Concept Analysis of Clinical Judgment in Nursing Students: A Hybrid Model

Abstract

Background: Clinical judgment (CJ) is a complex process and is one of the most important concepts in the domain of education of the nursing students. Despite the special importance of its concept in nursing, this term still has not created an equal perception in the minds of many experts in the nursing education and no study has been done in order to define and explain this concept by concept analysis of the "CJ" in the educational domain. Objectives: The current study was done with the purpose of determining dimensions and features of this concept in the domain of clinical education of nursing students in Iran. Methods: The design of this study is qualitative with concept analysis method and hybrid model approach. It was done in three phases that were described by Walker and Avant. In the theoretical stage, reviews on the related and valid articles were accomplished. The articles were assessed and analyzed in order to present the working definition. In the stage of field work, the interview was done with 17 participants including 7 nursing students, 6 teachers, and 4 clinical instructors. In the final stage, the general analysis was done and the antecedents, attributes, and the consequences of the concept were extracted. Results: According to the final analysis, CJ for the nursing students is a cognitive and reasoning process, in order to achieve which, the nursing students by guidance of teachers in a secure clinical environment, assess the patients' needs, interpret, and evaluate the patients' response to the clinical practice and then reflect and perform the critical evaluation of the patients' conditions. In the meanwhile, making effective clinical decisions, increasing the trust of patient and quality of care, the necessary conditions for the promotion of their professional competence will be provided. Conclusions:In the concept analysis of CJ, some of the needed conditions for CJ in the nursing students have not been reported in the studies.

Decision making from the perspective of nursing students

“…Understanding how students make decisions enables a greater adequacy of the nursing education, maximizing learning situations based on scientific evidence that must support all practices (4)(5)7,9) . In this respect, the present study sought to analyze how students made decisions and which decisions they made through their learning diary reports and field notes made during clinical training.…”

“…Decision making focused on the understanding of the care situation also stood out in the way students made decisions. The relationship between this decision-making type and the development of critical thinking (29) may be close, since the reasoning strategies used in data analysis and interpretation promote clinical judgment (4) . The students' reasoning evolution throughout the course will contribute to the critical analysis that they make on events, thus improving their understanding (10) .…”

“…Decision making is a basic nursing skill. The cognitive and reasoning process that nurses use in the decision of care to be provided has led to an increasing concern in the teaching of this skill (4) . The basis for an effective decision making begins during the initial phase of the nursing education, when students are taught to make nursing diagnoses and choose appropriate interventions (5)(6)(7) .…”

“…The concern in understanding how nursing students develop their decision-making skills led to a search for evidence and explanatory concepts that would follow their acquisition and construction process (10) . In spite of the agreement on the importance of decision making in nursing education (3)(4)(5)(6)(7)(8)(9) , there are some misunderstandings on the definition and nature of this concept, which may be due to its complexity and change in several contexts (4) . Based on the systematic review of literature carried out by Thompson and Stapley (11) to analyze the effectiveness of educational interventions in the promotion of judgment and decision making in nursing curricula, six types of decision emerged as follows: intervention; targeting; timing; communication; service organization and management; and experiential, understanding or hermeneutic.…”

“…The development of decision-making skills has become an increasing area of nursing education, leading to a strong impact on international studies (11) . The context of the studies has addressed from the most appropriate pedagogical methods to teach decision-making (5,(8)(9)(12)(13)(14) up to the type of reasoning used in the decision learning on the care to be provided (4,7,(15)(16)(17) , as well as the development of this skill throughout education (18) .…”