, Davis Advantage has been created with the flexibility to encourage you to use only what works best for you and your students.

The Possibilities of “How” With six questions for each case study, you’ll likely see Clinical Judgment to be a reasonable, rather than overwhelming option to incorporate into your class. Is it really as simple as choosing which case studies to assign and have students complete? Yes, it can be. But, you can also look to using the materials in Clinical Judgment in more unique ways. Because the case studies are fairly concise, you could consider completing a case study or two during your class time. Students can share their answers and provide rationales. Such interactions can be great for discussion and uncovering any common misunderstandings. You can also facilitate conversations beyond the scope of the case for an even more integrative approach. Furthermore, by discussing the cases

as a group or a class, you create an opportunity to work on test-taking skills. Sometimes, students know the correct information, but stumble on answering a specific question. This can be especially true of the challenging question formats incorporated into the Next Generation NCLEX®.

Of course, if you decide to complete some of the case studies in groups or as a class, this will likely change how you consider assigning these cases for a grade. One option to consider is to ask your students to write a summary case report of the Clinical

Judgment case study in their own words. You can also consider incorporating the case study components and/or questions into your examinations. Another idea to consider is to wait until the end of the course to assign all the case studies. These can serve as excellent, culminating reviews for the material learned.

Regardless of how you decide to incorporate the Clinical Judgment case studies, remember that sometimes “less is more,” especially at the beginning. Often, I like feedback from my students about how a new addition is working for them before I fully commit to integrating it into my course. In this way, I may consider first incorporating a selection of the Clinical Judgment case studies as an extra credit opportunity. Not every student may complete this option, but enough do that I receive feedback about the student experience and how they see the value of this work.

Passing the Baton

In our classes, we face many choices about what we want to include. As the options available increase, so does our need to be selective. One thing that can make our decisions easier is when the inclusion of something new to our courses is so clearly beneficial to our students that we embrace the opportunity to change. The addition of Clinical Judgment in Davis Advantage is one such opportunity. As many of us have seen, an effective case study can help students synthesize patient information in ways that help them meet the expectations of clinical practice. As teachers, we delight in those moments when we pass the baton onto our students to further their education. Of course, we are still available to guide and encourage, but the focus now moves to the students and their ability to drive their own learning. Clinical Judgment in Davis Advantage is designed to help achieve this goal, and to make our passing of the baton a bit easier and more likely to be successful.

Using Davis Advantage gives you the flexibility to set up your course in a way that best meets your needs and the needs of your students. No “right” or “wrong” way exists for the use of these materials, but rather what is most important is to engage with these options in a way that best supports your abilities as an instructor and the abilities of your students to learn. We hope you see Clinical Judgment in Davis Advantage to be a part of the best you offer.

Learn More! § FADavis.com/NextGen § Hello@FADavis.com

About the author Kimberly Harding, MS, PhD is an instructor at

Colorado Mountain College where she teaches a 200-level Pathophysiology course to students online, hybrid, and in-person. She earned her MS at Ball State University in Muncie,

IN and her PhD at Indiana University School of Medicine, in Indianapolis, IN. She contributed content to Davis Advantage.

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