Using a Clinical Judgment Template to Examine Quality and Safety

Overview

In this activity, students apply nursing clinical judgment to a patient case while examining the AACN Essentials domains of Knowledge for Nursing Practice, Person-Centered Care, Population Health, Quality and Safety, Interprofessional Partnerships, Systems-Based Practice, Informatics and Healthcare Technologies, Professionalism, and Personal, Professional, and Leadership Development. This activity uses a nursing clinical judgment template to foster clinical reasoning and prioritization.

How to Use

Materials:

Instructions:

  • Divide the class into teams of 4-5 students
  • Teams should designate a “team leader” to fill in the CJT with their responses
  • As a class, watch the YouTube video: https://www.youtube.com/watch?v=cw6XboxeUac&t=188s
  • Provide the teams with a Clinical Judgment Template (CJT) and the following prompts:
    • What barriers to care did the patient and family experience?
    • What safety concerns did you observe, and what potential strategies can be used to reduce the risk of harm related to those concerns?
    • What is your role as a nurse in error prevention?
    • How can nurses collaborate with others to prevent errors?
    • What role does technology play in the quality and safety of patient care?
  • Instruct students that they have 20 minutes to complete the CJT using the above prompts as a guide.
  • Visit each team to assess progress and offer insight
  • When time is up, work through the template on the whiteboard using student input. During this time, a consensus is noted, and misconceptions are clarified.
  • Provide an additional 5 minutes for teams to update their CJTs.
  • Instruct teams to submit their CJTs to the LMS for grading.
  • Grade the CJT using the provided rubric. All members of the team receive the same grade.

Integrative Learning Strategies

Learning Objectives:

1. Recognize nursing’s essential role in improving healthcare quality and safety
2. Examine common barriers to the active involvement of patients in their own healthcare processes
3. Value active partnership with patients and families in planning, implementing and evaluating care
4. Value the influence of system solutions in achieving effective team functioning
5. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team
6. Describe examples of how technology and information management are related to the quality and safety of patient care
7. Implement nursing clinical judgment when making practice decisions

(Quality and Safety Education for Nurses, 2020).

In this activity, students apply nursing clinical judgment to a patient case while examining the AACN Essentials domains of Nursing of Knowledge for Nursing Practice, Person-Centered Care, Population Health, Quality and Safety, Interprofessional Partnerships, Systems-Based Practice, Informatics and Healthcare Technologies, Professionalism, and Personal, Professional, and Leadership Development. Clinical judgment is a relationship between nursing knowledge and applying that knowledge through intervention, management, and evaluation (Swift, 2021). This strategy uses a nursing clinical judgment template to foster clinical reasoning and prioritization.

During this activity, students watch a YouTube video that contains a case (Patient Safety Movement, 2020), are provided with a prompt for reflection, then work in teams to complete a nursing clinical judgment template based on Tanner’s Model of Clinical Judgment (TMCJ) (2006) and the National Council for State Boards of Nursing’s (NCSBN’s) Nursing Clinical Judgment Measurement Model (NCJMM) (2022). Teams are given 20 minutes to complete the template as the instructor walks the room to answer questions and provide feedback. Next, the instructor facilitates working through the template on the whiteboard. During this time, a consensus is noted, and misconceptions are clarified.

The CJT, derived from the CJM and the NCJMM, supports the demonstration of AACN Essentials competencies. Students apply new knowledge through noticing, interpreting, responding, and reflecting the tenets of the TMCJ. The NCJMM, a method for measuring nursing clinical judgment and decision-making ability, provides the foundation for the NCSBNs NGN exam (NCSBN, 2022). The NGN exam is designed to “measure the knowledge, skills, and abilities necessary for ensuring safe nursing practice in the evolving nursing practice environment” (NCSBN, 2017, p. 1). This innovative teaching strategy promotes clinical judgment when making safe, quality practice decisions in beginning students, which is integral for success in nursing practice and on the NGN exam.

Assessment Strategies

View the assessment rubric and Likert survey.

Exemplars

View student exemplar table and grading.

Possible Courses

  • Introduction to Nursing
  • Fundamentals of Nursing
  • Nursing Leadership

Additional Resources/Publications

American Association of Colleges of Nursing. 2021. “The Essentials: Core Competencies for Professional Nursing Education.” https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

National Council for State Boards of Nursing. 2017. “NGN News – Fall 2017”. https://www.ncsbn.org/NCLEX_Next_Fall17_Eng.pdf

National Council for State Boards of Nursing. 2022. “NCSBN Clinical Judgment Measurement Model.” https://www.ncsbn.org/14798.htm

Quality and Safety Education for Nurses. 2020. “QSEN Institute competencies.” https//qsen.org/competencies/pre-licensure-ksas/

Swift, Heather. 2021. “How to Best Develop Nursing Students’ Clinical Judgment Skills.” Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/how-to-better-develop-nursing-students-clinical-judgment-skills

Tanner, Christine. 2006. “Thinking Like a Nurse: A Research-based Model of Clinical Judgement in Nursing.” Journal of Nursing Education 45, no. 6: 204-211. https://doi-org.proxy.libraries.rutgers.edu/10.3928/01484834-20060601-04

Patient Safety Movement. 2020. “Uncoordinated Care Claimed Pat’s Life too Soon.” YouTube. https://www.youtube.com/watch?v=cw6XboxeUac&t=188s

Sub-competencies for entry-level professional nursing education:

  • 1.1b Apply knowledge of nursing science that develops a foundation for nursing practice.
  • 1.1d Articulate nursing’s distinct perspective to practice.
  • 1.2a Apply or employ knowledge from nursing science as well as the natural, physical, and social sciences to build an understanding of the human experience and nursing practice.
  • 1.2c Demonstrate social responsibility as a global citizen who fosters the attainment of health equity for all.
  • 1.2e Demonstrate ethical decision-making.
  • 1.3c Incorporate knowledge from nursing and other disciplines to support clinical judgment.

  • 2.1a Demonstrate qualities of empathy
  • 2.1b Demonstrate compassionate care.
  • 2.1c Establish mutual respect with the individual and family.
  • 2.2b Consider individual beliefs, values, and personalized information in communications.
  • 2.3f Apply nursing knowledge to gain a holistic perspective of the person, family, community, and population.
  • 2.4a Synthesize assessment data in the context of the individual’s current preferences, situation, and experience.
  • 2.4b Create a list of problems/health concerns.
  • 2.4c Prioritize problems/health concerns.
  • 2.4e Contribute as a team member to the formation and improvement of diagnoses.
  • 2.5e Anticipate outcomes of care (expected, unexpected, and potentially adverse).
  • 2.6b Communicate care delivery through multiple modalities.
  • 2.7c Recognize the need for modifications to standard practice.

  • 3.2a Engage with other health professionals to address population health issues.
  • 3.4b Describe the impact of policies on population outcomes, including social justice and health equity.
  • 3.5a Articulate a need for change.
  • 3.5b Describe the intent of the proposed change.
  • 3.5c Define stakeholders, including members of the community and/or clinical populations, and their level of influence.

  • 5.1a Recognize nursing’s essential role in improving healthcare quality and safety.
  • 5.1f Identify strategies to improve outcomes of patient care in practice.
  • 5.2a Identify strategies to improve outcomes of patient care in practice.
  • 5.2b Articulate the nurse’s role within an interprofessional team in promoting safety and preventing errors and near misses.

  • 6.1a Communicate the nurse’s roles and responsibilities clearly.
  • 6.1b Use various communication tools and techniques effectively.
  • 6.1c Elicit the perspectives of team members to inform person-centered care decision making.
  • 6.1e Communicate individual information in a professional, accurate, and timely manner.
  • 6.2c Engage in the work of the team as appropriate to one’s scope of practice and competency.
  • 6.3a Integrate the roles and responsibilities of healthcare professionals through interprofessional collaborative practice.

  • 7.1d Recognize internal and external system processes that impact care coordination and transition of care.
  • 7.2d Explain the relationship of policy, regulatory requirements, and economics on care outcomes.

  • 8.1a Identify the variety of information and communication technologies used in care settings.
  • 8.1f Explain the importance of nursing engagement in the planning and selection of healthcare technologies.
  • 8.2a Enter accurate data when chronicling care.
  • 8.2c Use appropriate data when planning care.
  • 8.3d Examine how emerging technologies influence healthcare delivery and clinical decision making.
  • 8.3e Identify impact of information and communication technology on quality and safety of care.
  • 8.4a Explain the role of communication technology in enhancing clinical information flows.
  • 8.4d Explain the impact of health information exchange, interoperability, and integration on health care.
  • 8.5e Discuss how clinical judgment and critical thinking must prevail in the presence of information and communication technologies.

  • 9.1b Reflect on one’s actions and their consequences.
  • 9.2c Demonstrate empathy to the individual’s life experience.
  • 9.3a Engage in advocacy that promotes the best interest of the individual, community, and profession.
  • 9.4a Advocate for policies that promote health and prevent harm.
  • 9.5a Describe nursing’s professional identity and contributions to the healthcare team.

  • 10.2a Engage in guided and spontaneous reflection of one’s practice.
  • 10.3i Recognize the importance of nursing’s contributions as leaders in practice and policy issues.

Posted: December 6, 2022
Submitted by:

Rachel Derr
Director of Prelicensure Programs and Clinical Assistant Professor
Rutgers University-Camden School of Nursing

Site Maintenance

Our system is currently down for scheduled maintenance. Your member services will be available again shortly. Please check back soon.