Promoting Curriculum Choices: Critical Thinking and Clinical Judgment Skill Development in Baccalaureate Nursing Students

Abstract

Critical thinking and clinical judgment have been identified as essential skills for practicing professional nurses (American Association of Colleges of Nursing, 2008; National League for Nursing, 2006). Nurses utilize critical thinking and clinical judgment in their practice every day. While critical thinking and clinical judgment are essential to professional nursing practice, research has indicated that the majority of graduate nurses are not capable of meeting entry-level expectations for clinical judgment (del Bueno, 2005). Nursing educators need to continue to develop and refine educational strategies that promote the development of critical thinking and clinical judgment skills that meet the learning needs of nursing students as well as the health care needs of the public. Tanner's Theory of Clinical Judgment (2006) provided a framework for this investigation. The purpose of this study was to evaluate the effectiveness of grand rounds as an educational strategy to develop critical thinking and clinical judgment skills in baccalaureate nursing students. Lasater's (2007b) Clinical Judgment Rubric was used to assess clinical judgment. Assessment Technologies Institute's (ATI) Critical Thinking Assessment was used to assess critical thinking skills. An experimental, pre-, post-test, mixed method research design was employed in this study. A convenience sample of 22 Level II baccalaureate nursing students from a Midwest nursing program provided the sample. There were four groups that received the teaching strategy and one comparison group that did not receive the strategy. Investigation results were statistically analyzed with Spearman's rho correlation to evaluate the strength of the relationship between critical thinking and clinical judgment. Paired t-tests evaluated the differences between critical thinking assessment scores. Independent t-tests were utilized to evaluate the difference between critical thinking assessment scores at the second session and clinical judgment scores. Qualitative analysis assessed interviews conducted with participants. Results indicated there was no significant relationship between critical thinking and clinical judgment. Results also indicated there was no significant difference between participants' scores on the ATI Critical Thinking Assessment at the beginning of the nursing program and at the conclusion of the study. Data indicated there was no significant difference between the intervention groups' scores and the comparison group' scores for the second ATI Critical Thinking Assessment. A significant difference was indicated between intervention groups' and the comparison group's clinical judgment scores, p < .10. Qualitative analysis indicated students preferred this strategy to other strategies currently in use at this school.