WEBVTT 00:00:07.000 --> 00:00:09.920 position:50% align:middle - [Dr. Monagle] Good morning, everybody. My name is Dr. Janet Monagle. 00:00:09.920 --> 00:00:15.790 position:50% align:middle I'm an associate professor at the School of Nursing, Mass General Health Institute of Health Professions. 00:00:15.790 --> 00:00:17.340 position:50% align:middle - [Lisa] Hi. 00:00:17.340 --> 00:00:23.050 position:50% align:middle My name is Lisa Gonzalez, and I'm a professor of nursing at the College of Southern Maryland. 00:00:23.050 --> 00:00:29.110 position:50% align:middle - We are both happy to be here to discuss clinical judgment model integration today, 00:00:29.110 --> 00:00:33.480 position:50% align:middle and I want to tell you what are three objectives for today's presentation. 00:00:33.480 --> 00:00:38.870 position:50% align:middle The first one is to describe the use of clinical judgment models as frameworks to guide teaching 00:00:38.870 --> 00:00:42.410 position:50% align:middle and learning, and also assessment and evaluation. 00:00:42.410 --> 00:00:48.290 position:50% align:middle The second is to discuss the application of a clinical judgment model in the classroom as well 00:00:48.290 --> 00:00:50.150 position:50% align:middle as the clinical settings. 00:00:50.150 --> 00:00:57.630 position:50% align:middle And the third objective is to identify three techniques to assess clinical judgment in the classroom. 00:00:57.630 --> 00:01:03.282 position:50% align:middle So to start talking about clinical judgment models today, we have to look back and see, 00:01:03.282 --> 00:01:06.132 position:50% align:middle what is the end game for teaching and learning? 00:01:06.132 --> 00:01:10.602 position:50% align:middle So we want to meet classroom objectives, we want to pass the course, graduate, 00:01:10.602 --> 00:01:16.622 position:50% align:middle have NCLEX success, but the most important thing that we need to remember as nurse educators is that 00:01:16.622 --> 00:01:21.802 position:50% align:middle readiness for practice and safe patient care is the most important outcome. 00:01:21.802 --> 00:01:30.252 position:50% align:middle And this has been the focus of the new NCLEX as well in order to measure safe patient care. 00:01:30.252 --> 00:01:37.632 position:50% align:middle So we did a study, my colleagues and I, and that was Dr. Kathie Lasater, Ann Nielsen, 00:01:37.632 --> 00:01:43.132 position:50% align:middle Mary Ann Jessee, and Lisa Gonzalez, along with Phil Dickinson from the NCSBN, 00:01:43.132 --> 00:01:46.572 position:50% align:middle and we did a cross-sectional study across the nation. 00:01:46.572 --> 00:01:51.652 position:50% align:middle And we had a representative sample of both ADN and BSN programs. 00:01:51.652 --> 00:01:55.192 position:50% align:middle And if you take a look at the graph, this is exactly what we found. 00:01:55.192 --> 00:01:59.262 position:50% align:middle We found something that we were really surprised about. 00:01:59.262 --> 00:02:08.960 position:50% align:middle Only 27% of the schools across the nation reported that they actually use a model and 71% reported that they 00:02:08.960 --> 00:02:10.610 position:50% align:middle did not use a model. 00:02:10.610 --> 00:02:17.170 position:50% align:middle So if you look at this, you can see that in the orange, there are 51% of schools that don't use a model 00:02:17.170 --> 00:02:19.950 position:50% align:middle currently but intend to start. 00:02:19.950 --> 00:02:25.260 position:50% align:middle And we think the impetus for this is much has to do with the NextGen NCLEX. 00:02:25.260 --> 00:02:31.260 position:50% align:middle Because what we found was that those using a model said it was extremely or somewhat important to the adoption 00:02:31.260 --> 00:02:35.650 position:50% align:middle of the model. 00:02:35.650 --> 00:02:38.020 position:50% align:middle So what else did we find? 00:02:38.020 --> 00:02:42.540 position:50% align:middle What deans and directors said, they said that the most frequently described use of a 00:02:42.540 --> 00:02:47.910 position:50% align:middle model was to inform the design and the implementation of teaching strategies. 00:02:47.910 --> 00:02:54.470 position:50% align:middle And secondly, they said that models were used to facilitate teaching in the clinical area 00:02:54.470 --> 00:02:57.160 position:50% align:middle as well as evaluation. 00:02:57.160 --> 00:03:03.036 position:50% align:middle And when we just asked the questions about using models, many responded that seeing improved clinical 00:03:03.036 --> 00:03:10.116 position:50% align:middle reasoning and judgment after implementation of the model to inform the curriculum. 00:03:10.116 --> 00:03:14.906 position:50% align:middle So what is the purpose of a clinical judgment model in education? 00:03:14.906 --> 00:03:19.476 position:50% align:middle So using a clinical judgment model is a useful framework, not only to guide teaching and 00:03:19.476 --> 00:03:23.496 position:50% align:middle learning strategies, but its purpose is to promote clinical 00:03:23.496 --> 00:03:27.276 position:50% align:middle judgment development, and that's very clear in the literature. 00:03:27.276 --> 00:03:34.416 position:50% align:middle Also, clinical judgment models as frameworks have produced better results in studies that are already 00:03:34.416 --> 00:03:37.046 position:50% align:middle in the literature. 00:03:37.046 --> 00:03:42.566 position:50% align:middle Also, what we know about clinical judgment models is that now, we know that they provide a needed structure 00:03:42.566 --> 00:03:48.176 position:50% align:middle for curriculum design as well as assessment strategies and now, new in the literature, 00:03:48.176 --> 00:03:54.336 position:50% align:middle is that they provide a common language for both students and faculty. 00:03:54.336 --> 00:04:00.206 position:50% align:middle So what we found in our research is that Tanner's Clinical Judgment Model is the most commonly used 00:04:00.206 --> 00:04:02.883 position:50% align:middle clinical judgment model for teaching and learning. 00:04:02.883 --> 00:04:10.213 position:50% align:middle And out of our sample, 65% of schools reported that they were using the 00:04:10.213 --> 00:04:12.723 position:50% align:middle Tanner's Clinical Judgment Model. 00:04:12.723 --> 00:04:16.243 position:50% align:middle If you look at the list there, you can see that there are other models that were 00:04:16.243 --> 00:04:23.873 position:50% align:middle also used, the Outcome-Present State-Test model by Pesut & Herman that was published in 1998. 00:04:23.873 --> 00:04:32.593 position:50% align:middle And then we have the Developing Nurse Thinking model by Tesoro in 2019, as well as the Caputi Model 00:04:32.593 --> 00:04:38.063 position:50% align:middle for Teaching Thinking in Nursing, which was published in Caputi, 2020. 00:04:38.063 --> 00:04:42.993 position:50% align:middle And also, the Clinical Reasoning Cycle by Levett-Jones in 2010. 00:04:42.993 --> 00:04:52.043 position:50% align:middle The second most commonly used model in our study was found to be the Clinical Reasoning Cycle model. 00:04:52.043 --> 00:04:57.213 position:50% align:middle So if you take a look at these models, it's a little bit difficult for you to read each one, 00:04:57.213 --> 00:05:00.485 position:50% align:middle but I just wanted to show you the gist of the model. 00:05:00.485 --> 00:05:06.265 position:50% align:middle The first one is the OPT model on your left, and that is kind of a bridge between the nursing 00:05:06.265 --> 00:05:08.625 position:50% align:middle process and the development of thinking. 00:05:08.625 --> 00:05:12.835 position:50% align:middle And there's a lot of influence on Benner on that model. 00:05:12.835 --> 00:05:17.345 position:50% align:middle And then if you look at the Tanner's model, which is on your right, you can see that in yellow, 00:05:17.345 --> 00:05:21.485 position:50% align:middle the steps to the clinical judgment process are listed. 00:05:21.485 --> 00:05:25.805 position:50% align:middle But what was added to this model was context, background, relationships. 00:05:25.805 --> 00:05:33.375 position:50% align:middle The importance of the nurses' relationship to the patient does also influence the decision making. 00:05:33.375 --> 00:05:39.965 position:50% align:middle And it's important to note that Tanner's model, this research was done on expert nurses, 00:05:39.965 --> 00:05:43.645 position:50% align:middle not on novice nurses or student nurses. 00:05:43.645 --> 00:05:49.775 position:50% align:middle And then if you look to your left at the bottom, you can see the Developing Nurse Thinking model. 00:05:49.775 --> 00:05:53.445 position:50% align:middle And the impetus for this model is really safety. 00:05:53.445 --> 00:05:57.795 position:50% align:middle The focus is on safety and recognize and danger. 00:05:57.795 --> 00:06:02.934 position:50% align:middle And then on the bottom right is the Clinical Reasoning Cycle model. 00:06:02.934 --> 00:06:12.024 position:50% align:middle And this one shows phases and steps like, look, collect, process, decide, plan, act, 00:06:12.024 --> 00:06:17.754 position:50% align:middle evaluate, and reflect. 00:06:17.754 --> 00:06:22.414 position:50% align:middle Right now, here is the NCSBN clinical judgment measurement model. 00:06:22.414 --> 00:06:27.034 position:50% align:middle So this model differs from the clinical judgment models in that it is based on three 00:06:27.034 --> 00:06:28.744 position:50% align:middle thinking cognition frameworks. 00:06:28.744 --> 00:06:34.474 position:50% align:middle And we heard a lot about this, this morning but I just wanted to review briefly what 00:06:34.474 --> 00:06:36.514 position:50% align:middle this model was intended to do. 00:06:36.514 --> 00:06:42.564 position:50% align:middle So this model includes developmental elements that measure both analytic thinking appropriate to the 00:06:42.564 --> 00:06:44.834 position:50% align:middle developmental level of a graduate nurse. 00:06:44.834 --> 00:06:50.124 position:50% align:middle So that differs from the Tanner model and that it's appropriate to entry-level graduate nurses. 00:06:50.124 --> 00:06:56.654 position:50% align:middle And this model was intended to frame the NCLEX, the NextGen NCLEX, and it's intended 00:06:56.654 --> 00:06:58.524 position:50% align:middle to use for measurement. 00:06:58.524 --> 00:07:05.280 position:50% align:middle And if you take a look at the layers, you can see Layer 3 actually gives you the steps to the 00:07:05.280 --> 00:07:09.750 position:50% align:middle formation of clinical judgment, which is listed there on Level 3. 00:07:09.750 --> 00:07:18.880 position:50% align:middle So the clinical judgment measurement model, the role in NextGen NCLEX, 00:07:18.880 --> 00:07:21.550 position:50% align:middle improves the assessment of clinical judgment. 00:07:21.550 --> 00:07:28.320 position:50% align:middle The point in the development that we've already heard about the CJMM is that the point was to improve new 00:07:28.320 --> 00:07:33.630 position:50% align:middle grads' practice on graduation, to make sure that they were thinking rather than just 00:07:33.630 --> 00:07:34.950 position:50% align:middle passing a test, right? 00:07:34.950 --> 00:07:38.830 position:50% align:middle They were able to use clinical judgment in the field. 00:07:38.830 --> 00:07:43.990 position:50% align:middle It's also been useful to the development of assessment and evaluation tools, 00:07:43.990 --> 00:07:50.380 position:50% align:middle designing test questions as well as simulation scenarios and case study development. 00:07:50.380 --> 00:07:59.000 position:50% align:middle It gives people, it gives nurse educators, the actual steps on what needs to be included in a case 00:07:59.000 --> 00:08:07.492 position:50% align:middle study to make sure that it has enough information so that the student can understand it clearly. 00:08:07.492 --> 00:08:10.442 position:50% align:middle If you take a look at so what's the relationship, you might be wondering, 00:08:10.442 --> 00:08:16.052 position:50% align:middle why wouldn't you just use the clinical judgment measurement model for teaching and learning as well 00:08:16.052 --> 00:08:17.912 position:50% align:middle as assessment and evaluation? 00:08:17.912 --> 00:08:22.722 position:50% align:middle Well, I kind of want to show you this relationship between the clinical judgment measurement model and the 00:08:22.722 --> 00:08:26.302 position:50% align:middle clinical judgment model, they're like a puzzle that fits together. 00:08:26.302 --> 00:08:30.962 position:50% align:middle A clinical judgment model is used for teaching and the clinical judgment measurement model is used 00:08:30.962 --> 00:08:34.402 position:50% align:middle to assess and evaluate. 00:08:34.402 --> 00:08:41.312 position:50% align:middle And the point being is that multiple teaching strategies can also influence the clinical…can also use 00:08:41.312 --> 00:08:46.692 position:50% align:middle the clinical judgment model and be influenced by a clinical judgment model and you can still get to the 00:08:46.692 --> 00:08:54.132 position:50% align:middle end game of NCLEX success as well as safe entry level into practice. 00:08:54.132 --> 00:08:59.272 position:50% align:middle So if you take a look at Tanner's Clinical Judgment, this is our example. 00:08:59.272 --> 00:09:04.498 position:50% align:middle And we chose this example because it was the most broadly used in our study. 00:09:04.498 --> 00:09:12.458 position:50% align:middle But what's important to see about the clinical judgment model here is that it's an intuitive humanistic 00:09:12.458 --> 00:09:16.038 position:50% align:middle paradigm and it accounts for all the context. 00:09:16.038 --> 00:09:24.098 position:50% align:middle If you look at first, the yellow steps, the noticing, interpreting, responding, and reflecting, 00:09:24.098 --> 00:09:26.198 position:50% align:middle that gives you four key steps. 00:09:26.198 --> 00:09:30.808 position:50% align:middle But then, if you look deeper at the model, you can see that context is important to form 00:09:30.808 --> 00:09:36.918 position:50% align:middle expectations and interpreting involves more than just one reasoning pattern. 00:09:36.918 --> 00:09:42.828 position:50% align:middle We know that new nurses would use more analytic patterns but there's also intuitive and narrative 00:09:42.828 --> 00:09:46.848 position:50% align:middle patterns that are used to frame actions and then outcomes. 00:09:46.848 --> 00:09:53.608 position:50% align:middle And then there's reflection in action that you look at exactly what happened with the patient and then this 00:09:53.608 --> 00:09:59.268 position:50% align:middle reflection on action leading to clinical learning. 00:09:59.268 --> 00:10:03.339 position:50% align:middle So Tanner's Clinical Judgment Model, one of the main advantages, I think, 00:10:03.339 --> 00:10:12.719 position:50% align:middle why many of our participants used this model over other models is probably because it has the Lasater Clinical 00:10:12.719 --> 00:10:18.859 position:50% align:middle Judgment Rubric associated with it, which follows Tanner's step to the clinical judgment. 00:10:18.859 --> 00:10:25.719 position:50% align:middle And, you know, the Lasater Clinical Judgment Rubric, LCJR, we call it, includes 11 dimensions that actually 00:10:25.719 --> 00:10:32.999 position:50% align:middle have developmental steps so that nurse educators can see the progress that students are making. 00:10:32.999 --> 00:10:36.039 position:50% align:middle So how is Tanner's Clinical Judgment Model used? 00:10:36.039 --> 00:10:38.039 position:50% align:middle So this is in the literature clearly. 00:10:38.039 --> 00:10:42.399 position:50% align:middle It's used to frame curriculum and guide teaching and learning. 00:10:42.399 --> 00:10:45.519 position:50% align:middle It's used for higher-level questioning. 00:10:45.519 --> 00:10:49.059 position:50% align:middle It's used to frame questions for reflective journaling. 00:10:49.059 --> 00:10:56.189 position:50% align:middle It's used to provide a common language for students and faculty and also to develop clinical education 00:10:56.189 --> 00:11:00.069 position:50% align:middle learning modules, which Lisa is going to talk more about as we move on. 00:11:00.069 --> 00:11:05.447 position:50% align:middle The clinical education learning modules, the focused assessment, priority nursing diagnosis, 00:11:05.447 --> 00:11:08.997 position:50% align:middle as well as communication. Okay. 00:11:08.997 --> 00:11:15.477 position:50% align:middle So this slide shows the clinical judgment measurement model and the clinical judgment model and how we put 00:11:15.477 --> 00:11:17.167 position:50% align:middle the two of them together. 00:11:17.167 --> 00:11:22.187 position:50% align:middle So if you look at the blue arrows, those are the steps to the clinical 00:11:22.187 --> 00:11:24.607 position:50% align:middle judgment measurement model. 00:11:24.607 --> 00:11:32.127 position:50% align:middle And you can see that recognizing cues relies on astute observation and noticing skills, 00:11:32.127 --> 00:11:35.437 position:50% align:middle which coincides with the Tanner Clinical Judgment Model. 00:11:35.437 --> 00:11:41.197 position:50% align:middle And then if you look on the right side of the graph, you can see that the steps to the clinical judgment 00:11:41.197 --> 00:11:47.607 position:50% align:middle model analyze cues, prioritize hypotheses, and generate solutions, 00:11:47.607 --> 00:11:54.217 position:50% align:middle rely on interpreting with reasoning patterns, analytic, intuitive, or narrative. 00:11:54.217 --> 00:12:00.648 position:50% align:middle And then you can see on the bottom right, take action, and with the blue arrow. 00:12:00.648 --> 00:12:05.458 position:50% align:middle That is a step of the clinical judgment measurement model which relies on action in the 00:12:05.458 --> 00:12:07.108 position:50% align:middle clinical judgment model. 00:12:07.108 --> 00:12:11.428 position:50% align:middle And then all the way over to the other side of the screen is evaluate outcomes. 00:12:11.428 --> 00:12:17.528 position:50% align:middle Evaluate outcomes is one of the steps of the clinical judgment measurement model that relies on reflecting 00:12:17.528 --> 00:12:21.358 position:50% align:middle in the clinical judgment model. 00:12:21.358 --> 00:12:25.698 position:50% align:middle So now, my colleague, Lisa is going to speak about teaching and learning, 00:12:25.698 --> 00:12:27.108 position:50% align:middle assessment and evaluation. 00:12:27.108 --> 00:12:29.008 position:50% align:middle - Good. 00:12:29.008 --> 00:12:33.458 position:50% align:middle So we've just heard all about different clinical judgment models. 00:12:33.458 --> 00:12:38.208 position:50% align:middle So how can we apply clinical judgment models within nursing education? 00:12:38.208 --> 00:12:48.008 position:50% align:middle What strategies can we use for the purpose of teaching and learning along with assessment and evaluation? 00:12:48.008 --> 00:12:52.138 position:50% align:middle We can integrate a model across the learning environment. 00:12:52.138 --> 00:12:56.878 position:50% align:middle We have clinical, classroom, and laboratory learning environments. 00:12:56.878 --> 00:13:04.464 position:50% align:middle A model fully integrated across the curriculum can enhance development of clinical reasoning skills and 00:13:04.464 --> 00:13:09.864 position:50% align:middle clinical judgment because students will have multiple exposures, repetition, 00:13:09.864 --> 00:13:14.804 position:50% align:middle and opportunities to connect their learning in the various learning environments. 00:13:14.804 --> 00:13:20.394 position:50% align:middle What they notice in clinical now makes sense with what they learned in theory. 00:13:20.394 --> 00:13:25.004 position:50% align:middle So consider Tanner's Clinical Judgment Model as an example. 00:13:25.004 --> 00:13:32.134 position:50% align:middle Associated terminology with the model is noticing, interpreting, responding, and reflecting. 00:13:32.134 --> 00:13:37.924 position:50% align:middle All could be present in learning objectives, activities, and assessment. 00:13:37.924 --> 00:13:43.454 position:50% align:middle Also, a clinical judgment model should be used with integrating new content in a classroom. 00:13:43.454 --> 00:13:50.409 position:50% align:middle A clinical judgment model, as a framework, streamlines new information for students to help them learn. 00:13:54.360 --> 00:14:00.264 position:50% align:middle We want our students to learn, and as teachers, we can facilitate their learning. 00:14:00.264 --> 00:14:07.764 position:50% align:middle Cognitive information processing theory highlight the importance of connections to meaningful learning. 00:14:07.764 --> 00:14:13.964 position:50% align:middle Driscoll shares that in order for information to be processed and stored into long-term memory, 00:14:13.964 --> 00:14:19.094 position:50% align:middle the information must be meaningful and connect with knowledge from long-term memory. 00:14:19.094 --> 00:14:26.724 position:50% align:middle For example, a student who has learned symptoms of hypoxia from a previous learning experience may draw 00:14:26.724 --> 00:14:32.774 position:50% align:middle in this knowledge when learning about management of a patient with a pulmonary embolus. 00:14:32.774 --> 00:14:39.204 position:50% align:middle Even though this might be new and a higher level for the student, they can still use their knowledge 00:14:39.204 --> 00:14:47.764 position:50% align:middle of hypoxia to recognize or notice a decline of a patient with a PE and they can use it to evaluate the 00:14:47.764 --> 00:14:50.944 position:50% align:middle effectiveness of a treatment, for example. 00:14:50.944 --> 00:14:56.914 position:50% align:middle Another point that we can apply from cognitive information processing theory is the power of episodic 00:14:56.914 --> 00:14:59.624 position:50% align:middle memory versus semantic memory. 00:14:59.624 --> 00:15:02.998 position:50% align:middle Episodic memory is created from specific events. 00:15:02.998 --> 00:15:10.178 position:50% align:middle Think about a moment your students experience in clinical, or think about moments they experience when 00:15:10.178 --> 00:15:14.578 position:50% align:middle you tell stories about patients within the classroom. 00:15:14.578 --> 00:15:19.608 position:50% align:middle Semantic memory is memory related to general information like facts, for example, 00:15:19.608 --> 00:15:22.578 position:50% align:middle like steps of a skill, maybe an IV start. 00:15:22.578 --> 00:15:29.868 position:50% align:middle Classroom teaching that explores clinical situations allows students to experience decision making. 00:15:29.868 --> 00:15:35.028 position:50% align:middle When the experiences are brought by the students, it gives them additional opportunities to relive or 00:15:35.028 --> 00:15:41.448 position:50% align:middle reflect on those experiences and share that with the rest of the class. 00:15:41.448 --> 00:15:45.448 position:50% align:middle Also, adding context influenced clinical judgment. 00:15:45.448 --> 00:15:49.648 position:50% align:middle No matter the learning environment, we should always refer back to the context 00:15:49.648 --> 00:15:50.898 position:50% align:middle of patient care. 00:15:50.898 --> 00:15:52.428 position:50% align:middle Who is the patient? 00:15:52.428 --> 00:15:54.488 position:50% align:middle What environment are they in? 00:15:54.488 --> 00:15:58.238 position:50% align:middle What environment is the nurse providing care for this patient? 00:15:58.238 --> 00:16:03.946 position:50% align:middle Clinical provides a natural contextual situation, but think about how you can replicate that within the 00:16:03.946 --> 00:16:07.126 position:50% align:middle classroom or lab. 00:16:07.126 --> 00:16:13.816 position:50% align:middle Here's the Lasater Clinical Judgment Rubric, the LCJR, that Janet already referred to. 00:16:13.816 --> 00:16:20.546 position:50% align:middle This is a tool that we can use for the purpose of teaching and learning and evaluation and assessment. 00:16:20.546 --> 00:16:24.656 position:50% align:middle The Lasater Clinical Judgment Rubric pairs well with Tanner's Clinical Judgment Model, 00:16:24.656 --> 00:16:28.466 position:50% align:middle and was developed with the CJM in mind. 00:16:28.466 --> 00:16:33.866 position:50% align:middle The LCJR is useful as both a tool for teaching and learning as well as assessment and evaluation. 00:16:33.866 --> 00:16:42.216 position:50% align:middle For example, noticing from Tanner's model is further explored in Lasater's dimension of focused observation, 00:16:42.216 --> 00:16:47.626 position:50% align:middle recognizing deviations from expected patterns, and information-seeking behaviors. 00:16:47.626 --> 00:16:54.826 position:50% align:middle This linkage between Tanner's model and the LCJR with teaching specific skills and behaviors associated 00:16:54.826 --> 00:16:58.086 position:50% align:middle with local judgment, more practical for students and teachers. 00:16:58.086 --> 00:17:05.005 position:50% align:middle The Lasater Clinical Judgment Rubric is also useful for progression with four levels from developing, 00:17:05.005 --> 00:17:09.105 position:50% align:middle accomplish…excuse me, from beginning to developing to accomplish, 00:17:09.105 --> 00:17:14.795 position:50% align:middle and exemplary, educators can see progression in their students' clinical judgment as they move 00:17:14.795 --> 00:17:18.265 position:50% align:middle through their learning. 00:17:18.265 --> 00:17:24.185 position:50% align:middle You can also use the LCJR to create higher-level questioning specific for each dimension. 00:17:24.185 --> 00:17:28.055 position:50% align:middle These are examples of questions that promote noticing and interpreting. 00:17:28.055 --> 00:17:33.475 position:50% align:middle You can use these types of questions to frame teaching clinical judgment in all the different 00:17:33.475 --> 00:17:40.875 position:50% align:middle education environments, clinical, lab, or the classroom. 00:17:40.875 --> 00:17:45.815 position:50% align:middle No matter which learning environment, we should consider how developing clinical judgment 00:17:45.815 --> 00:17:51.595 position:50% align:middle also involves developing finer, more intricate clinical reasoning skills. 00:17:51.595 --> 00:17:57.715 position:50% align:middle There are cognitive skills associated with clinical reasoning that students may not be aware of, 00:17:57.715 --> 00:17:59.105 position:50% align:middle much less have mastered. 00:17:59.105 --> 00:18:02.208 position:50% align:middle For example, observation and analyzing. 00:18:02.208 --> 00:18:09.918 position:50% align:middle So as you teach and as you're using a variety of strategies, you can focus these strategies on helping 00:18:09.918 --> 00:18:15.488 position:50% align:middle students learn each individual skill, and then offer them opportunities to put these skills 00:18:15.488 --> 00:18:22.598 position:50% align:middle together more fluidly one step at a time. 00:18:22.598 --> 00:18:27.498 position:50% align:middle Now that you've spent all this time with your students exploring clinical judgment, 00:18:27.498 --> 00:18:31.028 position:50% align:middle it's time for an assessment or an evaluation. 00:18:31.028 --> 00:18:35.328 position:50% align:middle Times of assessment and evaluation should provide opportunities for students 00:18:35.328 --> 00:18:37.288 position:50% align:middle to practice clinical judgment. 00:18:37.288 --> 00:18:42.168 position:50% align:middle It may not be fluid right away but with time and practice, clinical judgment develops. 00:18:42.168 --> 00:18:47.438 position:50% align:middle When you are creating assessments and evaluations, consider the steps of the clinical 00:18:47.438 --> 00:18:48.968 position:50% align:middle judgment measurement model. 00:18:48.968 --> 00:18:55.028 position:50% align:middle For example, you can ask yourself, what cues do you want students to recognize in the 00:18:55.028 --> 00:19:00.217 position:50% align:middle case study, test question, or other evaluation strategy? 00:19:00.217 --> 00:19:05.937 position:50% align:middle Consider the definition of a cue, a thing that is said or done that serves as a signal to an actor. 00:19:05.937 --> 00:19:09.587 position:50% align:middle Well, of course, for us, it's the signal to our students. 00:19:09.587 --> 00:19:13.007 position:50% align:middle Think about the synonyms, prompt, signal, or sign. 00:19:13.007 --> 00:19:17.447 position:50% align:middle So what prompts or cues would warrant follow-up by the nurse? 00:19:17.447 --> 00:19:22.077 position:50% align:middle That's what we want to make sure we include in our evaluation assessment strategy. 00:19:22.077 --> 00:19:26.877 position:50% align:middle What information does the nurse to proceed with the next step of the clinical judgment measurement 00:19:26.877 --> 00:19:29.057 position:50% align:middle model's decision making? 00:19:33.630 --> 00:19:38.570 position:50% align:middle So for example, with the case study, what cues would be important to include? 00:19:38.570 --> 00:19:45.710 position:50% align:middle Also, when you are developing these evaluation tools, create stopping points. 00:19:45.710 --> 00:19:49.111 position:50% align:middle Stopping points help you, the instructor, identify where a student 00:19:49.111 --> 00:19:52.330 position:50% align:middle could have gone wrong in their thinking. 00:19:52.330 --> 00:19:57.850 position:50% align:middle It also helps students raise their awareness that there are separate different skills involved 00:19:57.850 --> 00:19:59.140 position:50% align:middle in your decision making. 00:19:59.140 --> 00:20:05.481 position:50% align:middle So maybe they didn't come up with the right answer, but maybe a few of the steps in the decision making 00:20:05.481 --> 00:20:11.261 position:50% align:middle were solid and then maybe, they just need to work on prioritizing 00:20:11.261 --> 00:20:14.831 position:50% align:middle their hypothesis, for example. 00:20:14.831 --> 00:20:21.171 position:50% align:middle Also with item-writing, when we write test questions, we often identify the concept that we want to know if 00:20:21.171 --> 00:20:25.931 position:50% align:middle students have learned, such as management of patients with CHF. 00:20:25.931 --> 00:20:29.240 position:50% align:middle When test-writing to evaluate clinical judgment, 00:20:29.240 --> 00:20:31.851 position:50% align:middle you can also consider the skill that you want to measure. 00:20:31.851 --> 00:20:39.951 position:50% align:middle So again, back to our example of Tanner's, noticing, interpreting, responding, or very often, 00:20:39.951 --> 00:20:44.461 position:50% align:middle we know that nursing clinical judgment involves going through all the steps of clinical review. 00:20:44.461 --> 00:20:50.511 position:50% align:middle So many questions can include multiple layers and dimensions. 00:20:50.511 --> 00:20:56.551 position:50% align:middle So, for example, here's a test question that includes all three. 00:20:56.551 --> 00:21:02.810 position:50% align:middle In blue, you see the cues that have been put into the question to help the students. 00:21:02.810 --> 00:21:10.360 position:50% align:middle Hopefully, the students are identifying these cues of end stage renal, patient is anuric, generalized edema. 00:21:10.360 --> 00:21:15.920 position:50% align:middle And hopefully, they understand the significance of the different information they're seeing. 00:21:15.920 --> 00:21:18.560 position:50% align:middle So they're going through an interpreting phase. 00:21:18.560 --> 00:21:22.260 position:50% align:middle After they've interpreted, that should lead them to actually choosing the 00:21:22.260 --> 00:21:28.440 position:50% align:middle right answer, the appropriate response by the nurse. 00:21:28.440 --> 00:21:32.850 position:50% align:middle So now, we're going to talk about specific clinical teaching, learning strategies, 00:21:32.850 --> 00:21:34.300 position:50% align:middle assessment and evaluation. 00:21:34.300 --> 00:21:36.650 position:50% align:middle But first, we actually have an awareness test. 00:21:36.650 --> 00:21:42.570 position:50% align:middle - [Man 1] This is an awareness test. 00:21:42.570 --> 00:21:45.702 position:50% align:middle How many passes does the team in white make? 00:22:02.000 --> 00:22:04.800 position:50% align:middle The answer is 13. 00:22:04.800 --> 00:22:09.100 position:50% align:middle But did you see the moonwalking bear? 00:22:39.000 --> 00:22:43.750 position:50% align:middle - Okay. Now that we just watched that video, tell me, did you miss the bear? 00:22:43.750 --> 00:22:47.610 position:50% align:middle Most people do because your attention is elsewhere. 00:22:47.610 --> 00:22:52.610 position:50% align:middle The moral of the story, the point of the video is, it's easy to miss something that you're 00:22:52.610 --> 00:22:54.260 position:50% align:middle not looking for. 00:22:54.260 --> 00:22:58.630 position:50% align:middle So the same thing can happen to students when they are not aware of the cognitive components 00:22:58.630 --> 00:23:00.966 position:50% align:middle of clinical judgment. 00:23:00.966 --> 00:23:03.386 position:50% align:middle They might miss those bears. 00:23:03.386 --> 00:23:09.196 position:50% align:middle This is why it's so important that we take time for teaching and learning clinical reasoning concepts. 00:23:09.196 --> 00:23:13.296 position:50% align:middle Really, if you think about it, if a student has not learned how to notice the 00:23:13.296 --> 00:23:18.466 position:50% align:middle observation skills involved, how will they ever be able to recognize the cues 00:23:18.466 --> 00:23:27.156 position:50% align:middle in your test questions or the NCLEX questions or the case study that you develop for evaluation? 00:23:27.156 --> 00:23:29.446 position:50% align:middle So how do we develop noticing? 00:23:29.446 --> 00:23:32.326 position:50% align:middle Well, we can start by bringing awareness to students. 00:23:32.326 --> 00:23:38.396 position:50% align:middle We want them to be aware of what they need to look for, those bears in the room. 00:23:38.396 --> 00:23:42.286 position:50% align:middle So then you're going to ask yourself, how does a nurse practice observing? 00:23:42.286 --> 00:23:46.806 position:50% align:middle Because we want to make sure we bring it back to the real world. 00:23:46.806 --> 00:23:52.586 position:50% align:middle Remember, we're not just preparing them to recognize cues on the test question or the NCLEX exam, 00:23:52.586 --> 00:23:58.036 position:50% align:middle but more importantly, we're preparing them for actual nursing practice. 00:23:58.036 --> 00:24:01.558 position:50% align:middle So what do nurses do when they practice observation skills? 00:24:01.558 --> 00:24:09.028 position:50% align:middle Well, nurses use noticing and observation when they monitor a patient for a complication, for example, 00:24:09.028 --> 00:24:15.688 position:50% align:middle or when they're completing a focused assessment. 00:24:15.688 --> 00:24:19.038 position:50% align:middle When teaching noticing, consider unique features of various clinical 00:24:19.038 --> 00:24:23.198 position:50% align:middle environment such as long-term care versus acute care setting. 00:24:23.198 --> 00:24:29.618 position:50% align:middle In long-term care, nurses may have additional opportunities to get to know their patient baseline 00:24:29.618 --> 00:24:33.068 position:50% align:middle over a longer period of time versus an acute care nurse. 00:24:33.068 --> 00:24:35.748 position:50% align:middle So what would that mean for patient care? 00:24:35.748 --> 00:24:42.258 position:50% align:middle Also, when you're practicing noticing and evaluating noticing, you can use higher-level questioning such 00:24:42.258 --> 00:24:43.808 position:50% align:middle as notice below. 00:24:43.808 --> 00:24:49.178 position:50% align:middle These questions, I use as part of my clinical reasoning, clinical education curriculum that's 00:24:49.178 --> 00:24:55.138 position:50% align:middle grounded in Tanner's Clinical Judgment Model and Lasater's Clinicla Judgment Rubric with concepts 00:24:55.138 --> 00:24:58.398 position:50% align:middle adapted from both of those. 00:24:58.398 --> 00:25:05.895 position:50% align:middle So one thing that I like to do with my students is help them be part of nursing care for this patient, 00:25:05.895 --> 00:25:07.455 position:50% align:middle be part of the team. 00:25:07.455 --> 00:25:13.805 position:50% align:middle I ask them to identify real world focused assessments, such as alcohol withdrawal, NIH stroke scale, 00:25:13.805 --> 00:25:18.185 position:50% align:middle suicide risk assessment, or they can identify a system-based assessment 00:25:18.185 --> 00:25:20.475 position:50% align:middle such as cardiac. 00:25:20.475 --> 00:25:24.615 position:50% align:middle I always tell my students, something is going to go wrong with that patient quite 00:25:24.615 --> 00:25:26.885 position:50% align:middle often within their focused assessment. 00:25:26.885 --> 00:25:33.645 position:50% align:middle So I want to have a student that's very aware of observation and they're doing the right kinds 00:25:33.645 --> 00:25:37.695 position:50% align:middle of observations so that way, they can catch these complications. 00:25:37.695 --> 00:25:43.055 position:50% align:middle For example, I had a student that was able to catch an evolving stroke. 00:25:43.055 --> 00:25:46.855 position:50% align:middle They knew that the focused assessment for their shift needed to be neural, 00:25:46.855 --> 00:25:51.375 position:50% align:middle because of the reason that patient came in with a stroke. 00:25:51.375 --> 00:25:56.345 position:50% align:middle So about halfway through the shift, the student noticed a change in baseline from neuro, 00:25:56.345 --> 00:26:02.200 position:50% align:middle from when they assessed them at the beginning of the shift to now, and they actually went and, you know, 00:26:02.200 --> 00:26:05.410 position:50% align:middle explored it a little bit more, asked another fellow student, you know, 00:26:05.410 --> 00:26:08.260 position:50% align:middle then they came and found me, and we ended up calling a rapid response 00:26:08.260 --> 00:26:10.250 position:50% align:middle for that patient. So that was a good catch for them. 00:26:10.250 --> 00:26:15.840 position:50% align:middle And they caught it because they knew what to look for. 00:26:15.840 --> 00:26:20.620 position:50% align:middle Finally, we want to help students focus on the significance of their noticing. 00:26:20.620 --> 00:26:23.400 position:50% align:middle It helps put meaning to the work and gives them pride. 00:26:23.400 --> 00:26:28.730 position:50% align:middle It helps them understand the why behind their actions. 00:26:28.730 --> 00:26:36.740 position:50% align:middle So an example of this is we had…I had paired up two students for their first day to do an assessment. 00:26:36.740 --> 00:26:40.630 position:50% align:middle It was a long summer so I want them to jump in and do an assessment. 00:26:40.630 --> 00:26:43.000 position:50% align:middle I teach third-semester nursing students. 00:26:43.000 --> 00:26:47.850 position:50% align:middle So they went in and they noticed that the patient was getting a blood transfusion and they did the full 00:26:47.850 --> 00:26:52.750 position:50% align:middle specimen and listened to the lungs, and they noticed that the lungs had freckles in them. 00:26:52.750 --> 00:26:57.560 position:50% align:middle Well, the transfusion was just finishing up so they thought, "What could this mean? 00:26:57.560 --> 00:26:59.320 position:50% align:middle This is probably significant." 00:26:59.320 --> 00:27:02.210 position:50% align:middle So they came out and talked with me about it and then we explored options. 00:27:02.210 --> 00:27:05.890 position:50% align:middle I told them, "Let the nurse know, primary nurse know," because they might want 00:27:05.890 --> 00:27:07.140 position:50% align:middle to follow up, right? 00:27:07.140 --> 00:27:14.310 position:50% align:middle Well, that primary nurse ended up getting a order for LASIK. 00:27:14.310 --> 00:27:18.170 position:50% align:middle So the students were able to feel like they were part of the team, they made a difference for the patient, 00:27:18.170 --> 00:27:22.030 position:50% align:middle and it helped increase their confidence. 00:27:22.030 --> 00:27:25.830 position:50% align:middle Now, for interpreting, we want to help move students thoughtfully 00:27:25.830 --> 00:27:27.620 position:50% align:middle from noticing to interpreting. 00:27:27.620 --> 00:27:29.470 position:50% align:middle What do you think you can ask them? 00:27:29.470 --> 00:27:32.320 position:50% align:middle What do you think about all the data that you just collected? 00:27:32.320 --> 00:27:33.570 position:50% align:middle Do you have any hypothesis? 00:27:33.570 --> 00:27:35.790 position:50% align:middle Do you notice any issues beginning to emerge? 00:27:35.790 --> 00:27:39.090 position:50% align:middle We also want to help them make connections with the data. 00:27:39.090 --> 00:27:44.980 position:50% align:middle Some pieces of information are relevant when considering different priority problems or when certain 00:27:44.980 --> 00:27:50.540 position:50% align:middle pieces of data connect, they might signify a more critical issue. 00:27:50.540 --> 00:27:53.870 position:50% align:middle We want to talk about expected findings versus those critical issues. 00:27:53.870 --> 00:28:01.131 position:50% align:middle For example, a patient with tachycardia postsurgical with pain is going to be treated a little 00:28:01.131 --> 00:28:05.851 position:50% align:middle bit differently, maybe a little different priority than tachycardia with chest pain. 00:28:05.851 --> 00:28:09.301 position:50% align:middle A nurse will put greater weight on the patient with chest pain, but why? 00:28:09.301 --> 00:28:11.181 position:50% align:middle How would a nurse interpret the situation? 00:28:11.181 --> 00:28:14.271 position:50% align:middle So these are great conversations they can have. 00:28:14.271 --> 00:28:19.681 position:50% align:middle Students initially have trouble understanding how all the pieces connect or even which pieces connect. 00:28:19.681 --> 00:28:24.851 position:50% align:middle Having these conversations can help them make these connections. 00:28:24.851 --> 00:28:29.921 position:50% align:middle And then also, you want to have conversations with them about priority issues and how to determine 00:28:29.921 --> 00:28:35.611 position:50% align:middle changing priorities, such as priority nursing diagnosis. 00:28:35.611 --> 00:28:43.941 position:50% align:middle One activity that's really effective that I like to use as a teaching tool and as a way to help do formative 00:28:43.941 --> 00:28:47.501 position:50% align:middle assessments for my students to guide their thinking is concept mapping. 00:28:47.501 --> 00:28:51.981 position:50% align:middle So students can create cognitive linkages between data points and concepts, 00:28:51.981 --> 00:28:54.881 position:50% align:middle which help them with later retrieval of the information. 00:28:54.881 --> 00:29:00.437 position:50% align:middle It helps them categorize information and decide on the logical flow of data points. 00:29:00.437 --> 00:29:07.577 position:50% align:middle For example, they can learn how diarrhea leads to dehydration, which might have led to the patient's 00:29:07.577 --> 00:29:09.207 position:50% align:middle low blood pressure. 00:29:09.207 --> 00:29:14.877 position:50% align:middle When we trace back the origins of the problem, they may identify the importance of not only managing 00:29:14.877 --> 00:29:20.017 position:50% align:middle the dehydration but also identifying treatments that may resolve the diarrhea since the one led 00:29:20.017 --> 00:29:21.097 position:50% align:middle to the other problem. 00:29:21.097 --> 00:29:27.127 position:50% align:middle As a complete concept-based map, new knowledge is constructed. 00:29:27.127 --> 00:29:31.707 position:50% align:middle When knowledge is constructed, it holds more meaning and value to the learner. 00:29:31.707 --> 00:29:34.687 position:50% align:middle You can also use concept mapping as an evaluation tool. 00:29:34.687 --> 00:29:40.407 position:50% align:middle The instructor can see the students thinking since it becomes more visible if you put it down on paper. 00:29:40.407 --> 00:29:44.017 position:50% align:middle You can also use it to discuss the connections and provide feedback to the students. 00:29:44.017 --> 00:29:49.707 position:50% align:middle And another great strategy to use is concept-based learning activities. 00:29:49.707 --> 00:29:54.527 position:50% align:middle These activities help connect back with theory concepts. 00:29:54.527 --> 00:29:57.867 position:50% align:middle It's a great way to practice interpreting. 00:29:57.867 --> 00:30:03.209 position:50% align:middle So concept-based learning offers opportunities to connect clinical experiences with what they're learning 00:30:03.209 --> 00:30:08.249 position:50% align:middle in theory such as disease processes, complications, or body system. 00:30:08.249 --> 00:30:13.579 position:50% align:middle Understanding pathophysiology and disease processes we know are an important part of decision making. 00:30:13.579 --> 00:30:18.699 position:50% align:middle So it's important that we have opportunities to discuss these concepts and help students understand their 00:30:18.699 --> 00:30:20.479 position:50% align:middle connection to patient care. 00:30:20.479 --> 00:30:24.359 position:50% align:middle As students deepen their knowledge of concepts through concept-based learning activities, 00:30:24.359 --> 00:30:32.529 position:50% align:middle they practice making sense of information by retrieving previous knowledge from memory stores. 00:30:32.529 --> 00:30:37.109 position:50% align:middle Here's an example of a concept map one of my students completed. 00:30:37.109 --> 00:30:43.039 position:50% align:middle You look here, and what I do is I have them…I first dump the information that they notice, 00:30:43.039 --> 00:30:46.699 position:50% align:middle what do they notice, and then I have them draw lines and try to identify 00:30:46.699 --> 00:30:48.349 position:50% align:middle the connections between. 00:30:48.349 --> 00:30:53.479 position:50% align:middle The next thing I have them do is to write like a little sentence or a word describing the connection. 00:30:53.479 --> 00:30:55.139 position:50% align:middle So how does one connect with the other? 00:30:55.139 --> 00:31:00.453 position:50% align:middle For this concept map, for example, I might talk with the student about the logical flow 00:31:00.453 --> 00:31:06.793 position:50% align:middle of the condition, viral gastroenteritis, with diarrhea, and encouraging them to connect that with dehydration, 00:31:06.793 --> 00:31:12.313 position:50% align:middle and then we would discuss how it connects to dehydration. 00:31:12.313 --> 00:31:14.143 position:50% align:middle Okay. Now, we move to responding. 00:31:14.143 --> 00:31:17.633 position:50% align:middle So again, real world, how do nurses respond in practice? 00:31:17.633 --> 00:31:25.643 position:50% align:middle Well, a few common things that nurses need to do is communicate, they provide interventions, and of course, 00:31:25.643 --> 00:31:32.243 position:50% align:middle because they have multiple patients on their team, they have to decide how to prioritize care between all 00:31:32.243 --> 00:31:33.883 position:50% align:middle the different patients. 00:31:33.883 --> 00:31:39.273 position:50% align:middle So communication, there's many different forms of communication in healthcare settings. 00:31:39.273 --> 00:31:43.183 position:50% align:middle Some require prompt communication, so talking about situations that need 00:31:43.183 --> 00:31:47.343 position:50% align:middle quick communication, talking about the difference between SBAR, rounding, 00:31:47.343 --> 00:31:49.183 position:50% align:middle report, calling a doctor. 00:31:49.183 --> 00:31:54.013 position:50% align:middle Calling a doctor is probably the most concise form of communication. 00:31:54.013 --> 00:31:57.573 position:50% align:middle Also, we want to have conversations about what guides our interventions. 00:31:57.573 --> 00:32:01.989 position:50% align:middle So if you are in just a maintenance phase, your patient is stable, everything is okay, 00:32:01.989 --> 00:32:06.829 position:50% align:middle you might provide interventions a little different than if they're unstable. 00:32:06.829 --> 00:32:13.059 position:50% align:middle Also, there's a lot of protocols that are used in different healthcare settings now, like a DKA protocol, 00:32:13.059 --> 00:32:15.449 position:50% align:middle even a code blue or a sepsis protocol. 00:32:15.449 --> 00:32:19.789 position:50% align:middle So what's the purpose and how does nurses implement these protocols? 00:32:19.789 --> 00:32:22.999 position:50% align:middle I always tell my students, sometimes, they're just going to give you a list of orders and 00:32:22.999 --> 00:32:28.909 position:50% align:middle it's really up to you to kind of do that decision making and deciding what needs to come first and second 00:32:28.909 --> 00:32:32.709 position:50% align:middle and so on. Finally, like I said, prioritizing care. 00:32:32.709 --> 00:32:36.549 position:50% align:middle So I play a game of who are you going to see first, where I pair students up, 00:32:36.549 --> 00:32:41.339 position:50% align:middle they give report on their patients, and they decide who's the biggest priority and what 00:32:41.339 --> 00:32:46.219 position:50% align:middle interventions they need to complete on for whom and which order they're going to go in, 00:32:46.219 --> 00:32:47.989 position:50% align:middle because the nurse can only be in one place at one time. 00:32:47.989 --> 00:32:53.029 position:50% align:middle And a lot of times, these conversations come with patients that are stable versus unstable. 00:32:53.029 --> 00:32:54.579 position:50% align:middle So we have those conversations too. 00:32:54.579 --> 00:33:00.516 position:50% align:middle And then sometimes, though, if there's not…stability often relies on airway, 00:33:00.516 --> 00:33:05.016 position:50% align:middle breathing, and circulation, but sometimes, the patients are actually stable in those areas. 00:33:05.016 --> 00:33:10.106 position:50% align:middle So then, we talk about identifying underlying issues, because again, you can only do so much as a nurse. 00:33:10.106 --> 00:33:14.746 position:50% align:middle So for example, we had a patient come in with DKA, they were a few days out, 00:33:14.746 --> 00:33:16.806 position:50% align:middle and they were completely stable. 00:33:16.806 --> 00:33:18.616 position:50% align:middle Nothing wrong with airway, breathing, and circulation. 00:33:18.616 --> 00:33:20.066 position:50% align:middle They were completely stable. 00:33:20.066 --> 00:33:22.816 position:50% align:middle So I asked the student, "What is their priority?" 00:33:22.816 --> 00:33:27.896 position:50% align:middle And what they identified was that this patient actually didn't have insurance and so they were cutting back 00:33:27.896 --> 00:33:30.446 position:50% align:middle on their insulin which led to their DKA. 00:33:30.446 --> 00:33:34.416 position:50% align:middle So for that patient, their priority was actually identifying that underlying 00:33:34.416 --> 00:33:39.266 position:50% align:middle issue of not having insurance, so the student is able to connect them with resources. 00:33:39.266 --> 00:33:42.936 position:50% align:middle And also, collaboration is a really important component of responding. 00:33:42.936 --> 00:33:47.646 position:50% align:middle So anytime you can give them a chance to be part of the care team to participate in report, 00:33:47.646 --> 00:33:51.516 position:50% align:middle participate in rounding, or even practice these kinds of skills as a clinical 00:33:51.516 --> 00:33:53.876 position:50% align:middle group is great. Okay. 00:33:53.876 --> 00:33:59.916 position:50% align:middle So here is an activity that I have my students do as for our communication worksheet. 00:33:59.916 --> 00:34:05.342 position:50% align:middle My students are third-semester so they're really familiar with as far in the terminology, 00:34:05.342 --> 00:34:11.062 position:50% align:middle but what I'm trying to do with them at the third-semester level is help them really make their 00:34:11.062 --> 00:34:14.532 position:50% align:middle communication and their thinking much more concise. 00:34:14.532 --> 00:34:18.942 position:50% align:middle So we know when we first start off with students, they have a lot of thoughts, they, you know, 00:34:18.942 --> 00:34:23.352 position:50% align:middle think about everything, they're not quite sure what's important and what's not important. 00:34:23.352 --> 00:34:28.602 position:50% align:middle So we use this activity to actually call a doctor, and I have them call a doctor when it's appropriate or 00:34:28.602 --> 00:34:30.722 position:50% align:middle just practice with each other. 00:34:30.722 --> 00:34:37.932 position:50% align:middle But what I do is provide these guiding questions to help focus their thinking and make it more concise. 00:34:37.932 --> 00:34:42.362 position:50% align:middle So what would a doctor need to know in order for you to support the recommendation? 00:34:42.362 --> 00:34:44.702 position:50% align:middle They don't need to know your whole head to toe assessment, right? 00:34:44.702 --> 00:34:52.892 position:50% align:middle But they do need some supportive, pertinent, logical information. 00:34:52.892 --> 00:34:55.872 position:50% align:middle And then that leads us also to reflecting. 00:34:55.872 --> 00:35:00.310 position:50% align:middle Reflection is a powerful tool where deep learning happens. 00:35:00.310 --> 00:35:04.230 position:50% align:middle So any chance we can increase reflection is good. 00:35:04.230 --> 00:35:08.420 position:50% align:middle So one way that you can include more reflective opportunities in clinical is to actually add 00:35:08.420 --> 00:35:09.820 position:50% align:middle a mid-shift conference. 00:35:09.820 --> 00:35:13.620 position:50% align:middle So I use the mid-shift conference, about 45 minutes to an hour, 00:35:13.620 --> 00:35:16.420 position:50% align:middle in the middle of a clinical shift. 00:35:16.420 --> 00:35:21.370 position:50% align:middle And it's the time where you can think of it as debriefing the first part of the shift. 00:35:21.370 --> 00:35:25.850 position:50% align:middle Students are able to ask questions from me, the instructor, they're able to ask questions 00:35:25.850 --> 00:35:30.880 position:50% align:middle from each other, they're able to gain perspective, compare notes, maybe they've had two similar patients 00:35:30.880 --> 00:35:35.570 position:50% align:middle but they were a little different, and they're also able to revise their plan at this point. 00:35:35.570 --> 00:35:39.220 position:50% align:middle If they're on the right or wrong track, you're able to provide them a little bit 00:35:39.220 --> 00:35:41.120 position:50% align:middle of guidance as well. 00:35:41.120 --> 00:35:44.380 position:50% align:middle So that's been a great way to increase some reflection. 00:35:44.380 --> 00:35:49.250 position:50% align:middle Then they go back in with a little bit of a fresh perspective to finish out the clinical and keep working 00:35:49.250 --> 00:35:50.870 position:50% align:middle with their patient. 00:35:50.870 --> 00:35:55.760 position:50% align:middle Another way that we can increase reflection is through reflective journaling. 00:35:55.760 --> 00:36:00.477 position:50% align:middle Reflective journaling offers additional opportunities for students to practice their thinking and 00:36:00.477 --> 00:36:02.057 position:50% align:middle putting pieces together. 00:36:02.057 --> 00:36:06.797 position:50% align:middle It also gives you, the instructor, opportunities to assess your students' thinking, 00:36:06.797 --> 00:36:11.607 position:50% align:middle and you can engage in conversation with the students, if you like, use it as a teaching tool. 00:36:11.607 --> 00:36:15.477 position:50% align:middle You can provide feedback on their journal. 00:36:15.477 --> 00:36:22.077 position:50% align:middle So here's an example of a journal where Tanner's Clinical Judgment Model is used as a framework 00:36:22.077 --> 00:36:24.937 position:50% align:middle for questions for the students to answer. 00:36:24.937 --> 00:36:30.797 position:50% align:middle So in black are the questions that are provided to student and in the color font, 00:36:30.797 --> 00:36:32.787 position:50% align:middle is the student's response. 00:36:32.787 --> 00:36:38.477 position:50% align:middle So this student noticed, you know, a patient had come in with fluid overload. 00:36:38.477 --> 00:36:41.507 position:50% align:middle Their thoughts went to their focused assessment, because at this point, 00:36:41.507 --> 00:36:43.617 position:50% align:middle they've learned what focused assessment is. 00:36:43.617 --> 00:36:47.387 position:50% align:middle So they're starting to think fluid balance, and then they included things that they noticed 00:36:47.387 --> 00:36:49.097 position:50% align:middle about that that correlate. 00:36:49.097 --> 00:36:52.287 position:50% align:middle Then they go on to talk about how they interpreted their findings. 00:36:52.287 --> 00:36:56.067 position:50% align:middle So they think that there was fluid overload and it's related to chronic kidney disease. 00:36:56.067 --> 00:36:59.567 position:50% align:middle So you can see that they're pulling in some of what they're learning from theory. 00:36:59.567 --> 00:37:02.565 position:50% align:middle So again, integrating all these learning environments. 00:37:02.565 --> 00:37:08.315 position:50% align:middle Then they go to talk about responding. 00:37:08.315 --> 00:37:13.005 position:50% align:middle What they thought was really important was educating the patient on food choices, what they should eat, 00:37:13.005 --> 00:37:14.565 position:50% align:middle what they shouldn't. 00:37:14.565 --> 00:37:18.395 position:50% align:middle So in talking with the patient, they discovered that underlying issue. 00:37:18.395 --> 00:37:20.615 position:50% align:middle What did they learn from the situation? 00:37:20.615 --> 00:37:21.925 position:50% align:middle This is their reflection part. 00:37:21.925 --> 00:37:26.885 position:50% align:middle They've learned that it's important to take time and sit down with patients and teach them something simple, 00:37:26.885 --> 00:37:29.515 position:50% align:middle even about food, good food versus bad food. 00:37:29.515 --> 00:37:32.725 position:50% align:middle So you can tell that there was a lot of learning that happened in this journal. 00:37:32.725 --> 00:37:35.345 position:50% align:middle So it's a great tool, again, for them to think about their learning, 00:37:35.345 --> 00:37:41.165 position:50% align:middle for them to be aware of these pieces of decision making in nursing, and for also you, the instructor, 00:37:41.165 --> 00:37:45.525 position:50% align:middle to see their progression. 00:37:45.525 --> 00:37:47.865 position:50% align:middle So clinical teaching, assessment, and evaluation. 00:37:47.865 --> 00:37:52.905 position:50% align:middle So simulation scenarios are a great learning tool and a great evaluation strategy. 00:37:52.905 --> 00:37:57.545 position:50% align:middle So when you're building your simulation scenarios, keep the end in mind. 00:37:57.545 --> 00:38:03.947 position:50% align:middle You want to build in your clinical judgment process so we can identify your complication or standard of care, 00:38:03.947 --> 00:38:07.667 position:50% align:middle and then you can go through the steps of the clinical judgment measurement model. 00:38:07.667 --> 00:38:09.927 position:50% align:middle What cues should the nurse recognize? 00:38:09.927 --> 00:38:15.387 position:50% align:middle How do they need to analyze their cues to arrive at the priority hypothesis? 00:38:15.387 --> 00:38:17.387 position:50% align:middle What is the solution to the problem? 00:38:17.387 --> 00:38:22.587 position:50% align:middle What steps does the nurse need to take for appropriate action or responding? 00:38:22.587 --> 00:38:27.627 position:50% align:middle We can also build in a need for evaluation and follow-up, for example, 00:38:27.627 --> 00:38:34.917 position:50% align:middle low urine output after treatment, that would signal them to maybe go back in and go 00:38:34.917 --> 00:38:36.067 position:50% align:middle through the cycle again. 00:38:36.067 --> 00:38:45.657 position:50% align:middle And then finally, you can also use a clinical evaluation tool with a clinical judgment 00:38:45.657 --> 00:38:49.947 position:50% align:middle framework in mind. 00:38:49.947 --> 00:38:54.017 position:50% align:middle This is from my clinical reasoning clinical education curriculum. 00:38:54.017 --> 00:38:59.417 position:50% align:middle It's the focus…we have actually 10 different topics that we go through over the course 00:38:59.417 --> 00:39:00.821 position:50% align:middle of the clinical semester. 00:39:00.821 --> 00:39:03.631 position:50% align:middle This is Topic 3, focused assessment. 00:39:03.631 --> 00:39:06.981 position:50% align:middle So this actually just shows how, again, like Janet talked about, 00:39:06.981 --> 00:39:10.101 position:50% align:middle how those pieces come together, the teaching and learning and the 00:39:10.101 --> 00:39:11.541 position:50% align:middle assessment and evaluation. 00:39:11.541 --> 00:39:14.111 position:50% align:middle So at the top is their learning objectives. 00:39:14.111 --> 00:39:18.861 position:50% align:middle And then on the left-hand side, you see teaching methods and strategies. 00:39:18.861 --> 00:39:24.511 position:50% align:middle We have warm-up, we have mid-shift conference items that we go through, and then we have items that are 00:39:24.511 --> 00:39:26.931 position:50% align:middle learning activities throughout the shift. 00:39:26.931 --> 00:39:32.911 position:50% align:middle On the right-hand side is how these learning moments connect with their clinical evaluation tool, 00:39:32.911 --> 00:39:35.751 position:50% align:middle which is what we use to evaluate them in clinical. 00:39:35.751 --> 00:39:40.401 position:50% align:middle We evaluate them halfway through the semester, and they actually evaluate themselves truthfully 00:39:40.401 --> 00:39:45.121 position:50% align:middle as well because it's part of the learning, and then there's an evaluation at the end of the semester. 00:39:45.121 --> 00:39:51.721 position:50% align:middle So this week's learning activities and objectives correlate with the clinical evaluation components, 00:39:51.721 --> 00:39:57.601 position:50% align:middle focused assessment, recognizing deviations for expected patterns, prioritizing data, and information seeking. 00:39:57.601 --> 00:39:59.511 position:50% align:middle Those may sound familiar to you. 00:39:59.511 --> 00:40:01.915 position:50% align:middle They are from Lasater's Clinical Judgment Rubric. 00:40:01.915 --> 00:40:08.145 position:50% align:middle We adapted that to use as our clinical evaluation tool. 00:40:08.145 --> 00:40:14.745 position:50% align:middle - So now, I'm going to talk about using a clinical judgment model to teach in the classroom. 00:40:14.745 --> 00:40:19.945 position:50% align:middle So if you start with noticing, and again, we're still using Tanner's Clinical Judgment Model, 00:40:19.945 --> 00:40:28.185 position:50% align:middle and you can see in the yellow boxes that recognizing cues is a part of Layer 3 of the clinical 00:40:28.185 --> 00:40:30.305 position:50% align:middle judgment measurement model. 00:40:30.305 --> 00:40:33.235 position:50% align:middle In order to notice something, you have to recognize cues. 00:40:33.235 --> 00:40:35.485 position:50% align:middle They're both reliant on each other. 00:40:35.485 --> 00:40:42.795 position:50% align:middle So for an example, I would take, I like to use faculty-made videos that actually model 00:40:42.795 --> 00:40:45.945 position:50% align:middle expert judgment and expert action. 00:40:45.945 --> 00:40:52.705 position:50% align:middle So if we took a patient that, for example, had a respiratory issue and was in the home setting, 00:40:52.705 --> 00:41:00.185 position:50% align:middle we have a nurse who does a visit and visiting another faculty member who actually is acting as a patient, 00:41:00.185 --> 00:41:05.092 position:50% align:middle and like I said, it's on video, the patient has many symptoms, 00:41:05.092 --> 00:41:13.492 position:50% align:middle including circumoral pallor, shortness of breath, clubbed fingers, edema that's noticeable. 00:41:13.492 --> 00:41:18.722 position:50% align:middle And there's also things in the environment that are planted on the video, 00:41:18.722 --> 00:41:26.782 position:50% align:middle such as there could be a package of cigarettes on a table, there could be an inhaler that's not put 00:41:26.782 --> 00:41:34.932 position:50% align:middle together properly, a humidifier that doesn't look clean, anything that you can think of to plant in the 00:41:34.932 --> 00:41:36.852 position:50% align:middle environment that would be a cue. 00:41:36.852 --> 00:41:44.632 position:50% align:middle And then some of the strategies in the classroom that you would use after watching such a video would be 00:41:44.632 --> 00:41:46.782 position:50% align:middle listed there, like think, pair, and share. 00:41:46.782 --> 00:41:53.582 position:50% align:middle You pair the students together and you ask them, "What environmental cues did they see in that video 00:41:53.582 --> 00:41:55.812 position:50% align:middle that were negative?" 00:41:55.812 --> 00:41:57.352 position:50% align:middle And they come up with lists. 00:41:57.352 --> 00:42:04.811 position:50% align:middle And then you could also have them list the cues, the signs and symptoms, that would be of concern. 00:42:04.811 --> 00:42:11.401 position:50% align:middle And then sometimes when you do a video like that, you also have the nurse actually looking at the 00:42:11.401 --> 00:42:18.791 position:50% align:middle patient's record in the home and they may recognize several lab values that are in the chart and they would 00:42:18.791 --> 00:42:23.131 position:50% align:middle have many different types of lab values, both normal and abnormal. 00:42:23.131 --> 00:42:28.781 position:50% align:middle And what you're looking to do is have some rapid identification of abnormal lab values. 00:42:28.781 --> 00:42:31.761 position:50% align:middle And also, a list of patient medication. 00:42:31.761 --> 00:42:36.781 position:50% align:middle That may be medications that interact with each other, depending on the level of the student, 00:42:36.781 --> 00:42:43.541 position:50% align:middle or maybe medications that have a problem, say the person has a renal issue, a high creatinine, 00:42:43.541 --> 00:42:49.631 position:50% align:middle and you have a medication that would cause more of a problem with renal failure. 00:42:49.631 --> 00:42:52.271 position:50% align:middle So any of these can be used in the classroom. 00:42:52.271 --> 00:42:57.951 position:50% align:middle The point of classroom teaching and clinical teaching is to make the line blurry. 00:42:57.951 --> 00:43:01.727 position:50% align:middle We should not be teaching it separately, we should be teaching it together. 00:43:01.727 --> 00:43:07.877 position:50% align:middle And so it's important to keep context, as Lisa said, in the classroom. 00:43:07.877 --> 00:43:11.417 position:50% align:middle When we come to interpreting, it becomes a little more complex. 00:43:11.417 --> 00:43:17.007 position:50% align:middle And again, the best ways to do this, to teach interpreting and to assess interpreting is 00:43:17.007 --> 00:43:18.927 position:50% align:middle to use case studies. 00:43:18.927 --> 00:43:22.627 position:50% align:middle You can use unfolding case studies, you could use faculty videos, 00:43:22.627 --> 00:43:25.447 position:50% align:middle or you could use classroom simulation. 00:43:25.447 --> 00:43:30.857 position:50% align:middle But for an example, for this, you can see that interpreting, you must analyze cues, 00:43:30.857 --> 00:43:34.057 position:50% align:middle set priorities, hypotheses, and generate some illusions, 00:43:34.057 --> 00:43:38.887 position:50% align:middle which are Layer 3 of the clinical judgment measurement model. 00:43:38.887 --> 00:43:41.907 position:50% align:middle So for interpreting, we want to elicit behavior that's aimed 00:43:41.907 --> 00:43:46.957 position:50% align:middle at promoting thinking, we know that, and we know that if we allow students to create 00:43:46.957 --> 00:43:52.417 position:50% align:middle patterns in their mind that they could take the information for interpreting and apply it to different 00:43:52.417 --> 00:43:54.707 position:50% align:middle situations and different patients. 00:43:54.707 --> 00:44:00.331 position:50% align:middle But one of the most important things that we know with interpreting that we have to encourage with students is 00:44:00.331 --> 00:44:06.201 position:50% align:middle that they not only take this theoretical knowledge that we know from the literature and from the textbook, 00:44:06.201 --> 00:44:09.131 position:50% align:middle but they also add patient knowledge. 00:44:09.131 --> 00:44:13.741 position:50% align:middle This is really important, that they understand who the patient is and that the 00:44:13.741 --> 00:44:19.061 position:50% align:middle patient matters when they're interpreting the outcome of data. 00:44:19.061 --> 00:44:24.321 position:50% align:middle So if you look at the types of…the ways we could use this in the classroom, I always think about, "Okay, 00:44:24.321 --> 00:44:26.651 position:50% align:middle how would we teach diabetic emergencies?" 00:44:26.651 --> 00:44:34.951 position:50% align:middle So you have three major diabetic emergencies, DKA, hypoglycemia, and then HHS. 00:44:34.951 --> 00:44:41.551 position:50% align:middle So it's always good to use, as I said, unfolding case studies and look for salient points. 00:44:41.551 --> 00:44:43.121 position:50% align:middle Like, what is abnormal here? 00:44:43.121 --> 00:44:48.631 position:50% align:middle And you might have, on one of the unfolding case studies, a very low blood sugar with a patient who 00:44:48.631 --> 00:44:55.421 position:50% align:middle is confused, and you're asking them to not only eliminate data that's not important but highlight 00:44:55.421 --> 00:45:03.062 position:50% align:middle salient data such as the glucose and the confusion, and then list the priority diagnosis. 00:45:03.062 --> 00:45:13.652 position:50% align:middle Acute confusion or risk for injury would be your highest nursing diagnosis for hypoglycemia. 00:45:13.652 --> 00:45:20.352 position:50% align:middle And then also, you can have them list the three major medical diagnoses that are associated with a patient 00:45:20.352 --> 00:45:26.082 position:50% align:middle with hypoglycemia and what the associated nursing diagnosis might be. 00:45:26.082 --> 00:45:29.042 position:50% align:middle And then we come to responding. 00:45:29.042 --> 00:45:36.972 position:50% align:middle So one of the things we found in previous research is that new graduates, when they get to using SBAR, 00:45:36.972 --> 00:45:39.702 position:50% align:middle are very good at situation and background. 00:45:39.702 --> 00:45:42.472 position:50% align:middle When they come to assessment, they struggle a little bit, 00:45:42.472 --> 00:45:46.082 position:50% align:middle but they really struggle the most with recommendation. 00:45:46.082 --> 00:45:52.172 position:50% align:middle So it's really important that SBAR is practiced over and over again, not only in the clinical area, 00:45:52.172 --> 00:45:55.302 position:50% align:middle but it should be practiced in the classroom as well. 00:45:55.302 --> 00:46:01.814 position:50% align:middle SBAR infuses confidence in students so that when they become new grads, they can go out and communicate 00:46:01.814 --> 00:46:08.064 position:50% align:middle clearly with inter-professionals as well as physicians as well as each other, 00:46:08.064 --> 00:46:13.574 position:50% align:middle and be very clear about what it is they're assessing and what it is their recommendation is. 00:46:13.574 --> 00:46:18.584 position:50% align:middle So remember, responding requires clear interpretation of data. 00:46:18.584 --> 00:46:25.064 position:50% align:middle So that may be why new grads are less comfortable with it because you know in this multi-morbid complex 00:46:25.064 --> 00:46:31.284 position:50% align:middle environment that they have to function in, that the patients are so complex. 00:46:31.284 --> 00:46:36.254 position:50% align:middle So practicing SBAR again infuses some confidence in them. 00:46:36.254 --> 00:46:40.964 position:50% align:middle But one of the ways that I use it in the classroom is to use a case study. 00:46:40.964 --> 00:46:49.614 position:50% align:middle For example, if we think of a patient that has a renal issue, maybe a kidney stone, and you take a patient, 00:46:49.614 --> 00:46:55.534 position:50% align:middle a young patient comes into the doctor's office complaining of right upper back pain, 00:46:55.534 --> 00:47:02.713 position:50% align:middle 9 on a scale of 1 to 10, I mean, the patient is training for a marathon, 00:47:02.713 --> 00:47:09.803 position:50% align:middle the patient claims that they are having a lot of cramps in their legs and the pain is severe. 00:47:09.803 --> 00:47:14.713 position:50% align:middle You ask the patient, so what do you think is going on here and what 00:47:14.713 --> 00:47:16.893 position:50% align:middle intervention do you think is needed? 00:47:16.893 --> 00:47:22.723 position:50% align:middle And they really need to interpret all that information about the potential of dehydration as well as the 00:47:22.723 --> 00:47:27.693 position:50% align:middle potential of a kidney stone, and come up with the response of, you know, 00:47:27.693 --> 00:47:33.803 position:50% align:middle what they might see as a doctor's orders, such as a clean catch urine, increase fluid, 00:47:33.803 --> 00:47:35.403 position:50% align:middle start an IV. 00:47:35.403 --> 00:47:40.443 position:50% align:middle And then you might use what effects assizes to give them other data. 00:47:40.443 --> 00:47:46.983 position:50% align:middle What if the patient had a cardiac background and the pain was so severe and the pain was radiating? 00:47:46.983 --> 00:47:50.783 position:50% align:middle What if the patient had a previous MI? 00:47:50.783 --> 00:47:57.953 position:50% align:middle What if the patient was actually in fluid overload and was still complaining of this pain? 00:47:57.953 --> 00:48:06.482 position:50% align:middle So there were several ways in the classroom that we can promote responding and interpretation but one of the 00:48:06.482 --> 00:48:09.902 position:50% align:middle best ways, as I said, is to make sure that we're using a flipped 00:48:09.902 --> 00:48:11.702 position:50% align:middle classroom more often. 00:48:11.702 --> 00:48:16.582 position:50% align:middle Because this makes sure that that the students read the textbook, understand, 00:48:16.582 --> 00:48:22.462 position:50% align:middle and are able to come in and practice clinical judgment development in the classroom. 00:48:22.462 --> 00:48:25.732 position:50% align:middle So then reflection, as Lisa said, reflection is so important. 00:48:25.732 --> 00:48:29.262 position:50% align:middle There's so much learning that takes place when we use reflection. 00:48:29.262 --> 00:48:32.982 position:50% align:middle And the best way to do this is Socratic questioning. 00:48:32.982 --> 00:48:34.332 position:50% align:middle What is the outcome? 00:48:34.332 --> 00:48:36.092 position:50% align:middle What could be done differently? 00:48:36.092 --> 00:48:37.422 position:50% align:middle What have you learned? 00:48:37.422 --> 00:48:41.652 position:50% align:middle And this, I often use in the classroom, what's called a one-minute paper. 00:48:41.652 --> 00:48:47.222 position:50% align:middle If I've taught something that I think may have been more complex and some students may not have 00:48:47.222 --> 00:48:50.172 position:50% align:middle understood it, I have them, before the end of the classroom, just write, 00:48:50.172 --> 00:48:51.962 position:50% align:middle what did they learn from this class. 00:48:51.962 --> 00:48:55.462 position:50% align:middle And then you can see where there is some confusion. 00:48:55.462 --> 00:49:03.514 position:50% align:middle But again, reflection and debriefing, as the NLN in 2015 published, 00:49:03.514 --> 00:49:07.294 position:50% align:middle debriefing across the curriculum is important at all levels. 00:49:07.294 --> 00:49:10.544 position:50% align:middle So that's something that we should remember, not just in the clinical area, 00:49:10.544 --> 00:49:16.434 position:50% align:middle but debriefing can also be done in the classroom, after simulation with classroom simulation, 00:49:16.434 --> 00:49:22.864 position:50% align:middle it can also be done just after a difficult lesson or a difficult learning experience. 00:49:22.864 --> 00:49:27.154 position:50% align:middle So Lisa and I are just going to talk about the key points of this session. 00:49:27.154 --> 00:49:31.604 position:50% align:middle So clinical judgment models provides structure of a teaching and learning where the clinical judgment 00:49:31.604 --> 00:49:34.534 position:50% align:middle measurement model guides assessment and evaluation. 00:49:34.534 --> 00:49:38.514 position:50% align:middle So there, again, remember the puzzle pieces, they fit together beautifully, 00:49:38.514 --> 00:49:42.824 position:50% align:middle the clinical judgment model with the clinical judgment measurement model. 00:49:42.824 --> 00:49:47.994 position:50% align:middle And also, what's really important is to add context, not just to the clinical situation, 00:49:47.994 --> 00:49:53.034 position:50% align:middle obviously you have context, but add context to the classroom situation as well 00:49:53.034 --> 00:49:56.084 position:50% align:middle as to the strategies that influence clinical judgment. 00:49:56.084 --> 00:50:01.234 position:50% align:middle And then as Lisa had said, in the classroom or in clinical, 00:50:01.234 --> 00:50:08.344 position:50% align:middle we need to add stop points so the students have a chance to demonstrate what they're thinking and also, 00:50:08.344 --> 00:50:12.764 position:50% align:middle we can identify errors in judgment and misconceptions. 00:50:12.764 --> 00:50:20.234 position:50% align:middle - And also, we want to create patterns that can be transferred to different situations that can 00:50:20.234 --> 00:50:22.674 position:50% align:middle promote theoretical recognition. 00:50:22.674 --> 00:50:29.324 position:50% align:middle Also, consistent recognition and use of pattern may enhance ability to use theoretical information. 00:50:29.324 --> 00:50:34.944 position:50% align:middle So as they're learning the different steps of clinical judgment models, they'll be able to recognize 00:50:34.944 --> 00:50:40.584 position:50% align:middle those patterns, when they are in clinical situations, when we're talking about it in the classroom, 00:50:40.584 --> 00:50:42.414 position:50% align:middle or even in the laboratory. 00:50:42.414 --> 00:50:47.294 position:50% align:middle And that leads to the final point of debriefing across the curriculum is important at all level. 00:50:47.294 --> 00:50:51.654 position:50% align:middle So you could start it with your early students and earlier in the program, 00:50:51.654 --> 00:50:55.744 position:50% align:middle and then continue it all the way through the program and they'll be able to develop all these 00:50:55.744 --> 00:50:56.814 position:50% align:middle skills really nicely. 00:50:56.814 --> 00:51:05.366 position:50% align:middle So this leads us to the conclusion of our presentation and we have all the different references that we talked 00:51:05.366 --> 00:51:11.876 position:50% align:middle about so that way, they can be resources for you and your nursing program as you think about ways 00:51:11.876 --> 00:51:18.286 position:50% align:middle to incorporate clinical judgment models for teaching and learning and also the clinical judgment measurement 00:51:18.286 --> 00:51:20.956 position:50% align:middle model to help with evaluation and assessment. 00:51:20.956 --> 00:51:27.156 position:50% align:middle And like Janet said, together, they really piece nicely together for a whole 00:51:27.156 --> 00:51:30.486 position:50% align:middle curricular approach to teaching and learning clinical judgment. Thank you. 00:51:30.486 --> 00:51:32.920 position:50% align:middle - Thank you. 00:51:50.000 --> 00:51:52.090 position:50% align:middle - [Man 2] Thank you, Lisa. Thank you, Janet. 00:51:52.090 --> 00:51:55.730 position:50% align:middle We, as expected, received numerous questions. 00:51:55.730 --> 00:52:02.061 position:50% align:middle And I think the one with the most likes was, Lisa, can you share the moonwalking bear video? 00:52:02.061 --> 00:52:03.461 position:50% align:middle Folks would like to use that in class. 00:52:03.461 --> 00:52:05.671 position:50% align:middle Is there a way they can find that or get that from you? 00:52:05.671 --> 00:52:07.651 position:50% align:middle - Yeah, absolutely. 00:52:07.651 --> 00:52:11.311 position:50% align:middle So I actually think I saw that somebody found the link. 00:52:11.311 --> 00:52:13.311 position:50% align:middle We have really resourceful folks out there. 00:52:13.311 --> 00:52:20.621 position:50% align:middle Somebody found the link and had posted it but it was…if you go to YouTube, I think it's a search 00:52:20.621 --> 00:52:22.501 position:50% align:middle of awareness test. 00:52:22.501 --> 00:52:25.451 position:50% align:middle And that's my favorite, but there's a few others as well. 00:52:25.451 --> 00:52:28.661 position:50% align:middle - Fantastic. 00:52:28.661 --> 00:52:32.201 position:50% align:middle And yes, like you said, I think if folks scroll up a little bit in the chat, 00:52:32.201 --> 00:52:36.281 position:50% align:middle they'll see that somebody did find a link to it as well on YouTube. Fantastic. 00:52:36.281 --> 00:52:40.081 position:50% align:middle I think this is going to be a question for both of you, but Lisa, I'm going to start with you, 00:52:40.081 --> 00:52:43.751 position:50% align:middle and that is that the Benner and Dreyfus models associate clinical judgment with more 00:52:43.751 --> 00:52:47.841 position:50% align:middle experienced nurses, how do we reconcile this with attempts to measure clinical judgment 00:52:47.841 --> 00:52:51.101 position:50% align:middle at the pre-licensure level? 00:52:51.101 --> 00:52:58.381 position:50% align:middle - Well, you know, that's one reason why, you know, at our program, I shared some of the things that we're 00:52:58.381 --> 00:53:02.957 position:50% align:middle doing in my program, we do use Lasater's Clinical Judgment Rubric because it 00:53:02.957 --> 00:53:09.977 position:50% align:middle does show that developing, starting at that really beginning level and then being 00:53:09.977 --> 00:53:13.897 position:50% align:middle able to work through but also for us, it's been that consistency. 00:53:13.897 --> 00:53:20.117 position:50% align:middle So we use that same clinical evaluation tool starting in the first semester and then carrying it through. 00:53:20.117 --> 00:53:27.697 position:50% align:middle And then we have a level of expectation that we're hoping that they reach, you know, for example, 00:53:27.697 --> 00:53:30.957 position:50% align:middle developing by such and such a point in time. 00:53:30.957 --> 00:53:37.107 position:50% align:middle And so I feel like that understanding that they're not going to get it all right away, 00:53:37.107 --> 00:53:39.537 position:50% align:middle but that you are presenting those opportunities. 00:53:39.537 --> 00:53:47.757 position:50% align:middle And again, for me, just making sure that I'm teaching those skills, because when I first started using the 00:53:47.757 --> 00:53:51.187 position:50% align:middle clinical evaluation tool, I thought, "This is a great tool to evaluate students' clinical 00:53:51.187 --> 00:53:57.377 position:50% align:middle judgment," but I felt like it was not fair if I didn't spend the time teaching the actual clinical reasoning 00:53:57.377 --> 00:54:00.626 position:50% align:middle skills involved, like the observation, like, you know, 00:54:00.626 --> 00:54:03.524 position:50% align:middle their focused observation and how nurses actually do this in practice. 00:54:03.524 --> 00:54:09.334 position:50% align:middle So I think just starting at the basic level in, you know, foundations, for example of, hey, 00:54:09.334 --> 00:54:11.734 position:50% align:middle let's talk about a head to toe assessment first of all. 00:54:11.734 --> 00:54:13.544 position:50% align:middle Let's talk about noticing when you walk in the room. 00:54:13.544 --> 00:54:18.744 position:50% align:middle And then when they get into later semester, for example, I teach third-semester nursing students, 00:54:18.744 --> 00:54:21.554 position:50% align:middle so I expect them to know what a head to toe assessment is. 00:54:21.554 --> 00:54:27.444 position:50% align:middle So now, let's talk about those finer assessments like the focused assessment and the utility of that 00:54:27.444 --> 00:54:30.824 position:50% align:middle in recognizing deviations from expected patterns. 00:54:30.824 --> 00:54:38.514 position:50% align:middle So I think just how you build your curriculum can lend itself to honoring the fact that yes, 00:54:38.514 --> 00:54:40.994 position:50% align:middle this is a continuum. 00:54:40.994 --> 00:54:44.194 position:50% align:middle Yes, they do need time to develop these skills over time. 00:54:44.194 --> 00:54:49.324 position:50% align:middle - Lisa, thank you. 00:54:49.324 --> 00:54:52.104 position:50% align:middle And Janet, would you like to add anything to that? 00:54:52.104 --> 00:54:53.454 position:50% align:middle - Yeah. 00:54:53.454 --> 00:54:57.504 position:50% align:middle I think that it's good for everyone to understand that although Tanner's model, 00:54:57.504 --> 00:55:04.024 position:50% align:middle her research was done on experts, but what we do know is that Tanner and Lasater work 00:55:04.024 --> 00:55:10.744 position:50% align:middle together and the Lasater Clinical Judgment Rubric kind of spelled out a way to show progress 00:55:10.744 --> 00:55:12.574 position:50% align:middle towards Tanner's model. 00:55:12.574 --> 00:55:17.504 position:50% align:middle And I think that that's really what Lisa said, but I think when you look at the two together, 00:55:17.504 --> 00:55:28.544 position:50% align:middle you can see clearly that the LCJR is the way that we do show progress towards having an expert nurse. 00:55:28.544 --> 00:55:29.984 position:50% align:middle - Janet, thank you. 00:55:29.984 --> 00:55:31.954 position:50% align:middle And you brought up the LCJR. 00:55:31.954 --> 00:55:36.314 position:50% align:middle A question came in, is the Lasater Clinical Judgment Rubric specifically designed 00:55:36.314 --> 00:55:41.704 position:50% align:middle for pre-licensure students? 00:55:41.704 --> 00:55:44.414 position:50% align:middle - Do you want me to take that? 00:55:44.414 --> 00:55:45.824 position:50% align:middle - Go ahead, you can start? 00:55:45.824 --> 00:55:46.924 position:50% align:middle - Oh, yes. Please, Janet. 00:55:46.924 --> 00:55:49.404 position:50% align:middle - Yeah. Okay. Yeah. I do believe that it is. 00:55:49.404 --> 00:55:51.574 position:50% align:middle Lisa, do you know differently? 00:55:51.574 --> 00:55:53.134 position:50% align:middle - No. I do believe it was. 00:55:53.134 --> 00:55:58.244 position:50% align:middle What's interesting about the Lasater's Clinical Judgment Rubric is it was built 00:55:58.244 --> 00:56:00.353 position:50% align:middle by observing simulation. 00:56:00.353 --> 00:56:06.093 position:50% align:middle So initially, it was built as like a really great evaluation tool for students during simulation. 00:56:06.093 --> 00:56:09.323 position:50% align:middle But if you look at the literature, it's been adapted in numerous ways, 00:56:09.323 --> 00:56:13.643 position:50% align:middle including for new nurse graduate population. 00:56:13.643 --> 00:56:19.373 position:50% align:middle So you'll have to double-check the reliability and validity studies for all the adaptive ways but there 00:56:19.373 --> 00:56:21.113 position:50% align:middle are even those available as well too. 00:56:21.113 --> 00:56:26.203 position:50% align:middle And like I had mentioned, we adapted it as our clinical evaluation tool and I saw 00:56:26.203 --> 00:56:29.563 position:50% align:middle somebody else out there had also done the same. 00:56:29.563 --> 00:56:32.913 position:50% align:middle So that was great sharing that work. 00:56:32.913 --> 00:56:38.373 position:50% align:middle - In Lasater Clinical Judgment Rubric, her article, 2007, describes how she made it. 00:56:38.373 --> 00:56:46.383 position:50% align:middle And it was made using pre-licensure students, so that's why I believe that that's the intention. 00:56:46.383 --> 00:56:49.153 position:50% align:middle - Janet and Lisa, thank you for that. 00:56:49.153 --> 00:56:55.163 position:50% align:middle Also related to the Lasater Clinical Judgment Model or Rubric, would you expect that students should attain 00:56:55.163 --> 00:56:57.133 position:50% align:middle mastery before graduation? 00:56:57.133 --> 00:57:01.219 position:50% align:middle - So we… - Pardon me. I should have said exemplary. 00:57:01.219 --> 00:57:08.969 position:50% align:middle - You know what, we, so Janet and I, she mentioned that we have participated in research. 00:57:08.969 --> 00:57:16.179 position:50% align:middle So part of our research team is Mary Ann Jessee, Ann Nielsen, Kathie Lasater, 00:57:16.179 --> 00:57:18.549 position:50% align:middle and Phil Dickinson as part of the research project. 00:57:18.549 --> 00:57:25.299 position:50% align:middle So we've actually had conversations recently about what should we expect from students really. 00:57:25.299 --> 00:57:28.799 position:50% align:middle And so some of our...you know, some of the thoughts that I have personally, 00:57:28.799 --> 00:57:34.989 position:50% align:middle I'll share, and I believe Janet, you know, feel similarly, but I feel like it does not, 00:57:34.989 --> 00:57:38.519 position:50% align:middle and it's especially based on some of the new studies coming out. 00:57:38.519 --> 00:57:46.949 position:50% align:middle You might be aware of Kavanagh, new study, 2021, but it does appear that the evidence suggests that it 00:57:46.949 --> 00:57:53.489 position:50% align:middle is not realistic to expect students to be all the way at the very top level of proficiency. 00:57:53.489 --> 00:58:03.558 position:50% align:middle So to me, that speaks to how important those practice partnerships are, that we are communicating with those 00:58:03.558 --> 00:58:06.778 position:50% align:middle who have the new nurse residency programs. 00:58:06.778 --> 00:58:10.068 position:50% align:middle And, you know, maybe there could be some kind of transition point. 00:58:10.068 --> 00:58:17.528 position:50% align:middle You know, for us, we use the same Lasater's Clinical Judgment Rubric as our clinical evaluation tool, 00:58:17.528 --> 00:58:23.808 position:50% align:middle and then we expect students to maybe make it at a Level 2 and then Level 3, you know. 00:58:23.808 --> 00:58:29.098 position:50% align:middle So maybe that's where they should make it and then they move on to their first year of their 00:58:29.098 --> 00:58:30.258 position:50% align:middle nurse residency program. 00:58:30.258 --> 00:58:33.278 position:50% align:middle So I feel like the evidence would suggest that that is true. 00:58:33.278 --> 00:58:35.968 position:50% align:middle Go ahead, Janet, what do you think? 00:58:35.968 --> 00:58:39.338 position:50% align:middle - No. I think that's exactly true. 00:58:39.338 --> 00:58:44.268 position:50% align:middle I don't think that we should ever expect that everyone's going to get to exemplary and I don't think 00:58:44.268 --> 00:58:50.458 position:50% align:middle that was the intention either when Kathie made that tool. 00:58:50.458 --> 00:58:52.738 position:50% align:middle - Okay. Thank you. 00:58:52.738 --> 00:58:54.178 position:50% align:middle Question for both of you. 00:58:54.178 --> 00:58:55.618 position:50% align:middle And Janet, maybe I'll start with you. 00:58:55.618 --> 00:59:00.772 position:50% align:middle How do you envision applying clinical judgment in courses prior to clinical experience 00:59:00.772 --> 00:59:04.702 position:50% align:middle or clinical experiences? 00:59:04.702 --> 00:59:10.552 position:50% align:middle - So in the classroom, I think that it's really important for us to start 00:59:10.552 --> 00:59:15.262 position:50% align:middle off talking about patients in the classroom in the very early courses, even when you're talking 00:59:15.262 --> 00:59:19.542 position:50% align:middle about pathophysiology or pharmacology, that's before a clinical course, right? 00:59:19.542 --> 00:59:24.772 position:50% align:middle And I think that it's really important to talk about what it is the nurse would notice, interpret, 00:59:24.772 --> 00:59:28.882 position:50% align:middle how she would respond, and how she would reflect upon the situation. 00:59:28.882 --> 00:59:37.722 position:50% align:middle I think it's very easy to integrate this in to any curriculum at a very early place because there is a 00:59:37.722 --> 00:59:41.872 position:50% align:middle similarity to how we talk about nursing process. 00:59:41.872 --> 00:59:48.532 position:50% align:middle The difference is that, you know, Tanner's model adds all of the context and adds a lot 00:59:48.532 --> 00:59:51.912 position:50% align:middle more steps and a lot more theoretical background. 00:59:51.912 --> 00:59:56.212 position:50% align:middle So I do believe that it's something the student should be aware of. 00:59:56.212 --> 01:00:02.301 position:50% align:middle And then when I think about the clinical judgment measurement model, I think that's something that we use 01:00:02.301 --> 01:00:06.081 position:50% align:middle as educators and not something that the students have to be aware of at all. 01:00:06.081 --> 01:00:08.441 position:50% align:middle So that's where I make the distinction. 01:00:08.441 --> 01:00:12.751 position:50% align:middle The clinical judgment model should be something that the students are aware of very early 01:00:12.751 --> 01:00:20.761 position:50% align:middle in their education, but the measurement model can be for just educators. 01:00:20.761 --> 01:00:23.841 position:50% align:middle - Lisa, anything you'd like to add? 01:00:23.841 --> 01:00:26.341 position:50% align:middle - I think Janet did a really great job of describing it. 01:00:26.341 --> 01:00:30.741 position:50% align:middle I agree with her, I mean, incorporating this type of thinking. 01:00:30.741 --> 01:00:34.001 position:50% align:middle So really, what we're trying to say is we want to develop their thinking, right? 01:00:34.001 --> 01:00:38.671 position:50% align:middle And so the easy answer is absolutely yes, include that in the classroom. 01:00:38.671 --> 01:00:44.951 position:50% align:middle Now, when you start having clinical experiences, it does provide a natural context in which a nurse, 01:00:44.951 --> 01:00:50.941 position:50% align:middle you know, and a student can be presented with situations that are realistic, true to life, 01:00:50.941 --> 01:00:52.221 position:50% align:middle that they can practice this thinking. 01:00:52.221 --> 01:00:55.511 position:50% align:middle But I think you can also do that in classroom as well. 01:00:55.511 --> 01:00:59.631 position:50% align:middle I love some of the creative strategies out there and where people are actually bringing simulation 01:00:59.631 --> 01:01:04.750 position:50% align:middle opportunities into their classroom or unpacking case studies in their classroom. 01:01:04.750 --> 01:01:10.430 position:50% align:middle So maybe the student hasn't actually seen a real life patient yet but I mean, 01:01:10.430 --> 01:01:14.680 position:50% align:middle by being presented with this opportunity, they already can start that type of thinking. 01:01:14.680 --> 01:01:18.140 position:50% align:middle - Thank you, Lisa. 01:01:18.140 --> 01:01:23.850 position:50% align:middle And then we also had a question that I think, Janet, you actually answered in your previous response 01:01:23.850 --> 01:01:29.870 position:50% align:middle but Lisa, I want to send it to you directly, which is, do you believe there's any need or benefit or value 01:01:29.870 --> 01:01:33.920 position:50% align:middle in students knowing the NCSBN clinical judgment measurement model? 01:01:33.920 --> 01:01:43.770 position:50% align:middle - I think that the focus should be on developing their clinical reasoning skills in order to make 01:01:43.770 --> 01:01:45.800 position:50% align:middle sound clinical judgment. 01:01:45.800 --> 01:01:53.280 position:50% align:middle And I think that how you best do that is with understandable language, good conversations, 01:01:53.280 --> 01:01:56.530 position:50% align:middle and taking them back to real world, what do nurses do. 01:01:56.530 --> 01:02:03.083 position:50% align:middle So for me, personally, I do like teaching with the language of Tanner's model 01:02:03.083 --> 01:02:07.013 position:50% align:middle and the Lasater Clinical Judgment Rubric. 01:02:07.013 --> 01:02:10.123 position:50% align:middle The example that I always like to share is that focused observation. 01:02:10.123 --> 01:02:12.593 position:50% align:middle So again, real world application. 01:02:12.593 --> 01:02:17.443 position:50% align:middle What do nurses do when they're doing focused observations, while they're doing focused assessments, 01:02:17.443 --> 01:02:23.453 position:50% align:middle you know, while they're trying to recognize different patient complications? 01:02:23.453 --> 01:02:30.703 position:50% align:middle I feel like the best way you can…tools you can use to facilitate those conversations is better. 01:02:30.703 --> 01:02:36.063 position:50% align:middle And, you know, one of the things that I've been saying is, in the clinical judgment measurement model, 01:02:36.063 --> 01:02:38.743 position:50% align:middle recognizing cues is a step, right? 01:02:38.743 --> 01:02:44.093 position:50% align:middle But if we haven't had those conversations about, okay, well, how do nurses recognize cues? 01:02:44.093 --> 01:02:46.163 position:50% align:middle Like, how do they even start the process of looking? 01:02:46.163 --> 01:02:54.953 position:50% align:middle Well, they are doing focused assessments and they are analyzing the data that's available when they 01:02:54.953 --> 01:02:57.653 position:50% align:middle get report, when they're looking in the electronic health record. 01:02:57.653 --> 01:03:03.871 position:50% align:middle They are using their knowledge of pathophysiology, they are analyzing situations as they unfold. 01:03:03.871 --> 01:03:12.521 position:50% align:middle So again, you're not going to recognize cues until you've learned those observation skills. 01:03:12.521 --> 01:03:14.601 position:50% align:middle - Thank you, Lisa. 01:03:14.601 --> 01:03:21.121 position:50% align:middle And there was an observation that with your clinical being evaluated twice per semester, 01:03:21.121 --> 01:03:23.161 position:50% align:middle are you able to assign grade or is it pass/fail? 01:03:23.161 --> 01:03:27.211 position:50% align:middle - So for us, it's actually pass/fail. 01:03:27.211 --> 01:03:32.261 position:50% align:middle - Okay. 01:03:32.261 --> 01:03:36.421 position:50% align:middle So let me go to community-based nursing. 01:03:36.421 --> 01:03:42.301 position:50% align:middle How can we apply these concepts to community-based nursing, something stressed in new essentials? 01:03:42.301 --> 01:03:44.581 position:50% align:middle And let's start with Janet. 01:03:44.581 --> 01:03:49.491 position:50% align:middle - So I happen to teach community-based nursing, public health nursing, 01:03:49.491 --> 01:03:53.971 position:50% align:middle and I apply them on a regular basis in the classroom and clinical. 01:03:53.971 --> 01:03:59.961 position:50% align:middle I think when we talk about community-based nursing, it can be applied just as I talked about, you know, 01:03:59.961 --> 01:04:01.579 position:50% align:middle in my session. 01:04:01.579 --> 01:04:08.949 position:50% align:middle You know, you take the patient in a certain environment and you still apply the same steps to making a decision 01:04:08.949 --> 01:04:10.329 position:50% align:middle about clinical judgment. 01:04:10.329 --> 01:04:20.339 position:50% align:middle So it's really about making sure that your case studies or your classroom discussions or your simulations have 01:04:20.339 --> 01:04:25.079 position:50% align:middle enough detail when you put them in a different place like a community, like a doctor's office, 01:04:25.079 --> 01:04:30.069 position:50% align:middle it could be at a Boys and Girls Club, it could be anywhere, 01:04:30.069 --> 01:04:39.379 position:50% align:middle and that students are able to zoom in and still be able to notice, interpret, respond, and reflect on learning. 01:04:39.379 --> 01:04:47.569 position:50% align:middle So I really do believe it's inherent to the educator to actually make those changes in the case studies where 01:04:47.569 --> 01:04:52.479 position:50% align:middle it can easily be applied. 01:04:52.479 --> 01:04:55.819 position:50% align:middle - Okay. And Lisa, how about you? How would you approach? 01:04:55.819 --> 01:04:59.839 position:50% align:middle - I was going to say, I love Janet's response, because she is the expert here. 01:04:59.839 --> 01:05:01.833 position:50% align:middle She's taught there. 01:05:01.833 --> 01:05:07.073 position:50% align:middle But from what I understand about community-based nursing, sometimes, the students are not in one whole 01:05:07.073 --> 01:05:11.823 position:50% align:middle clinical group experiencing these going out into the community. 01:05:11.823 --> 01:05:20.023 position:50% align:middle So I would think journaling would be exceptionally beneficial to be able to bring back those experiences 01:05:20.023 --> 01:05:24.403 position:50% align:middle in a journal where the educator, you know, and again, I showed you guys the format of the journal, 01:05:24.403 --> 01:05:27.063 position:50% align:middle how you can use the Tanner's model. 01:05:27.063 --> 01:05:32.913 position:50% align:middle So that was the work…it was adapted from Ann Nielsen and Kathie Lasater. 01:05:32.913 --> 01:05:39.103 position:50% align:middle But the noticing and interpreting and responding, so then being able to take their situation in the 01:05:39.103 --> 01:05:44.013 position:50% align:middle community base and then to follow up and then write it up, and then you, the nurse educator, 01:05:44.013 --> 01:05:48.643 position:50% align:middle maybe you weren't with them on that clinical experience, maybe the other students weren't there, 01:05:48.643 --> 01:05:53.763 position:50% align:middle but they can reflect on their experiences and write them up and then you're able to really evaluate their 01:05:53.763 --> 01:05:55.783 position:50% align:middle thinking in that way. 01:05:55.783 --> 01:06:00.552 position:50% align:middle And then maybe even have like a weekly post-conference where all the students come together and then you can 01:06:00.552 --> 01:06:04.072 position:50% align:middle still go through that same format of what kinds of things did they notice. 01:06:04.072 --> 01:06:08.072 position:50% align:middle I feel like when students are able to compare notes, it just expands their clinical experiences. 01:06:08.072 --> 01:06:12.562 position:50% align:middle That one patient becomes a patient for all of them, even though they weren't there so it almost becomes 01:06:12.562 --> 01:06:18.922 position:50% align:middle like a case study patient for them if you, the educator, do a good job of helping create a 01:06:18.922 --> 01:06:24.742 position:50% align:middle framework that they can unpack their experiences in a way that's going to promote their clinical judgment. 01:06:24.742 --> 01:06:29.672 position:50% align:middle - Okay, Lisa, thank you. 01:06:29.672 --> 01:06:33.792 position:50% align:middle And then this is something that each of you may have addressed a bit but just in case. 01:06:33.792 --> 01:06:35.462 position:50% align:middle Lisa, let me start with you. 01:06:35.462 --> 01:06:39.072 position:50% align:middle Can you share your clinical evaluation tool? 01:06:39.072 --> 01:06:47.092 position:50% align:middle - Let me double-check if there's any...you know, I'll ask my nursing program but I 01:06:47.092 --> 01:06:49.212 position:50% align:middle personally wouldn't mind. I love sharing ideas. 01:06:49.212 --> 01:06:51.472 position:50% align:middle I think this is how we learn and grow from each other. 01:06:51.472 --> 01:06:52.802 position:50% align:middle You know, collaboration is a good thing. 01:06:52.802 --> 01:06:54.452 position:50% align:middle So let me double-check. 01:06:54.452 --> 01:06:59.232 position:50% align:middle I don't know if there's a way to generate a list of those that might be interested. 01:06:59.232 --> 01:07:03.480 position:50% align:middle It is an adapted version of Lasater's Clinical Judgment Rubric, but at least, 01:07:03.480 --> 01:07:09.080 position:50% align:middle just to go through the process of explaining how the adapted version connects with the actual Lasater's 01:07:09.080 --> 01:07:13.920 position:50% align:middle Clinical Judgment Rubric and perhaps maybe the implementation of it, 01:07:13.920 --> 01:07:17.310 position:50% align:middle I'm sure would serve other programs well. 01:07:17.310 --> 01:07:20.060 position:50% align:middle You know, sometimes, it's nice to know the process of how other people did 01:07:20.060 --> 01:07:25.190 position:50% align:middle things and then you can replicate it and make it fit your own program. 01:07:25.190 --> 01:07:28.240 position:50% align:middle - Yeah. Terrific. And then, Janet, same question. 01:07:28.240 --> 01:07:31.050 position:50% align:middle Would you be able to share your clinical evaluation tool? 01:07:31.050 --> 01:07:35.480 position:50% align:middle - We haven't adapted our clinical evaluation tool yet. 01:07:35.480 --> 01:07:40.640 position:50% align:middle We're in the process at MGH Institute of Health of changing some of those things. 01:07:40.640 --> 01:07:45.210 position:50% align:middle So no, I wouldn't be able to share it because I don't have it done yet. 01:07:45.210 --> 01:07:47.730 position:50% align:middle - Okay. Well, thank you for that. 01:07:47.730 --> 01:07:55.110 position:50% align:middle It looks like I've come to the end of the list of questions, Janet and Lisa, for your program. 01:07:55.110 --> 01:08:00.600 position:50% align:middle So thank you very much for the presentations and for staying on for our live Q&A. 01:08:00.600 --> 01:08:06.590 position:50% align:middle And with that, I'll invite attendees to begin the final break of our program, 01:08:06.590 --> 01:08:12.400 position:50% align:middle but be sure to be back by 1:30 Central Time for our presentation on test design. 01:08:12.400 --> 01:08:15.400 position:50% align:middle So thank you very much, Janet, Lisa, thanks again. 01:08:15.400 --> 01:08:18.070 position:50% align:middle - All right, bye-bye. 01:08:18.070 --> 01:08:19.602 position:50% align:middle - Bye.