Assessing Clinical Judgment Skills Among Entry-Level Nurses: A Cognitive Processing Approach

Monday, 30 October 2017: 1:35 PM

Joe Betts, PhD, NCSP
Pearson VUE, Chicago, IL, USA

The National Council of State Boards of Nursing (NCSBN) is the developer of the NCLEX, a nursing licensure examination used in all U.S. states, District of Columbia and territories. For the past several years, NCSBN has been conducting research on nursing clinical judgment and its relevance to entry-level nursing competency. The speaker will review existing models for classifying the nursing clinical judgment process and psychological research on decision-making (e.g., Benner, 2000; Harbison, 2001; Phaneuf, 2008; Saintsing, Gibson & Pennington, 2011). Combining current nursing clinical judgment models and cognitive psychology literature on decision-making (e.g., Oppenheimer & Kelso, 2015), NCSBN staff proposes an assessment framework for nursing clinical judgment (Dickison, Luo, Woo, Muntean & Bergstrom, 2016).

In this proposed session, NCSBN staff will introduce a clinical judgment assessment framework developed by the organization. The nursing clinical judgment process in this cognitive-based model is divided into by five procedural components: (1) cue recognition, (2) hypotheses generation, (3) hypotheses evaluation, (4) solution generation and taking action and (5) outcome evaluation. In addition to discussing each component of the proposed model, the speaker will focus on the interactions between the clinical judgment process and contextual factors that may influence the quality of clinical judgments. These contextual factors may encompass the care environmental (e.g., resources, time constraints, distractions and task complexity), characteristics of the nurse (e.g., knowledge, experience and perceptions) and characteristics of the client (e.g., disease progression and family dynamics).

To gather validity evidence for this clinical judgment model, NCSBN Examinations staff is conducting on-going research on this topic. A number of research projects have been completed regarding entry-level nursing practice and clinical judgment. The speaker will conclude the session by describing the NCSBN clinical judgment research agenda and sharing highlights from completed projects, including the results from a pilot study using current NCLEX item data.