The experience and understanding of clinical judgment of internationally educated nurses

Abstract

Clinical judgment is critical to the development of professional knowledge, as it supports the reasoning necessary for nursing practice. However, the literature indicates that a significant number of novice practitioners in health care do not meet entry-to-practice expectations for clinical judgment and have difficulty transferring knowledge and theory into practice, regardless of educational preparation and credentials. In the Ontario health-care environment, Internationally Educated Nurses (IENs) are considered novice practitioners. This study explores IENs’ experience and understanding of clinical judgment when engaged in a simulated clinical environment and in stimulated recall and reflective practice. The research employs qualitative descriptive open-ended exploratory and interpretive methods, informed by constructivism and transformative-learning theories. The participants (four IENs, aged 27-37, who were attending a university academic bridging program) participated in three interactive simulated clinical activities using high-fidelity SimMan™ manikins; each simulated activity was followed by a stimulated recall session and a focus group. The simulated activities were videotaped and stimulated recall and focus groups were audiotaped. Tanner’s Model of Clinical Judgment was used to guide this process. Thematic analysis uncovered six themes pertaining to IEN’s experience and understanding of clinical judgment: the shift from expert to novice, the need to rethink cultural competence and culturally competent care, the acknowledgement that culture and diversity are integral to understanding clinical judgment, the role of communication as a means to understanding clinical judgment, the recognition of unlearning as a way to understanding clinical judgment, and the phenomenon of unknowing as a dimension of understanding clinical judgment.