Strategies to Teach the National Council of State Boards of Nursing Clinical Judgment Model

Abstract

BACKGROUND There is a growing concern that novice nurses who achieve licensure do not have the clinical judgment to practice safely. The National Council of State Boards of Nursing (NCSBN) began the Next Generation NCLEX (NGN) project to find methods to better assess entry-level competency. The NGN project is based on an integrative clinical judgment model (CJM) with 6 well-defined cognitive steps. PROBLEM Teaching and assessing clinical judgment skills using the NCSBN-CJM will take faculty planning and commitment. APPROACH Clinical scenarios can be used to teach clinical judgment. Using prompts, instructors can deliberately lead students through the steps of recognizing cues, analyzing cues, prioritizing hypothesis, generating solutions, taking action, and evaluating outcomes. CONCLUSION Committing to integrating a CJM throughout the curriculum, using realistic clinical scenarios, and having students work through all the steps of a selected model are important ways educators can help students prepare for safe clinical practice.

Guided reflective writing as a teaching strategy to develop nursing student clinical judgment

“…Utilization of prompts and encouraging students to ask questions, based on their assessment of the patient environment, helps the student develop clinical judgment to promote patient safety. 4 Reflective writing as an assessment, provides faculty with an inside look at students' thought processes and clinical judgment development. With frequent reflective writing submission and review, faculty can provide feedback regarding the student's thought process to guide their experience interpretation.…”

Question Prompts to Integrate Clinical Judgment Into Medication Administration

“…Faculty can engage students in the practice of thinking by asking questions to guide students through the phases of the National Council State Boards of Nursing Clinical Judgment Measurement Model. 1 Following are prompts developed by the authors to elicit students' judgment during medication administration: (1) Recognizing cues: What data support the indication for the medications? (eg, history of present illness, past medical history); (2) Analyzing cues: Are there data that influence whether to hold or administer the medications?…”

Think-Aloud Approach to Model Clinical Judgment in Next-Generation Case Studies

“…TA has been an innovative teaching strategy used by educators to build clinical reasoning skills among students in medical training and nursing education. 1,3,4 Previous literature noted the benefits of TA to develop nursing students' thought processes while performing a physical assessment. 4 This strategy also applies when educators verbalize and explain their thinking used to identify and organize relevant information and describe the steps used to make decisions that solve a clinical problem.…”

“…TA has been an innovative teaching strategy used by educators to build clinical reasoning skills among students in medical training and nursing education 1,3,4. Previous literature noted the benefits of TA to develop nursing students' thought processes while performing a physical assessment 4.…”