Teaching Clinical Judgment and Decision-Making: A Cognitive Processing Model for the Education of Entry-Level Nurses

In the United States, the landscape of healthcare has seen many changes in the past few decades.  As an integral part of the healthcare team, nurses face many of the challenges associated with these changes.  With over three million practitioners, nursing is the largest part of the healthcare workforce in the U.S. The increase in patient acuity, aging of the population and healthcare reform have all contributed to the heightened demand for nurses in all practice levels.  In the Institute of Medicine (IOM) Future of Nursing report published in 2010, the IOM cited that nurses at all levels should practice at their full scope. As clinical judgement skills are a fundamental part of the healthcare profession, this suggested that entry-level nurses are expected to make sound clinical decisions just as their more experienced colleagues.

In this proposed session, the authors 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; Saintsburg, Gibson & Pennington, 2011).  Combining current nursing clinical judgment models and cognitive psychology literature on decision-making (e.g., Oppenheimer & Kelso, 2015), the authors propose an education framework for the instruction of nursing clinical judgment.  In this proposed model, nursing clinical judgment is broken down 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 components of the proposed model, the authors will focus on the interactions between the clinical judgment process and contextual factors that may impact 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).

This proposed nursing clinical judgment model is useful as a pedagogical tool in training entry-level nurses to make sound clinical decisions.  It also serves as a tool for understanding how nurses make decisions in the clinical setting.  The authors will conclude the session by applying the model to several clinical nursing scenarios that will illustrate how the model may be used for training of entry-level nurses.