Cadavero, Oermann Write Article for Wolters Kluwer

Cadavero, Oermann Write Article for Wolters Kluwer

marilyn oermannallen cadaveroAllen Cadavero, assistant professor, and Marilyn Oermann, Thelma M. Ingles Professor of Nursing, wrote "Teaching clinical judgment through cases" for Wolters Kluwer. 

Introduction

At all levels of nursing education, an important program outcome is for students to develop higher-level cognitive skills. The ability to analyze data, consider possible patient problems or diagnoses and think through and decide on the best approaches to use are critical skills not only for prelicensure students but also for learners preparing for advanced practice.

Providing safe care requires more than knowledge: students need to use their knowledge to interpret data, identify and prioritize patient problems and arrive at carefully thought-out decisions about the best actions to take in a clinical situation. These are skills that students need to develop in their nursing courses.

There has been extensive literature over the years describing the cognitive skills nurses use in their daily work caring for patients and making other decisions in clinical settings. Some studies have focused on problem-solving and decision making; others have explored critical thinking skills—the ability to think through a situation considering alternate perspectives and approaches to make an informed decision. More recently the complexity of nursing care has been studied from the framework of clinical judgment. Early on, Tanner (2006) described clinical judgment as including four aspects: (a) noticing (what is expected in a clinical situation, what is noticed first and what additional information should be collected; (b) interpreting (meaning of the data); (c) responding (possible interventions); and (d) reflecting on decisions and what could be done differently next time. In addition to Tanner’s model, other frameworks of nursing clinical judgment have also been described.

Recognizing that sound clinical judgment is critical for safe and effective patient care, the National Council of State Boards of Nursing (NCSBN) determined the need for assessing clinical judgment on the Next Generation NCLEX (NGN). The NCSBN (2019) defined clinical judgment as the “observed outcome of critical thinking and decision making” (p. 1). With this process, the nurse assesses patients and clinical situations, identifies, and prioritizes patient problems and concerns, consider potential solutions and implements evidence-based solutions, and evaluates outcomes.

There are many teaching strategies that are effective in developing students’ clinical judgment and other cognitive skills. These strategies include questions, simulation with debriefing, think-aloud activities, discussions, cases and unfolding cases, reflection, and clinical practice. For these strategies to be effective, students need to explore different perspectives and alternatives rather than the expectation that all students will arrive at one correct response or decision. The purpose of this article is to describe the use of cases for promoting students’ clinical judgment and other higher-level cognitive skills. Cases with open-ended questions are easy to develop and lead to discussions about different perspectives and alternatives—the key to promoting clinical judgment.

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