Title : The effect of clinical judgment methods for care plan development in nursing students
Abstract:
Student nursing care plans typically present two prioritized patient health problems. Student nurses research patient information to plan care, identify patient problems and plan the appropriate nursing interventions. The completed 3-phase pre-post qualitative study has significance as the American Association of Colleges of Nursing in its Essentials of Baccalaureate Education for Professional Nursing Practice (2008) stress clinical reasoning and critical thinking in the ever-changing health care environment (Marchigiano, Eduljee and Harvey, 2011). The 3-phase qualitative study examined traditional junior students’ perceived level of confidence in using critical thinking skills creating a written nursing care plan. The first phase included a Qualtrix survey students completed prior to starting their medical-surgical clinical rotation. The survey consisted of 7 Likert-type items, each asking the respondent to indicate their level of confidence in their ability to address the following: analyzing information, making connections among clinical data, determining relevant data from clinical examination, setting priorities in patient needs, selecting appropriate resources to address patient needs, applying relevant knowledge to identify interventions, and effectively assessing whether goals are met. In Phase 2 the same cohort of students was queried after introduction of a clinical judgment model (CJM) care plan. Repeated measures ANOVA was used to test mean differences in the overall confidence from pre- to post-survey and Wilcoxon T was used to test specific item response changes from pre- to post-survey. There was a statistically significant (p=0.01) increase in students’ ability to select appropriate resources to address patient needs. There was a statistically significant (p=0.04) increase in students’ ability to apply relevant knowledge to identify interventions. For the overall confidence composite, there was an increase in total confidence from 4.61 (SD=0.98) to 5.13 (SD=0.92), noting a trend for this difference to be statistically significant (p=0.09). The CJM care plan demonstrated merit, thus supporting usability.
