Cultivating Clinical Judgment in Pharmacological Decision Making Through Reflection on Practice

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University of Alabama Libraries

Registered nurses practicing across diverse clinical settings all spend significant time providing and making judgments about pharmacological therapies. However, traditional methods of teaching pharmacology have rarely focused toward clinical application of content. This study investigated whether the inclusion of reflective debriefing after pharmacology activities impacted clinical judgment of nursing students during provision of pharmacological therapies in the clinical learning environment. A sample of 168 senior, prelicensure, Bachelor of Science in nursing student participants were assigned to either the intervention or control groups. Three measurements of clinical judgment were obtained for each participant by faculty data collectors over a twelve-week critical care rotation using Lasater’s (2007) Clinical Judgment Rubric. Students in the intervention group participated in two hour-long sessions of reflective debriefing about their pharmacology decisions, one between each measurement. Statistically significant changes in clinical judgment were observed between the first and second and first and third measurements for the full cohort. However, while measurements for the intervention group were observed to increase more over the semester than measurements for the control groups, changes were not found to be statistically significant. This study addresses the recommendation for nursing education research to make conclusions based on measurement of learning, rather than relying on student perception. Findings are congruent with prior studies that measured statistically significant changes in clinical judgment after one semester of learning, and support Tanner’s (2006) theory that multiple opportunities for reflection are necessary to foster clinical judgment.

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Clinical Education, Clinical Judgment, Lasater's Clinical Judgment Rubric, Pharmacology, Prelicensure Nursing, Reflection on Practice