Round and Round We Go: Utilizing Post Conference Clinical Rounds to Improve Clinical Judgment

Friday, March 27, 2020

Carrie Stroup, DNP
School of Nursing and Health Sciences, Malone University, Canton, OH, USA

Purpose: A gap has been demonstrated between the acquired clinical judgment skills of newly graduated nurses and the required competence necessary for safe clinical practice. A study of more than 5,000 newly graduated nurses found that only 23% demonstrated entry-level competencies in clinical judgment (Kavanagh & Swezda, 2017). Nurse educators are challenged to develop clinical judgment skills in undergraduate students to prepare them for safe practice. The development of evidence-based teaching strategies is integral to the achievement of this goal. This project pilot study examined the effectiveness of structured clinical rounds as a post conference strategy in the development of clinical judgment skills of undergraduate nursing students.

Methods: A quasi-experimental design was used to determine if participation in post conference via clinical rounds utilizing a SBAR framework positively impacted clinical judgment compared with participation in classroom-based post conference discussions. A mixed method analysis approach of pretest, posttest, and reflective journal findings was utilized.

Results: A designated case study was given to participants as a pretest and posttest which was scored with the Lasater Clinical Judgment Rubric (LCJR). Quantitative data from a two-sample t-test did not reveal statistically significant results. However, there was a positive trend as LCJR mean scores increased in clinical rounding groups (n=33; +0.76) as compared with a decrease in classroom-based discussion groups (n=13; -1.0). Qualitative data revealed themes of increased problem-solving ability and risk identification among students who participated in the clinical rounding strategy.

Conclusion: Utilizing clinical rounding as a post conference strategy may provide an important tool that can be customized to various curricular models and promote the development and evaluation of clinical judgment skills in the future nursing workforce. Findings suggest application of structured clinical rounding has the potential to improve clinical judgment in undergraduate nursing students. This study was approved by IRB’s at Carlow University, Malone University, and Mercy Medical Center.