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Strategies to Transform the Clinical to Develop Clinical Judgment

By August 23, 2021June 6th, 2023No Comments

How can a nurse educator read a student’s mind? Ask the right questions! You can strengthen clinical learning by incorporating evidence-based questions in clinical paperwork and in your practice as an educator.

Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. Leighton’s systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students.

No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments.

This is an opportunity to develop rigorous studies to develop new knowledge on effective clinical models to strengthen student learning and connect knowledge to practice by developing competency-based education.

Teaching Clinical Reasoning in the Clinical
Lisa Gonzalez developed a concept-based clinical reasoning teaching method with weekly themes, lessons, and learning activities adapted from Tanner’s clinical judgment model and Lasater’s Clinical Judgment Rubric.

Teaching Clinical Reasoning Piece by Piece: A Clinical Reasoning Concept-Based Learning Method offers an organized, consistent approach to teaching and learning clinical reasoning, with multiple opportunities for student reflection, instructor guidance, and discussing clinical reasoning concepts. 

Clinical education became transformed for both the nurse educator and nursing students as clinical reasoning became a visible part of students’ budding nursing practice.

Integrating clinical reasoning skills weekly through Gonzalez’s Model

  • Each week had an emphasis w/activities
  • Documentation/EMR navigation
  • Noticing skills
  • Clustering cues/pattern recognition
  • Connecting assessment data to nursing priority/plan of care
  • Problem recognition
  • Prioritization skills
  • Acceptable ambiguity
  • Put it all together

Clinical Reasoning Skills/Competencies

Noticing skills:

  • Notices significant or relevant clinical data
  • Distinguishes between clinical data that is expected and unexpected
  • Systematically review the medical record
  • Perform thorough focused assessment

Questions to ask students to develop NOTICING skills:

  • In one sentence, concisely describe the essence of your patient’s story?
  • What is the current medical diagnosis of your patient? 
  • Summarize the pathophysiology of this diagnosis in your own words.
  • What clinical data do you notice that is relevant?

Interpreting skills

  • Determine meaning of relevant clinical data
  • TREND data to identify direction
  • Clusters data to determine patterns
  • Determine acceptable ambiguity of clinical data

Questions to ask students to develop INTERPRETING skills:

  • What is the clinical significance of relevant clinical data?
  • What is the trend of relevant clinical data?
  • Do trends suggest status is improving, worsening, no change?
  • What clinical data have a relationship that can be clustered together?
  • What additional clinical data is needed to identify the current problem?

What questions do you have on developing clinical judgement in the clinical? What do you need to know to have clarity to confidently teach it? Leave your questions in the comments below!

Watch the video below to learn more best practices for developing clinical judgment in the clinical!

Keith Rischer – Ph.D., RN, CCRN, CEN

As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…

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