Nursing students’ clinical judgment in high-fidelity simulation based learning: A quasi-experimental study

Abstract

Background: Improving students' decision making and judgment skills becomes an essential part of nursing education. The purpose of this Quasi-experimental study was to assess nursing students' clinical judgment in high-fidelity simulation based learning using observational measures. Method:Based on Tanner's clinical judgment model, a single group repeated-measures design was used with a purposive sampling at one nursing school in Macao. A total of 113 baccalaureate nursing students (49 in year two, 64 in year three) completed five simulation sessions within a 36 hour period. Two tutors used the Clinical Judgment Rubric to assess students' clinical judgment at the end of each simulation session. The inter-rater reliability for the sessions ranged from 0.833 to 0.910. Results:The scores for clinical judgment increased from the first simulation scenario to the last scenario. Compared with third-year students, second-year students had significantly higher scores of clinical judgment in scenarios two, three, four and five. The debriefing was essential to preparing students for improving their thinking and reasoning skills. Students perceived that simulation strengthened their theoretical knowledge and helped them to notice, interpret, and respond appropriately to contingencies and emergencies. Tutors' comments indicated that second-year students valued the newly learned knowledge and used it to analyze the simulated scenarios while third-year students presented less knowledge and skill preparation.Conclusions: High-fidelity simulation using a computer-controlled human patient simulator has potential to support the development of clinical judgment in nursing students. Tutors are challenged to enhance students' intrinsic motivation for learning, and encourage them to continue their efforts in learning. Further research is needed to explore whether senior students have better performance in clinical judgment than junior students.

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

“…It is compatible with the attribute of "proper interaction with patient" in the theoretical phase and studies existing in Iran. Since most of the participants in this study emphasized the importance of effective communication with nursing staff and patients in the 6 Iran Red Crescent Med J. 2017; 19(5):e45373.…”

“…CJ is the precise assessment to identify evident and hidden data in different situations and to interpret their means (6,24) by a non-linear and changeable pattern (23).…”

“…The nurses with the help of their knowledge and experience assess the needs of the patients and decide about the continuance or adjustment in taking care of them in a cognitive and reasoning thinking process (1,2). As it is one of the key factors in the education of nursing students (3), the role of nursing educators has been emphasized in the development of the students' CJ (4)(5)(6). In order to create such competence in students, nursing education systems must enhance the conceptual understanding of CJ (7).…”

“…In order to create such competence in students, nursing education systems must enhance the conceptual understanding of CJ (7). Despite the agreement about the importance of the CJ in nursing education, there are some disagreements about the definition and the nature of this concept which can be due to its complexity and changeability in different contexts (4)(5)(6)8). The absence of a common language and the presence of the ambiguity of the concept in nursing education resulted in weakness in the development of the students' CJ.…”

Designing and Psychometric Evaluation of Questionnaire of Influencing Factors of Nursing Students’ Clinical Judgment: A Mixed Method Study in an Iranian Context

“…Inattention to the influencing factors to develop judgment in clinical education, and ineffective CJ, result in undesirable outcomes such as inappropriate, expensive, and unsafe and low-quality clinical interventions that also lack ethical considerations (2).Yuan et al, believed that insufficient educational opportunities in the clinical environments are the affecting factors of CJ (4). Garb believed that cognitive and social factors including client characteristics and context were the underlying factors of CJ in psychiatric practice (3).…”