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The education-to-practice gap is magnified in pediatric nursing due to decreasing pediatric content offered in undergraduate programs, including less pediatric clinical time and inconsistent and inadequate clinical experiences. Examine student perceptions of learning and confidence by comparing a high-fidelity pediatric simulation series and acute care pediatric clinical. The SET-M tool compared settings and included open-ended questions to add insight. Sample: In an undergraduate nursing program in a university in the Midwest United States, 124 students completed the anonymous survey rating each experience for learning and confidence in assessment, clinical decision-making, communication, and safety. Results: Students rated the simulation series higher than clinical for all categories except patient communication. Student perceptions of learning in high-fidelity simulation revealed increased confidence and competence and the belief that simulation complements the clinical experience and bridges the theory and clinical courses. • Pediatric content in undergraduate nursing curriculum has declined. • Undergraduate nursing students get limited exposure to pediatric clinical experiences. • High-fidelity simulation is an effective teaching modality in undergraduate nursing. • Students rate learning in simulation experiences favorably. [ABSTRACT FROM AUTHOR]

Aims Design Methods Data source Results Conclusion Implications for the profession Impact Reporting method To characterize the thematic foci, structure, and evolution of nursing research on clinical reasoning and judgment.Bibliometric analysis.We used a bibliometric method to analyze 1528 articles.We searched the Scopus bibliographic database on January 7, 2024.Through a keyword co‐occurrence analysis, we found the most frequent keywords to be clinical judgment, clinical reasoning, nursing education, simulation, nursing, clinical decision‐making, nursing students, nursing assessment, critical thinking, nursing diagnosis, patient safety, nurses, nursing process, clinical competence, and risk assessment. The focal themes, structure, and evolution of nursing research on clinical reasoning and judgment were revealed by keyword mapping, clustering, and time‐tracking.By assessing key nursing research areas, we extend the current discourse on clinical reasoning and clinical judgment for researchers, educators, and practitioners. Critical challenges must still be met by nursing professionals with regard to their use of clinical reasoning and judgment within their clinical practice. Further knowledge and comprehension of the clinical reasoning process and the development of clinical judgment must be successfully translated from research to nursing education and practice.This study highlights the nursing knowledge gaps with regard to nurses’ use of clinical reasoning and judgment and encourages nursing educators and professionals to focus on developing nurses’ clinical reasoning and judgment with regard to their patients’ safety.In addressing nurses’ use of clinical reasoning and judgment, and with regard to patient safety in particular, this study found that, in certain clinical settings, the use of clinical reasoning and judgment remains a challenge for nursing professionals. This study should thus have an effect on nursing academics’ research choices, on nursing educators’ teaching practices, and on nurses’ clinical practices.Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods. [ABSTRACT FROM AUTHOR]

AIM The aim of this study was to evaluate the development and impact of a project to create a statewide test bank of Next Generation NCLEX®-style items. BACKROUND Using a train-the-trainer model, champions created an open access resource of Next Generation NCLEX-style items to use to teach clinical judgment and then trained peers on item writing and test bank use. METHOD Stufflebeam's CIPP (context, inputs, process, and products) model provided the framework for the evaluation. Data were synthesized from multiple sources including participation rates, item utilization, and survey data. RESULTS Twenty faculty from 13 schools were trained as champions and submitted 54 case studies, 33 bowties, and 21 trend items to the test bank. Items were used over 60,000 times in the first year. CONCLUSION The statewide test bank met a need for more teaching resources. The train-the-trainer model was an effective strategy for helping faculty learn to prepare for Next Generation NCLEX. [ABSTRACT FROM AUTHOR]

Test construction and test reviews are responsibilities nursing faculty arduously undertake, with an obligation to give appropriate effort and time to prepare and review exams. During test review, item analysis and statistical analysis offer valuable empirical information about the exam. However, objective compassion is also needed and can be demonstrated through careful test question construction and item analysis. Furthermore, compassion is needed in preparing students for the Next Generation NCLEX-RN (NGN) and constructing exams that appropriately test students' clinical judgment. [ABSTRACT FROM AUTHOR]

Background: Nursing education programs continue to face an immense amount of change over a short period of time. The introduction of the National Council of State Boards of Nursing (NCSBN) clinical judgement model (NCJMM), the Next Generation (NGN) version of the National Council Licensure Examination for Registered for Registered Nurses (NCLEX-RN), and The Essentials: Core Competencies for Professional Nursing Education from the American Association of Colleges of Nursing (AACN) have nursing programs quickly adjusting curriculum to meet national nursing education agency's recommendations for future nurses. Methods: This paper provides reflection and interventions for nursing educators and leaders to consider as they navigate the post-pandemic healthcare demands of new graduate nurses. Implementing activities encouraging critical thinking to build clinical judgement is paramount for undergraduate nursing curriculum. Conclusion: Curriculum must match the required knowledge and skills of their discipline. With the growing acuity of illness and diversity of those seeking healthcare, nursing knowledge does not merely represent textbook content, but a mindset which can analyze the full clinical picture and plan of care accordingly. [ABSTRACT FROM AUTHOR]

• Need innovative teaching to improve clinical judgment and RN practice readiness. • Adds new perspective to traditional clinical care plan and concept map utilization. • Clinical care worksheets followed by concept maps ideal to build clinical judgment. Nursing faculty must develop innovative strategies to foster pre-licensure student development of clinical judgment and improve practice readiness. Clinical care worksheets are traditionally long, linear assignments to help students identify various elements of patient care. Clinical concept map assignments help student identify relationships and prioritize care needs. Comparison of clinical concept maps and clinical care worksheets was performed with pre-licensure nursing students in their first clinical course. Student and faculty perceptions on clinical judgment development, learning, time spent, and preference of assignment were evaluated. Both assignment types were beneficial to student learning but in different ways. Most students perceived that concept maps contained less busywork and were more helpful to improve learning, thus preferring this assignment. Students and faculty recognized the value of building base knowledge with clinical care worksheets followed by incorporation of clinical concept maps to connect the entire patient care picture and maximize learning. We recommend using clinical care worksheets then advancing to clinical concept maps to help build clinical judgment and learning most efficiently and effectively. [ABSTRACT FROM AUTHOR]

AIM The aim of this study was to determine what is currently known about just culture's impact on nursing students' development of self-confidence with clinical judgment. BACKGROUND Graduates of nursing programs must execute sound nursing judgment to provide safe client care. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided the scoping review. The review elicited 1,411 sources and included 18 data sources. RESULTS Just culture was found to provide elements of trust, fairness, and psychological safety needed by nursing students to be self-confident in learning and executing clinical judgments that promote client safety. CONCLUSION Just culture promotes client safety in nursing education. Limited information exists on just culture's influence on student self-confidence with clinical judgment; more research is therefore required. [ABSTRACT FROM AUTHOR]

Background: To prepare students for Next Generation National Council Licensure Examination-Registered Nurse (NCLEX-RN), nurse educators need to develop teaching strategies to foster students' clinical judgment. Purpose: This study examined the effects of unfolding case-based learning (CBL) on baccalaureate nursing students' clinical judgment upon graduation. Methods: A prospective cohort design was adopted. Students' self-reported responses to the Lasater Clinical Judgment Rubric were compared between the unfolding CBL (n = 140) and non-CBL (n = 126) cohorts at a school of nursing in the United States. Results: While students' responses were similar between the study cohorts, a trend was noted for improved clinical judgment among students in the unfolding CBL cohort. Furthermore, unfolding CBL significantly enhanced students' perceived proficiency in conducting focused observation. Conclusions: The findings support early introduction and consistent use of the unfolding CBL throughout the undergraduate nursing program so that students have ample opportunities and contexts to cultivate clinical judgment skills in the classroom. [ABSTRACT FROM AUTHOR]

• Game-based learning supports assessments of knowledge and improved soft skills. • Escape room simulations are a proven method for enhancing clinical judgment skills. • Nurse educators can use escape rooms to build these critical skills prior to transitioning into practice. Clinical judgment is foundational in nursing to maintain safe patient care, yet students rarely get the opportunity to fully evolve this skill. Alternative teaching strategies of simulation and game-based learning can provide students with the experiences necessary to advance clinical judgment skills. The purpose of this study was to investigate the impact of an escape room simulation on student clinical judgment skills. Nursing student perceived clinical judgment levels were measured using the 10-question Skalsky Clinical Judgment Scale (SCJS) in a quantitative quasi-experimental study with a pre/post-test approach. A paired t-test revealed a statistically significant increase in SCJS survey scores from the presurvey total (M = 32.3, SD = 3.86) to the postsurvey total (M = 35.8, SD = 4.32), t (43) = -5.41, p = <.001 (two-tailed). Findings support nurse faculty using an escape room simulation to promote the progression of clinical judgment skills in students. [ABSTRACT FROM AUTHOR]

• There are few studies on clinical judgment development of nursing students in the clinical setting. • Clinical reasoning exercises improved clinical judgment and confidence with decision making. • Teaching clinical reasoning concepts is an effective means to improve students' clinical judgment. Studies of graduate nurses demonstrate unpreparedness for practice, leaving nursing education programs to examine methods of instruction that support clinical judgment development. To evaluate effectiveness of active-learning concept-based themes to improve clinical judgment and self-confidence in nursing students. A quasi-experimental, repeated-measures design was conducted using Gonzalez clinical reasoning concepts during a medical-surgical clinical. Pre-, mid- and post-clinical judgment scores were measured using the Lasater Clinical Judgment Rubric by students and faculty. Pre-and postself-confidence student scores were measured using White's Nursing Anxiety & Self Confidence with Clinical Decision-Making scale. Improved overall clinical judgment scores were noted by students (t 27 = 10.12, p <. 001) and instructors (t 27 = 12.58, p <.001). Overall confidence scores increased (t 22 = 3.72, p <.001) while anxiety scores decreased (t 22 = -3.28, p <.001). Clinical nurse educators should assess and support the development of clinical reasoning skills in nursing students with active learning concepts. [ABSTRACT FROM AUTHOR]

Abstract Background Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students’ clinical judgment ability and understanding of nursing students’ experiences of the combined simulation. Methods A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data. Results Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students’ clinical judgment ability. Conclusions The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students’ self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Background: Clinical judgment, also known as gestalt or gut feeling, can predict deterioration and can be easily and rapidly obtained. To date, it is unknown what clinical judgement precisely entails. The aim of this study was to elucidate which features define the clinical impression of health care professionals in the ED. Method: A nominal group technique (NGT) was used to develop a consensus-based instrument to measure the clinical impression score (CIS, scale 1–10) and to identify features associated with either a more severe or less severe estimated disease severity. This single-center observational cohort study included 517 medical patients visiting the ED. The instrument was prospectively validated.. The predictive value of each feature for the clinical impression was assessed using multivariate linear regression analyses to adjust for potential confounders and validated in the infection group. Results: The CIS at the ED was associated with ICU admission (OR 1.67 [1.37–2.03], p < 0.001), in-hospital mortality (OR 2.25 [1.33–3.81], p < 0.001), and 28-day mortality (OR 1.33 [1.07–1.65], <0.001). Dry mucous membranes, eye glance, red flags during physical examination, results of arterial blood gas analysis, heart and respiratory rate, oxygen modality, triage urgency, and increased age were associated with a higher estimated disease severity (CIS). On the other hand, behavior of family, self-estimation of the patient, systolic blood pressure, and Glascow Coma Scale were associated with a lower estimated disease severity (CIS). Conclusion: We identified several features that were associated with the clinical impression of health care professionals in the ED. Translating the subjective features and objective measurements into quantifiable parameters may aid the development of a novel triage tool to identify patients at risk of deterioration in the ED. [ABSTRACT FROM AUTHOR]

Microbial keratitis (MK) is a potentially blinding corneal disease caused by an array of microbial etiologies. However, the lack of early organism identification is a barrier to optimal care. We investigated clinician confidence in their diagnosis of organism type on initial presentation and the relationship between confidence and presenting features. This research presents secondary data analysis of 72 patients from the Automated Quantitative Ulcer Analysis (AQUA) study. Cornea specialists reported their confidence in organism identification. Presenting sample characteristics were recorded including patient demographics, health history, infection morphology, symptoms, and circumstances of infection. The association between confidence and presenting characteristics was investigated with 2-sample t-tests, Wilcoxon tests, and Chi-square or Fisher's exact tests. Clinicians reported being "confident or very confident" in their diagnosis of the causal organism in MK infections for 39 patients (54%) and "not confident" for 33 patients (46%). Confidence was not significantly associated with patient demographics, morphologic features, or symptoms related to MK. MK cases where clinicians reported they were confident, versus not confident in their diagnosis, showed significantly smaller percentages of previous corneal disease (0% versus 15%, p = 0.017), were not seen by an outside provider first (69% versus 94%, p = 0.015), or had no prior labs drawn (8% versus 33%, p = 0.046), and a significantly larger percentage of cases wore contact lenses (54% versus 28%, p = 0.029). In almost half of MK cases, cornea specialists reported lack of confidence in identifying the infection type. Confidence was related to ocular history and circumstances of infection but not by observable signs and symptoms or patient demographics. Tools are needed to assist clinicians with early diagnosis of MK infection type to expedite care and healing. [ABSTRACT FROM AUTHOR]

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum. • A champion supports faculty in implementing clinical judgment in the curriculum. • Faculty development prepares faculty to foster student clinical judgment. • Faculty development increases use of clinical judgment strategies in curriculum. [ABSTRACT FROM AUTHOR]

This study examines the perception of change in patients, therapists, and family members after a year of weekly psychodynamic psychotherapy. Conducted at a university health service in Uruguay, it combines systematic evaluation instruments with the clinical method. The results show variability, consensus, and differences in perceptions of change, without a defined pattern. The triangulation of methods reveals the importance of combining research and clinical practice. Eight fundamental categories for the perception of change were identified, useful in evaluating psychotherapeutic treatments. This approach, which combines clinical judgment and interviews, can be valuable for both research and clinical practice by offering an agile way to evaluate crucial dimensions of the self and interpersonal relationships. [ABSTRACT FROM AUTHOR]

• There is a need for teaching strategies to develop students' clinical judgment. • Interactive whiteboard technology facilitates clinical judgment skill development. • Educators are provided a framework to develop students' clinical judgment skills. New graduate registered nurses are entering clinical practice with deficient clinical judgment skills. A convergent parallel mixed-methods design was used to describe and evaluate interactive whiteboard technology (IWB) as a method for development of students' clinical judgment skills. Dual application of IWB technology facilitated dynamic, interactive learning in the classroom and simulation laboratory and provided multiple opportunities for students to practice and hone critical thinking and clinical judgment skills. The novelty of this study lies in the unique procedures and methods used in the implementation of IWB technology to develop students' clinical judgment skills. The culmination of data indicates IWB technology promotes clinical judgment skills by providing a visual platform for the early identification of patterns and cues, facilitating team communication and collaborative decision-making. Future quantitative research is needed to examine the effects of IWB technology on clinical judgment to develop generalizable evidence for nursing education. [ABSTRACT FROM AUTHOR]

Objective: Historically, the American Board of Surgery required surgeons to pass the qualifying examination (QE) before taking the certifying examination (CE). However, in the 2020-2021 academic year, with mitigating circumstances related to COVID-19, the ABS removed this sequencing requirement to facilitate the certification process for those candidates who were negatively impacted by a QE delivery failure. This decoupling of the traditional order of exam delivery has provided a natural comparator to the traditional route and an analysis of the impact of examination sequencing on candidate performance. Methods: All candidates who applied for the canceled July 2020 QE were allowed to take the CE before passing the QE. The sample was then reduced to include only first-time candidates to ensure comparable groups for performance outcomes. Logistic regression was used to analyze the relationship between the order of taking the QE and the CE, controlling for other examination performance, international medical graduate status, and gender. Results: Only first-time candidates who took both examinations were compared (n=947). Examination sequence was not a significant predictor of QE pass/fail outcomes, OR=0.54; 95% CI, 0.19--1.61, P=0.26. However, examination sequence was a significant predictor of CE pass/ fail outcomes, OR=2.54; 95% CI, 1.46--4.68, P=0.002. Conclusions: This important study suggests that preparation for the QE increases the probability of passing the CE and provides evidence that knowledge may be foundational for clinical judgment. The ABS will consider these findings for examination sequencing moving forward. [ABSTRACT FROM AUTHOR]

Background: Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation. Methods: A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data. Results: Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability. Conclusions: The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only. [ABSTRACT FROM AUTHOR]

Background: Clinical judgment is one of the most important competencies required for safe care, decision-making, and diagnosis in nursing profession. Therefore, it is necessary to examine clinical judgment in nursing care. Existing a standard questionnaire based on cultural and social conditions can accurately evaluate clinical judgment in nurses. Objective: The present study aimed to develop and validate clinical judgment capability questionnaire in nurses. Design: The current research was a sequential exploratory mixed method study. Setting: The teaching hospitals affiliated to Jahrom University of Medical Sciences in the South of Iran in 2023. Participants: Twelve clinical nurses were included in the qualitative part and 181 nurses in the quantitative part. Methods: The study was conducted in two parts: one qualitative and one quantitative. In the qualitative part, the concept of clinical judgment was explored using qualitative content analysis. Then, the initial pool of items was generated to develop a questionnaire. In the quantitative part, psychometric properties of the questionnaire were evaluated including face, content, and structure validity and reliability (internal consistency and stability). Results: After examining the psychometric properties, 22 items were developed for the final questionnaire. The results of factor analysis led to the extraction of four factors, including noticing, interpreting, responding, and reflecting. The internal consistency of the questionnaire was confirmed with a Cronbach's alpha coefficient of 0.95 and its stability with an intraclass correlation coefficient of 0.84. Conclusion: The developed 22-item questionnaire is a valid and reliable tool for assessment of clinical judgment capability in nurses.

Ineffective use of the early warning score (EWS) can compromise recognition and response to patients' deteriorating condition. This study explores nurses' and physicians' ideas on initiatives for supporting the effective use of the EWS in a hospital setting. Participatory workshops were conducted, and data were analyzed using content analysis. Ideas generated for integrating new functions into the EWS protocol to facilitate effective use are described. Also recommended was that all users receive training and an update on how to use the EWS score to support acceptance and confidence using the protocol and thereby increase adherence to the EWS. Further research is needed on the efficiency of incorporating nurses' clinical judgment in the EWS protocol within different specialties and the effect on adherence to the tool. [ABSTRACT FROM AUTHOR]

Background: New nurse attrition jeopardizes patient safety, devastates career plans, and negatively impacts costs to hospitals and patients. Employers and educators recognize the widening transition-to-practice gap in meeting expectations for practice-ready, resilient nurses. Purpose: The purpose of this study was to test the use of computer-based simulation activities (CBSAs) to measure processes in Aller's Development of Decision-Making and Self-Efficacy Model (ADD-SEM). Methods: BSN students (N = 50) in a multisite, cross-sectional study used CBSAs to provide data on decision making (Virtual Patient Lasater's Clinical Judgment Rubric), psychological capital (Nursing Anxiety and Self-Confidence in Decision-Making Scale©), and reflection. Results: Repeated-measures analysis of variance and reflexive thematic analysis revealed that decision-making (DM) scores were highest in noticing and lowest in interpreting with significant differences in cohorts (DM) (juniors: P < .001; seniors: P = .013) and self-confidence/anxiety (P < .001). Conclusion: The CBSAs are an effective means of measuring student development of DM and psychological capital needed to retain resilient nurses. [ABSTRACT FROM AUTHOR]

Context: Cooperative learning activities benefit novice and beginning nurses' learning. However, knowledge about the learning process in these activities and their benefits for expert nurses remains limited. Aim: This study aimed to explore, from the perspective of expert critical care nurses, the contribution of cooperative learning activities to their clinical judgment competency. Methods: For this descriptive qualitative study, semi-structured interviews were conducted with seven experts of critical care experience who had recently experienced cooperative learning activities with nurses at different levels of competency development, from novice to expert. The data were analyzed thematically. Findings: Discussion during cooperative learning activities allows experts to develop their clinical judgment through mechanisms of comparison and explanation. These mechanisms allow them to question their reasoning, understand their automatisms, and review and expand their knowledge. The characteristics of cooperative learning activities—i.e., the establishment of a safe environment and the heterogeneity of the group of learners—appear as prerequisites and necessary conditions for discussion. Conclusion: These findings suggest that expert nurses benefit from discussion in cooperative learning activities to the same extent as less experienced nurses. Forming diverse learning groups is a promising avenue for maximizing the benefits of cooperative learning activities, particularly when learners from different professions, clinical settings and stages of development are involved. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effects of an electronic fetal monitoring simulation with problem-based learning (EFM SPBL) program based on the Clinical Judgment Model. Methods: Third-year nursing students were randomly allocated to the control (n = 46) or experimental groups (n = 46). The control group participated in the conventional clinical practice, while the experimental group participated in the EFM SPBL program. The students completed a structured questionnaire on Google surveys. Results: Nursing performance confidence (t = 10.72, p < .001) and clinical judgment (t = 2.53, p = .015) increased significantly in the experimental group. Conclusions: This study recognized improvement in students' clinical judgment in the context of learning transfer. A standardized SPBL with various cases is recommended. [ABSTRACT FROM AUTHOR]

Sanjay Shinde, Firew Tiruneh, Dinaol Abdissa Fufa Department of Midwifery, Mizan Tepi University, Mizan Teferi, EthiopiaCorrespondence: Firew Tiruneh, Email mtu2012x@gmail.comBackground: Worldwide, quality education is one of the important tools to improve healthcare quality. Healthcare practitioners must be competent in their clinical judgement to meet clients’ need. However, poor clinical judgment skill accounts for almost one-third of all patient problems in health care. Expert patient simulation has been used as a training method for clinical judgement skill. However, according to empirical studies, using expert patients to develop clinical judgement skill is unclear. The method is effective in one situation but not in another.Objective: To examine the effect of expert patient simulation on the clinical judgment skill of health science students of Mizan-Tepi University.Methods: A pre-test/post-test quasi-experimental design was used on 92 randomly selected samples from the graduating cohort of midwifery students. The research subjects who took part in the experiment were picked at random. Tools included the Creighton Competency Evaluation Instrument (C-CEI®), the Learning Satisfaction and Self-Confidence Questionnaire, and the Kolb Learning Style Inventory (LSI). The Wilcoxon-signed rank test was utilized to compare the self-confidence scores among intervention and control group of students, and the paired sample test was used to compare clinical judgment scores. Cohen’s d was used to assess the effect size, and Spearman correlation was used to explore the association.Results: Clinical decision-making ability and self-confidence measures revealed statistical and practical differences between before and after simulation. There was a mean difference of 2.28 (95% CI, 1.78, 2.79), t (45)=9.13, p 0.001, and an effect size of 1.3, p 0.001. A pre-and post-simulation self-confidence measure showed statistically significant improvement after simulation (W = 1, Z = − 3.57, P 0.001). A moderately significant positive connection (r = 0.419, p 0.004) was also discovered.Conclusion: The study found that human expert patient simulation is a tremendous clinical training technique for improving students’ clinical decision-making skill competency and self-confidence.Keywords: effect, patient, simulation, clinical judgment, health science students

Venous thromboembolism, commonly presented as pulmonary embolism and deep-vein thrombosis, is a paramount and potentially fatal condition with variable clinical presentation. Diagnosis is key to providing appropriate treatment in a safe and timely fashion. Clinical judgment and assessment using clinical scoring systems should guide diagnostic testing, including laboratory and imaging modalities, for optimal results and to avoid unnecessary testing.

Abstract Background Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey from novice to expert.

Background: Ethical debates as an active learning strategy encourage students to think critically through complex ethical issues while using evidence-based literature to compare views and support decision-making actions that affect patient outcomes. Problem: The current complexity of health care implies that nurses will continue to encounter ethical dilemmas that demand essential knowledge of ethical principles, critical thinking strategies, and practical communication skills. Approach: Student groups were assigned a health care-related ethical issue and collaborated to present their pro or con position. The American Nurses Association (ANA) Code of Ethics and the American Association of Colleges of Nursing (AACN) Baccalaureate Essentials guided the structure of the student debates. Conclusion: Utilizing the ANA Code and AACN Essentials as supportive frameworks to guide students' ethical debate preparation and execution enhanced students' knowledge and supported their critical thinking about ethical issues in health care. [ABSTRACT FROM AUTHOR]

Public and clinician attitudes are important to consider when studying the reentry of individuals who sexually offend. Uninformed public attitudes drive the continued use of ineffective policies like registries and residential restrictions in the United States, and experts must assess risk to decide what level of supervision and control to recommend upon release from prison. This study investigated whether actuarial feedback could change participant attitudes about recidivism risk and disposition. Association for the Treatment and Prevention of Sexual Abuse (ATSA) members and a sample from MTurk completed a survey using vignettes to assess recidivism risk and dispositional outcomes of individuals who had sexually offended and varied in their risk to reoffend. They received feedback about the individuals' Static-99R risk levels and adjusted their initial ratings. ATSA members were less punitive than MTurk participants, initially predicted risk that was more consistent with actuarial data, and adjusted when incorrect. MTurk participants held more negative attitudes towards individuals who sexually offend, as measured by the ATS-21. They adjusted their risk ratings more than ATSA members, though their estimates were still higher than the ATSA members after feedback. Implications for US public policy, including the recommendation to use actuarials across the country, are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many studies have demonstrated that physicians often err in estimating patient prognosis. No studies have directly compared physician to model predictive performance in heart failure (HF). We aimed to compare the accuracy of physician versus model predictions of 1-year mortality. METHODS: This multicenter prospective cohort study on 11 HF clinics in 5 provinces in Canada included consecutive consented outpatients with HF with reduced left ventricular ejection fraction (<40%). By collecting clinical data, we calculated predicted 1-year mortality using the Seattle HF Model (SHFM), the Meta-Analysis Global Group in Chronic HF score, and the HF Meta- Score. HF cardiologists and family doctors, blinded to model predictions, estimated patient 1-year mortality. During 1-year follow- up, we recorded the composite end point of mortality, urgent ventricular assist device implant, or heart transplant. We compared physicians and model discrimination (C statistic), calibration (observed versus predicted event rate), and risk reclassification. RESULTS: The study included 1643 patients with ambulatory HF with a mean age of 65 years, 24% female, and mean left ventricular ejection fraction of 28%. Over 1-year follow-up, 9% had an event. The SHFM had the best discrimination (SHFM C statistic 0.76; HF Meta-Score 0.73; Meta-Analysis Global Group in Chronic Heart Failure 0.70) and calibration. Physicians’ discrimination differed little (0.75 for HF cardiologists and 0.73 for family doctors) but both physician groups substantially overestimated risk by >10% in both low- and high-risk patients (poor calibration). In risk reclassification analysis, among patients without events, the SHFM better classified 51% in comparison to HF cardiologists and 43% in comparison to family doctors. In patients with events, the SHFM erroneously assigned lower risk to 44% in comparison to HF cardiologists and 34% in comparison to family doctors. CONCLUSIONS: Family doctors and HF cardiologists showed adequate risk discrimination, with however substantial overestimation of absolute risk. Predictive models showed higher accuracy. Incorporating models in family and HF cardiology practices may improve patient care and resource use in HF with reduced left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

Background: There is a gap in evidence for effective clinical teaching strategies to promote nursing students' development of clinical judgment (CJ). Purpose: This study examined the effect of active learning strategies (ALSs) during clinical postconference sessions on the CJ of undergraduate nursing students. Methods: This quasi-experimental study of ALSs or standard postconferences used the Lasater Clinical Judgment Rubric (LCJR) to rate CJ at 3 time points. All faculty members and students were trained on use of the LCJR. Ratings were done by both faculty and students. Results: All ratings of CJ improved over time (P <.001). Ratings of CJ varied between the control and intervention groups. Conclusions: The findings of this study contribute to knowledge regarding the effectiveness of clinical teaching strategies for CJ and preparation for entry to nursing practice. [ABSTRACT FROM AUTHOR]

• Next Generation NCLEX (NGN) has increased classroom use of NGN-style case studies. • Educational innovation to mesh NGN cases and practice realism via expert collaboration. • Create cases to address timely bedside care issues and improve clinical judgment. The Next Generation NCLEX (NGN) has led to increased classroom utilization of NGN-style case studies to improve clinical judgment skills; however, these case study topics are often standardized cases developed by NCLEX preparation products or are developed at the discretion of didactic nursing faculty and may not be entirely reflective of the diverse patient populations, acuity, and evolving challenges occurring directly at the bedside. This potential gap between case study content and practice realism led to the development of a collaborative education innovation between nursing school faculty and a certified wound and ostomy nurse in a prelicensure nursing course. The clinical judgment activity addressed skin and wound care skillsets in students through the creation of three NGN case studies that reflected current bedside issues experienced by new graduate nurses at the affiliated academic medical center. Following the activity, students demonstrated improvement on clinical judgment questions and increased confidence in skin and wound topic areas. Findings indicated that utilizing a brief stepwise process that emphasizes collaboration between faculty and content experts to regularly update NGN case studies can serve a dual benefit of addressing NGN certification success, as well as addressing potential bedside care challenges experienced by new graduate nurses. [ABSTRACT FROM AUTHOR]

• Next generation National Council Licensure Exam NCLEX beginning spring, 2023. • Bow-tie and trend questions will appear in the new test format. • Incorporate active learning strategies into class and simulation. The National Council of State Boards of Nursing (NCSBN) is making changes to the national council licensure exam (NCLEX) to improve measurement of nursing clinical judgment. Good clinical judgment is crucial in promoting patient safety. A review of the literature reveals that one-half of all nurses make a significant error within the first year of their practice. The NCSBN is instituting new formatted questions on the NCLEX to assess candidates' level of clinical judgment. This new format includes case studies, new formatted question types within case studies, and new format stand-alone questions. A review of some of the changes and analysis of two new question types is included. Two new stand-alone types are Bow-tie and trend. These questions require the candidate to incorporate multiple aspects of the nurse clinical judgement model to successfully answer the question. Constructing these types of questions as well as implementation strategies to incorporate these item types is described. The NCLEX will be challenging for educators and students with the new format and unfamiliar question types. Nurse educators can implement active learning strategies into the classroom to prepare students. [ABSTRACT FROM AUTHOR]

• SLEs develop clinical judgment and competence among novice nursing students. • A strong, relationship exists between clinical judgment and clinical competence. • Dosing of SLEs support development of clinical judgment and clinical competence. • SLEs with a high degree of fidelity to the HSSBPTM advance simulation science. Clinical judgment and competence are two essential skills for undergraduate nursing students to learn. These two skills have been taught mostly in upper division nursing courses. A single group repeated measures design was used to evaluate the effect of three simulated learning experiences using standardized participants (SP) in the development of clinical judgment and clinical competence among 47 sophomore nursing. The study also examined the relationship between clinical judgment skills and clinical competence among the study participants. Study participants demonstrated increased abilities in clinical judgment skills (F [2, 92] = 11.41, p <.001, η2 p = 0.20) as well as clinical competence (F [2, 92] = 10.79, p <.001, η2 p = 0.19), and the relationship between the them was positive and significant at each measurement (Measurement # 1: r = 0.66, p <.001; Measurement # 2: r = 0.36, p =.013; Measurement # 3: r = 0.55, p <.001). Simulation is an effective teaching strategy to develop clinical judgment and competence among nursing students early in a curriculum. [ABSTRACT FROM AUTHOR]

Clinical judgment is the cognitive process that emerges from critical thinking or clinical reasoning that affects patient safety. For example, not noticing clients' deterioration signs while making a clinical judgment may cause inaction errors. Therefore, nursing students must have sound clinical judgment before entering professional nursing practice. Simulation-based learning has become a vital pedagogy used widely to develop students' clinical judgment. However, to date, simulation-based learning in Thailand has focused on theoretical content and clinical practices rather than the development of cognitive ability. Nursing instructors are vital in developing the thinking process of nursing students. Therefore, a deep understanding of nursing instructors' perspectives on the essential components of designing a simulation scenario for enhancing clinical judgment among nursing students remains important. This qualitative descriptive study aimed to explore the critical components in the design characteristics of nursing simulation scenarios for improving nursing students' clinical judgment based on the perception of nursing instructors. Participants were 23 nursing instructors purposively selected from a nursing college in Thailand. Data were collected during March 2021 in focus group discussions with all participants, then five participants with simulation-based learning expertise undertook individual in-depth interviews. Data were analyzed using content analysis. From the findings, four themes emerged: 1) fostering instructor support, 2) recognizing students' strengths, 3) enhancing specificity in scenarios, and 4) promoting cognitive development. Nursing instructors can apply the findings in creating simulation-based activities to develop their clinical judgment to support nursing students' cognitive processes. Such actions will help to ensure patient safety and quality of care. [ABSTRACT FROM AUTHOR]

Abstract Background Clinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment. Aims This study aimed to compare the same group of students’ self-assessment of clinical judgment with an evaluator’s assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students’ self-assessment of clinical judgment. Methods The study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson’s correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot. Results The results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator’s assessment. Differences between students’ scores and the evaluator’s scores were larger when the evaluator’s scores were low, indicating the presence of the Dunning-Kruger effect. Conclusion It is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student’s clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students’ clinical judgment skills.

Background: Clinical judgment, also known as gestalt or gut feeling, can predict deterioration and can be easily and rapidly obtained. To date, it is unknown what clinical judgement precisely entails. The aim of this study was to elucidate which features define the clinical impression of health care professionals in the ED. Method: A nominal group technique (NGT) was used to develop a consensus-based instrument to measure the clinical impression score (CIS, scale 1–10) and to identify features associated with either a more severe or less severe estimated disease severity. This single-center observational cohort study included 517 medical patients visiting the ED. The instrument was prospectively validated.. The predictive value of each feature for the clinical impression was assessed using multivariate linear regression analyses to adjust for potential confounders and validated in the infection group. Results: The CIS at the ED was associated with ICU admission (OR 1.67 [1.37–2.03], p < 0.001), in-hospital mortality (OR 2.25 [1.33–3.81], p < 0.001), and 28-day mortality (OR 1.33 [1.07–1.65],

• This manuscript highlights the process that was used to create a virtual reality (VR) scenario. • VR is a computer-simulated, interactive three-dimensional (3D) environment that gives the students an immersive experience with a client situation. Nurse educators are forced to adopt new, innovative methods to assist students in getting the clinical experience necessary to develop into competent clinicians. The rise of students seeking entry into nursing programs and the barriers that have challenged clinical placement has forced nursing programs to use alternate clinical experiences. Virtual reality is a newer technological advancement that serves as an alternate clinical experience. A four-step development process created a three (3) part VR clinical scenario. VR is quickly emerging, and although not extensively used in nursing education, educators can benefit from implementing it as an alternate clinical experience. [ABSTRACT FROM AUTHOR]

• Limited literature exists specifically focusing on peer mentoring and nursing clinical judgment. • This project can be implemented in other nursing programs to enhance leadership skills with the peer mentor leaders and encourage nursing clinical judgment with nursing students. • The peer mentoring quality improvement project provides an opportunity for collaboration between nursing faculty and peer mentors to build nursing clinical judgment. Integrating various opportunities for nursing students to rehearse their use of nursing clinical judgment (NCJ) is needed to prepare for the licensure exam and clinical practice. Two exceptional nursing students were selected to provide peer mentoring sessions for nursing students enrolled in nursing courses designed to assist students with development of cognitive problem-solving skills. Two peer mentoring sessions were conducted to provide rehearsal of next generation style questions including case studies. This quality improvement project warrants further research to explore whether this innovative approach to coaching and mentoring has an impact on students' use of NCJ. [ABSTRACT FROM AUTHOR]

Background: Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods: Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results: Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions: The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians' journey from novice to expert. [ABSTRACT FROM AUTHOR]

Accurate clinical judgments are critically important for counselors in their work with clients. To date, there are no studies that have assessed rehabilitation counselors' knowledge of clinical judgment and its importance to implement in practice. In this internet-based study, a random sample of certified rehabilitation counselors (CRCs; n = 579) were surveyed using the clinical judgment skill inventory (CJSI). The CJSI measures clinical judgment skills across seven clinical judgment skill areas (scientific attitude, cognitive complexity, cultural bias, confirmatory bias, memory bias, negative bias, and evidence-based practice). CRC participants overall rated clinical judgment skills to be important. Significant multivariate analysis of variance (MANOVA) test indicated significant mean differences between practice settings (Wilks' Lambda F = 3.31, p value <.01) in "scientific attitude" (F -statistic = 3.91, p value <.01), "cultural bias" (F -statistic = 3.71, p value <.01), "confirmatory bias" (F -statistic = 3.02, p value =.01), and "evidence-based practice" (F -statistic = 5.62, p value <.01). Specifically, CRCs working for a college or university perceived clinical judgment skill areas to be more important than CRCs working in other practice settings. Implications for rehabilitation counseling practice are discussed. [ABSTRACT FROM AUTHOR]

Development of standardized diagnostic instruments has facilitated the systematic characterization of individuals with autism spectrum disorders (ASD) in clinical and research settings. However, overemphasis on scores from specific instruments has significantly detracted from the original purpose of these tools. Rather than provide a definitive "answer," or even a confirmation of diagnosis, standardized diagnostic instruments were designed to aid clinicians in the process of gathering information about social communication, play, and repetitive and sensory behaviors relevant to diagnosis and treatment planning. Importantly, many autism diagnostic instruments are not validated for certain patient populations, including those with severe vision, hearing, motor, and/or cognitive impairments, and they cannot be administered via a translator. In addition, certain circumstances, such as the need to wear personal protective equipment (PPE), or behavioral factors (e.g., selective mutism) may interfere with standardized administration or scoring procedures, rendering scores invalid. Thus, understanding the uses and limitations of specific tools within specific clinical or research populations, as well as similarities or differences between these populations and the instrument validation samples, is paramount. Accordingly, payers and other systems must not mandate the use of specific tools in cases when their use would be inappropriate. To ensure equitable access to appropriate assessment and treatment services, it is imperative that diagnosticians be trained in best practice methods for the assessment of autism, including if, how, and when to appropriately employ standardized diagnostic instruments. [ABSTRACT FROM AUTHOR]

• Further research is needed to identify learning activities that promote clinical judgment. • This manuscript provides additional research to support the use of virtual escape rooms as a method to promote clinical judgment in an Adult Health clinical. • Virtual escape rooms promote clinical judgment in nursing students. Educators are challenged to develop pedagogy that incorporates clinical judgment. Teaching strategies should include collaboration, clinical practice, and reflection to promote clinical judgment in nursing students. The literature suggests escape rooms which are game-based educational learning tools, promote safety awareness, teamwork, collaboration, clinical judgment, and content retention. A virtual escape room was created based on the topics of heart failure, post-operative care, and fluid overload in attempt to. Five junior level nursing students enrolled in an adult health clinical participated in the quality improvement project. The students were evaluated using the Lasater Clinical Judgment Rubric. The results revealed that the virtual escape room activity may have promoted clinical judgment. Future research is needed to further validate the use of virtual escape rooms in nursing education. [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.