The Impact of Critical Thinking upon Clinical Judgment during Simulation with Senior Nursing Students

 The purpose was to examine the impact of critical thinking (CT) upon clinical judgment (CJ) during pediatric medication administration Objective Structured Clinical Evaluations (OSCE) with 160 pre-licensure baccalaureate senior-level nursing students. Nurse educators are now called to “radically transform” teaching strategies from a focus on CT to CJ in order to bridge the education-practice gap. The problem of overlapping definitions of CT and CJ further confuses the direction of these teaching strategies. 

 A descriptive correlational study design was used to examine the strength of relationships between CT components: demographics, scores on the Tower of Hanoi (TOH; behavioral measure of CT), and total and five subscale scores on the Health Science Reasoning Test (HSRT; standardized computer test for CT). CJ was measured by total scores on the Lasater Clinical Judgment Rubric (LCJR) from researcher-reviewed videotaped OSCE performances. Descriptive statistics were used to describe sample and measurement scores. Multiple regression analysis examined how twelve CT components accounted for variance in CJ. 

 Of 160 students, 85% were female, 42% Caucasian, mean age of 26 years, with 49% having healthcare experience. For the 15-task TOH), students averaged 13 minutes to completion; required an average of seven moves over minimum to complete each task. Students averaged 25 points on HSRT with Induction as highest score, Inference as lowest. Reviewer-based LCJR scores (total points = 44) averaged 31 for the OSCEs. Four CT variables were statistically significant as predictors of CJ: gender, African-American, HSRT deduction, and HSRT analysis. Twelve CT variables accounted for 17% of LCJR score variance. 

 In CT, levels of deduction, analysis, gender and ethnicity predicted degrees of clinical judgment. Nurse educators can develop innovative teaching strategies that offer attention to these predictors of clinical judgment. CT and CJ require separate concise definitions since there was a small overlap between CT and CJ components.