A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula

Abstract

AIM This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment. BACKGROUND Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used. METHOD A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models. RESULTS Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation. CONCLUSION Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.

Current Practices for Teaching Clinical Judgment

“…The survey was developed by a group of researchers with significant experience related to clinical reasoning and judgment. Survey items were designed to elicit practices in model use (described elsewhere 20 ), teaching strategy use for the specific purpose of developing clinical reasoning and judgment (response options listed in the Table ), and beliefs about how the choice to use or not use teaching strategies to promote clinical reasoning and judgment is influencing student outcomes.…”

“…For reporting purposes, the number and types of teaching activities used were analyzed by model use status, as described in the article reporting first results of the larger study. 20 Qualitative A qualitative research expert who was not part of the research team conducted a preliminary analysis of the data for differences among program types and use or nonuse of a clinical judgment model, identified codes, and proposed themes. Members of the research team separately coded and categorized the data.…”

“…The research described in this article was part of a larger project designed to provide foundational evidence for how US prelicensure nursing programs are using clinical judgment models and teaching strategies to promote development of students' clinical judgment. The findings about model use have been described elsewhere 20 and identified that only 27% of deans and directors surveyed reported that their schools currently use a model to teach clinical judgment. Of the schools not currently using a model, 72% indicated that they intended to start whereas 28% indicated that they did not intend to start.…”

Learning Clinical Judgments With a Lens of Inclusivity

“…A recent national survey showed that some nursing programs use clinical judgment models (CJMs) to promote the development of students' clinical judgment and prepare students for the Next Generation NCLEX®. CJMs are used to guide curriculum design and provide a framework for implementing effective teaching strategies for clinical judgment development (Jessee et al, 2023).…”

“…Several models illustrate clinical judgment in nursing. Tanner’s model of clinical judgment, the most widely used in US nursing education programs that use a model (Jessee et al, 2023), describes the influence of contextual factors and the nurse’s background and relationship with the client (Tanner, 2006). Tanner’s model provides an iterative process that incorporates key elements of background information and provides steps for making clinical decisions: noticing, interpreting, responding, and reflecting.…”