WEBVTT

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Measuring clinical judgment has
been one of the major undertakings of the

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Next Generation NCLEX
Project.

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Clinical Judgment is defined
as the observed outcome

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of critical thinking
and decision-making.

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It is an iterative process that uses
nursing knowledge to observe and assess

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presenting situations,
identify and prioritize client concerns,

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and generate the best possible
evidence-based solutions,

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in order to deliver
safe client care.

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NCSBN Research identified a list of
contextual factors that play a role in the

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quality of nursing
clinical judgment.

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These factors may
be divided into conditions

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that are internal or
external to the nurse.

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Internal conditions include education,
experience, knowledge, communication,

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consequences and risks, emotions and
perceptions, and professional orientation.

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Examples of external conditions are task
complexity, time pressures, distractions,

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interruptions,
and professional autonomy.

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Recognizing that it is necessary to
determine whether clinical judgment is

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more than just
possessing nursing knowledge,

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NCSBN conducted a
pilot study in 2016.

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This study found that knowledge is
essential, but isn't enough to validate

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the clinical judgment essential
to safe nursing practice.

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The study also showed that the average
ability of a nurse to demonstrate the

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different steps in the clinical
judgment process is progressive.

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A nurse's ability to recognize cues,
develop hypotheses, and take appropriate

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actions does not guarantee the ability to
evaluate the outcomes of the action taken.

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Ultimately, no single
element of clinical judgment

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adequately predicts a nurse's
clinical judgment ability.

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It is the combination of all the elements
that add validity and reliability to the

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measurement of a nurse's
clinical judgment ability.

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In short,
having content knowledge

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does not always translate to
having clinical judgment skills.

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The NCSBN Clinical Judgment Model, or CJM,
represents a fundamental shift from the

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current measurement models, in which
something is either right or wrong.

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When context is removed and items are
extremely sterile, a very precise and

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stable measurement
can be obtained.

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But the context in which an individual
makes decisions matters.

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Consequences,
time constraints, and risks

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cause someone to
make decisions a certain way.

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The CJM can be broken
down into four levels.

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Imagine that a nurse
walks into a client's room.

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Cues exist that must be
first recognized and then analyzed

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in order to care
for the client properly.

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So the nurse forms hypotheses,
prioritizes them, generates solutions,

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and then
takes actions.

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Research thus far has indicated
that these actions can be measured.

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These levels of the CJM
are divided into six layers.

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One: recognize cues where relevant and
important information is identified

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from different sources,
such as medical history or vital signs.

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Two: Analyze cues, which is organizing and
linking the recognized cues to the

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client's
clinical presentation.

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Three: Prioritize hypotheses,
where hypotheses

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are evaluated and ranked
according to priority.

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This can include urgency, likelihood,
risk, difficulty and/or time.

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Four: Generate solutions,
which is identifying expected outcomes and

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using hypotheses to define a set of
interventions for the expected outcomes.

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Five: Take action, where
the solutions that

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address the highest
priorities are implemented.

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And the sixth
is, evaluate outcomes,

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which is comparing observed outcomes
against expected outcomes.

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Layer four in the CJM, the context,
is one that has not been introduced in any

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psychometric
models before now.

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The question is whether you can put
context around items in a way that makes

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it more like actual
nursing practice.

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NCSBN continues to develop item
prototypes, collect data and do research

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on measuring clinical judgment and
measuring the layers of the CJM.

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You can learn more
about the NGN Project at ncsbn.org.