Lasater Clinical Judgment Rubric Research Articles

The Effect of Preventable Harm Simulation on Entry-Level Nurses' Clinical Judgment

Beginning nurses face challenges such as increased care complexities, an aging patient population, and the knowledge-to-practice gap, resulting in practice errors. The project used preventable harm simulation scenarios, using the Lasater Clinical Judgment Rubric to evaluate clinical judgment behaviors in pre- and post-simulation exercises and a 30-minute facilitator-led group discussion.Eight two percent of the LCJR scores increased from the pre-simulation (mean 25.86; SD 3.93) to post-simulation (mean 30.59; SD 4.58). The evaluation noted 90% of the nurses indicated the project was extremely helpful in facilitating clinical judgment. It is essential to interpret these results cautiously due to the small sample size.

The Lasater Clinical Judgment Rubric: 17 Years Later.

Nearly 17 years ago, the Lasater Clinical Judgment Rubric (LCJR) was published to provide a common language and trajectory of students' development to think like a nurse. This article traces the uses of the LCJR from creation to the present and cites lessons learned from its use. During the intervening years, the LCJR has been used effectively as a debriefing guide in simulation and as a research instrument, as well as for formative assessment. The LCJR has been translated or is in process in 19 languages besides English. This article provides evidence of the efficacy of the LCJR and discusses important lessons learned. [J Nurs Educ. 2024;63(3):149-155.].

Implementation of clinical reasoning concepts to improve clinical judgment and self-confidence of nursing students in the clinical setting

IntroductionStudies of graduate nurses demonstrate unpreparedness for practice, leaving nursing education programs to examine methods of instruction that support clinical judgment development. AimTo evaluate effectiveness of active-learning concept-based themes to improve clinical judgment and self-confidence in nursing students. MethodsA quasi-experimental, repeated-measures design was conducted using Gonzalez clinical reasoning concepts during a medical-surgical clinical. Pre-, mid- and post-clinical judgment scores were measured using the Lasater Clinical Judgment Rubric by students and faculty. Pre-and postself-confidence student scores were measured using White's Nursing Anxiety & Self Confidence with Clinical Decision-Making scale. ResultsImproved overall clinical judgment scores were noted by students (t27 = 10.12, p <. 001) and instructors (t27 = 12.58, p < .001). Overall confidence scores increased (t22 = 3.72, p < .001) while anxiety scores decreased (t22 = -3.28, p < .001). DiscussionClinical nurse educators should assess and support the development of clinical reasoning skills in nursing students with active learning concepts.

Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study

BackgroundVirtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students’ clinical judgment ability and understanding of nursing students’ experiences of the combined simulation.MethodsA sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data.ResultsStudents in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students’ clinical judgment ability.ConclusionsThe integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students’ self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Examining the Reliability and Usability of the Lasater Clinical Judgment Rubric Japanese Version (LCJR-J)

Examining the Reliability and Usability of the Lasater Clinical Judgment Rubric Japanese Version (LCJR-J)

Effectiveness of simulation-based case studies on knowledge acquisition and clinical judgment in undergraduate nursing students

BackgroundThe development of clinical judgment and nursing knowledge are essential in nursing. However, new graduate nurses do not possess the knowledge and clinical judgment needed to provide safe nursing care. Therefore, nurse educators must find ways to promote the development of clinical judgment and knowledge in nursing students. ObjectivesTo examine the effectiveness of simulation-based case studies as a classroom teaching strategy versus traditional lecture on the development of knowledge acquisition and clinical judgment in undergraduate nursing students. DesignQuasi-experimental two-group, pretest-posttest study. SettingThe study was conducted at a public university in the South-Central region of the United States. ParticipantsA total of 120 students enrolled in a medical-surgical course over two semesters. MethodsStudents in the control group (n = 54) attended a traditional lecture while students in the experimental group (n = 66) participated in simulation-based case studies. A knowledge quiz and the Lasater Clinical Judgment Rubric were completed before and after exposure to the teaching strategy. Data were analyzed using independent samples t-tests. ResultsThere was a significant increase in the knowledge quiz scores found in the experimental group. However, there was not a significant difference found in clinical judgment scores in the experimental group. There was a significant increase in knowledge and clinical judgment scores in both groups. ConclusionBoth attendance in traditional lecture and participation in simulation-based case studies in the classroom are effective in increasing knowledge and clinical judgment scores in undergraduate nursing students.

Effect of Unfolding Case-Based Learning on Clinical Judgment Among Undergraduate Nursing Students.

To prepare students for Next Generation National Council Licensure Examination-Registered Nurse (NCLEX-RN), nurse educators need to develop teaching strategies to foster students' clinical judgment. This study examined the effects of unfolding case-based learning (CBL) on baccalaureate nursing students' clinical judgment upon graduation. A prospective cohort design was adopted. Students' self-reported responses to the Lasater Clinical Judgment Rubric were compared between the unfolding CBL (n = 140) and non-CBL (n = 126) cohorts at a school of nursing in the United States. While students' responses were similar between the study cohorts, a trend was noted for improved clinical judgment among students in the unfolding CBL cohort. Furthermore, unfolding CBL significantly enhanced students' perceived proficiency in conducting focused observation. The findings support early introduction and consistent use of the unfolding CBL throughout the undergraduate nursing program so that students have ample opportunities and contexts to cultivate clinical judgment skills in the classroom.

Person-Centered Care and Clinical Judgment: Mapping the AACN Essentials with Simulation in Prelicensure Nursing Programs

The purpose of this article is to describe simulation as a strategy for teaching and mapping the AACN Essentials domain of Person-Centered Care and the concept of clinical judgment with prelicensure nursing students. A validated assessment tool, Lasater clinical judgment Rubric, may be used to evaluate the AACN concept of clinical judgment with simulation. A variety of high-fidelity simulation scenarios, standardized clients, and embedded participants increase realism and student learning. Encompassing a variety of clients across the lifespan, while incorporating cultural diversity in each scenario, offers an opportunity to teach the AACN domain of Person-Centered Care. Evaluating student performance progressively in interactive simulation activities aims to prepare practice-ready nurses.

Evaluation of Peer Simulations Utilizing Student-Generated Case Studies with Pre-clinical Veterinary Students.

A novel student-driven model of peer simulations using reverse case studies was developed during the COVID-19 pandemic to provide virtual instruction to fourth-year clinical veterinary students. Focus groups suggested that, while this teaching method could not replace hands-on clinical experience, it could be a valuable tool to clinically prepare students during their pre-clinical curriculum. The primary aim of this study was to determine whether this teaching method enhanced earlier curricular student comfort with clinical reasoning, communication, and peer role play as measured by pre- and post-surveys. A secondary aim was to evaluate clinical reasoning ability using the validated Modified Lasater Clinical Judgment Rubric (MCJR). Eighteen pre-clinical veterinary students participated in a 1-week course where they designed and presented clinical cases and participated through virtual role play as clients, clinicians, and observers. Our results demonstrated that students' comfort in clinical reasoning and peer role play significantly improved (p < .001 and p = .003, respectively) after participating in this activity. The role perceived to be the most helpful at developing clinical reasoning and communication skills was clinician, followed by client then observer. Results from the MCJR found significant discrepancies between facilitator scoring and student self- and peer-assessment (p < .001). Common themes emerged including the benefits of engaging in self-reflection, peer-to-peer learning, experiencing case ownership and autonomy, and practicing communication and clinical reasoning skills. This teaching method provides a valuable alternative to client simulators and suggests having students create a case as a client offers a unique educational opportunity.

The impact of tutoring on nursing students' clinical judgment: A quasi-experimental study.

Nurses' lack of clinical judgment often leads to adverse patient outcomes due to failure to recognize clinical deterioration, intervene, and manage complications. Teaching clinical judgment through a nursing process can help nursing students provide safe and competent patient care with improved health outcomes and to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The aim of this study was to examine the effect of tutoring on clinical judgment of undergraduate nursing students utilizing Lasater's Clinical Judgment Rubric (LCJR). This study also compared the clinical judgment of male and female nursing students and students from different semester levels. This quasi-experimental study utilized a single group pretest, posttest design. A convenience sample of n = 40 undergraduate nursing students from the Los Angeles County College of Nursing and Allied Health participated in the study. The participants underwent a pretest simulation, four sessions of the Clinical Judgment Model (CJM)-based tutoring, and a posttest simulation. The posttest clinical judgment scores (35.70 ± 3.6) were significantly different from the pretest scores (25.78 ± 5.20). The tutoring had a significant effect on the clinical judgment of nursing students t(39) = -11.64, n = 40, p < .001, at 95% CI of the mean difference. Enhancing nursing students' clinical judgment is crucial to provide high-quality, safe patient care with improved health outcomes. The CJM-based tutoring is an effective strategy for developing clinical judgment in nursing students. This new teaching approach can train students to critically think, develop clinical judgment, and prepare for the complex healthcare environment. Therefore, nurse educators should focus on integrating clinical judgment into the prelicensure nursing program curriculum as a priority.

The implementation of Tanner's Clinical Judgment Model and the Indonesian version of the Lasater Clinical Judgment Rubric in the clinical setting

A critical component for nurses to provide safe and quality care with strong patient outcomes is clinical judgment. This study aimed to identify the difference in the clinical judgment score in newly graduated nurses by implementing Tanner's Clinical Judgment Model. This study followed an experimental design with a pretest-posttest and involved thirty-two newly graduated nurses from three private hospitals in Indonesia. The intervention group had a scheduled post-conference with their preceptors using Tanner's Clinical Judgment Model's guidelines with high-level, open-ended questions for two consecutive weeks. Independent samples t-test was used to compare pre-and post-test scores utilizing the valid and reliable Indonesia version of the Lasater Clinical Judgment Rubric. There was no significant difference between the pre-test results of the intervention and control groups, with a significance value of 0.647. The results indicated a significant difference in the mean clinical judgment scores between the intervention and control groups after two weeks of intervention, where the intervention group's scores were higher than the control group's with a significance value of <0.001 with a mean difference of 6.75 and CI of 95 % (4.18–9.31). Tanner's Clinical Judgment Model showed a significant impact in increasing clinical judgment scores. The Indonesia version of the Lasater Clinical Judgment Rubric is a valuable tool for assessing and evaluating the development of clinical judgment and provides detailed targeted areas needing improvement. Preceptors and nursing leaders in the clinical setting should continue to use this model and tools to assist newly graduated nurses in developing clinical judgment skills during their transition period.

Measuring Nursing Student Development Through Computer-Based Simulation Activities.

New nurse attrition jeopardizes patient safety, devastates career plans, and negatively impacts costs to hospitals and patients. Employers and educators recognize the widening transition-to-practice gap in meeting expectations for practice-ready, resilient nurses. The purpose of this study was to test the use of computer-based simulation activities (CBSAs) to measure processes in Aller's Development of Decision-Making and Self-Efficacy Model (ADD-SEM). BSN students (N = 50) in a multisite, cross-sectional study used CBSAs to provide data on decision making (Virtual Patient Lasater's Clinical Judgment Rubric), psychological capital (Nursing Anxiety and Self-Confidence in Decision-Making Scale©), and reflection. Repeated-measures analysis of variance and reflexive thematic analysis revealed that decision-making (DM) scores were highest in noticing and lowest in interpreting with significant differences in cohorts (DM) (juniors: P < .001; seniors: P = .013) and self-confidence/anxiety ( P < .001). The CBSAs are an effective means of measuring student development of DM and psychological capital needed to retain resilient nurses.

Clinical judgment performance of nurses in the application of the nursing process

Objective: To verify the applicability of the Lasater Clinical Judgment Rubric (LCJR) instrument to rate nursing professionals’ performance regarding the development of clinical judgment in the application of the Nursing Process (NP). Materials and methods: Descriptive survey using the LCJR instrument —consisting of four phases and eleven dimensions— to classify clinical judgment. Results: Thirty-four nurses from a public hospital in western Santa Catarina, Brazil, distributed in six sectors, participated in the study. Nurses were classified by performance levels in relation to the ability of clinical judgment in the application of the steps of the NP. It was observed that at the “beginner” level there is a higher prevalence of professionals related to the dimensions Search for information, Recognizing deviations from expected standards, and Technical skills, linked to the intensive care unit clinic. As for the “exemplary” level, none of the sectors scored on the analyzed dimensions. Moreover, it was found that a longer time of clinical experience and of systematic application of the steps of the NP fosters a better classification in almost all dimensions. Conclusions: Through this research, we verified the assertiveness of the use of the instrument to evaluate the clinical judgment of nurses regarding the application of the steps of the NP. Thus, the use of the LCJR is encouraged as a tool to evaluate the effectiveness of educational interventions performed to nurses and, consequently, stimulate clinical judgment.

Innovative Use of Cadavers in Perioperative Nursing Orientation.

The Periop 101 program administrator at a US Navy medical center worked with personnel in the facility's simulation and bioskills laboratories to develop an innovative perioperative nurse orientation curriculum that included the use of human cadavers during simulation activities. Participants were able to practice common perioperative nursing skills (eg, surgical skin antisepsis) on human cadavers rather than simulation manikins. The orientation program comprises two three-month phases. Participants were evaluated twice during phase 1: at the six-week mark and again six weeks later at the end of the phase. Using the Lasater Clinical Judgment Rubric, the administrator scored participants on their clinical judgment skills; results showed that mean scores increased for all learners between the two evaluation sessions. Practicing skills in a safe environment allows new staff members to learn without fear of causing accidental patient harm, and the additional use of cadavers further increased simulation fidelity and learner satisfaction.

Nursing students’ clinical judgment skills in simulation and clinical placement: a comparison of student self-assessment and evaluator assessment

BackgroundClinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment.AimsThis study aimed to compare the same group of students’ self-assessment of clinical judgment with an evaluator’s assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students’ self-assessment of clinical judgment.MethodsThe study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson’s correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot.ResultsThe results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator’s assessment. Differences between students’ scores and the evaluator’s scores were larger when the evaluator’s scores were low, indicating the presence of the Dunning-Kruger effect.ConclusionIt is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student’s clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students’ clinical judgment skills.

Exploring the impact of escape rooms on clinical judgment to improve patient outcomes: A quality improvement project

Educators are challenged to develop pedagogy that incorporates clinical judgment. Teaching strategies should include collaboration, clinical practice, and reflection to promote clinical judgment in nursing students. The literature suggests escape rooms which are game-based educational learning tools, promote safety awareness, teamwork, collaboration, clinical judgment, and content retention. A virtual escape room was created based on the topics of heart failure, post-operative care, and fluid overload in attempt to. Five junior level nursing students enrolled in an adult health clinical participated in the quality improvement project. The students were evaluated using the Lasater Clinical Judgment Rubric. The results revealed that the virtual escape room activity may have promoted clinical judgment. Future research is needed to further validate the use of virtual escape rooms in nursing education.

Lasater clinical judgment rubric reliability for scoring clinical judgment after observing asynchronous simulation and feasibility/usability with learners

BackgroundThere is strong evidence supporting using the Lasater Clinical Judgment Rubric (LCJR) for scoring learners' clinical judgment during in-person simulation performance and clinical experience reflections. However, a gap exists for using LCJR to evaluate clinical judgment after observing asynchronous simulation. ObjectiveWe aimed to determine the reliability, feasibility, and usability of LCJR for scoring learners' written reflections after observing expert-modeled asynchronous simulation videos. Design/setting/participantsWe used a one-group, descriptive design and sampled pre-licensure, junior-level bachelor's learners from the Southwestern United States. MethodsParticipants observed eight expert-modeled asynchronous simulation videos over one semester and provided written responses to clinical judgment prompts. We scored clinical judgment using LCJR. We studied reliability by measuring internal consistency of 11 clinical judgment prompts and interrater reliability with two raters. This study also investigated feasibility and usability of the asynchronous simulation learning activity using descriptive statistics. Feasibility included time learners spent completing written responses and time raters spent evaluating written responses. Learners reported usability perceptions using an instructor-developed survey. ResultsSixty-three learners completed 504 written responses to clinical judgment prompts. Cohen's kappa ranged from 0.34 to 0.86 with a cumulative κ = 0.58. Gwet's AC ranged from 0.48 to 0.90, with a cumulative AC = 0.74. Cronbach's alpha was from 0.51 to 0.72. Learners spent on average 28.32 ± 12.99 min per expert-modeling video observation. Raters spent on average 4.85 ± 1.34 min evaluating written responses for each participant. Learners reported the asynchronous learning activity was usable. ConclusionsNurse educators can reliably use LCJR for scoring learners' clinical judgment after observing asynchronous expert-modeled simulation. Logistically, learners complete the reflective learning activity and faculty use LCJR to measure clinical judgment in feasible time. Further, participants perceived the asynchronous learning activity usable. Nurse educators should utilize this learning activity for evaluating and tracking observer clinical judgment development.

Using Simulation to Develop Clinical Judgment in Undergraduate Nursing Students.

The National Council of State Boards of Nursing plans to update the National Council Licensure Exam for nursing graduates to better measure clinical judgment. It is important that schools of nursing provide opportunities for nursing students to practice and develop clinical judgment skills. Simulation offers nursing students opportunities to use clinical reasoning and clinical judgment to care for patients in a safe environment The purpose of this study was to evaluate an unfolding case study using high-fidelity simulation to develop nursing students' clinical judgment skills across three practice settings: primary care office, acute care hospital, and home healthcare. This was a mixed-method, posttest study design with a convenience sample of 91 nursing students using the Lasater Clinical Judgment Rubric (LCJR) and survey questions. The posttest analysis mean of the LCJR subgroups revealed students felt accomplished following the intervention. Four themes emerged from content analysis of the qualitative data: 1.) increased knowledge of management of diabetes in various clinical settings, 2.) using clinical judgment/critical thinking in the home care setting, 3.) being able to self-reflect on actions, and 4.) a desire for more simulation experiences in the home healthcare setting. The results of the LCJR indicated that students felt accomplished after the simulation experience. This outcome was also evident in the qualitative data, indicating that students felt more confident in managing the care of a patient with a chronic illness using clinical judgment skills in various clinical settings.

Clinical judgment in new nurse graduates: identifying the gaps.

Clinical judgment has been identified as a key component of clinical practice. We sought to measure the elements of clinical judgment in new nurse graduates to identify future educational interventions. Lasater's clinical judgment rubric was adapted and distributed to nurse preceptors at two significant health care systems in central Illinois. One hundred and six surveys were returned and one hundred and five of those were included in the study. New nurse graduates were found to be the lowest ranking in ability to identify significant data and calm, confident responses. The findings can guide nurse educators to create innovative, targeted educational interventions to improve students' ability to identify important pieces of data and respond to challenging situations in a self-assured manner. Identifying and addressing the gaps to improve students' clinical judgment may facilitate NCLEX success and entry to practice.

Clinical Judgment Development and Assessment in Clinical Nursing Education.

There is a gap in evidence for effective clinical teaching strategies to promote nursing students' development of clinical judgment (CJ). This study examined the effect of active learning strategies (ALSs) during clinical postconference sessions on the CJ of undergraduate nursing students. This quasi-experimental study of ALSs or standard postconferences used the Lasater Clinical Judgment Rubric (LCJR) to rate CJ at 3 time points. All faculty members and students were trained on use of the LCJR. Ratings were done by both faculty and students. All ratings of CJ improved over time ( P < .001). Ratings of CJ varied between the control and intervention groups. The findings of this study contribute to knowledge regarding the effectiveness of clinical teaching strategies for CJ and preparation for entry to nursing practice.