There is a reason why case studies will be used to measure clinical judgment on the NextGen NCLEX (NGN) starting in April 2023. Educators need to make case studies a foundational active learning strategy. You can start changing the way nursing is taught now to better prepare your students for practice and licensure.
Educational Best Practice
In Educating Nurses: A Call for Radical Transformation, Dr. Patricia Benner and her coauthors identified three essential paradigm shifts that educators need to implement to transform the way nursing is taught (Benner, Sutphen, Leonard, & Day, 2010).
These paradigm shifts are:
- Contextualize content to the bedside of patient care. Students quickly forget textbook information that isn’t put into the context of practice. For knowledge to be retained and retrieved, it needs the “hook” of context, so students can see how this knowledge is used by the nurse.
- Integrate classroom and clinical learning. Bring clinical realities consistently into the classroom. No more silos between classroom teaching and clinical learning. Bring them together!
- Emphasize clinical reasoning and multiple ways of thinking. Nurses need to develop multiple ways of thinking, including clinical reasoning, the ability to think in action, and reason as a patient situation changes over time (Benner, Sutphen, Leonard, & Day, 2010).
Tanner’s Clinical Judgment Model (CJM) is an example of an evidence/practice-based framework of clinical reasoning. It has four steps (noticing-interpreting-responding-reflecting) that align with the six steps of the NCSBN NextGen framework that measures clinical judgment.
Evidence to Support
As you review these three paradigm shifts from Educating Nurses, what teaching strategy checks off all three of these boxes? A case study that provides clinical context and integrates questions that emphasize clinical reasoning.
In addition to aligning with the research findings from Dr. Benner and her coauthors, articles in the nursing literature support the value of case studies and a case-based curriculum.
Case studies remain one of the most effective methods to teach a practice-based profession such as nursing.
- Connecting theory to practice
- Facilitating the development of clinical reasoning and decision-making
- Providing repeated experiences to practice clinical judgment in the safety of the classroom
- Immersing students in the reality and complexity of clinical realities
- Promoting the acquisition of essential knowledge
- Improving patient outcomes (McLean, 2016)
These outcomes are needed in nursing education right now and are another reason why case studies should not only be a foundational way to teach nursing, but also be integrated and leveled throughout the curriculum.
Why KeithRN Case Studies?
As a new nurse educator, I quickly realized that not all case studies have equal learning value. The case studies in nursing textbooks and other resources have multiple choice questions that emphasized knowledge but not the higher-level thinking skills of clinical reasoning.
I also noticed that every case study had a different set of questions which made it difficult for students to transfer learning to make clinical judgments and were one-size-fits-all, with only one level available.
I decided to create case studies differently and wrote my own, guided by the paradigm shifts from Educating Nurses and what I experienced as a nurse current in clinical practice. I translated in my case studies how nurses encounter complex patient scenarios derived from real-world practice and then used educational best practices to strengthen student learning that includes the following features not found in other case studies.
What makes KeithRN cases unique:
- Use scenarios that unfold over time, requiring students to retrieve essential knowledge and apply it to the bedside.
- Integrate practice-informed frameworks of clinical reasoning that include the nursing process and Tanner’s CJM.
- Use open-ended questions to support critical thinking. No multiple choice because practice does not provide a nurse with this option!
- Consistent use of clinical reasoning questions that provide a Socratic framework to develop clinical judgment.
- Two different levels of complexity; concise (SKINNY Reasoning and complex UNFOLDING Reasoning).
- All case studies have a comprehensive answer key.
Take the Next Step
See the value of KeithRN case studies for yourself. They are available to educators through two channels:
- KeithRN website: Limited number of topics that can be purchased individually.
- Think Like a Nurse Membership: Access more than 100 topics, most are exclusive to members with application worksheets for class and clinical, plus faculty development webinars.
I am humbled, a bit nervous, but also excited that Dr. Phil Dickison reached out to me to share best practice strategies to teach and develop clinical judgment in the classroom at the NCSBN Next Generation Virtual Conference, coming up this Thursday, September 22, 2022.
I hope to connect with you there as there will be a live Q&A after my presentation.
The transformation of nursing education that Dr. Benner and her colleagues identified twelve years ago has yet to be realized. Yet how do you reform nursing education? One educator at a time!
You are right where you are for a reason. Use these insights to guide you to take the next step and do what is needed for such a time as this!
- How to Design a Curriculum that Develops Clinical Judgment Skills
- Frameworks to Teach Clinical Judgment
- Integrating Tanner’s Clinical Judgment Model in Your Teaching
- The Best Definition of Clinical Reasoning to Help Students Think More Like a Nurse
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
McLean S. F. (2016). Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. Journal of medical education and curricular development, 3, JMECD.S20377. https://doi.org/10.4137/JMECD.S20377
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211.