AIM This study examined US prelicensure nursing program use of clinical judgment models and teach... more AIM This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students’ clinical judgment. BACKGROUND Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used. METHOD A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs’ use of clinical judgment educational models. RESULTS Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner’s clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation. CONCLUSION Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.
This course is one of a series of courses making up a national emergency medical services (EMS) e... more This course is one of a series of courses making up a national emergency medical services (EMS) educational program for out-of hospital care. The First Responder is a designated level of emergency medical care provider as outlined by the "National EMS Education and Practice Blueprint". The curriculum was designed and developed based on the 1995 release of the "First Responder: National Standard Curriculum". This refresher curriculum should be used in conjunction with a task analysis of student needs, the "National EMS Education and Practice Blueprint", the 1995 "First Responder: National Standard Curriculum", the 1994 "EMT Basic: National Standard Curriculum", and state guidelines for refresher training. It is not the intent of the course to introduce new material, but to ensure that the students have the necessary knowledge and skills to continue to function as First Responders. This curriculum includes skills necessary for the individual to provide emergency medical care with a limited amount of equipment.
BACKGROUND Sound nursing clinical judgment is at the core of competent and safe client care. New ... more BACKGROUND Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents the National Council of State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) and discusses the use of the model. METHOD A multidisciplinary team conducted a qualitative comparative analysis of the relationships between the NCSBN-CJM and the three leading frameworks for providing clinical judgment education to entry-level nurses. RESULTS The NCSBN-CJM aligns with the Information-Processing Model and the Intuitive-Humanistic Model. The NCSBN-CJM also can be used to assess the Dual Process Reasoning Theory. CONCLUSION The NCSBN-CJM can assist nurse educators in designing effective tools for assessing clinical judgment by helping them target specific cognitive operations. This flexible model expresses the complexities associated with decision making in a simplified manner to enable better measurement of clinical judgment. [J Nurs Educ. 2019;58(2):72-78.].
The confidence interval (CI) stopping rule is commonly used in licensure settings to make classif... more The confidence interval (CI) stopping rule is commonly used in licensure settings to make classification decisions with fewer items in computerized adaptive testing (CAT). However, it tends to be less efficient in the near-cut regions of the θ scale, as the CI often fails to be narrow enough for an early termination decision prior to reaching the maximum test length. To solve this problem, this study proposed the projection-based stopping rules that base the termination decisions on the algorithmically projected range of the final θ estimate at the hypothetical completion of the CAT. A simulation study and an empirical study were conducted to show the advantages of the projection-based rules over the CI rule, in which the projection-based rules reduced the test length without jeopardizing critical psychometric qualities of the test, such as the θ and classification precision. Operationally, these rules do not require additional regularization parameters, because the projection is si...
The Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) provides ... more The Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) provides a representative sampling of EMTs throughout the United States. This study examines the relationship between instructor quality and National Registry of Emergency Medical Technicians certification examination outcomes. Results show significant correlations, based on instructor quality on initial exam scores as well as on the number of tries to obtain a passing score. Implications for HRD practitioners, adult educators, and researchers are discussed. (Contains 6 tables.)
Personal risk behaviors are modifiable. This report describes the 2002 national baseline of behav... more Personal risk behaviors are modifiable. This report describes the 2002 national baseline of behavioral health risk factors of US emergency medical technicians (EMTs) that can guide policy and program development in improving EMT well-being. A 19-item Health Behavioral Risk Survey (Appendix) was added to the 2002 Longitudinal Emergency Medical Technician Demographic Study mail survey. Risk survey questions covering physical activity, tobacco use, and alcohol use were modeled after the Centers for Disease Control and Prevention 2002 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. Personal, non-work related seatbelt use and motor vehicle driving questions were adopted from the 2002 US National Highway Traffic Safety Administration (NHTSA) Motor Vehicle Occupant Safety Survey (MVOSS). Post-stratification adjustment factors were used to allow comparisons with BRFSS and MVOSS national estimates. A total of 1,919 EMT respondents were compared with 239,866 BRFSS and 5,220 ...
Designing a theory-based assessment with sound psychometric qualities to measure a higher-order c... more Designing a theory-based assessment with sound psychometric qualities to measure a higher-order cognitive construct is a highly desired yet challenging task for many practitioners. This paper proposes a framework for designing a theorybased assessment to measure a higher-order cognitive construct. This framework results in a modularized yet unified assessment development system which includes elements spanning from construct conceptualization to model validation. The paper illustrates how to implement this framework by using the construct of nursing clinical judgement. Using this framework, many difficult design decisions can be made with strong theoretical rationales. The framework is also flexible to accommodate modifications and extensions that will be required to be made to the assessment as new knowledge related to the construct is generated over time. The goal of this framework is to provide practitioners with a practical and accessible methodology to assess sophisticated cons...
Clinical judgment has become an increasingly important aspect of modern health service profession... more Clinical judgment has become an increasingly important aspect of modern health service professionals. To ensure public safety, licensure exams must go beyond assessing only knowledge and skills when evaluating entry-level professions to evaluating clinical judgment. This importance necessitates licensure and certification examinations in these professions to evaluate the extent to which this domain can be measured. This study will provide background of a large-scale licensure examination’s process for measuring clinical judgment in entry-level nursing. As clinical judgment is seen to be a higherorder, more complex construct than measuring basic knowledge, an outline of the process that was used to develop the construct and build items to a specific task model will be highlighted. In accordance with existing adult learning theories and contemporary nurse program delivery, the process of specifying the requisite cognitive theories guiding nursing practice will be elucidated and interw...
AIM This study examined US prelicensure nursing program use of clinical judgment models and teach... more AIM This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students’ clinical judgment. BACKGROUND Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used. METHOD A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs’ use of clinical judgment educational models. RESULTS Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner’s clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation. CONCLUSION Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.
This course is one of a series of courses making up a national emergency medical services (EMS) e... more This course is one of a series of courses making up a national emergency medical services (EMS) educational program for out-of hospital care. The First Responder is a designated level of emergency medical care provider as outlined by the "National EMS Education and Practice Blueprint". The curriculum was designed and developed based on the 1995 release of the "First Responder: National Standard Curriculum". This refresher curriculum should be used in conjunction with a task analysis of student needs, the "National EMS Education and Practice Blueprint", the 1995 "First Responder: National Standard Curriculum", the 1994 "EMT Basic: National Standard Curriculum", and state guidelines for refresher training. It is not the intent of the course to introduce new material, but to ensure that the students have the necessary knowledge and skills to continue to function as First Responders. This curriculum includes skills necessary for the individual to provide emergency medical care with a limited amount of equipment.
BACKGROUND Sound nursing clinical judgment is at the core of competent and safe client care. New ... more BACKGROUND Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents the National Council of State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) and discusses the use of the model. METHOD A multidisciplinary team conducted a qualitative comparative analysis of the relationships between the NCSBN-CJM and the three leading frameworks for providing clinical judgment education to entry-level nurses. RESULTS The NCSBN-CJM aligns with the Information-Processing Model and the Intuitive-Humanistic Model. The NCSBN-CJM also can be used to assess the Dual Process Reasoning Theory. CONCLUSION The NCSBN-CJM can assist nurse educators in designing effective tools for assessing clinical judgment by helping them target specific cognitive operations. This flexible model expresses the complexities associated with decision making in a simplified manner to enable better measurement of clinical judgment. [J Nurs Educ. 2019;58(2):72-78.].
The confidence interval (CI) stopping rule is commonly used in licensure settings to make classif... more The confidence interval (CI) stopping rule is commonly used in licensure settings to make classification decisions with fewer items in computerized adaptive testing (CAT). However, it tends to be less efficient in the near-cut regions of the θ scale, as the CI often fails to be narrow enough for an early termination decision prior to reaching the maximum test length. To solve this problem, this study proposed the projection-based stopping rules that base the termination decisions on the algorithmically projected range of the final θ estimate at the hypothetical completion of the CAT. A simulation study and an empirical study were conducted to show the advantages of the projection-based rules over the CI rule, in which the projection-based rules reduced the test length without jeopardizing critical psychometric qualities of the test, such as the θ and classification precision. Operationally, these rules do not require additional regularization parameters, because the projection is si...
The Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) provides ... more The Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) provides a representative sampling of EMTs throughout the United States. This study examines the relationship between instructor quality and National Registry of Emergency Medical Technicians certification examination outcomes. Results show significant correlations, based on instructor quality on initial exam scores as well as on the number of tries to obtain a passing score. Implications for HRD practitioners, adult educators, and researchers are discussed. (Contains 6 tables.)
Personal risk behaviors are modifiable. This report describes the 2002 national baseline of behav... more Personal risk behaviors are modifiable. This report describes the 2002 national baseline of behavioral health risk factors of US emergency medical technicians (EMTs) that can guide policy and program development in improving EMT well-being. A 19-item Health Behavioral Risk Survey (Appendix) was added to the 2002 Longitudinal Emergency Medical Technician Demographic Study mail survey. Risk survey questions covering physical activity, tobacco use, and alcohol use were modeled after the Centers for Disease Control and Prevention 2002 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. Personal, non-work related seatbelt use and motor vehicle driving questions were adopted from the 2002 US National Highway Traffic Safety Administration (NHTSA) Motor Vehicle Occupant Safety Survey (MVOSS). Post-stratification adjustment factors were used to allow comparisons with BRFSS and MVOSS national estimates. A total of 1,919 EMT respondents were compared with 239,866 BRFSS and 5,220 ...
Designing a theory-based assessment with sound psychometric qualities to measure a higher-order c... more Designing a theory-based assessment with sound psychometric qualities to measure a higher-order cognitive construct is a highly desired yet challenging task for many practitioners. This paper proposes a framework for designing a theorybased assessment to measure a higher-order cognitive construct. This framework results in a modularized yet unified assessment development system which includes elements spanning from construct conceptualization to model validation. The paper illustrates how to implement this framework by using the construct of nursing clinical judgement. Using this framework, many difficult design decisions can be made with strong theoretical rationales. The framework is also flexible to accommodate modifications and extensions that will be required to be made to the assessment as new knowledge related to the construct is generated over time. The goal of this framework is to provide practitioners with a practical and accessible methodology to assess sophisticated cons...
Clinical judgment has become an increasingly important aspect of modern health service profession... more Clinical judgment has become an increasingly important aspect of modern health service professionals. To ensure public safety, licensure exams must go beyond assessing only knowledge and skills when evaluating entry-level professions to evaluating clinical judgment. This importance necessitates licensure and certification examinations in these professions to evaluate the extent to which this domain can be measured. This study will provide background of a large-scale licensure examination’s process for measuring clinical judgment in entry-level nursing. As clinical judgment is seen to be a higherorder, more complex construct than measuring basic knowledge, an outline of the process that was used to develop the construct and build items to a specific task model will be highlighted. In accordance with existing adult learning theories and contemporary nurse program delivery, the process of specifying the requisite cognitive theories guiding nursing practice will be elucidated and interw...
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