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Background: The National Council of State Boards of Nursing (NCSBN) developed Next Generation NCLEX (NGN) case studies and new test items, based on the NCSBN Clinical Judgment Measurement Model, to assess nurse graduates' clinical judgment and decision-making ability. Purpose: This study investigated nursing students' perceptions of learning with NGN-style case studies. Methods: A mixed-methods approach collected nursing students' perceptions in a 6-item survey. Results: Overall respondents agreed that the case studies were helpful in learning (n = 45; 90%), applying course concepts (n = 46; 92%), learning clinical judgment (n = 46, 92%), and promoting active learning (n = 43, 86%), and were a useful learning strategy (n = 48, 96%). Themes identified in narrative comments were critical thinking, real-life application, and a learning tool. Conclusions: NGN-style case studies were useful as an active learning strategy to promote clinical judgment and real-life application of course concepts. [ABSTRACT FROM AUTHOR]

Background: Nurses make decisions about care individually and as part of a team. Collective competence, the effective team management of patient care situations, is partially dependent on nurses' individual confidence and clinical judgment competence. Purpose: To describe individual and team-based facilitators and barriers to collective competence in teams of senior baccalaureate-level prelicensure nursing students during a team-based simulation. Methods: With a cross-sectional design, the study used a 26-item survey based on the National Council of State Boards of Nursing (NCSBN)-Clinical Judgment Measurement Model (CJMM) (α=.86) to assess individual student confidence and perceptions of clinical judgment competence while observation of team dynamics and task completion assessed collective competence. Results: Closed-loop communication and role assignment were facilitators of collective competence when present and barriers when absent. Additional barriers were lack of student confidence and perceived competence with Layers 3 and 4 of the NCSBN-CJMM. Conclusions: Team-based simulation strategies can be effectively used to assess collective clinical judgment competence. [ABSTRACT FROM AUTHOR]

Background: Virtual reality simulation (VRS) is an emerging pedagogy in nursing education. Purpose: The purpose of this qualitative exploratory study was 2-fold: to determine nursing students' learning experiences when engaged in VRS, and to explore learners' problem-solving/clinical reasoning approach after participation in a VRS clinical scenario. This article reports student descriptions of clinical reasoning/clinical judgment when considering their VRS experience. Methods: Qualitative description provided a methodological orientation for the study. Widely accepted frameworks for nursing clinical judgment provided a theoretical basis. Results: Focus group participant narratives reveal evidence about nursing clinical judgment when applied to established descriptions and phases. Conclusion: Study findings suggest that VRS experiences promote development of nursing clinical judgment among students. [ABSTRACT FROM AUTHOR]

Escape rooms have gained popularity as a means for team building while working to accurately complete challenging puzzles to 'escape' the room. The use of escape rooms is starting to emerge in healthcare education, including nursing, medicine, dentistry, pharmacology, and psychology. An escape room intensive was created and piloted using the Educational Escape Room Development Guide during the second year of the DNP program. The objective was to challenge their clinical judgment and critical thinking as they solved a series of puzzles created to provide hints for resolving a complex patient scenario. All faculty (n = 7) and most students (96 %, n = 26/27) felt the activity contributed to students' learning process while all students and the majority of faculty (86 %, 6/7) strongly agreed that content was relevant to develop decision making skills. Educational escape rooms can provide engaging, innovative learning to support development of critical thinking and clinical judgment. • Nursing students must develop critical thinking, reasoning, and clinical judgment for practice. • Educational escape rooms can be relevant for developing decision-making skills. • Educational escape rooms can build teamwork among students. • Complex clinical puzzles can help build critical thinking. [ABSTRACT FROM AUTHOR]

Clinical judgment is imperative for the emergency nurse caring for the acutely ill patients often seen in the emergency department. Without optimal clinical judgment in the emergency department, patients are at risk of medical errors and a failure to rescue. A descriptive observational approach using the Lasater Clinical Judgment Rubric evaluated nurses during a task that required recognition of clinical signs of deterioration and appropriate clinical care for simulated patients. A total of 18 practicing emergency nurses completed only 44.6% of the patient assessments leading to low levels of clinical judgment throughout the simulation. Nurses expressed 4 levels of clinical judgment: exemplary (n = 1), accomplishing (n = 6), developing (n = 9), and beginning (n = 2). On average, nurses completed 69% of required tasks. Assessments were completed less than half the time, demonstrating a breakdown in the noticing phase of clinical judgment. The nurses shifted to task completion focus with minimal use of clinical judgment. As the nurses remained task oriented, several medication and medical errors were noted while caring for the simulated patients. Experience and education did not influence observed clinical judgment among the participants. Given the extreme demands placed on the emergency nurse, it cannot be assumed that nurses have developed or can use clinical judgment when caring for their patients. Time and training targeting clinical judgment are essential for emergency nurse development. [ABSTRACT FROM AUTHOR]

The purpose of this study was to obtain a broad view of the knowledge, attitudes, beliefs, and lived experiences of emergency nurses regarding implicit and explicit bias. An exploratory, descriptive, sequential mixed-methods approach using online surveys and focus groups to generate study data. Two validated instruments were incorporated into the survey to evaluate experiences of microaggression in the workplace and ethnocultural empathy. Focus group data were collected using Zoom meetings. The final sample comprised 1140 participants in the survey arm and 23 focus group participants. Significant differences were found in reported experiences of institutional, structural, and personal microaggressions for non-white vs white participants. Respondents who identified Christianity as their religious group had lower mean scores on items representing empathetic awareness. Respondents who identified as nonheterosexual had significantly higher mean total Scale of Ethnocultural Empathy scores, empathetic awareness subscale scores, and empathetic feeling and expression subscale scores. Thematic categories that arose from the focus group data included witnessed bias, experienced bias, responses to bias, impact of bias on care, and solutions. In both our survey and focus group data, we see evidence that racism and other forms of bias are threats to safe patient care. We challenge all emergency nurses and institutions to reflect on the implicit and explicit biases they hold and to engage in purposeful learning about the effects of individual and structural bias on patients and colleagues. We suggest an approach that favors structural analysis, intervention, and accountability. [ABSTRACT FROM AUTHOR]

The focus of this paper is to address the issue of rehabilitation professionals having their credibility and the admissibility of their opinions challenged when called to testify in litigation matters, and how rehabilitation professionals should adhere to proper methodology that reflects their day-to-day clinical work. The objectives of this paper are to identify what qualifies rehabilitation professionals to provide opinions to the court, to discuss subjects of credibility often raised in a deposition and at trial, and how to address these subjects from various perspectives. Beginning at the point of referral and moving through the full spectrum of an assessment (i.e. clinical interview, testing, research, consultations, and report writing), the authors discuss effectively defending the relevance and admissibility of their opinions in a deposition and at trial. This paper covers the following topics: clinical practice, methodology, court rules, and the line between professional style, professional preference, and admissible practices. [ABSTRACT FROM AUTHOR]

AIM This study examined US prelicensure nursing program use of clinical judgmentmodels 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. [ABSTRACT FROM AUTHOR]

Debriefing is an important learning component of simulation-based education (SBE) for nursing students. The evidence-based, scripted, and structured debriefing model— Promoting Excellence and Reflective Learning in Simulation (PEARLS) is meeting the standard of best practice by using a blended approach in the debriefing process with appropriate integration of feedback, debriefing, and/or guided reflection. Evidence demonstrating that PEARLS promotes better outcomes than other debriefing strategies is lacking. Our study compared PEARLS to a standard debriefing on nursing students' professional competence and clinical judgment abilities. A quasi-experimental design was applied to compare differences in the effects of PEARLS (intervention group) and standard debriefing (control group) on nursing students' self-reported professional competence and clinical judgment in SBE and clinical placement. No significant differences in nursing students' self-reported professional competence or clinical judgment were found between the two groups. Professional competence and clinical judgment increased significantly within the intervention group, but not the control group. The results provide some support for implementation of PEARLS debriefing in nursing education. Faculty should receive the training and resources necessary for implementation. [ABSTRACT FROM AUTHOR]

This paper concerns the ethical judgment that lies at the heart of assessing requests for Medical Assistance in Dying (MAID) in Canada and Quebec, namely is it ethically right to help the person requesting assistance to end his or her life? We address situations in which making this judgment may be challenging despite the person fulfilling legal eligibility requirements. Using three clinical cases that are challenging by virtue of the legal requirement that a person experience intolerable suffering we explore this issue. We review practice guidance provided to providers and assessors in six jurisdictions and discuss potential resources to inform the ethical judgments involved in MAID assessments.

Background: With the development of multidisciplinary addictology teams, the ability of an addictologist to reliably assess personality psychopathology can be considered an important prerequisite that significantly enters the process of treatment planning. Aims: Verification of the reliability and validity of the assessment of personality psychopathology in master's students of Addictology (addiction science) based on the Structured Interview of Personality Organization (STIPO) scoring course. Methods: 31 Master's students of Addictology independently evaluated 7 STIPO protocols based on recordings. The presented patients were unknown to the students. The resulting scores of students were compared with 1. expert scores of a clinical psychologist with extensive experience with the STIPO; 2. scores of 4 psychologists without previous experience with the STIPO who have attended the course; 3. information on previous clinical experience and education of the students. The comparison of scores was performed using a coefficient of intraclass correlation, a social relation model analysis and linear mixed-effect models. Results: Students demonstrated a high degree of inter-rater reliability with a significant degree of agreement in patient assessments, as well as a high to satisfactory degree of validity in the STIPO assessments. An increase in validity after the individual phases of the course was not proven. Their evaluations were generally independent of previous education, as well as diagnostic and therapeutic experience. Conclusions: The STIPO seems to be a useful tool to facilitate the communication of personality psychopathology between independent experts within multidisciplinary addictology teams. Training in the STIPO can be a useful addition to the study curriculum.

Background: One of the key indicators of a quality prelicensure nursing program is the NCLEX first-time pass rate. NCLEX-RN pass rates have been decreasing over the last several years. Problem: The decrease in NCLEX pass rates suggests that nursing programs analyze their curriculum with the goal of increasing NCLEX scores. Approach: One small associate degree in nursing program implemented strategic changes to positively improve NCLEX success, which included curriculum revisions and incorporating a clinical judgment framework. Outcomes: By using several innovative strategies, this program increased its first-time NCLEX pass rates by 24%. Conclusions: The purpose of this article is to provide strategies that significantly increased the NCLEX-RN pass rates within 1 year. With the Next Generation NCLEX's launch in April 2023, nursing programs must be proactive in identifying strategies to prepare students for the NCLEX. [ABSTRACT FROM AUTHOR]

In forensic psychiatry, it is common practice to use an unstructured clinical judgment for treatment evaluation. From risk assessment studies, it is known that the unstructured clinical judgment is unreliable and the use of instruments is recommended. This paper aims to explore the clinical judgment of change compared to the calculated change using the Instrument for Forensic Treatment Evaluation (IFTE) in relation to changes in inpatient violence This study shows that the clinical judgment is much more positive about patient's behavioral changes than the calculated change. And that the calculated change is more in accordance with the change in the occurrence of inpatient violence, suggesting that the calculated change reflects reality closer than the unstructured clinical judgment. Therefore, it is advisable to use the IFTE as a base to make a structured professional judgment of the treatment evaluation of a forensic psychiatric patient. [ABSTRACT FROM AUTHOR]

• Simulation anxiety has been assumed to be problematic. • Suggested anxiety-reducing interventions in the literature have mixed effectiveness. • In this study, anxiety did not significantly predict clinical judgment scores. • Faculty should help students function through anxiety rather than eliminating it. High anxiety during simulation has been well documented with calls to reduce students' anxiety. Simulation anxiety is often assumed to be harmful to students and a variety of anxiety-reducing interventions have been suggested. The purpose of this study was to explore the effect of different types of anxiety on the clinical judgment of undergraduate nursing students in simulation. This research used a one-group repeated measures quantitative design using the conceptual framework of Tanner's (2006) model of clinical judgment. Anxiety did not have a significant impact on clinical judgment, both overall and within each of the four phases of Tanner's (2006) model. The findings imply a changed focus to reframe anxiety and how we think about its effects. Understanding that not all anxiety is debilitating but some is facilitative challenges the assumption that faculty need to attempt to lower students' anxiety in simulation. Rather than seeking to lower anxiety for all students, nursing educators should help students function despite anxiety, in order to prepare them for real world nursing practice. [ABSTRACT FROM AUTHOR]

• Assigning expert-modeled simulation observations increased clinical judgment. • Asynchronous simulation observations helped low, medium, and high performers. • Observation reflections revealed differences in knowledge, thinking, and approach. • Time spent responding to prompts favorably influenced clinical judgment scores. Novice nurses have clinical judgment (CJ) deficiencies leading to errors. We used mixed methods to describe learners' CJ trajectory after observing eight expert-modeled videos (EM) asynchronously over a semester. Learners responded to CJ prompts after observing EMs and were scored using Lasater Clinical Judgment Rubric (LCJR). Learners were assigned to low, medium, or high-performance groups based on cumulative LCJR rankings. Next, we analyzed whether background variables related to LCJR scores. Finally, we used Framework Method to describe characteristics of written responses for select low, medium, and high performers. Sixty-three junior-level nurses participated. Observing eight EMs increased CJ significantly over time, F (5.514, 341.858) = 24.18, p <.001, η p 2 = 0.28. Furthermore, all three performance groups significantly increased CJ over time. Longer time spent responding to prompts predicted whether learners were high versus low performers. Qualitative analysis revealed low, medium, and high performers nursing knowledge, thinking, and approach differs. Assigning EM observations and CJ prompts increased CJ development. Assigning EM observations and reflections allows educators to track CJ and overcome variable clinical experiences. [ABSTRACT FROM AUTHOR]

Most nursing simulation programs focus on persons' healthcare needs in hospital settings, and little is known about how to identify them in home settings. This study aims to develop and validate a virtual reality (VR) simulation program for nursing students to improve their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings. We developed a VR simulation program based on a literature review and expert discussion. In Phase 1, home visit nurses or public health nurses will validate the program through their interviews in 2022. In Phase 2, we will conduct a pilot and main single-blinded randomized trial for nursing students to confirm the effectiveness from 2022 and 2023. Participants will be randomly allocated into an intervention group using VR simulations and a control group receiving videos regarding three kinds of community residents' lives [1:1]. After obtaining informed consent, the students will submit their anonymous data to the researchers to prevent associating their grade evaluation. The primary outcome will be their clinical reasoning skills. The second outcome will include their satisfaction and self-confidence. This study will examine the effectiveness of improving their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings. [ABSTRACT FROM AUTHOR]

Background: Clinical reasoning is an important skill that enables health care professionals to identify and evaluate patients' real or potential problems, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes. Purpose: The goal of this study was to go beyond individual professions and seek consensus across health care professions on the essential elements of the clinical reasoning process. Methods: This study used a traditional Delphi methodology to seek consensus from clinical reasoning experts from the fields of nursing, medicine, and physical and occupational health. Results: The experts reached a consensus on 56 essential elements identified from the clinical reasoning literature. This is the first time health care professions have reached a consensus on the essential elements of the clinical reasoning process using a Delphi study. Conclusions: Achieving consensus on the essential elements of the clinical reasoning process is essential to better understanding, improved teaching, and evaluation of clinical reasoning skills. [ABSTRACT FROM AUTHOR]

Background: Clinical reasoning is a cognitive and metacognitive process that is essential for positive patient outcomes. Simulation experiences provide situations and reflection where students can build clinical reasoning. Purpose: This study examined the impact of a higher number of simulation experiences on undergraduate student outcomes. Methods: A retrospective comparison study examined differences between group grade point average, Assessment Technologies Institute (ATI) predictor, and National Council Licensure Examination (NCLEX) scores (P <.05). A sample of 395 students was included in data analysis. Results: No differences were noted in grade point average or NCLEX pass rates. However, students who completed a simulation elective had significantly higher ATI predictor scores. Cohen's d (0.39) approached a medium effect size. Conclusions: Incorporating higher levels of in-person simulation through creative delivery models can improve student outcomes. Simulations may enhance students' clinical reasoning skills. [ABSTRACT FROM AUTHOR]

The work of psychotherapy is complex and seems to resist algorithmic formulation. Psychotherapy theory, technique, and research help to manage this complexity to some degree, but clinical excellence also seems to require clinical judgment, and this judgment cuts across therapeutic theories. However, the content and process of clinical judgment remain relatively untheorized, often relegated to the "art of psychotherapy." This article focuses on elucidating clinical judgment in terms of the neo-Aristotelian concept of practical wisdom, which includes recognizing what is salient, integrating multiple considerations, infusing emotional experience with reason, and pursuing an intervention plan with discernment and flexibility. The argument is that practical wisdom provides a rich description of the work of clinically adept therapists by more clearly portraying therapists' decisions and activities than the general, unsystematic concept of clinical judgment or in terms of the many theories of psychotherapy. [ABSTRACT FROM AUTHOR]

Individualization and iterative design are essential components of the assessment and treatment of challenging behavior. Currently, there are few validated frameworks for engaging in iterative processes. Due to the nature of single‐case design, empirically rigorous evaluations of decision‐tree processes are particularly prohibitive. Notwithstanding, evaluations are needed. In this paper we first describe a function‐informed and mechanisms‐based (FIMB) framework for selecting treatment components employed by a university‐based practicum experience designed to expose pre‐service practitioners to a valid treatment process for challenging behavior. Then, we share a completed retrospective consecutive case series across a 6‐year period in which we conducted a technique analysis to identify which procedures were most commonly selected in the practicum, and the impact of those choices on client outcomes. The results suggest that the model can be highly effective for some, but not all, cases. Implications are discussed. [ABSTRACT FROM AUTHOR]

• International collaboration assists in development of cultural competence. • Students increased their cultural knowledge during an international collaboration. • Feasible options are available to allow international student collaboration. Participation in an international education experience provides an opportunity for nursing students to gain knowledge of other cultures and develop cultural competence. Using Collaborative Online International Learning/Globally Networked Learning model, students from the United States and Denmark collaborated for 3 weeks focusing on development of collaborative relationships and learning about nurses' roles and clinical judgment in other countries. Students felt the international experience was positive, developed relationships, and increased their knowledge of the nurses' role and use of clinical judgment in other countries. Providing an international education experience is an option for faculty regardless of institution size, location, and level of student. [ABSTRACT FROM AUTHOR]

• AV simulation can raise student nurses' cultural awareness. • AV simulation elicits students' noticing and interpreting skills in pain management. • One AV simulation can prompt student reflection on multiple practice issues. • AV simulation has potential to develop students' clinical judgment. Pain is a complex and multi-dimensional phenomenon. Nurses play a vital role in assessing and managing pain and must use sound clinical reasoning to accurately make clinical judgments to notice, interpret and respond to patients' pain. Exploratory research on the impact of a newly developed AV simulation on nursing students' Noticing and Interpreting skills in assessing pain of culturally diverse patients. Data were collected via self-administered pre and post–intervention surveys. The majority of participants were able to identify that the patient was in greater pain than reported, however some participants were unable to notice and interpret the impact of culture during pain assessment. Participants were more aware of the subjectivity of pain (cultural knowledge), and that the strategies learnt would improve their future clinical practice (cultural desire). Findings support the need to include AV simulations in the nursing curriculum to enhance student nurses' cultural awareness, knowledge, and skills regarding pain, all complex factors for making the best clinical judgments to respond to pain. [ABSTRACT FROM AUTHOR]

Electronic medical records are increasingly used to store patient information in hospitals and other clinical settings. There has been a corresponding proliferation of clinical natural language processing (cNLP) systems aimed at using text data in these records to improve clinical decision-making, in comparison to manual clinician search and clinical judgment alone. However, these systems have delivered marginal practical utility and are rarely deployed into healthcare settings, leading to proposals for technical and structural improvements. In this paper, we argue that this reflects a violation of Friedman's "Fundamental Theorem of Biomedical Informatics," and that a deeper epistemological change must occur in the cNLP field, as a parallel step alongside any technical or structural improvements. We propose that researchers shift away from designing cNLP systems independent of clinical needs, in which cNLP tasks are ends in themselves-"tasks as decisions"-and toward systems that are directly guided by the needs of clinicians in realistic decision-making contexts-"tasks as needs." A case study example illustrates the potential benefits of developing cNLP systems that are designed to more directly support clinical needs. [ABSTRACT FROM AUTHOR]

Abstract Background Patients that arrive in the emergency department (ED) with COVID-19-like syndromes testing negative at the first RT-PCR represent a clinical challenge because of the lack of evidence about their management available in the literature. Our first aim was to quantify the proportion of patients testing negative at the first RT-PCR performed in our Emergency Department (ED) that were confirmed as having COVID-19 at the end of hospitalization by clinical judgment or by any subsequent microbiological testing. Secondly, we wanted to identify which variables that were available in the first assessment (ED variables) would have been useful in predicting patients, who at the end of the hospital stay were confirmed as having COVID-19 (false-negative at the first RT-PCR). Methods We retrospectively collected data of 115 negative patients from2020, March 1st to 2020, May 15th. Three experts revised patients’ charts collecting information on the whole hospital stay and defining patients as COVID-19 or NOT-COVID-19. We compared ED variables in the two groups by univariate analysis and logistic regression. Results We classified 66 patients as COVID-19 and identified the other 49 as having a differential diagnosis (NOT-COVID), with a concordance between the three experts of 0.77 (95% confidence interval (95%CI) 0.66- 0.73). Only 15% of patients tested positive to a subsequent RT-PCR test, accounting for 25% of the clinically suspected. Having fever (odds ratio (OR) 3.32, (95%CI 0.97-12.31), p = 0.06), showing a typical pattern at the first lung ultrasound (OR 6.09, (95%CI 0.87-54.65), p = 0.08) or computed tomography scan (OR 4.18, (95%CI 1.11-17.86), p = 0.04) were associated with a higher probability of having COVID-19. Conclusions In patients admitted to ED with COVID-19 symptoms and negative RT-PCR a comprehensive clinical evaluation integrated with lung ultrasound and computed tomography could help to detect COVID-19 patients with a false negative RT-PCR result.

• We aimed to identify an objective evaluation system sensitive to analyze changes in different muscular conditions in different neuromuscular tests. • Digital dynamometry was identified as the most sensitive tool for detecting changes in neuromuscular tests. • Significant differences were found in objective parameters and clinical judgment between practitioners of different expertise levels. • Higher expertise participant presented a clinical judgment like digital dynamometer. Muscle testing is an integral component in assessing musculoskeletal function and tailoring rehabilitation efforts. This study aimed i. to identify an objective evaluation system sensitive to analyze changes in different muscular conditions in different neuromuscular tests across a spectrum of professional experience levels; and ii. to analyze differences in objective parameters and clinical judgment between participants of different levels of expertise in different muscular conditions in different neuromuscular tests. Participants included 60 subjects with Level I to III expertise who performed blinded neuromuscular tests on the middle deltoid and rectus femoris muscles of 40 volunteer subjects. The methodology centered on standardizing test protocols to minimize variability, employing EMG to quantify muscle activity, thermography to capture thermographic muscular response, and digital dynamometry to measure muscular resistance. The findings revealed that while traditional methods like thermography and electromyography provide valuable insights, digital dynamometry stands out for its sensitivity in detecting muscle condition changes in neuromuscular test. Moreover, the data underscored the pivotal role of advanced training and expertise in enhancing the precision and accuracy of neuromuscular diagnostics, since there were significant differences in objective parameters and clinical judgment between participants of different levels of expertise in the different muscular conditions in Middle deltoid and Rectus femoris neuromuscular tests analyzed, presenting higher expertise participant clinical judgment like objective validated instrument. [ABSTRACT FROM AUTHOR]

This study explores the impact of simulation-based training on nursing students' readiness to respond to patient deterioration in clinical practice. With limited in-hospital training opportunities, nursing educators seek alternative strategies to teach clinical skills. Simulation-based training offers a controlled environment for skill development and refinement. A narrative research design was used to examine the experiences of senior undergraduate nursing students (n = 12) at a private university in the Western United States. Data were collected through semi-structured interviews conducted via Zoom. The study identified three key themes: the application of simulation experiences to real-world settings, the aspects of simulation training valued by students and the role of simulation in emotional regulation and coping. The findings highlight the importance of simulation training in preparing nursing students for clinical emergencies. Simulation training enhances clinical judgment and emotional resilience in nursing students, equipping them to handle emergent patient care. Integrating simulation into nursing curricula prepares students for clinical roles and nurse educators can enhance this by creating realistic clinical challenges in simulations. [ABSTRACT FROM AUTHOR]

• Simulation-based learning provides clinical opportunities in obstetric nursing. • Experiential learning promotes students' higher order thinking that leads to better clinical judgment. Obstetric nursing students have less opportunity to practice due to limited clinical placement sites and safety concerns, which leads to inadequate clinical judgment. Previous studies used simulation as a learning method but there was a lack of structured activities for learning, which is a vital aspect to support clinical judgement development. The study aim was to investigate the effect of an Experiential Learning Simulation-Based Learning Program on clinical judgment among nursing students. A quasi-experimental two-group pre-test post-test design was employed. The participants were 44 nursing students. The intervention comprised three obstetrics nursing clinical scenarios in antepartum, peripartum, and postpartum periods guided by Kolb's Experiential Learning Theory that included concrete experiences, reflective observations, abstract conceptualization, and active experimentation. Clinical judgment was assessed through a questionnaire. After the program, the experimental group had higher scores of clinical judgment than the control group. Significant differences in the clinical judgment scores were noted between groups. The Experiential Learning Simulation-Based Learning Program demonstrated effectiveness in increasing clinical judgment among nursing students. [ABSTRACT FROM AUTHOR]

Aim: The study aims to determine the validity and reliability of the Nurse Decision-Making Instrument. Method: The data of the methodological study was obtained from 215 nurses working in two public hospitals in Bolu. The psycholinguistic and psychometric properties of the Decision-Making Instrument were examined in the study. Results: Goodness-of-fit index results of confirmatory factor analysis did not confirm the previously assumed four-factor model in the sample. As a result of the Explanatory Factor Analysis, since some items were not included in their factor group, the scale was accepted as one-dimensional. The Cronbach's alpha coefficient of the scale was.97. Conclusion: The Turkish Nurse Decision-Making Instrument can be used as an assessment tool that reflects the decision-making processes of nurses.

Abstract Objective To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it. Methods An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing tech nicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women’s health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: “there is something wrong with the women”; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care. Results Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs. Conclusion Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.

Background: High-quality healthcare decisions need to balance input from science and clinical practice. When two sources of evidence — such as scientific and practice-derived evidence — are compared, integrated, or need to stand-in for one another, they need to be comparable on similar dimensions. Since 1891, Swedish physicians have been operating under a legal requirement to base their healthcare decisions on science and “proven experience” (approximately clinical expertise), and today all healthcare personnel in Sweden fall under this legal requirement. Objectives: We investigated the dynamics between these two kinds of evidence with respect to importance, systematicity, and certainty by studying Swedish healthcare professionals. Design: Survey to professionals; document studies of political discourse. Method: In this study, a survey was sent to simple random samples of Swedish professionals in medicine, nursing, occupational therapy, dentistry, and dental hygiene, asking about the roles of science and proven experience in medical decision making. Outcome measures were how important, certain, and systematic science and proven experience are for successful medical decision making. Participants: The sampling frame was each profession's most recent occupational registry accessed by the Swedish federal statistical agency. 3500 surveys were distributed. 1626 surveys were returned. 26 participants were removed prior to analysis (exclusion criteria: more than one profession indicated, missing certificate, and mistake in stratum). The final sample consisted of 295 physicians, 300 nurses, 365 occupational therapists, 339 dentists, and 301 hygienists. 162 responses in questions used as variables in the analyses were either uninterpretable or empty; those were replaced with the modal response for a given participant's profession on a given question. Results: In the study, proven experience's perceived importance for clinical decision making is positively correlated with its certainty and systematicity, and an increased certainty and systematicity is positively correlated with a diminished difference in importance between science and proven experience for almost all professions surveyed in this study. Conclusions: Proven experience has an evidentiary role in clinical decision making, and this role depends in part on its certainty and systematicity. Notably, this makes the EBM-based perspective that practice-derived knowledge is primarily of implementation value less plausible.

Aim: To offer a clear understanding of the definition, attributes, antecedents, and consequences of undergraduate nursing students' clinical judgment in the nursing education context. Background: Clinical judgment is a concept with broad uses among healthcare professionals. Its definitions and attributes vary across contexts. There is no established understanding of clinical judgment in nursing students. Design: This concept analysis was performed using the eight steps of Walker and Avant's framework. Data Sources: A literature search was conducted using search engines and included peer‐reviewed articles related to clinical judgment in nursing students. Results: Clinical judgment in nursing students was defined as the cognitive process exhibited via a nursing action by observation, patient assessment, interpreting, and prioritizing data that lead to responding using the appropriate nursing practice with the patient. Reflection was used to evaluate nursing students' clinical judgment to revise nursing practice. Antecedents included nursing education curriculum, student's knowledge, previous clinical experience, critical thinking, and clinical reasoning. The consequences of clinical judgment were clinical judgment ability, safe nursing practice, nursing care quality, and patient safety. Conclusions: This concept analysis gives clear insights into the definition, attributes, antecedents, and consequences of undergraduate nursing student's clinical judgment. [ABSTRACT FROM AUTHOR]

Background: New nurses often struggle with recognizing cues and applying clinical judgment. Nurse educators develop educational simulation scenarios to support students in developing clinical judgment, which includes the foundational step of recognizing cues. Purpose: A scoping review on undergraduate nursing students' cue recognition during simulation was conducted to systematically map the existing research and identify knowledge gaps. Methods: From initial identification of 228 studies published between 2010 and 2020, a total of 17 quantitative or qualitative studies were independently appraised using the Joanna Briggs Institute scoping review process and PRISMA-ScR reporting guidelines. Results: Cues were missed with varying levels of frequency. Participants frequently failed to recognize respiratory rates and physical assessment changes as salient cues to patient deterioration. Verbal cues from simulated patients were often missed or resulted in distancing behaviors. Conclusion: Research is needed to determine the most effective methods for helping learners develop skills in cue recognition and analysis. [ABSTRACT FROM AUTHOR]

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example, whom to test, when to offer the tests, and how to explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt. [ABSTRACT FROM AUTHOR]

• Quantitative outcomes of virtual learning on clinical reasoning and judgment are not known. • Clinical reasoning, judgment, and NCLEX-RN® pass rates were similar for virtual and traditional groups. • Virtual simulation may be a viable solution for a portion of the clinical experience. The study compared outcomes between articulating nursing student cohorts virtual learning during COVID-19 and traditional learning prior to COVID-19. Clinical reasoning is vital to developing clinical nursing judgment. During the COVID-19 pandemic, nursing schools replaced traditional classroom and in-hospital clinical with virtual classroom and clinical learning. A quantitative retrospective cohort study compared outcomes of the nursing students virtual learning during COVID-19 (n = 18) with traditional learning methods before COVID-19 (n = 14) at one college in Texas. Outcomes of the study were measured using a standardized Health Education Systems Inc. (HESI®) specialty exam, HESI® end of program (Exit) exam, and HESI® clinical judgment subscales. Independent-samples t -tests and Chi square were conducted to compare outcomes from virtual and traditional learning. No statistically significant difference was observed between the traditional group (M = 752.93, SD = 148.88) and virtual learning group (M = 761.72, SD = 152.11); t (30) = −0.16, p = 0.87 was identified on the HESI® Maternal pediatric Specialty exam. No statistically significant differences were observed on the HESI® Exit exam or clinical judgment subscales; no relationship between the type of learning and NCLEX-RN® pass rates. The study findings are encouraging, yet limited, warranting further investigation of virtual learning. [ABSTRACT FROM AUTHOR]

Background: Artwork can be used to practice the development of holistic care for nursing students. This activity was designed for senior nursing students to develop their holistic nursing skills through a series of in-class activities while viewing Frida Kahlo's The Broken Column . Aim: This study's aim was to design an educational experience to develop a more holistic approach to caring for patients for nursing students. Method: Students submitted their initial impressions of the painting via an anonymous quiz. After a guided Visual Thinking Strategies (VTS) session, students submitted impressions of the artwork. A VTS facilitator read a history of an accident which revealed the cause of Kahlo's medical and emotional pain. Students then wrote about their perceptions of the painting's meaning and how they might use VTS in caring for their patients. Answers were analyzed using Braun and Clark's thematic analysis. Results: The themes identified were emotions and feelings, metaphor, life/story, and listening to inform perspective. Most found that VTS changed their impressions and enhanced their ability to question patients and inform their care. Conclusion: Students found that VTS expanded their view of patient care and helped them see the patient more holistically, aligning with the development of clinical judgment.

The 3-Minute Memo was developed as an activity to synthesize clinical preparation in a preconference setting. The short, three-part tool requires students to develop and concisely present the patient's story, the patient's most significant priorities, and a planned intervention. It helps students make sense of their clinical preparation while demonstrating skills of clinical reasoning, priority setting, and communication. The 3-Minute Memo is an innovative tool to use in preconference to make sense of clinical preparation and develop the skills necessary to think like a nurse. [ABSTRACT FROM AUTHOR]

The Dual Discrepancy/Consistency (DD/C) pattern of strengths and weaknesses (PSW) method is the most prominent "other alternative research-based procedure" used to identify a specific learning disability (SLD). The DD/C method is intended to be used with multiple data sources, but no research has examined identification decision making using the DD/C PSW analysis of cognitive and academic achievement test scores with other assessment data (e.g., pre-referral intervention data, parent/teacher reports, observations, evaluation of exclusionary factors). This study used an experimental vignette methodology to investigate school psychologists' (N = 343) identification decision making using the DD/C method with multiple data sources. Results showed that school psychologist participants made highly accurate (97.50%) identification decisions when both cognitive and achievement test score patterns and other assessment data were clearly indicative of SLD, but that overall identification accuracy was only 65.60%. Participants made less accurate identification decisions when examining test score data that did not meet DD/C PSW criteria for SLD than when examining test score data that did. Participants made less accurate decisions when other assessment data (interpreted in conjunction with test scores) did not meet DD/C PSW criteria for SLD or were ambiguous than when they did. In addition, male school psychologists were less likely to make accurate identification decisions than female school psychologists, and participants who were Nationally Certified School Psychologists were less likely to make accurate identification decisions than those who were not. Last, more experience with DD/C resulted in less accurate identification decisions, and participants who made accurate decisions reported higher levels of confidence, although the effect size was negligible. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: It is essential to explore virtual learning experiences to identify their impact on nursing students' learning. Purpose: The purpose of this study was to investigate the relationship between the virtual delivery of a health assessment laboratory course and nursing students' clinical judgment. Methods: Using a mixed-methods explanatory sequential design, the investigators appraised the final laboratory examinations of both in-person and virtual delivery cohorts using the Lasater Clinical Judgment Rubric (LCJR) and then interviewed faculty members. Results: The LCJR total mean scores (mean = 10.64) and mean scores for Effective Noticing (mean = 3.48) were higher for the virtual delivery students. The faculty reported that virtual delivery advances students' critical appraisal skills related to subjective assessment but advocated for in-person delivery to develop physical examination techniques. Conclusion: Although the mean clinical judgment scores were higher for the students whose course delivery was virtual, in-person experiences are necessary to develop psychomotor techniques to prepare students for clinical practice. [ABSTRACT FROM AUTHOR]

Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive validity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these indicators reflecting the patient's condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30-point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4. • INTEGRARE is as a predictive tool to assess the risk of developing pressure ulcers. • INTEGRARE allows to develop systematic re-evaluations of health outcomes. • Nursing managers could use the tool to reduce the annual cost of adverse events. [ABSTRACT FROM AUTHOR]

Background: Nursing students in Canada are typically enrolled in a four-year bachelor degree program that provides students with the necessary skills and knowledge to enter a highly demanding and challenging workforce. Strong critical thinking, clinical reasoning, and clinical judgment skills are essential skills for safe nursing practice. Therefore, educational institutes and their mentors are mandated to teach and assess these skills. In addition, nursing programs operate under an apprenticeship model, which entails the fulfillment of practical experience during which students are expected to develop and refine their skills in critical thinking, clinical reasoning, and clinical judgment. Purpose: The purpose of this scoping review of the literature is to assess the available evidence of how higher-level thinking, including critical thinking, clinical reasoning, and clinical judgment are evaluated in undergraduate nursing students in clinical settings. Methods: The inclusion criteria consisted of quantitative research articles published in the last 10 years. Search databases accessed included CINAHL Plus (EBSCO), Medline, and PubMed. Results: Seven articles that fit the inclusion criteria became the focus of this scoping review. Four tools to evaluate higher-thinking processes in clinical settings were located and scrutinized: Lasater Clinical Judgment Rubric (LCJR), Script Concordance Testing, and Yoon's Critical Thinking Disposition Instrument. Relevance to Practice: The scoping review will provide direction and contextualize future studies that focus on the appraisal of nursing students' critical thinking, clinical reasoning, and clinical judgment in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Clinical decision-making is a key component of clinical practice that affects the quality of providing patient services. The explosion of medical knowledge and the need for autonomy of residents' performance has made clinical decision making more difficult for residents. This study explores the experiences of medical residents from clinical decision making. Methods: A qualitative content analysis approach was adopted. Individual semi-structured interviews with medical residents were done. The participants were the medical residents from the hospitals of Tabriz University of medical sciences. Purposive sampling method with the maximum variation was employed. Data collected by individual semi-structured interviews until data saturation and concurrently analyzed. MAXQDA 10 was used to manage the textual data. Results: Three main categories emerged from the experiences of medical residents including, inadequacy of clinical decision making requirements, decision making based on the prevailing conditions in the clinical setting and lack of supportive professional relations. Conclusion: Given that clinical decision making is formed in a structure consisting of the climate of clinical setting, available facilities and equipment as well as professional relationships in workplace; therefore, elimination of barriers requires improving the cultural, educational, professional settings and interpersonal relationship.

• Instructors must employ teaching strategies to engage students in clinical judgement. • Use of Bloom's Taxonomy to scaffold questions can guide student's thinking. • Scaffolded questions can be used in any setting to foster higher order thinking. Nursing instructors must select teaching strategies that foster clinical judgment to prepare nursing students for licensure and practice. Questioning is not a new strategy, but it is an effective method to engage students in higher-order thinking including clinical judgment. By scaffolding and sequencing the questions around Bloom's Taxonomy, instructors can guide student thinking in a stepwise fashion toward the evaluation and synthesis levels where clinical judgment occurs. This manuscript provides instructions on how to employ scaffolded questions to foster clinical judgment. [ABSTRACT FROM AUTHOR]