Development of clinical judgment model to guide nursing interns

Abstract

Every day and every moment, nurses have to deal with a wide variety of patient’s issues and problems, with multiple difficulties and conflicts. Nurse’s judgment considers the core component of healthcare activities. This judgment directs her/his achievement and choices, not for her/him only, but for other healthcare professionals. Thus, nurses have to be competent observers and decision makers with reasoning and sound regarding their intervention and practice. Clinical judgment skills are essential aptitudes in nursing practice, predominantly, in nursing internship intermediary period, in which, a graduate nurse faced several predicaments and obstacles in such transitory experience from academic work to real labor. The present study aimed to develop a clinical judgment model to guide nursing interns in their nursing practice and assess its effectiveness on nursing interns’ clinical judgment knowledge and skills. The study passed through Quasi-experimental pretest-posttest research design. A stratified random sampling approach was used to recruit 50 nursing interns as an experimental group out of 305. The collection of data was carried out in the following hospitals of nurses’ intern’s training: Damanhur Medical National Institute, El Raee El Saleh, El Farok and Kafer El Dawar Hospitals, in Damanhur, Egypt. The Clinical Judgment Evaluation Sheet (CJES) was employed to collect necessary data. It included two parts: the Clinical Judgment Knowledge Test that was developed by Fathi & Aly in 2018, beside the Lasater Clinical Judgment Rubric (LCJR) that was developed by Kathie Lasater et al., in 2009. Results before using the developed model demonstrated that there were observed lacking in knowledge and skills about clinical judgment in nursing practice among experimental group. Then improvements were noticed after using the developed clinical judgment model. These results confirm that the use of an educational and self-learning reference such as the developed clinical judgment model is a successful tool for Egyptian nursing interns in nursing practice. Conclusion and recommendations: There is an understandable deficiency of nursing interns’ clinical judgment knowledge and skills in nursing practice. But, after using the developed clinical judgment model with them as a self-learning reference, it was confirmed that it is a helpful approach to develop and improve clinical judgment knowledge and skills of nursing interns. Creativity in using instructional aides and self-learning approaches is an essential ability that is important among nurse educators and preceptors who direct nursing intern’s performance. For further sturdies, replicate the study using the developed model with different subjects in nursing practice or develop new instructive models about creative, reflective, discovery, and decision-making models among nursing interns.