Fostering Prelicensure Nursing Student Clinical Judgment in the Traditional Clinical Learning Environment: A Delphi Study
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Bielefeldt, Sabrina
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Abstract
Nursing clinical judgment is a complex cognitive and metacognitive process, which develops with time and experience, that integrates evidence-based practice, intuition, experiential knowledge, and a patient’s situational context to inform patient care decisions. Clinical judgment is essential for nurses to deliver safe, accurate, and timely care, supporting their ability to make decisions that promote positive patient outcomes. Current evidence suggests that new graduate nurses lack the clinical judgment needed for entry to practice which can compromise patient safety. The purpose of this mixed methods Delphi study was to gain consensus from expert clinical nurse educators on teaching and assessment strategies to foster the development of clinical judgment in prelicensure nursing students in the traditional clinical learning environment. This study was guided by situated learning theory (SLT), which postulates that learning is facilitated when it occurs in settings where it is applied, within real-world contexts, and through social interactions. This study used three iterative survey rounds to build consensus, with an expert panel of clinical nurse educators (n = 18) rating their agreement or disagreement to provided statements using a Likert Scale, as well as contributing perspectives through open-ended questions. Four teaching strategies achieved consensus as effective for fostering the development of clinical judgment in the traditional clinical learning environment: (a) concept mapping, (b) questioning, (c) coaching, and (d) debriefing and reflection. In addition, debriefing and reflection were the only assessment strategies to achieve consensus as a strategy to assess clinical judgment development in the traditional clinical learning environment. Other key findings include strategies in the traditional clinical learning environment should reflect a consistent clinical judgment model across prelicensure curriculum and learning settings, academic clinical nurse educators need additional support and guidance to implement these strategies, and there must be collaboration and coordination among stakeholders in nursing education and practice to improve nursing clinical judgment and patient outcomes. Recommendations for future research include studies to examine how and when to implement the identified strategies, and to determine the efficacy on prelicensure nursing student clinical judgment development.
