Clinical judgment development: using simulation to create an assessment rubric

AbStRACt Clinical judgment is a skill every nurse needs, but nurse educators sometimes struggle with how to present it to students and assess it. This article describes an ex-ploratory study that originated and pilot tested a rubric in the simulation laboratory to describe the development of clinical judgment, based on Tanner’s Clinical Judgment Model. Clinical judgment is viewed as an essential skill for every nurse and distinguishes professional nurses from those in a purely technical role (Coles, 2002). Nurses care for patients with multifaceted issues; in the best interests of these patients, nurses often must consid-er a variety of conflicting and complex factors in choosing the best course of action. These choices or judgments must be made specific to the situation, as well as to the patient (Coles, 2002; Tanner, 2006). Educators identify the development of clinical judg-ment in their students as “learning to think like a nurse” (Tanner, 2006). Most research on clinical judgment has relied on participants ’ responses to cases, portrayed ei-ther in text or videotaped form, or on participants ’ recall of particular situations in practice. Their responses have been analyzed, using either verbal protocol analysis (e.g., Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003) or ob-servation and interviews, with descriptive qualitative or interpretive methods (e.g., Benner, Tanner, & Chesla, 1996). With few exceptions (White, 2003), most descriptive research on processes of clinical judgment has centered on its use in nurses ’ practice rather than on its development in students. A review of the literature identified only one instru-ment that purports to measure or evaluate clinical judg-ment. That instrument, developed by Jenkins (1985), is a self-report measure in which respondents are asked to identify processes or strategies used in deriving clinical decisions. Because clinical judgment is particularistic (i.e., beyond specific) and dependent on the situation, the valid-ity of a general self-report measure, especially one used for judging the quality and development of clinical judg-ment, would be questionable. Recent advances in high-fidelity simulation present an ideal arena for developing skill in clinical judgment