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

This episode of the NLN Nursing EDge Unscripted Scholarship track features guests Mary Ann Jessee and Janet Monagle. They discuss their study on the use of clinical judgment models in prelicensure nursing curricula, highlighting the importance of these models in preparing students for the next generation NCLEX. The study found that while only 27% of nursing programs currently use a clinical judgment model, many plan to adopt one due to the upcoming changes in the NCLEX. Tanner's clinical judgment model was identified as the most frequently used due to its clear language and ease of integration into curricula. The conversation emphasizes the need for faculty development and strategic teaching strategies to effectively implement these models and enhance students' clinical judgment skills.

Learn more about their work, A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula.

Jessee MA, Nielsen A, Monagle J, Gonzalez L, Lasater K, Dickison P. A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula. Nurs Educ Perspect. 2023 Jan-Feb 01;44(1):4-10. doi: 10.1097/01.NEP.0000000000001062. Epub 2022 Oct 14. PMID: 36580615.

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Transcript

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[Music][Music] Welcome everyone to this episode of NLN podcast Nursing EDge Unscripted the Scholarship track.  I'm your host Dr. Steven Palazzo, a member of the editorial board for Nursing Education  Perspectives. Nursing EDge Unscripted and our track entitled Scholarship celebrates  the published work of select nurse educators from NLN's official journal Nursing Education  Perspectives and the NLN Nursing EDge blog. The conversations embrace the author's unique  perspectives on teaching and learning innovations and implications for nursing program development  and enhancement. This episode is about using clinical judgment model to promote students  clinical judgment. We will discuss the author's article, "A National Report on Clinical Judgment  Model Use in Prelicensure Nursing Curricula." The discussion will focus on the unique findings of  the authors who published a manuscript in the January February 2023 issue of Nursing  Education Perspectives. Our speakers today are Dr. Mary Jesse, who's an assistant dean  for academics generalist nursing practice at Vanderbilt University School of Nursing  in Nashville, Tennessee and Dr. Janet Monangle, associate professor at NGH Institute of Health  Professions in Boston, Massachusetts. We want to thank both our guests today for  taking some time out of their day to give us a little deeper dive into this article and  talk it's about some of the implications for practices so welcome to both of our speakers.  Thank you. Good to be here. Yeah. Great. Glad to have you here. So first question I want to ask is just  kind of briefly describe the purpose of your study and its relevance to this next generation  NCLEX that will be implemented it looks like starting in August or excuse me April. April, that's right.  So several years ago our team including Janet, myself, Kathy Lasater, and Ann Nielsen, Lisa Gonzalez,  and Phil Dickison we met together to discuss the next gen NCLEX and talk about what it is  we felt like we needed to know before that went into effect. Because the next-gen NCLEX is  designed to better measure the cognitive processes involved in clinical judgment and to measure them  as they are used in practice it was imperative that we have a baseline understanding of what  our pre-licensure nursing programs were doing to promote clinical judgment. This study did  just that. Our purpose was to examine how pre-licensure nursing programs were using  clinical judgment models in their curricula or to drive their curricula and what teaching  strategies are used specifically to teach clinical judgment. What we found was that while only 27  percent of respondents said they were using a clinical judgment model currently to inform  their curricula, of those - that 70 or so percent not using a model - 51 percent of those said  that they intended to start and a lot of that intent to start was because of next gen NCLEX.  That was interesting to us. One of the key reasons that respondents identified they were using a model was to inform their strategic teaching of clinical reasoning  and judgment through their curriculum. Many said that they specifically used it to inform  how they thread and/or use multiple teaching learning strategies throughout the curriculum to  promote the development of clinical judgment across the curriculum and that's encouraging.  Additionally, I would say that the results of this study provide us some foundational  context for that initial analysis that NCSBN will be doing of the candidate performance on  that first iteration of next gen NCLEX in those particular item types. We're looking  forward to that and to how that analysis will help us identify and put out true best  practices for the use of a clinical judgment model and teaching strategies to prepare  students first for practice but also for the NCLEX with regard to clinical judgment.  Thank you. That was a great overview. In the article you talked about Tanner's clinical judgment model  that was found to be the most frequently used model to guide curriculum development due to I  think it's clear language and ease of use. How would a school or college of nursing begin  the process of integrating this framework or a similar framework into their curriculum? And I  just want to follow up that question with your thoughts on Tanner's clinical judgment model  as a useful tool in this regards to preparing students for not only the NCLEX next  generation but as a guide for clinical judgment, clinical reasoning in their clinical spaces.  So I'll answer that question Steve. Tanner's model, as you were talking about, 65 percent of  our respondents said that they were using Tanner's model. The ones that were using a model and I think  it's like you said, like ease of use but also that it includes certain steps and it includes  background information not only of the patient but of the nurse. It's really important that  it includes several criteria when you're looking at how to make a clinical judgment. It is easy  to use because the language is clear and concise. Actually in 2021 I was one of those schools  that answered that...answered this survey and we were in the process of integrating  Tanner's model. We were one of those that were planning to integrate and so we went through  the process in September of 2021 and we just really finished it up in this past May. The best  way to approach it is number one - start with faculty development. We had five one-hour workshops.  We talked about the research, about Tanner's model, the language of Tanner's model,  the ideas behind Tanner's model. We moved into how you could use Tanner's model for evaluation of a  student as well as for teaching and learning. Then after we did the faculty workshops we moved  into using it - actually creating strategies that use the language. Then we brought in all of  our adjuncts. I cannot stress enough how important it is to bring in the adjunct faculty. We had  Dr. Kathy Lasater, everyone knows created the Lasater clinical judgment rubric  which is based on Tanner's model. She came and spoke with our adjuncts, talked about how to use utilize  the language in post-conference as well using it for evaluation. The next step  was we again met as a faculty and worked on really creating strategies in the classroom,  in the clinical, and case studies and concept mapping and everything that integrated this  language. The last step we did was we looked at all of our student SLOs to make sure that we had  clinical judgment in there, which we really didn't have to make many changes to clinical judgment.  Then we did put it in our student and faculty handbook as a reference,  which I think is very important, right, and one of the things that I think we did in our one of our  adjunct meetings is we had faculty actually model how to talk to a student using Tanner's  model so they had we had like a you know they play they role played right situation when a student  was having difficulty in clinical and they role played a situation when a student was doing well  and they talked about decisions that were made in clinical and I think that it went really well and  I think it really helps us as a faculty have a common language and a common goal.  How was that received by faculty? Was that difficult to bring it into the curriculum? Was  there some resistance? Was it widely accepted? Initially it was widely accepted  initially because I think people are understanding with the new NCLEX, the next gen NCLEX people  are understanding that it is about clinical judgment preparation is about making students  able to enter practice safely and use clinical judgment so it was very well accepted. It was not...  there was really no problem with it. We did make some changes  to the model to meet our curriculum and it went really well. Oh that's great to hear. So what can  faculty and schools of nursing do today? Let's say this is a little bit overwhelming for them  to think about right now, but they want to do some things that will best prepare their students to  attain some of that clinical judgment competencies that we just discussed and get them better  prepared not only to enter practice but for the NCLEX next gen. What could some schools do today?  So I think that's a great question and so preparing students to make sound judgments  in practice really needs to be approached using holistic process but as you say  that can take a while to do that so really starting with some key teaching strategies  while they are helping faculty begin to understand the Tanner clinical judgment  model or the clinical judgment model of their choice. I think understanding that  case studies bring clinical into the classroom so anytime you can do that you can shift from  simply delivering content delivering facts and telling students what they will see and what they  should do anytime you can shift that and have them actually use those facts that they have learned in  class and actually make decisions in the classroom, in the sim lab, in clinical conference, and actually  in the clinical setting is the best way to start. So any way that you can engage students in making  those decisions so just as a faculty member even a novice faculty member who has practiced as a  nurse, I think thinking about what is it that you do in practice when you are doing an assessment  for instance. What is it that you notice and why so? Ask the same questions of the students.  Give them a patient situation and say, what do you notice and why about this  assessment data and then what does that data mean in the context of this care? And so on and so forth.  So you can hear me kind of using that language right from the Tanner clinical judgment model to  guide the students thinking and decision making through clinically based situations. So to recap,  anything you can do to bring those clinical situations to the classroom or to any instance  in which you have students engaging in learning is important. It doesn't have to be a large case study. It  can just be a simple, a couple of line case about a particular element of a patient  situation and asking those questions related to the clinical judgment model can really get  your students thinking about how they are thinking, what they're noticing, and why and how they will  then move forward through the decision-making process to make sound judgments and practice.  Those are helpful tips and you know it's been decades in the making, right. We've needed this  transition this for many decades. It's finally looks like it's going to start happening and I  know it is happening at some places. I think some of the resistance not only comes from faculty and  administration to some extent but our students, right, who want to be taught in a traditional  manner. They say they don't want it, but then when they don't get it they want the PowerPoints and  the lecture and the slides and just tell me what I need to do right. It's about us  also educating and creating that culture for our students about this type of educational processes  and learning that may look unfamiliar to them coming into a program so I think we have to do  just as good a job prepping our students as we do integrating and implementing the model. Absolutely. That is absolutely true. Beginning any program with kind of a  review of cognitive science and...how people learn, right, is really  important so that individual students don't get hung up on the fact that they feel like  I'm a visual learner and I have to see this in order to do it. You can learn in a variety of ways  and really best practice is to use a variety of teaching and learning strategies that really enable students to engage with content and concepts and decision making multiple times  so that it's not, there's never a one and done type of approach to learning about a  particular concept or clinical situation. So where does this leave the nursing process? Is the  nursing process still an important rite of passage? Absolutely. That's a great question and what I will  say about that is it's important to understand that the nursing process and a clinical judgment  model are complementary and both are part of that holistic and necessary preparation of students  for safe practice. The nursing process really is an organizational model at its heart  that guides how we deliver nursing care in that organized fashion; however, it doesn't  directly foster the development or the use of clinical judgment per se.  So for example, when we assess which is the first step of the nursing process, we're  gathering data about the clinical situation, but we also need to take it a step further and be  considering what it is we are noticing as we're doing that assessment and why we're noticing  that and what is most relevant about what we're noticing. A lot of using a clinical judgment  model facilitates our thinking in the moment while we're using the nursing process, but it also then  is key to our reflection after the fact so that we can grow in our ability to do that thinking  in the moment like a nurse does, so looking, doing my assessment on my patient, but recognizing what  needs to be done right then and why that's the best decision and taking action swiftly.  Hopefully that gives a little example about how the two can work together and why both are  important. Thank you so much. I would add to that. I would add to that Steve that the faculty has  to understand that as well, has to have more understanding, faculty development because  nursing process we need for categorization but really clinical judgment is more but I do  believe that if all the faculty understood that I think that we would be on our way.  Well I heard heard this, both of you stressed the importance of faculty development  in this process and I think that's important to note and for us to take away one of the  things to take away from this conversation is this is going to be a very difficult  process to do if there's no faculty development or faculty support resources because we need to  get everybody to a level of understanding that will allow for the thoughtful and accurate  implementation of a model like this so that we're getting the results we expect from our students.  Well I want to thank you so much for joining us for this conversation. I appreciate so much  your expertise and time in sharing this work. I think it's very important it gives us a better  understanding of the use of this model and other models and what's happening across the country as  we prepare for the next gen NCLEX exam. To our listeners, if you have not had the opportunity  to read about this work you will find this manuscript published in Nursing Education  Perspectives, "A National Report on Clinical Judgment Model Use the Prelicensure Nursing  Curricula," nursing faculties perceptions which was published in January February again of 2023.  Thank you for joining us. Please take a look at this article and I think it will help  you at least have an understanding of what's happening out there and where we need to go.  Thank you for joining us both again, much appreciated. Thank you Steve for having us.[Music]