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NCLEX National Council Licensure Examination

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NCLEX exam Dumps Source : National Council Licensure Examination

Test Code : NCLEX
Test Name : National Council Licensure Examination
Vendor Name : Medical
: 368 Real Questions

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Medical National Council Licensure Examination

Integrating the national Council of State Boards of Nursing medical Judgment model Into Nursing tutorial Frameworks | killexams.com Real Questions and Pass4sure dumps

youngsters a familiar definition of nursing medical judgment has been elusive, three established and authorized paradigms for nursing medical judgment consist of the Intuitive-Humanistic model (Benner, 1984), which changed into later built-in into the Tanner model (2006); twin manner Reasoning concept (Croskerry, 2009; Pelaccia, Tardif, Triby, & Charlin, 2011), anchored within the cognitive continuum conception (Harbison, 2001); and the assistance Processing model (Oppenheimer & Kelso, 2015). Nursing educators have found each and every of these paradigms to be positive in making ready students to develop into professional nurses.

The country wide Council of State Boards of Nursing (NCSBN) has developed a framework for outlining and assessing clinical judgment that's bendy and encompasses all three of the leading theoretical frameworks used with the aid of nurse educators when teaching scientific judgment in prelicensure and carrying on with training classes. this article gifts a framework of medical judgment for use through educators and NCSBN when constructing formative and summative efficiency and licensure reviews and assessments. Such an integrated framework promotes the capabilities for congruence between academic and licensure reviews whereas improving the constancy and validity of nurses' school room, clinical, and regulatory evaluation and assessment event.

the first step in developing a framework for clinical judgment concerned building a conceptual model. as a result of medical judgment is an improved-order cognitive construct, the NCSBN-clinical Judgment model (NCSBN-CJM) had to synthesize cognitive theories of the assemble from the literature, facilitate an understanding of the assemble, and lay theoretical grounds for outlining and assessing clinical judgment (Dickison et al., 2016). Nurses with the skills to recognize, analyze, hypothesize, reply, and evaluate accurately may still be able to carry magnificent care inside a mess of contexts when you consider that they are more likely to make first rate scientific judgments (Dickison et al., 2016).

The NCSBN-CJM

The NCSBN-CJM (determine 1) is a multilayered mannequin that includes commentary (Layer 0), cognitive operations (Layers 1–three), and contextual factors (Layer 4) (Dickison et al., 2016). Layer 0 contains two naturally observable entities: client wants that initiate the manner of scientific judgment and clinical decisions to comprehensive the technique. Layers 1–three (the cognitive layers) depict the evaluation of an iterative or recursive collection of cognitive operations. Layer 1 is a single entity that comprises the whole thing of scientific judgment, which is described by using the observable entities depicted in Layer 0 and the unobservable cognitive operations depicted in Layers 2–3. Layer 2 represents an iterative process of three cognitive operations: kind hypotheses, refine hypotheses, and evaluate hypotheses. Layer three divides these operations into independent, recursive operations imperative for completion of each Layer 2 operation. as an example, respect cues and analyze cues (Layer 3) are essential to kind hypotheses (Layer 2). Layer four (the context layer) carries a collection of contextual components that might also influence the efficiency of the cognitive operations inside the mannequin. There are two styles of contextual elements: individual factors and environmental factors.

The National Council of State Boards of Nursing-Clinical Judgment Model.

figure 1.

The national Council of State Boards of Nursing-medical Judgment mannequin.

Examples of particular person components include abilities, abilities, forte, candidate traits, prior event, and stage of adventure. Examples of environmental components encompass actual atmosphere, client statement, substances, clinical statistics, consequences and risks, time pressure, assignment complexity, and cultural consideration. These factors (individual and environmental) aren't crucial to interpretation of the ratings acquired from objective scoring fashions but are simple to the development of assessments as a result of they make certain that contextual fidelity is regarded in any assessment of scientific judgment.

however Layer four should still be modified as the scope of nursing observe changes or emerging analysis suggests extra individual and environmental factors, the scoring model continues to be intact (Dickison et al., 2016). The cost of this layered model is that it affords assessment builders and users extremely good flexibility in deciding upon the level of dimension in accordance with the aim of the assessment. as an example, the assessment developer and person can also make a decision to handiest focal point on Layer 1 to make an overall move/fail resolution, which is common in high-stakes licensure examinations. Conversely, educators can also come to a decision to center of attention on Layer 3 for formative assessment all over a student's matriculation through a module of guide for finer tiers of diagnostic counsel but use Layer 2 for summative examinations to confirm attainment of tutorial goals and aims.

Integration of the NCSBN-CJM With Three medical Reasoning Frameworks

Nursing educators have adopted loads of academic frameworks to raise student acquisition of clinical reasoning abilities. The development of foundational advantage, abilities, and knowledge obligatory by nurses to independently evaluate complicated suggestions and situations to make appropriate scientific choices requires prelicensure classes to include a call-making framework into their curricula (Smith, Thurkettle, & Dela Cruz, 2004; Thompson, Dowding, & McCaughan, 2004). Nursing education within the u.s. uses three important instructing-researching frameworks for providing the decision-making concepts to prelicensure nursing students: Intuitive-Humanistic mannequin, dual method Reasoning thought, and guidance-Processing model. These fashions provide frameworks that let the identification of subcomponents of the overall choice-making method, thus permitting educators to plot tutorial actions and subsequent school room evaluation on the mastery of those subcomponents.

it is going to be stated that the nursing procedure at the start was synonymous with medical judgment and reasoning, and blanketed five components of difficulty solving: assessment, nursing diagnosis, planning, implementation, and contrast. as the nursing process won acceptance in the profession, nurses noted that even though it become a useful gizmo for beginning students as a foundation for fixing customer problems, the mannequin failed to embody the complexities of scientific reasoning and the factors that impact it (Tanner, 2006). hence, it turned into not covered as a leading model listed here.

Intuitive-Humanistic model. Benner (1984) brought the conception whereby the nurse strikes from beginner to professional via experiential increase in abilities and abilities. Thompson (1999) identified this idea as one of the most ideal examples of the Intuitive-Humanistic mannequin. Benner cited that nursing practice had accelerated in each complexity (acuity levels of valued clientele, lowered size of clinic stays) and accountability (career building, adjustments between amateur and skilled nurses), and realized that the exigencies of medical apply can't be described by using idea alone. because of this, Benner used the Dreyfus mannequin of ability Acquisition (DMSA), which states that the nurses transitions via 5 stages of proficiency: amateur, advanced beginner, competent, trained, and expert (Benner, 1984; Dreyfus & Dreyfus, 1987). Benner integrated these 5 stages of skill acquisition into her definition of nursing medical judgment.

Tanner (2006), in establishing the model of clinical Judgment, recognized intuitive-humanistic as one class of reasoning that nurses use moreover analytic and narrative reasoning, acknowledging that nurses go back and forth among these sorts of reasoning. Tanner defined that much less skilled nurses, together with students, may also count more closely on analytic reasoning, whereas experienced nurses are more likely to use intuitive reasoning in line with their scientific experiences. Lasater's (2007) analysis accelerated Tanner's features of medical judgment, in keeping with skilled nurses, to explain a trajectory of scientific judgment building for students. Tanner diagnosed that nurses' backgrounds, both clinical and private, affect what they word about sufferers. An illustration of this is when an authority nurse accurately anticipates the wants of a client in response to his or her outdated experiences.

within the NCSBN-CJM, Layers 2, three, and four aid and explain these underlying cognitive methods for nursing clinical judgment and are complementary to Benner and Tanner in that nursing consists of both theoretical abilities and purposeful experiences. Nurses require deep competencies to make decisions that outcomes in greatest customer effects (Benner, Tanner, & Chesla, 2009). As nursing college students flow on the continuum from amateur to improved capabilities in apply, their skill to admire and analyze cues, prioritize hypotheses, and generate options for customers, primarily based in facts and experiences with shoppers, raises. Their concrete experiences in medical follow serve to ebook their actions and improve their clinical judgment.

dual process Reasoning conception. This thought arose from Hammond's cognitive continuum conception (1978) that defined clinical judgment as an adaptive strategy that lies between analytic thinking and intuitive considering, counting on the context. The cognitive continuum theory recommended nursing actions that require choice making may also be viewed on a continuum ranging from intuitive notion to analytical concept, based on the points of the motion (complexity, ambiguity, and presentation) that have an effect on the thinking processes of the nurse.

more currently, reviews have identified and discussed the twin manner Reasoning idea of scientific reasoning. Two sorts of reasoning are discretely identified, nonanalytical reasoning (e.g., sample cognizance, gut feelings, experiential) and analytical reasoning (e.g., hypothesis-pushed, purposeful) (Croskerry, 2009; Durham, Fowler, & Kennedy, 2014; Pellacia, Tardif, Triby, & Charlin, 2011). in line with Croskerry (2009), the previous is often short, greater reflexive, and in keeping with previous experiences, whereas the latter involves a more deliberate, purposeful category of reasoning, including producing hypotheses and critically considering them. despite the fact these are diverse kinds of reasoning, the underlying theory is that used collectively, health care practitioners are capable of motive greater precisely in scientific situations. Croskerry (2009) suggested in opposition t entirely relying on one or the other process, which might also result in unlucky error; quite, he encouraged that nonanalytical reasoning and analytical reasoning should still be used to move-examine each and every other to arrive on the most correct judgments or selections. at the beginning, researchers presumed that learners didn't use pattern cognizance or instinct for reasoning as a result of their lack of fitness care experiences; besides the fact that children, Ark, Brooks, and Eva (2007) found that each one ranges are able to use nonanalytical tactics. This helps Tanner's (2006) proposal that the expert or very own history of the nurse influences what the nurse notices in regards to the patient.

An example of nurse moves resulting in analytic thinking could be adjusting ventilator settings for a shopper with a historical past of continual obstructive pulmonary disorder. The nurse might immediately establish that the client is hypoxic, in line with observations made while caring for the client for several days and noting a metamorphosis within the client's stage of awareness. a quick pattern attention from outdated experiences commonly outcomes in intuitive considering or nonanalytical reasoning (Durham, et al., 2014). as soon as the instant motion is taken, the nurse might function a more purposeful and thorough evaluation, compare existing data with old facts, and increase a speculation concerning the explanation for the customer's symptoms, which is analytical reasoning (Durham et al., 2014)

The NCSBN-CJM complements the dual manner Reasoning theory in that it develops a cognitive model inside nursing contexts of care (Muntean, 2012). The NCSBN-CJM at Layers 2 and three acknowledges that however some parts of scientific judgment, akin to recognizing and analyzing cues, commonly ensue at the intuitive (or nonanalytical) layer, greater complicated materials of decisions, corresponding to generating hypotheses and solutions, and evaluating outcomes, may also require in-depth knowledge derived from scientific counsel (analytical). furthermore, in Layer 4, the NCSBN-CJM explicitly references the content material or external components that impact scientific judgments. just as Tanner (2006) emphasized the relationship between what the nurse notices and the context of care, the dual technique Reasoning theory, principally nonanalytical reasoning, acknowledges the magnitude of context (i.e., customer and environmental elements, and traits of the nurse him- or herself) to a nurse's clinical determination-making capability (Croskerry, 2009).

guidance-Processing model. Oppenheimer and Kelso (2015) posit that throughout professions, determination making may still be modeled from “basic cognitive constructing blocks” together with memory, consideration, and causal reasoning and that decision methods are ultimate understood through developing fashions of how choice-imperative advice is sampled, retrieved, and integrated. This position implies that nursing clinical judgment is tremendously correlated with popular cognition.

Dickison et al. (2016) used the assistance-Processing framework to propose a nursing clinical judgment model with 5 iterative processes: admire cues, generate hypotheses, decide hypotheses, take motion, and evaluate effects. This mannequin allows for identification of the manner and identification of elements of error. Clinicians must use prerequisite expertise and competencies to e-book them when organizing information, and since of this, NCSBN concentrated on decision making established inside context-particular situations. The construct of choice making is established in that decisions are made in all types of professions: fitness care suppliers (Botti & Reeve, 2003), auditors (Libby, 1985), mechanics (Mehle, 1982), and scientists (Fischhoff, 1977). despite the fact, every discipline needs to specify the way to put into effect a decision-making model. although resolution making is regular to all professions, each and every career requires deep advantage and must center of attention on the choice-making facets most critical to their career.

Describing medical judgment through the use of an assistance-processing mannequin permits for specification of the mental add-ons worried in decision making and the interactions between them. the first assumption in the NCSBN-CJM is that the realm is represented as a group of movements that may also be accompanied, akin to client wants and responses to those wants or to scientific decisions. NCSBN further developed the model (determine 1) to explain the underlying cognitive processes that nurses use when entering a situation that requires a choice (Muntean, 2012). Clinicians should first appreciate and analyze the cues associated with the medical difficulty. Hypotheses are activated and generated in response to the cue inputs. After hypotheses are prioritized, nurses will try and unravel the current problem by way of taking motion in response to the leading speculation. in the simplest case, a speculation may be associated with a single motion; when it's judged as most likely, only one outcomes naturally follows. One example may be the deserve to assess a diabetic client's blood glucose if the client complained of lightheadedness.

putting It collectively: NCSBN-CJM example

An example of how nurse educators can use the NCSBN-CJM to construct valuable assessments of medical judgment is proven in table 1, which offers a hypothetical motion mannequin for a pediatric atmosphere. the sort of mannequin can be used to check even if students are in a position to make a suitable nursing clinical judgment inside a given state of affairs via following the cognitive operation steps through a whole case analyze or opting for one or more of them to goal for assessment applications. The cognitive operations within the first column in the desk 1 represent integral operations described in Layer three of the NCSBN-CJM. The column for aspect conditioning describes the context (Layer 4 of the NCSBN-CJM) that directs the content material of students' evaluation. This context will also be used to write dissimilar-choice test objects or to enhance case-examine or simulation activities designed to elicit the observable results or behaviors. at last, the column for anticipated conduct/moves describes appropriate student movements, or observable results, that can also be measured.

Hypothetical Action Model for a Pediatric Case Study

table 1:

Hypothetical action model for a Pediatric Case look at

As this illustration indicates, the NCSBN-CJM can aid nurse educators and producers of nursing tutorial materials design beneficial tools for assessing clinical judgment by means of helping them goal specific cognitive operations (e.g., analyzing cues to generate observable movements that reflect college students' clinical judgment competencies). These assessments also can be used to verify where the process changed into bolstered or damaged down. The layered design of the model (determine 1) allows educators to determine even if student errors are regarding cognitive operations (Layers 1–3) or contextual elements (Layer 4). After the focus of the students' error were identified, educators can use the motion mannequin to book focused evaluation and remediation plans (individualized or community) on the particular areas of the of the NCSBN-CJM (Layer 3).

in more complex situations, despite the fact, a hypothesis could be linked to a couple of economical actions. In these cases, nurses prompt and generate a set of cost effective moves and then rank them. consequently, a good deal like speculation generation and refining hypothesis, the equal underlying mental strategies take place for generating and rating a set of comparatively cheap movements. it is critical to notice that a nonaction, similar to waiting and accumulating greater suggestions (e.g., hypothesis guided search) (Thomas, Dougherty, Sprenger, & Harbison, 2008), is itself a choice.


relocating a national Licensure Examination to computing device | killexams.com Real Questions and Pass4sure dumps

writer affiliations: medical college Admission examine, association of american scientific faculties, Washington, DC (Dr Julian); country wide Council of State Boards of Nursing, Chicago, ill (Dr Wendt); educational testing services (Dr approach); expert Licensing and Certification, NCS Pearson company, Eden Prairie, Minn (Dr Zara).

Corresponding writer: Anne Wendt, PhD, RN, country wide Council of State Boards of Nursing, 676 N. St. Clair, Suite 550, Chicago IL 60611 (awendt@ncsbn.org).


UAE Council approves draft law regulating practice of medical occupation | killexams.com Real Questions and Pass4sure dumps

The Federal countrywide Council, FNC, during its session today at its headquarters in Abu Dhabi headed by using its Speaker, Dr. Amal Abdullah Al Qubaisi, authorized a draft federal legislation regulating practising the medical profession.

Its provisions observe to all folks that observe or request to observe the profession inner the nation including the free zones. The session turned into attended through Dr. Abdul Rahman bin Mohammad bin Nasser Al Owais, Minister of health and Prevention, and Minister of State for Federal country wide Council Affairs.

in accordance with the draft legislations, no one is allowed to observe drugs until they're licenced through the health body, and have got the licence, in accordance with the provisions of this legislations. It doesn't exempt any one from receiving some other clinical licences mandated through law, and doctors have to apply the occupation inside the scope of the licence granted to them and the licence of the fitness institution they are working with.

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The draft legislation aims to protect the neighborhood from unlawful medical practices and places in area the prison foundations for practising the occupation which ensures the optimum clinical capabilities to people, as neatly as the crucial knowledgeable standards which stop unlawful scientific practices that compromise clinical ethics.

The FNC stressed out the significance of the draft legislations in light of the swift advancement witnessed by way of the country in the diverse sectors, principally the health sector, which is a promise of construction and achieves the countrywide Agenda of the UAE vision. This includes a health equipment that depends on probably the most sophisticated foreign requirements and presents health services, first-rate and efficiency- measuring techniques whereas setting up the preventive factor. It ensures the readiness of the health gadget to contend with the epidemics and health dangers, for the UAE to have the choicest healthcare quality through 2021.

© Copyright Emirates information company (WAM) 2019.


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National Council Licensure Examination

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Integrating the National Council of State Boards of Nursing Clinical Judgment Model Into Nursing Educational Frameworks | killexams.com real questions and Pass4sure dumps

Although a universal definition of nursing clinical judgment has been elusive, three established and accepted paradigms for nursing clinical judgment include the Intuitive-Humanistic Model (Benner, 1984), which was later integrated into the Tanner Model (2006); Dual Process Reasoning Theory (Croskerry, 2009; Pelaccia, Tardif, Triby, & Charlin, 2011), anchored in the cognitive continuum theory (Harbison, 2001); and the Information Processing Model (Oppenheimer & Kelso, 2015). Nursing educators have found each of these paradigms to be useful in preparing students to become professional nurses.

The National Council of State Boards of Nursing (NCSBN) has developed a framework for defining and assessing clinical judgment that is flexible and encompasses all three of the leading theoretical frameworks used by nurse educators when teaching clinical judgment in prelicensure and continuing education programs. This article presents a framework of clinical judgment for use by educators and NCSBN when developing formative and summative performance and licensure evaluations and assessments. Such an integrated framework promotes the potential for congruence between educational and licensure evaluations while enhancing the fidelity and validity of nurses' classroom, clinical, and regulatory evaluation and assessment experience.

The first step in constructing a framework for clinical judgment involved building a conceptual model. Because clinical judgment is a higher-order cognitive construct, the NCSBN-Clinical Judgment Model (NCSBN-CJM) had to synthesize cognitive theories of the construct from the literature, facilitate an understanding of the construct, and lay theoretical grounds for defining and assessing clinical judgment (Dickison et al., 2016). Nurses with the skills to recognize, analyze, hypothesize, respond, and evaluate appropriately should be able to deliver excellent care within a multitude of contexts since they are more likely to make good clinical judgments (Dickison et al., 2016).

The NCSBN-CJM

The NCSBN-CJM (Figure 1) is a multilayered model that includes observation (Layer 0), cognitive operations (Layers 1–3), and contextual factors (Layer 4) (Dickison et al., 2016). Layer 0 contains two naturally observable entities: client needs that initiate the process of clinical judgment and clinical decisions to complete the process. Layers 1–3 (the cognitive layers) depict the analysis of an iterative or recursive series of cognitive operations. Layer 1 is a single entity that comprises the entirety of clinical judgment, which is defined by the observable entities depicted in Layer 0 and the unobservable cognitive operations depicted in Layers 2–3. Layer 2 represents an iterative process of three cognitive operations: form hypotheses, refine hypotheses, and evaluate hypotheses. Layer 3 divides these operations into independent, recursive operations necessary for completion of each Layer 2 operation. For example, recognize cues and analyze cues (Layer 3) are necessary to form hypotheses (Layer 2). Layer 4 (the context layer) contains a set of contextual factors that may impact the performance of the cognitive operations within the model. There are two types of contextual factors: individual factors and environmental factors.

The National Council of State Boards of Nursing-Clinical Judgment Model.

Figure 1.

The National Council of State Boards of Nursing-Clinical Judgment Model.

Examples of individual factors include knowledge, skills, specialty, candidate characteristics, prior experience, and level of experience. Examples of environmental factors include physical environment, client observation, resources, medical records, consequences and risks, time pressure, task complexity, and cultural consideration. These factors (individual and environmental) are not critical to interpretation of the scores obtained from objective scoring models but are essential to the development of assessments because they ensure that contextual fidelity is considered in any assessment of clinical judgment.

Although Layer 4 should be modified as the scope of nursing practice changes or emerging research suggests additional individual and environmental factors, the scoring model remains intact (Dickison et al., 2016). The value of this layered model is that it affords assessment developers and users great flexibility in determining the level of measurement based on the purpose of the assessment. For example, the assessment developer and user may decide to only focus on Layer 1 to make an overall pass/fail decision, which is common in high-stakes licensure examinations. Conversely, educators may decide to focus on Layer 3 for formative assessment during a student's matriculation through a module of instruction for finer levels of diagnostic information but use Layer 2 for summative examinations to confirm attainment of educational goals and objectives.

Integration of the NCSBN-CJM With Three Clinical Reasoning Frameworks

Nursing educators have adopted a variety of educational frameworks to enhance student acquisition of clinical reasoning skills. The development of foundational knowledge, skills, and abilities needed by nurses to independently evaluate complex information and situations to make appropriate clinical decisions requires prelicensure programs to incorporate a decision-making framework into their curricula (Smith, Thurkettle, & Dela Cruz, 2004; Thompson, Dowding, & McCaughan, 2004). Nursing education in the United States uses three major teaching-learning frameworks for presenting the decision-making concepts to prelicensure nursing students: Intuitive-Humanistic Model, Dual Process Reasoning Theory, and Information-Processing Model. These models provide frameworks that permit the identification of subcomponents of the overall decision-making process, thus allowing educators to plan educational activities and subsequent classroom assessment on the mastery of these subcomponents.

It should be acknowledged that the nursing process originally was synonymous with clinical judgment and reasoning, and included five components of problem solving: assessment, nursing diagnosis, planning, implementation, and evaluation. As the nursing process gained acceptance in the profession, nurses noted that although it was a useful tool for beginning students as a foundation for solving client problems, the model failed to encompass the complexities of clinical reasoning and the factors that influence it (Tanner, 2006). Hence, it was not included as a leading model in this article.

Intuitive-Humanistic Model. Benner (1984) introduced the theory whereby the nurse moves from novice to expert through experiential growth in knowledge and skills. Thompson (1999) identified this theory as one of the best examples of the Intuitive-Humanistic Model. Benner noted that nursing practice had increased in both complexity (acuity levels of clients, decreased length of hospital stays) and responsibility (career development, differences between novice and experienced nurses), and realized that the exigencies of clinical practice cannot be defined by theory alone. As a result, Benner used the Dreyfus Model of Skill Acquisition (DMSA), which states that the nurses transitions through five levels of proficiency: novice, advanced beginner, competent, proficient, and expert (Benner, 1984; Dreyfus & Dreyfus, 1987). Benner incorporated these five stages of skill acquisition into her definition of nursing clinical judgment.

Tanner (2006), in developing the Model of Clinical Judgment, recognized intuitive-humanistic as one type of reasoning that nurses use in addition to analytic and narrative reasoning, acknowledging that nurses go back and forth among these types of reasoning. Tanner explained that less experienced nurses, including students, may rely more heavily on analytic reasoning, whereas experienced nurses are more likely to use intuitive reasoning based on their clinical experiences. Lasater's (2007) research expanded Tanner's aspects of clinical judgment, based on experienced nurses, to describe a trajectory of clinical judgment development for students. Tanner recognized that nurses' backgrounds, both clinical and personal, impact what they notice about patients. An example of this is when an expert nurse accurately anticipates the needs of a client based on his or her previous experiences.

In the NCSBN-CJM, Layers 2, 3, and 4 support and explain these underlying cognitive processes for nursing clinical judgment and are complementary to Benner and Tanner in that nursing is composed of both theoretical knowledge and practical experiences. Nurses require deep knowledge to make decisions that result in optimal client outcomes (Benner, Tanner, & Chesla, 2009). As nursing students move on the continuum from novice to greater expertise in practice, their ability to recognize and analyze cues, prioritize hypotheses, and generate solutions for clients, based in evidence and experiences with clients, increases. Their concrete experiences in clinical practice serve to guide their actions and improve their clinical judgment.

Dual Process Reasoning Theory. This theory arose from Hammond's cognitive continuum theory (1978) that defined clinical judgment as an adaptive strategy that lies between analytic thinking and intuitive thinking, depending on the context. The cognitive continuum theory suggested nursing actions that require decision making can be viewed on a continuum ranging from intuitive thought to analytical thought, based on the features of the action (complexity, ambiguity, and presentation) that influence the thinking processes of the nurse.

More recently, studies have identified and discussed the Dual Process Reasoning Theory of clinical reasoning. Two types of reasoning are discretely identified, nonanalytical reasoning (e.g., pattern recognition, gut feelings, experiential) and analytical reasoning (e.g., hypothesis-driven, purposeful) (Croskerry, 2009; Durham, Fowler, & Kennedy, 2014; Pellacia, Tardif, Triby, & Charlin, 2011). According to Croskerry (2009), the former is often quick, more reflexive, and based on past experiences, whereas the latter involves a more deliberate, purposeful type of reasoning, including generating hypotheses and critically thinking about them. Although these are distinct types of reasoning, the underlying idea is that used together, health care practitioners are able to reason more accurately in clinical situations. Croskerry (2009) cautioned against solely relying on one or the other process, which may lead to unfortunate mistakes; rather, he advocated that nonanalytical reasoning and analytical reasoning should be used to cross-check each other to arrive at the most accurate judgments or decisions. Initially, researchers presumed that novices did not use pattern recognition or intuition for reasoning because of their lack of health care experiences; however, Ark, Brooks, and Eva (2007) found that all levels are able to use nonanalytical processes. This supports Tanner's (2006) proposal that the professional or personal background of the nurse influences what the nurse notices about the patient.

An example of nurse actions resulting in analytic thinking would be adjusting ventilator settings for a client with a history of chronic obstructive pulmonary disease. The nurse could quickly identify that the client is hypoxic, based on observations made while caring for the client for several days and noting a change in the client's level of consciousness. A quick pattern recognition from previous experiences often results in intuitive thinking or nonanalytical reasoning (Durham, et al., 2014). Once the immediate action is taken, the nurse might perform a more purposeful and thorough assessment, compare current data with previous data, and develop a hypothesis about the cause of the client's symptoms, which is analytical reasoning (Durham et al., 2014)

The NCSBN-CJM complements the Dual Process Reasoning Theory in that it develops a cognitive model within nursing contexts of care (Muntean, 2012). The NCSBN-CJM at Layers 2 and 3 recognizes that although some parts of clinical judgment, such as recognizing and analyzing cues, often occur at the intuitive (or nonanalytical) layer, more complex parts of decisions, such as generating hypotheses and solutions, and evaluating outcomes, may require in-depth knowledge derived from scientific information (analytical). In addition, in Layer 4, the NCSBN-CJM explicitly references the content or external factors that influence clinical judgments. Just as Tanner (2006) emphasized the relationship between what the nurse notices and the context of care, the Dual Process Reasoning Theory, particularly nonanalytical reasoning, acknowledges the importance of context (i.e., client and environmental factors, and characteristics of the nurse him- or herself) to a nurse's clinical decision-making ability (Croskerry, 2009).

Information-Processing Model. Oppenheimer and Kelso (2015) posit that across professions, decision making should be modeled from “basic cognitive building blocks” including memory, attention, and causal reasoning and that decision systems are best understood by developing models of how decision-relevant information is sampled, retrieved, and integrated. This position implies that nursing clinical judgment is highly correlated with general cognition.

Dickison et al. (2016) used the Information-Processing framework to propose a nursing clinical judgment model with five iterative processes: recognize cues, generate hypotheses, judge hypotheses, take action, and evaluate outcomes. This model allows for identification of the process and identification of points of error. Clinicians must use prerequisite knowledge and skills to guide them when organizing information, and because of this, NCSBN focused on decision making situated within context-specific conditions. The construct of decision making is universal in that decisions are made in all types of professions: health care providers (Botti & Reeve, 2003), auditors (Libby, 1985), mechanics (Mehle, 1982), and scientists (Fischhoff, 1977). However, each discipline needs to specify how to implement a decision-making model. Although decision making is common to all professions, each profession requires deep knowledge and must focus on the decision-making aspects most relevant to their profession.

Describing clinical judgment by using an information-processing model allows for specification of the mental components involved in decision making and the interactions between them. The first assumption in the NCSBN-CJM is that the world is represented as a set of events that can be observed, such as client needs and responses to those needs or to clinical decisions. NCSBN further developed the model (Figure 1) to describe the underlying cognitive processes that nurses use when entering a situation that requires a decision (Muntean, 2012). Clinicians must first recognize and analyze the cues associated with the clinical problem. Hypotheses are activated and generated based on the cue inputs. After hypotheses are prioritized, nurses will attempt to resolve the current problem by taking action based on the leading hypothesis. In the simplest case, a hypothesis will be associated with a single action; when it is judged as most likely, only one outcome naturally follows. One example would be the need to assess a diabetic client's blood glucose if the client complained of lightheadedness.

Putting It Together: NCSBN-CJM Example

An example of how nurse educators can use the NCSBN-CJM to construct effective assessments of clinical judgment is shown in Table 1, which provides a hypothetical action model for a pediatric setting. Such a model can be used to assess whether students are able to make an appropriate nursing clinical judgment within a given scenario by following the cognitive operation steps through an entire case study or choosing one or more of them to target for assessment purposes. The cognitive operations in the first column in the Table 1 represent necessary operations described in Layer 3 of the NCSBN-CJM. The column for factor conditioning describes the context (Layer 4 of the NCSBN-CJM) that directs the content of students' assessment. This context can be used to write multiple-choice test items or to develop case-study or simulation activities designed to elicit the observable outcomes or behaviors. Finally, the column for expected behavior/actions describes appropriate student actions, or observable outcomes, that can be measured.

Hypothetical Action Model for a Pediatric Case Study

Table 1:

Hypothetical Action Model for a Pediatric Case Study

As this example shows, the NCSBN-CJM can help nurse educators and producers of nursing educational materials design effective tools for assessing clinical judgment by helping them target specific cognitive operations (e.g., analyzing cues to generate observable actions that reflect students' clinical judgment abilities). These assessments also can be used to determine where the process was strengthened or broken down. The layered design of the model (Figure 1) allows educators to determine whether student errors are related to cognitive operations (Layers 1–3) or contextual factors (Layer 4). After the focus of the students' errors have been identified, educators can use the action model to guide focused evaluation and remediation plans (individualized or group) on the specific areas of the of the NCSBN-CJM (Layer 3).

In more complicated scenarios, however, a hypothesis may be associated with several reasonable actions. In these situations, nurses activate and generate a set of reasonable actions and then rank them. Thus, much like hypothesis generation and refining hypothesis, the same underlying mental processes occur for generating and ranking a set of reasonable actions. It is important to note that a nonaction, such as waiting and collecting more information (e.g., hypothesis guided search) (Thomas, Dougherty, Sprenger, & Harbison, 2008), is itself a decision.


Helping At-Risk Nursing Students Succeed on the National Council Licensure Examination-Registered Nurse | killexams.com real questions and Pass4sure dumps

As the nursing student population becomes increasingly diverse, more and more students have diverse learning needs and present risk of passing the National Council Licensure Examination-Registered Nurse. Nursing faculty need to be more aware of strategies to assist students prepare and be successful in the National Council Licensure Examination and succeed in the nursing program. This article describes the development of a course to help students take tests and improve study skills. The course NUR 090, Strategies for Nursing Success, has proven successful in facilitating success in nursing school.

Author Affiliations: Bethel College, Mishawaka, Indiana (Ms Cramer); and School of Nursing, Bethel College, Mishawaka, Indiana (Ms Davidhizar).

Corresponding author: Connie Cramer, RNC, MSN, Bethel College, 1001 W. McKinley Ave., Mishawaka, IN 46545 (cramerc@bethelcollege.edu).


BCC nursing class does well on exams | killexams.com real questions and Pass4sure dumps

Thursday Feb 7, 2019 at 3:58 PM

FALL RIVER — Bristol Community College’s nursing class of 2018 has achieved a 97 percent pass rate on the National Council Licensure Examination exam.

The NCLEX is an examination for the licensing of nurses in the United States and Canada. The National Council of State Boards of Nursing, Inc.  develops and administers the exam on behalf of its board members across each state in the United States.

Each state board of nursing requires a candidate for licensure to pass the appropriate NCLEX examination that corresponds with their education level. NCLEX examinations are designed to test the knowledge, skills and abilities essential for the safe and effective practice of nursing at the entry-level.

For more information about the National Council Licensure Examination, visit www.ncsbn.org/nclex.htm.

For more information about Bristol’s Nursing program, visit www.bristolcc.edu/nursing.



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