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Dr. Ashley is Associate Professor, and Dr. Stamp is Assistant Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.
The authors have disclosed no potential conflicts of interest, financial or otherwise.
Clinical judgment is essential for every professional working in health care today. Tanner (2006) described clinical judgment as a conclusion that nurses reach regarding a patient's needs or a clinical problem (Lasater, 2007). Clinical reasoning is the process used to make the judgment. It requires weighing the evidence, recognizing patterns, and generating alternatives (Tanner, 2006). The authors used Tanner's model of clinical judgment in nursing to guide this academic quality improvement project with baccalaureate nursing students.
Purpose
The purpose of this project was to examine the clinical judgment and reasoning skills of novice nursing students in a high-fidelity simulation experience. Two levels of nursing students participated in the project, which allowed the nurse educators to compare the clinical judgment and reasoning skills of beginning nursing students with those of students who were slightly more advanced. A qualitative methodology was used because a major goal of the project was to describe the way novice students think through simulation experiences. The following questions were considered: What assessments do they make? How do they interpret findings and attend to the data? What interventions do they implement, and for what reason?
Method
Design
In this project, students were interviewed about the decisions they made during a simulation experience. Each student participated in a 15- to 20-minute videotaped simulation. Immediately after the simulation, the student viewed the videotape of his or her performance with a researcher. During one-to-one debriefing, the student described what he or she was thinking, feeling, and doing at various points in the scenario and provided a rationale for his or her interventions. The researchers used a debriefing script to guide the interview, but questions were tailored according to the assessments and interventions performed by the student during the simulation. Interviews were audiotaped and transcribed for analysis. The project was approved by the institutional review board, and students signed informed consent. The simulation experience was not a requirement of any course and was not graded. The researchers were not clinical instructors for the students participating in the project.
Sample
The sample consisted of...