Teaching Clinical Judgment in Nursing Education: Balancing NGN Questions and Safe Practice

Introduction:

Teaching clinical judgment to nursing students is a multifaceted endeavor crucial for ensuring safe and effective patient care. The National Council of State Boards of Nursing (NCSBN) has outlined six cognitive processes in its Clinical Judgment Measurement Model, providing a framework for educators to enhance students' clinical decision-making skills (NCSBN, n.d.). However, the question arises whether teaching clinical judgment solely through questioning that aligns with these cognitive processes is sufficient.

This article explores whether nursing education's goal is merely to equip students to answer Next Generation NCLEX (NGN) questions or to foster genuine clinical judgment for safe practice. It delves into the best approaches to preparing nursing students to achieve both objectives.

The Complexity of Clinical Judgment:

Clinical judgment in nursing extends beyond the ability to answer standardized questions. It integrates theoretical knowledge, practical experience, critical thinking, and ethical considerations to make informed decisions in dynamic healthcare environments (Tanner, 2006). While the cognitive processes identified by NCSBN are valuable components of clinical judgment, they alone do not encapsulate the richness and complexity of real-world nursing practice.

Goal of Nursing Education:

Nursing education aims to produce competent and compassionate practitioners capable of delivering safe and holistic care to diverse patient populations (NLN Board of Governors, 2010). While preparing students to succeed in standardized exams such as the NGN is important for licensure, it should be within the broader objective of cultivating clinical judgment for real-world scenarios. Therefore, nursing education should strive to balance teaching to the test and fostering genuine clinical reasoning skills.

Teaching Clinical Judgment:

Educators must employ various instructional strategies beyond simple questioning to effectively prepare nursing students for exam success and safe practice. These may include:

• Case-Based Learning:

Engaging students in real or simulated patient cases encourages them to apply theoretical knowledge to practical situations, fostering critical thinking and clinical reasoning (Levett-Jones et al., 2011).

• Clinical Simulation:

Simulated clinical scenarios provide a safe environment for students to practice decision-making, communication, and problem-solving skills without compromising patient safety (Jeffries, 2007).

• Reflective Practice:

Encouraging students to reflect on their clinical experiences helps them recognize patterns, identify areas for improvement, and develop a deeper understanding of their clinical judgment processes (Gibbs, 1988).

• Interprofessional Education:

Collaborative learning experiences with students from other healthcare disciplines promote a holistic approach to patient care and enhance students' ability to consider multiple perspectives in clinical decision-making (Reeves et al., 2016).

• Preceptorship and Mentorship:

Pairing students with experienced nurses as preceptors or mentors exposes them to real-world clinical practice and provides invaluable opportunities for guided learning and feedback (Lekan et al., 2016).

In nursing education, the pursuit of simplicity is not about oversimplification but rather about distillation—distilling complex concepts into understandable, actionable principles that effectively guide nursing practice.

Embracing the S.I.M.P.L.I.C.I.T.Y framework (Moraros 2019) offers a structured approach to nurturing nursing students' clinical judgment. This ensures they are prepared for the rigors of Next Generation NCLEX (NGN) questions and the demands of safe clinical practice.

S.I.M.P.L.I.C.I.T.Y. stands for:

S = Standardization of the nursing curriculum:

S – Strive for Clarity: Clear communication and understanding are foundational in nursing education. Educators must present information in a manner that is easily comprehensible to students. Clear language, visual aids, and interactive teaching methods can enhance comprehension and retention of essential concepts related to clinical judgment.

I = Introduce/Integrate: the N.C.L.E.X. blueprints should be introduced.

I – Integrate Intuition: Intuition plays a significant role in clinical decision-making. Encouraging students to trust their intuition while grounded in evidence-based practice fosters a holistic approach to clinical judgment. Integrating reflective practices and experiential learning opportunities allows students to develop and refine their intuitive abilities over time.

M =Modernize: Nursing education must be modern and adaptable for 21st-century nursing students. Nursing schools should decrease technological barriers by providing an educational experience on the go, especially as we navigate toward N.C.L.E.X. Next Gen.

M – Master Skills: Mastery comes through deliberate practice and continuous learning. Nursing education should provide students with ample opportunities to practice clinical judgment skills in simulated and real-world clinical settings. Feedback and reflection on performance are integral to mastering clinical judgment competencies and ensuring readiness for safe practice.

P = Practice: Nursing schools should provide students with multiple practice academic didactic and hands-on experiences to enhance their critical thinking

P – Promote Practical Application: Theoretical knowledge alone is insufficient for developing clinical judgment. Practical application of concepts in clinical scenarios allows students to apply their understanding in real-time situations. Incorporating case studies, simulation exercises, and hands-on clinical experiences provides students with the practical skills necessary for safe and effective nursing practice.

L = Lasting: Providing a curriculum experience will have a long-lasting positive effect and decrease burnout.

L – Leverage Leadership: Leadership skills are essential for nursing professionals. Nursing education should empower students to take on leadership roles in clinical settings, advocate for patient-centered care, and drive positive change. Leadership development enhances students' clinical judgment in complex healthcare environments.

I = Integration & Interdisciplinary Academic Experience: Nursing schools should provide a multidisciplinary approach that allows and includes an interdisciplinary level of providers (OT, PT, PA, R.N., LVN, Respiratory Tech, Nurse Aide). This approach may have the desired effect and early simulation experience, further facilitating students' becoming well-versed and adaptable within the healthcare arena.

I—Informed Decision-Making: Informed decision-making is a cornerstone of clinical judgment. Nursing education should equip students with the knowledge and tools to make evidence-based decisions that prioritize patient safety and well-being. Critical thinking exercises and ethical case studies help students develop the skills to make informed choices in diverse clinical scenarios.

C =Critical Judgment:?Increase student critical thinking through various in-didactic and hands-on assignments, case studies, and clinical scenarios.C –

Cultivate Critical Thinking: Critical thinking is essential for effective clinical judgment. Nursing education should foster critical thinking skills through active learning strategies such as problem-solving activities, group discussions, and reflective writing assignments. Encouraging students to question assumptions and explore alternative perspectives enhances their critical thinking ability and makes sound judgments in complex situations.

I = Implementation:?Nursing Educators must implement new teaching and learning strategies to minimize potential barriers within our nursing programs and student body.

I – Implement Innovation: Embracing innovation in nursing education enhances the learning experience and prepares students for the evolving healthcare landscape. Integrating technology, such as virtual simulations and interactive learning platforms, provides students with immersive learning experiences that mirror real-world clinical practice.

T = Transparent:? All academic student learning outcomes must be clear, concise, and effective from the first day of every course and every assignment due.

T-Tailor Teaching Methods: Recognizing students' diverse learning styles and preferences in nursing education is essential. Tailoring teaching methods to accommodate different learning needs ensures that all students have the opportunity to develop their clinical judgment skills effectively. Utilizing a variety of teaching modalities, including lectures, discussions, hands-on activities, and multimedia resources, promotes engagement and enhances learning outcomes.

Y =Yield: Y is the last letter and, as in any recipe, depends on the execution and implementation of all previous steps.

Y—Yield to Growth: Growth and development are ongoing processes in nursing education. Embracing a growth mindset encourages students to view challenges as opportunities for learning and improvement. A supportive learning environment that fosters resilience and self-reflection enables students to continually refine their clinical judgment skills throughout their nursing education and professional careers.

In conclusion, the S.I.M.P.L.I.C.I.T.Y framework (Moraros 2019) offers a comprehensive approach to teaching clinical judgment in nursing education. By striving for clarity, integrating intuition, mastering skills, promoting practical application, leveraging leadership, fostering informed decision-making, cultivating critical thinking, implementing innovation, tailoring teaching methods, and yielding growth, educators can effectively prepare nursing students for the complexities of contemporary healthcare practice.

By intentionally applying the S.I.M.P.L.I.C.I.T.Y framework (Moraros 2019), nursing education can empower students to become proficient, confident, and compassionate practitioners capable of delivering safe, high-quality care to diverse patient populations. By incorporating these strategies into nursing education curricula, educators can effectively prepare students to excel in standardized assessments and real-world clinical practice.

This will ultimately enhance patient outcomes and advance the nursing profession.

Conclusion:

Teaching clinical judgment to nursing students goes beyond merely asking questions aligned with cognitive processes or preparing them for standardized exams. It involves cultivating critical thinking, practical skills, and ethical reasoning to ensure safe and effective patient care. While success in exams like the NGN is important for licensure, it should not overshadow the broader goal of fostering genuine clinical judgment.

By employing various instructional strategies, such as case-based learning, simulation, reflective practice, interprofessional education, and preceptorship, educators can equip nursing students with the skills necessary to excel on exams and in real-world practice, thereby fulfilling the overarching mission of nursing education.

References:

Gibbs, G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechnic.

Jeffries, P. R. (2007). Simulation in Nursing Education: From Conceptualization to Evaluation. New York: National League for Nursing.

Lekan, D., Corazzini, K., Gilliss, C., Bailey, D., & Utley-Smith, Q. (2016). Nursing student perceptions of community in online learning. Journal of Nursing Education, 55(3), 140-144.

Levett-Jones, T., Lapkin, S., Govind, N., & Pich, J. (2011). ?Academic literacy and numeracy standards in nursing education. Nurse Education Today, 31(8), 757-763.

National League for Nursing (NLN) Board of Governors. (2010). Outcomes and Competencies for Graduates of Practical/Vocational, Diploma, Associate Degree, Baccalaureate, Master’s, Practice Doctorate, and Research Doctorate Programs in Nursing. New York: National League for Nursing.

Moraros, N. S. S. (2022, November 30). C.E.T + S.I.M.P.L.I.C.I.T.Y. https://www.dhirubhai.net/pulse/cet-simplicity-nikolaos-s-moraros-edd-mshsa-msn-rn-phn/?trackingId=H2mYD90GR3O1DTWtzmKnew%3D%3D

Reeves, S., Fletcher, S., Barr, H., Birch, I., Boet, S., Davies, N., & Kitto, S. (2016). A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39. Medical Teacher, 38(7), 656-668.

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.