Advances in Clinical Teaching and Learning: Development of a New Tool

PURPOSE: This innovative clinical education project sought to facilitate student development of clinical judgment skills through utilization of a new tool across the clinical curriculum.

BACKGROUND: Clinical judgment is essential to nursing practice, but student development of clinical reasoning processes necessary to make judgments in the context of client care does not occur by chance. Nursing faculty seek to facilitate student development of clinical judgment, but how often are we successful?

METHODS: Following an extensive review of the literature and brainstorming, a needs assessment included course coordinators, adjunct clinical faculty and students from all levels of the undergraduate baccalaureate nursing program during open stakeholder meetings. An innovative clinical teaching technique was developed and implemented with undergraduate nursing students beginning in the first clinical course. Faculty and students used a three-level clinical teaching and learning tool designed to foster clinical judgment through an intentional, progressive process and facilitate deeper discussions and reflective thinking within the context of clinical client care situations. Students and faculty identified development of clinical judgment skills using Laster’s Clinical Judgment Rubric. When students progressed to new clinical environments or no longer demonstrated mastery of an upper level, faculty guided students to revisit prior levels and achieve confidence and mastery of that level before progressing to subsequent levels.

DISCUSSION: Students reported that the Clinical Teaching and Learning Tool helped them “think about thinking” to discover patient problems and make connections, set priorities, and develop an interdisciplinary plan of care that honored the patient’s needs. Clinical faculty reported greater ease in teaching clinical judgment during the clinical experience and identified student progression of clinical judgement skills from one clinical experience to the subsequent semester across the clinical curriculum.

RECOMMENDATIONS: Use of an innovative clinical teaching and learning tool provides faculty and students with resources to enhance the clinical teaching and learning experience to focus on progressive development of clinical judgment skills to better prepare nursing students for real world clinical practice.