Clinical Decision-Making in Last Semester Senior Baccalaureate Nursing Students

2.50
Hdl Handle:
http://hdl.handle.net/10755/621755
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Clinical Decision-Making in Last Semester Senior Baccalaureate Nursing Students
Author(s):
Phillips, Beth
Lead Author STTI Affiliation:
Beta Epsilon
Author Details:
Beth Phillips, PhD, RN, CNE, Professional Experience: Full-time faculty member for 20 years; published on teaching innovations and interprofessional education; presented on teaching innovations and educational excellence; received awards for excellence in teaching Author Summary: Dr. Beth Phillips has been a nursing educator for over 20 years. She teaches at the undergraduate and graduate level. Her expertise is in educational innovation and strategies to help the learner grow and develop. She is interested in improving the connections students make between the classroom and practice.
Abstract:

Purpose: Clinical decision making (CDM) is an integral part of what nurses do. Yet, nursing literature reveals concerns about the lack of preparation of new graduates to engage in effective clinical decision making (Benner, Sutphen, Leonard & Day, 2010). How students make clinical decisions has been of interest for many years (Baxter & Rideout, 2006). One of the challenges plaguing nursing education today regarding CDM is the interchangeable use of terms that gives rise to lack of conceptual clarity. It is not uncommon to encounter terms such as critical thinking, clinical reasoning, clinical judgment, and clinical decision making (Tanner, 2006; Benner, Sutphen, Leonard & Day, 2010) when describing how students make clinical decisions. These terms are interconnected but are not the same thing. How students are taught to make decisions may be a critical factor contributing to their inability to meet clinician expectations. What remains unclear is the way in which nursing students perceive they learn to make clinical decisions. The nature of the decisions they make, whether analytical or intuitive, remains unknown but such information is critical to guide development and implementation of educational interventions that enhance student clinical decision-making. This study was conducted to better understand 1) how senior nursing students learn to make clinical decisions and 2) the nature of students’ decision making based on Hammond’s (1996) Cognitive Continuum Theory (CCT), the conceptual underpinnings for this study. Relationships between clinical decision making and age, program type, previous degree/s, previous healthcare experience, or minority status were examined.

Methods: Nursing students in their final semester participated in this embedded mixed methods study. Following a pilot study, quantitative data were collected from 168 students at 11 schools in 4 states in the United States. Twenty-eight of these students also participated in focus groups (qualitative data). Two instruments were used: a demographic data form, and the Nurse Decision Making Instrument-Revised 2014 (NDMI). The NDMI, based on Hammond’s (1996) CCT, is comprised of 24 items, and has 4 subscales reflective of decision making (Lauri & Salantera, 2002). Overall NDMI internal consistency for this study was 0.90.

Results: Six themes emerged from the focus group data: Partners in Learning, Finding One’s Voice, Becoming Confident, Multiple Sources of Learning, Patient-Centered Care, and The Turning Point. These six themes were interrelated, leading to a core concept of Coalescing for Action. Nature of the decisions made: Three quarters of the participants scored in the quasi-rational range, indicating they were flexible making decisions. There were no statistically significant relationships between clinical decision making and the predictor variables.

Conclusion: Based on Hammond’s CCT, the process of growing as a nursing student, through practice and experience requires time and systematic cognitive processing. As students recognized more cues, they were better positioned to make quicker decisions. Decision making is dependent on cognition, the cues recognized, and the task at hand. Curricular development and planning clinical experiences for students in regards to skills and complex patient care situations may greatly enhance decision making abilities. Limitations include a small sample size, homogeneous focus groups, and the inadvertent omission of gender on the demographic instrument. Longitudinal studies throughout nursing school and into practice may better inform clinical decision making abilities.

Keywords:
clinical decision making; nursing education; undergraduate nursing students
Repository Posting Date:
10-Jul-2017
Date of Publication:
10-Jul-2017
Other Identifiers:
INRC17PST428
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleClinical Decision-Making in Last Semester Senior Baccalaureate Nursing Studentsen_US
dc.contributor.authorPhillips, Bethen
dc.contributor.departmentBeta Epsilonen
dc.author.detailsBeth Phillips, PhD, RN, CNE, Professional Experience: Full-time faculty member for 20 years; published on teaching innovations and interprofessional education; presented on teaching innovations and educational excellence; received awards for excellence in teaching Author Summary: Dr. Beth Phillips has been a nursing educator for over 20 years. She teaches at the undergraduate and graduate level. Her expertise is in educational innovation and strategies to help the learner grow and develop. She is interested in improving the connections students make between the classroom and practice.en
dc.identifier.urihttp://hdl.handle.net/10755/621755-
dc.description.abstract<p><strong>Purpose: </strong><span>Clinical decision making (CDM) is an integral part of what nurses do. Yet, nursing literature reveals concerns about the lack of preparation of new graduates to engage in effective clinical decision making (Benner, Sutphen, Leonard & Day, 2010). How students make clinical decisions has been of interest for many years (Baxter & Rideout, 2006). One of the challenges plaguing nursing education today regarding CDM is the interchangeable use of terms that gives rise to lack of conceptual clarity. It is not uncommon to encounter terms such as critical thinking, clinical reasoning, clinical judgment, and clinical decision making (Tanner, 2006; Benner, Sutphen, Leonard & Day, 2010) when describing how students make clinical decisions. These terms are interconnected but are not the same thing. How students are taught to make decisions may be a critical factor contributing to their inability to meet clinician expectations. What remains unclear is the way in which nursing students perceive they learn to make clinical decisions. The nature of the decisions they make, whether analytical or intuitive, remains unknown but such information is critical to guide development and implementation of educational interventions that enhance student clinical decision-making. This study was conducted to better understand 1) how senior nursing students learn to make clinical decisions and 2) the nature of students’ decision making based on Hammond’s (1996) Cognitive Continuum Theory (CCT), the conceptual underpinnings for this study. Relationships between clinical decision making and age, program type, previous degree/s, previous healthcare experience, or minority status were examined.</span></p> <p><strong>Methods: </strong>Nursing students in their final semester participated in this embedded mixed methods study. Following a pilot study, quantitative data were collected from 168 students at 11 schools in 4 states in the United States. Twenty-eight of these students also participated in focus groups (qualitative data). Two instruments were used: a demographic data form, and the Nurse Decision Making Instrument-Revised 2014 (NDMI). The NDMI, based on Hammond’s (1996) CCT, is comprised of 24 items, and has 4 subscales reflective of decision making (Lauri & Salantera, 2002). Overall NDMI internal consistency for this study was 0.90.</p> <p><strong>Results: </strong>Six themes emerged from the focus group data: Partners in Learning, Finding One’s Voice, Becoming Confident, Multiple Sources of Learning, Patient-Centered Care, and The Turning Point. These six themes were interrelated, leading to a core concept of Coalescing for Action. Nature of the decisions made: Three quarters of the participants scored in the quasi-rational range, indicating they were flexible making decisions. There were no statistically significant relationships between clinical decision making and the predictor variables.</p> <p><strong>Conclusion: </strong>Based on Hammond’s CCT, the process of growing as a nursing student, through practice and experience requires time and systematic cognitive processing. As students recognized more cues, they were better positioned to make quicker decisions. Decision making is dependent on cognition, the cues recognized, and the task at hand. Curricular development and planning clinical experiences for students in regards to skills and complex patient care situations may greatly enhance decision making abilities. Limitations include a small sample size, homogeneous focus groups, and the inadvertent omission of gender on the demographic instrument. Longitudinal studies throughout nursing school and into practice may better inform clinical decision making abilities.</p>en
dc.subjectclinical decision makingen
dc.subjectnursing educationen
dc.subjectundergraduate nursing studentsen
dc.date.available2017-07-10T18:01:53Z-
dc.date.issued2017-07-10-
dc.date.accessioned2017-07-10T18:01:53Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.