Thinking Instead of Doing: Enhancing Clinical Judgment in Changing Times

Thinking Instead of Doing: Enhancing Clinical Judgment in Changing Times

On clinical days, educators often find themselves focused on completing tasks from a long to-do list. I remember having a spreadsheet that listed all the tasks my students had to finish during clinical time, and I would mark them off as they were done. Consider this scenario: you have around eight to ten students in a six-hour traditional clinical group. Each student needs to complete several tasks during this time:

– Conduct a morning safety check
– Check vital signs
– Prepare the patient for breakfast
– Administer morning medications
– Provide care for daily activities
– Perform a physical assessment
– Administer intravenous medications
– Handle additional procedures like changing dressings, inserting or removing catheters, giving enemas, checking blood glucose levels, helping patients walk
– Administer pre-lunch medications
– Get the patient ready for lunch
– Present an SBAR report to the nurse

Essential Tips for Developing Nursing Leadership

This adds up to a total of 88 to 110 tasks that your students need to finish, and you need to supervise or review each one! There’s hardly any time left for students to truly think about their patients, and you have limited time to guide them in developing clinical judgment.

According to the NCSBN, new nursing graduates lack strong clinical judgment skills. Many educators agree that real patient care experience is irreplaceable in cultivating this mindset. However, the COVID-19 pandemic has caused significant changes to clinical experiences for nursing students. Despite these challenges, this situation presents an opportunity for educators to dedicate more time to helping students focus on the critical thinking involved in patient care, rather than just hands-on skills.

With the support of Elsevier’s resources, educators can offer students the chance to care for multiple “patients.” These resources include HESI Case Studies, SimChart Case Studies, and the Simulation Learning System (SLS) simulations. Educators can design meaningful activities around these tools to foster clinical judgment. Here are some examples:

HESI Case Studies:

– Have students review pharmacology information in these cases and create guides for medication information and patient education. They can use Elsevier’s comprehensive database, Clinical Key, to find patient education materials and drug details. During discussions, select students to role-play patient education sessions.
– Ask students to create care plans or discharge teaching plans for the case study patients. During debriefing sessions, ask clinical judgment questions like:
– What is the most important nursing assessment for this patient?
– What is your top priority intervention?
– How would you handle complications for this patient?
– Which therapeutic communication techniques are appropriate for this patient and why?
– What nursing skills would you expect to perform on this patient and why?
– How would you evaluate the effectiveness of your care? Include labs, assessments, etc.

SimChart Case Studies and SLS Simulations:

– Keep in mind that students can access a fully developed Electronic Health Record (EHR) for each patient in these cases. This allows students to explore the patient’s chart realistically and identify essential information for planning care.
– Activities can include reviewing provider charts (history, physicals, orders, consultation notes, progress notes) to determine crucial information for care planning.
– Students can analyze safety risks exhibited by the patient.
– Evaluating provider orders and selecting the ones to implement first.
– Reviewing the medication administration record (MAR) and developing patient education guides for each medication.
– Using patient reports for prioritization exercises.
– Students can prioritize patient assignments based on patient reports.
– End-of-shift reporting where one student hands off care to another.

These examples highlight how students can focus on making nursing decisions about patient care, enhancing their clinical judgment skills.

Your “checklist” can now include tasks like:

– Supervise care provided by others (e.g., LPN/VN, assistive personnel, other RNs)
– Initiate, evaluate, and update client care plans
– Share and receive hand-offs (reports) for assigned clients
– Utilize resources to improve client care (e.g., evidence-based research, technology, policies)
– Educate clients about safety concerns
– Implement effective therapeutic communication techniques
– Assess client responses to medications
– Assess the appropriateness and accuracy of medication orders
– Assess reactions to procedures and treatments
– Perform targeted assessments
– Educate clients about treatments and procedures

This list could go on! You might recognize these points as Activity Statements from the RN Practice Analysis report by NCSBN, which outlines content areas assessed in the NCLEX. This can be a valuable resource as you adapt your teaching and prepare students for clinical practice. Seize this opportunity to help students develop clinical judgment in the online learning environment!