Clinical Reasoning, Judgment, and Safe Medication Administration Practices in Senior Nursing Students.

BACKGROUND AND PURPOSE: Medication errors occur at alarming rates. Safe medication administration practices require more than observing patient safety rights and psychomotor skills. The purpose of this study was to explore the relationships between clinical judgment skills and reasoning processes and safe medication practices in senior nursing students. METHODS: Using a cross-sectional design, 29 students from 3 schools of nursing watched a video simulation of a nurse administering medications in a clinical setting. At predetermined times, reflections on the medication administration practices were journaled. Journals were scored for clinical reasoning processes and clinical judgment using the Clinical Judgment Rubric-Reflective Journal (CJR-RJ) and for medication administration best practices. RESULTS: Students scored low on the CJR-RJ (mean [SD], 5.2 [1.7]). We found a positive relationship between clinical judgment skills and safe medication practices (r = 0.39, t27 = 2.94, P = .018). The clinical reasoning process of Interpreting was a significant indicator of best practices (b = 1.4, t28 = 2.81, P = .010). CONCLUSION: Our findings suggest that students struggle to connect theory to practice, emphasizing the need to plan experiential learning opportunities for students to develop clinical reasoning, particularly in Interpreting, and judgment skills to prevent medication errors upon entry to practice.

The Lasater Clinical Judgment Rubric: Implications for Evaluating Teaching Effectiveness.

BACKGROUND: Concern with patient safety necessitates valid and reliable measures to evaluate clinical judgment. The purpose of this article is to describe how the Lasater Clinical Judgment Rubric (LCJR) has been used to evaluate the effectiveness of educational interventions to promote clinical judgment and its psychometric properties. METHOD: Search terms included nurse, student, clinical judgment, and Lasater Clinical Judgment Rubric in Scopus, ERIC, and CINAHL with EBSCOhost databases. The final review included 20 studies. RESULTS: Researchers reported alphas for total scales as .80 to .97, subscales as .89 to .93, and students' self-scored as .81 to .82. Themes were: Individual Versus Group Evaluations, Clinical Judgment Scenarios, and Adaptation for Nonobservation Activities. CONCLUSION: Results of this review indicate that the LCJR can be used to evaluate clinical judgment, but educators need to consider inter- and intrarater reliability, individual versus group evaluation, clinical judgment scenarios, and adapting the rubric for nondirect observation activities. [J Nurs Educ. 2021;60(2):67-73.].