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What is Clinical Judgment?
In the winter, 2018 edition of the Next Generation News, (https://www.ncsbn.org/NCLEX_Next_Winter18_Eng_05.pdf), the NCSBN defined Clinical Judgment as “the skill of recognizing cues about a clinical situation, generating and weighing hypotheses, taking action and evaluating outcomes for the purpose of arriving at a satisfactory clinical outcome. Clinical judgment is the observed outcome of two unobserved underlying mental processes, critical thinking and decision making.”
The NCSBN found that clinical judgment is used for 46% of tasks performed by beginning (entry-level) nurses, as opposed to only 30% of tasks using critical thinking and problem solving (decision making). Therefore, clinical judgment is deemed very important for the entry-level nurses, which is leading the NCSBN to reevaluate and make plans for revising the way in which graduate nurses are tested.
Because clinical judgment involves actual client care and/or exposure to as many client situations possible, it is challenging for nurse educators. Clinical experiences are fewer than they ever have been and students are often held to observational experiences. Therefore, simulated clinical experiences are the best way in which to encourage students to use clinical judgment and debriefing following the simulated experiences is the ideal place for students to be challenged and to help them recognize cues, prioritize care, and evaluate outcomes.
What questions can I ask that will promote clinical judgment?
See the NCSBN Clinical Judgment Model (https://www.ncsbn.org/2018_Webinar_NGN.pdf).
How can I challenge my students to think beyond the simulation activity?
By asking a few questions, you can encourage your students to think beyond this one simulated experience – to begin to think about other circumstances, other cues, other hypotheses, etc. Here are a few examples of questions that might help.
As a side-note, this same technique can be used when bringing the client to the classroom – whether in a simulated experience format or in a case study format! Imagine this … You are giving a lecture about a particular concept or topic and you have just presented the first exemplar. You stop and have the class divide into groups. You assign a HESI Case Study related to the exemplar. The students complete the Case Study in groups and submit their answers. Then, you debrief the case study using the above questions. Following this, you use the What if/What about questions to move on to other exemplars.