Clinical judgment performance of undergraduate Nursing students

a cross-sectional study with the application of the Lasater Clinical Judgment Rubric-Brazilian Version in 166 undergraduate Nursing students from a Brazilian public university. The data were analyzed descriptively and analytically (by comparing the level of clinical judgment among students from the initial, intermediate, and concluding groups). The following tests were applied: Chi-square, Fisher’s Exact and Kruskal-Wallis, and a p-value of 0.05 was adopted. The reliability of the global instrument (Cronbach’s alpha) was 0.786.

Results:

of the 166 students, 65.7% evaluated themselves as proficient in relation to the reported performance on clinical judgment. Of the rubric’s 11 dimensions (focused observation, recognizing deviations from expected patterns, information seeking, prioritizing data, making sense of data, calm and confident manner, clear communication, well-planned intervention/flexibility, being skillful, evaluation/self-analysis, and commitment to improvement), only four groups did not present significant differences among them (p<0.05): focused observation, information seeking, prioritizing data, and calm and confident manner.

Conclusion:

the performance on clinical judgment reported as proficient was pointed out by 65.7% of the students and a significant statistical difference was verified in seven dimensions, among beginners, intermediate, and concluding students, compatible with the evolution of learning.

Descriptors:
Nursing Education; Nursing Students; Clinical Decision-Making; Clinical Competence; Nursing Process; Self-Assessment

Variables		n	%
Gender	Female	147	88.6
Gender	Male	19	11.4
Term	Fourth	24	14.5
	Fifth	27	16.3
	Sixth	25	15.1
	Seventh	27	16.3
	Eighth	27	16.3
	Ninth	18	10.8
	Tenth	18	10.8
Other Higher Education course	No	158	95.2
Other Higher Education course	Yes	8	4.8
Professionalizing course	No	157	94.6
	Technician	9	5.4
	Assistant	0	0.0
Works as a technician	No	162	97.6
Works as a technician	Yes	4	2.4

Terms		Classification
Terms		Developing	Accomplished	Exemplary
4th (n=24)	Beginner	3 (12.5%)	19 (79.2%)	2 (8.3%)
5th (n=27)	Beginner	5 (18.5%)	15 (55.6%)	7 (25.9%)
6th (n=25)	Intermediate	2 (8%)	17 (68%)	6 (24%)
7th (n=27)		2 (7.4%)	13 (48.1%)	12 (44.4%)
8th (n=27)		2 (7.4%)	21 (77.8%)	4 (14.8)
9th (n=18)	Concluding	0	13 (72.2%)	5 (27.8%)
10th (n=18)	Concluding	1 (5.6%)	11 (61.1%)	6 (33.3%)
Total (n=166)		15 (9.0)	109 (65.7)	42 (25.3)

Evaluated domain	Levels	Study period			p-value
Evaluated domain	Levels	Beginner 4th and 5th	Intermediate 6th to 8th	Concluding 9th and 10th	p-value
Focused Observation	Exemplary	1 (1.9%)	1 (1.3%)	0 (0.0%)	0.696^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	11 (21.6%)	14 (17.7%)	3 (8.3%)
	Developing	24 (47.1%)	38 (48.1%)	21 (58.3%)
	Beginning	15 (29.4%)	26 (32.9%)	12 (33.3%)
Recognizing deviations from expected patterns	Exemplary	3 (5.9%)	2 (2.5%)	0 (0.0%)	0.003^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	24 (47.1%)	22 (27.8%)	4 (11.1%)
	Developing	21 (41.1%)	49 (62.1%)	26 (72.2%)
	Beginning	3 (5.9%)	6 (7.6%)	6 (16.7%)
Information seeking	Exemplary	2 (3.9%)	1 (1.3%)	0 (0.0%)	0.222^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	5 (9.8%)	5 (6.3%)	0 (0.0%)
	Developing	23 (45.1%)	28 (35.4%)	16 (44.4%)
	Beginning	21 (41.2%)	45 (57.0%)	20 (55.6%)
Prioritizing data	Exemplary	1 (1.9%)	2 (2.5%)	0 (0.0%)	0.886^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	10 (19.6%)	17 (21.5%)	10 (27.8%)
	Developing	26 (51.0%)	44 (55.7%)	17 (47.2%)
	Beginning	14 (27.5%)	16 (20.3%)	9 (25.0%)
Making sense of data	Exemplary	1 (1.9%)	0 (0.0%)	0 (0.0%)	0.005^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	20 (39.2%)	12 (15.2%)	4 (11.1%)
	Developing	27 (53.0%)	59 (74.7%)	26 (72.2%)
	Beginning	3 (5.9%)	8 (10.1%)	6 (16.7%)
Calm and confident manner	Accomplished	10 (19.6%)	14 (17.7%)	7 (19.4%)	0.883^† † p-value of the Chi-square test for homogeneity;
	Developing	23 (45.1%)	43 (54.5%)	18 (50.0%)
	Beginning	18 (35.3%)	22 (27.8%)	11 (30.6%)
Clear communication	Exemplary	1 (1.9%)	0 (0.0%)	1 (2.7%)	0.015‡
	Accomplished	5 (9.8%)	9 (11.4%)	2 (5.6%)
	Developing	30 (58.9%)	31 (39.2%)	10 (27.8%)
	Beginning	15 (29.4%)	39 (49.4%)	23 (63.9%)
Well-planned intervention/flexibility	Exemplary	3 (5.9%)	0 (0.0%)	0 (0.0%)	0.029^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	12 (23.5%)	7 (8.8%)	3 (8.3%)
	Developing	9 (17.6%)	16 (20.3%)	5 (13.9%)
	Beginning	27 (53.0%)	56 (70.9%)	28 (77.8%)
Being skillful	Exemplary	2 (3.9%)	0 (0.0%)	0 (0.0%)	0.002^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	12 (23.5%)	4 (5.0%)	1 (2.8%)
	Developing	33 (64.8%)	65 (82.3%)	27 (75.0%)
	Beginning	4 (7.8%)	10 (12.7%)	8 (22.2%)
Evaluation/self-analysis	Exemplary	0 (0.0%)	1 (1.3%)	0 (0.0%)	0.013^‡ ‡ p-value of the Fisher's Exact Test Value
	Accomplished	12 (23.5%)	7 (8.8%)	2 (5.6%)
	Developing	27 (53.0%)	52 (65.8%)	31 (86.1%)
	Beginning	12 (23.5%)	19 (24.1%)	3 (8.3%)
Commitment to improvement	Accomplished	7 (8.8%)	2 (5.6%)	2 (5.6%)	0.030^‡ ‡ p-value of the Fisher's Exact Test Value
	Developing	31 (60.8%)	41 (51.9%)	17 (47.2%)
	Beginning	13 (25.5%)	36 (45.6%)	17 (47.2%)
Total Score	-	32.0 [6.0]	35.0 [4.0]	36.0[4.0]	0.001^§ § p-value of the Kruskal-Wallis test

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[1] Corresponding author: Sheila Coelho Ramalho Vasconcelos Morais E-mail: sh25crvm@gmail.com https://orcid.org/0000-0001-9831-0338

Brasil

Brasil

Clinical judgment performance of undergraduate Nursing students* * This article refers to the call “Human Resources in Health and Nursing: Training and Performance in the Americas”.

Objective:

Method:

Results:

Conclusion:

Clinical judgment performance of undergraduate Nursing students^* * This article refers to the call “Human Resources in Health and Nursing: Training and Performance in the Americas”.