Measuring and enhancing clinical decision-making ability among students in an Associate Degree Nursing program

Date of Completion

January 2009


Education, Community College|Education, Adult and Continuing|Health Sciences, Nursing




Clinical decision-making (CDM) in nursing practice is a systematic process involving critical thinking concerning an identified problem resulting in decisions and/or actions. Student nurses begin developing CDM ability by applying classroom-based theoretical concepts and skills to real patient situations in clinical practice. This study addressed challenges nurse educators face in facilitating students' CDM ability and the need for a valid and reliable means to assess this ability. ^ The conceptual framework included four themes from empirical research that guided the design of key learning experiences—analogical reasoning, self-reflection, and self-evaluation—for third-semester Associate Degree Nursing students engaged in a 5-week clinical rotation. An educational intervention was designed that incorporated key learning experiences into weekly small-group analogy-guided case development activities and individual reflective journal writing activities, both based on students' actual clinical experiences. A pilot study was conducted to design the Assessment of Critical Incident Reflective Journals (ACIRJ) to assess indicators of CDM ability in the student reflective journals. The instrument proved to have strong content validity, evidence of construct validity, and high score reliability. ^ The main study used a quasi-experimental, non-equivalent group, post-test only, comparison group design to assess CDM ability between two student groups. The intervention group (n = 34) participated in analogy-guided learning activities facilitated by clinical instructors (n =7) trained in the educational intervention. Students in the control group (n =17) participated in learning activities facilitated by clinical instructors (n = 3) who used their conventional practices to support students during the clinical rotation. Reflective journal entries by students in each group were assessed for indicators of CDM ability using the ACIRJ. ^ Data analysis indicated that, compared to the control group, the intervention group demonstrated significantly higher levels of CDM ability in their journals. The effect of the intervention was moderately strong (Essen = .52). Additional analyses indicated students with no prior health care experience benefited the most from the analogy-guided learning activities. Based on results, a Model of Factors that Enhance Student Clinical Decision-making Ability was developed to guide nurse educators and researchers in assessing and enhancing student clinical decision-making ability within clinical practice environments. ^