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Ms. Cappelletti is a graduate of McMaster University, Hamilton; Dr. Engel is Associate Professor, Department of Nursing, and Dr. Prentice is Associate Professor, Department of Nursing, Brock University, St. Catharines, Ontario, Canada. At the time of this study, Ms. Cappelletti was a health sciences honors student, McMaster University.
The authors have disclosed no potential conflicts of interest, financial or otherwise.
Clinical judgment and reasoning are essential elements of a nurse's decision-making process and have long been considered to be the hallmarks of professional nursing (Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003). Clinical judgment refers to the cognitive processes involved in making judgments, which includes making sense of data and cues and is defined as an interpretation about "a patient's needs, concerns, or health problems,â[euro]* followed by a determined course of action (Tanner, 2006, p. 204). Numerous studies have investigated clinical reasoning among RNs and nursing students, often with contradictory results (White, 2003). Findings from these studies suggest that both clinical reasoning and judgment are influenced by multiple factors, such as education and the nursing environment (Johansson, Pilhammar, & Willman, 2009); thus, much debate exists regarding how these skills ought to be modeled and taught (Lasater, 2007).
To improve on the traditional nursing process model of practice, Tanner (2006) extended her earlier review (Tanner, 1998) by further examining the existing English-language literature from the United States and international sources on clinical judgment. From these two literature reviews, Tanner devised a model of clinical judgment that describes how nurses reason in complex clinical situations requiring judgment and how that could be used as a "framework for instructionâ[euro]* (Tanner, 2006, p. 204). This model of clinical judgment has influenced how many academic institutions teach students to develop clinical judgment and reasoning skills (Cato, Lasater, & Peeples, 2009; Dillard et al., 2009; Glynn, 2012; Lasater & Nielsen, 2009). Various educational strategies to teach these skills have shown promise according to the more recent literature (Bartlett et al., 2008; Huang, Chen, Yeh, & Chung, 2012; Palese, Saiani, Brugnolli, & Regattin, 2008), although there is still no consensus in nursing on the best teaching method (Lasater, 2007; Palese et al., 2008) or even whether these skills can be taught. To reduce the current gap in knowledge and to work toward resolving...