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Debriefing after Clinical Experiences to Improve Clinical Judgment

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).

  • What hypotheses did you formulate after being given report?
    • What cues helped you to form your hypotheses?
    • How did you group the cues to develop the hypotheses?
  • After your first interaction with the client, how did you refine the hypotheses?
    • How did you prioritize your hypotheses?
    • Did you change any of your hypotheses after your initial encounter with the client?
  • What actions did you take?
    • Identify the cues that led to the hypothesis for this action. How did you choose the priority for this action?
    • What was the actual outcome of the action?
    • Would you do anything different as a result of the outcome?

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.

  • What if…
    • The client had been 10 years old. Would you have changed anything?
    • The client had been unresponsive with an increased heart rate and decreased oxygen saturation when you walked into the room? Would you have changed anything? (Priorities)
    • The client had a different respiratory problem. Would your hypotheses have been any different? Would your priorities have been any different?
  • What about…
    • Did you consider the client’s developmental stage when you were looking at cues and forming hypotheses?
    • Did you consider the client’s baseline medical state when you were looking at cues and forming hypotheses?
    • (If teaching in a concept-based curriculum) Which of the interrelated concepts did you consider when forming your hypotheses?

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.

Donna Walls,

PhD, RN, CHSE

For more tips and resources from Donna Walls, click here.
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