Factors Contributing to Clinical Judgment Development in Nursing Students During Simulation Using the Creighton Competency Evaluation Instrument

Abstract

It is imperative that nurse educators find inventive ways to advance nursing practice by developing a dynamic and divergent nursing workforce. Health care environments can be unpredictable and unsettling due to high acuity levels of patients. The development of excellent clinical judgment is necessary for nurses to meet the workforce demands that this type of environment poses. Nurse leaders report dissatisfaction with new graduates' ability to adequately perform competencies such as critical thinking. Nurse educators must establish approaches that teach, enforce, and evaluate the development of higher level thinking in nursing students. This non-experimental descriptive correlational study explored factors that affect the development of clinical judgment in Bachelor of Science nursing students during a synthesis simulation. The Creighton Competency Evaluation Instrument (CCEI) was used to measure clinical judgment. Tanner's Clinical Judgment Model provided the theoretical foundation for this study. The clinical judgment of 108 BSN students in their fourth semester of a traditional nursing program was assessed by the researcher using the CCEI in the lab during a synthesis simulation. Students also completed a demographic questionnaire. Statistical methods used to analyze the data included descriptive statistics, independent samples t-tests, one way analysis of variance, and Pearson product correlation. Males were found to have significantly higher overall clinical judgment. Males also scored statistically higher on the communication subscale. There were no other statistical differences in demographics or the subscale scores of the CCEI. Work experience had no significant impact on total clinical judgment scores. Participants that reported working in healthcare scored significantly higher on the patient safety subscale of the CCEI that those reporting working but not in healthcare. The unemployed group did not differ significantly from the employed in healthcare or the employed not in healthcare groups on the patient safety subscale. Small correlations were found between HESITM (E2) raw scores and CCEI total as well as communication and clinical judgment subscale scores. The findings of this study contributed to the overall knowledge about clinical judgment and the CCEI as a means to evaluate clinical judgment. Application of findings could be used to increase the use of simulation and foster the development of clinical judgment in nursing students. Clinical judgment terminology should be a standard part of every nursing curriculum. Simulation, with an emphasis on clinical judgment, could be used to increase HESI[trademark] (E2) scores of students thus better preparing them for NCLEX. It is recommended that future studies use a longitudinal approach to measuring clinical judgment. This would provide more discernible data to evaluate the development of clinical judgment over time. It is also recommended that more research be done to establish the CCEI as a valid and reliable tool to measure clinical judgment as well as faculty perceptions of the CCEI.