Comparing Junior and Senior Nursing Students Development of Clinical Judgment Utilizing Clinical Simulation

Thursday, 15 July 2010: 8:50 AM

Carole A. McKenzie, PhD, CNM
Nursing Division, Northwestern Oklahoma State University, Alva, OK
James L. Bowen, PhD
Professional Studies, Northwestern Oklahoma State University, Alva, OK
Sherrie L. Craig, RNC, BSN
Nursing, Northwestern Oklahoma State University, Enid, OK

Learning Objective 1: apply the use of clinical reasoning/reflective judgment models and methodology to improve students ability to manage clinical crisis situations.

Learning Objective 2: manage ways to use technologies to teach students in "safe" environments


Utilizing innovative and effective technologies are one way to bridge the gap in teaching students about clinical reasoning.  Utilizing the pilot work completed by McKenzie and Bowen (2008) on the use of simulation in developing reflective judgment, this study compares a group of students at two different times in their nursing curriculum .   Using the model developed by (Spurgeon and Bowen, 2002; King and Kitchener, 1994), nursing students were evaluated for reflective judgment at the end of their junior year and again at the end of senior year.

Student epiphanies in the clinical simulation experience provided the context for students to reflect on their experience and be assessed in terms of reflective judgment.  Students became more cognizant of  learning needs and deficits, and clearer about the nursing role.  They also recognized their lack of judgment regarding a crisis situation. 


For this study, students were given a clinical situation upon which to proactively reflect that was a higher acuity patient situation. They were given a reflective journal template to record their proactive reflections as well as their post experience reflections. They were videotaped during the clinical scenario presentation to determine if anticipatory or “proactive” reflection enhanced insight into  appropriate solutions to clinical situations.  In the second phase of the study, students were evaluated utilizing the same methodology.


The results of the two phases were correlated with their reflective judgment period at the time of each data collection.  Students were more progressed in their clinical judgment and clarity regarding roles. Students gained insight into their behaviors during these clinical situations via the videotaping and debriefing, particularly when the manikin ”expired”. 


These insights provide mandates for utilization of simulation and reflection in assisting students to gain appropriate levels of clinical reasoning  but in assisting faculty in teaching clinical  judgment.