The impact of guided reflection on clinical judgment of associate degree nursing students
The health care environment continues to be fraught with errors and poor patient outcomes. Nurses, having the most constant time with patients, are in a position to make a difference in those outcomes. Due to many technological, social, and health care changes and advancements, nurses have responsibilities requiring high levels of clinical judgment. Nursing education must respond to the changes and expanded roles of nurses by changing how students are taught, specifically in the clinical setting. Pedagogical tools and methods are needed to assist the student with making integrations between classroom theory and clinical practice. The purpose of this study was to explore the use of a guided reflection tool based on a model developed from the practice of novice and experienced registered nurses on clinical judgment development as measured by a rubric based on the same model, of associate degree nursing students, in an acute care setting. A mixed methods approach was used. Clinical judgment scores of a comparison group (n = 9) were compared with an intervention group (n = 9) and each groups’ scores were examined for progression of clinical judgment abilities using a quasi-experimental time series design for the quantitative portion of the study. Using RM-ANOVA, findings indicated there was no statistical significance between the two groups or within the time intervals for either of the groups. A focus group interview was also held to identify perceptions of each group concerning reflective journaling and development of clinical judgment. Both groups felt reflective journaling enhanced development of clinical judgment; however, the intervention group articulated situational learning to a greater degree than the comparison group.