Clinical Judgment and Test-Taking Strategies

Clinical Judgement

  • Clinical judgment is the observed outcome of critical thinking.
  • Critical thinking:
    • The ability to determine the appropriate action in a clinical situation based on knowledge.
    • Involves applying knowledge to clinical scenarios.
    • A lifelong skill that develops over time.
    • Evaluated in exams and the NCLEX (state licensure board exam).

Example of Critical Thinking

  • Scenario: A post-operative patient with a heart rate of 160 (normal is 60-100).
    • Identify the abnormal heart rate.
    • Consider potential causes:
      • Hypovolemia (low blood volume)
      • Pain
      • Fever
    • Assess the patient:
      • Check the dressing for blood loss.
      • Review the chart for surgical blood loss.
      • Assess vital signs.
      • Ask about pain level.
    • In the example scenario, diaphoresis and guarding of the abdomen alongside patient verbalization of a 9/10 pain level leads you to believe the problem could potentially because of pain.
    • Determine that the high heart rate is likely due to pain.
    • Action: Administer pain medication.
      • Check orders for pain medication (e.g., morphine, Dilaudid).
      • If no order exists, contact the doctor for an order.

Application

  • Apply knowledge of tachycardia and hypovolemia to the patient's situation.
  • Clinical judgment requires knowing what is abnormal, identifying potential problems, assessing the patient, and taking action.
  • Critical thinking and clinical judgment are crucial for acting in real-world clinical situations.
  • Developing sound clinical judgment is an ongoing process.

Clinical Judgment Measurement Model (NCSPN)

  • Developed by the National Council for State Boards of Nursing.
  • Framework for measuring clinical judgment and decision-making.
  • The NCLEX and nursing exams assess clinical judgment.
  • To succeed, adapt study skills to focus on application rather than memorization.
  • Example test question: A patient with a heart rate of 160 post-abdominal surgery presents with specific signs and symptoms; what action should you take?

Steps in the Measurement Model

  1. Recognize cues: Identify high heart rate.
  2. Analyze cues: Collect data (review chart, assess vitals, check incision, ask about pain, note sweating and guarding).
  3. Prioritize hypothesis: Determine pain as the most likely cause.
  4. Generate solutions: Decide to administer pain medication.
  5. Take action: Obtain and administer pain medication.
  6. Evaluate outcome: Reassess the patient after medication administration to see if there is any improvement/positive changes.

Differences in Nursing Exams

  • Previous exams relied on memorization.
  • Nursing exams require applying knowledge to clinical scenarios.
  • Some memorization is still necessary (e.g., lab values (\text{e.g., }\text{Na}^+ = 135 - 145 \text{ mEq/L}), formulas).
  • A deeper understanding is required to apply knowledge of pathophysiology, diagnosis, and treatment.
  • The majority of the exam will be multiple-choice questions, including select all that apply, math, and NGN (Next Generation Nursing) style questions.
  • NGN questions focus on applying clinical judgment and addressing the identified gap in new grad nurses' abilities.

Ways to Study

  • Complete all required readings.
  • Practice exam questions to prepare for application-based questions.
  • Use resources like NurseHub to create quizzes on specific topics.
  • Access NCLEX question banks.
  • Take practice questions after studying a topic to assess application skills.
  • Adapt study style to your learning preferences.
    • Rewrite/Review notes.
    • Flashcards.
    • Study groups. (teaching others).
  • Ask questions to clarify understanding, and don't be afraid to ask questions.

Tutors

  • Utilize nursing program tutors for assistance.
  • Tutors can explain concepts in different ways.
  • Seeking help from a tutor does not reflect negatively on your abilities.

Breaks

  • Take regular breaks during study sessions.
  • The length of a break varies; it could be every 30, 60, or 90 minutes, depending on individual preference.
  • Short breaks (e.g., 10 minutes) help maintain focus and prevent distraction.
  • Studying while unfocused is unproductive.

Learning Styles

  • Identify your personal learning style to optimize study methods.
  • Multiple learning styles:
    • Visual
    • Auditory
    • Reading/Writing
    • Kinesthetic

Visual Learners

  • Learn best through visual methods.
  • Tend to be neat and organized.
  • Visualize information.
  • Attracted to color.
  • Prefer spoken language with imagery.
  • Strategies:
    • Sit in front of the classroom.
    • Check eyesight.
    • Use flashcards.
    • Visualize concepts.
    • Write down keywords.
    • Draw pictures.
    • Color-code notes.

Auditory Learners

  • Learn by hearing and listening.
  • Remember information by the way it sounds.
  • Understand spoken instructions more easily.
  • Strategies:
    • Sit where you can hear clearly.
    • Check hearing.
    • Read assignments aloud.
    • Record lectures and listen back.
    • Have questions read aloud.

Reading/Writing Learners

  • Learn through notes and written materials.

Kinesthetic Learners

  • Learn by touching and doing.
  • Understand through physical movements.
  • Need to be active and take frequent breaks.
  • May have difficulty sitting still.
  • Are hands on learners.
  • Strategies:
    • Participate in activities involving touching, building, drawing, moving.
    • Chew gum or walk while studying.
    • Take frequent breaks.
    • Use a computer to reinforce learning.
    • Focus on doing rather than just reading, seeing, or hearing.

Study Skills

  • Time management is crucial.

Time Management Strategies

  • Use a calendar to schedule activities.
  • Plan to attend all classes and clinicals.
  • Write out a calendar for the semester, focusing on one week at a time.
  • Be disciplined and prioritize studying.

The Study Plan

  • For every one hour of lecture, study for three hours.
  • Develop a study plan that incorporates all daily routines and commitments.
  • Visually map out available study times.
  • Adapt the plan based on the course load (e.g., 6 hours/week for the current course, 36 hours/week in the fall).

Smart Study Habits

  • Plan specific study times.
  • Avoid cramming.
  • Break down study sessions by topic (e.g., focus on hypertension one day, other diseases the next day).
  • Set goals for each study session.
  • Do not procrastinate.
  • Study difficult content when most alert.
  • Minimize distractions.
  • Ask questions.
  • Consult study partners, tutors, or online resources.
  • Take study breaks.
  • Eat a healthy diet and exercise regularly.
  • Get enough sleep.

Test Anxiety

  • A type of performance anxiety associated with pressure to perform well on exams.
  • Physiological process: Stress hormones (adrenaline) are released, preparing the body for fight or flight.
  • Symptoms: Sweating, pounding heart, rapid breathing, increased GI motility.
  • Some anxiety can be helpful to focus and motivate, but excessive anxiety hinders performance.

Alleviating Test Anxiety

  • Be well-prepared through effective time management and studying.
  • Avoid procrastination.
  • Study daily instead of cramming.
  • Use stress reduction techniques:
    • Muscle relaxation exercises.
    • Meditation.
    • Breathing exercises (long, deep breaths).
  • Take care of your whole body (holistic approach):
    • Address sources of stress in your life.
    • Get enough sleep the night before the exam.
    • Engage in relaxing activities before sleep.
    • Wake up earlier and eat a good breakfast.
    • Practice confidence-boosting techniques (e.g., power poses).

What to do During the Exam

  • Breathe deeply.
  • Read instructions carefully.
  • Do not rush.
  • If feeling anxious, take a break to breathe and reread the question.

Ingredients of Test Questions

  • Case event: The scenario or information presented in the question.
  • Question query: The actual question being asked.
  • Question options: The possible answers.

Sample Question

  • A client at 20 weeks gestation comes into the OB triage reporting contractions. (Case event)
  • Which statement by the client indicates a need to reinforce the instructions about preterm labor? (Question query)
  • Options: Four possible answers related to preterm labor (Question options)
    • These answers are either numbered A, B, C, D or 1, 2, 3, 4, etc.

Exam Question Formats

  • Multiple choice: Select one correct answer from four options.
  • Alternate formats:
    • Fill in the blank: Provide a specific term or answer (e.g., math calculation).
    • Select all that apply: Choose all correct answers from a list; there may be multiple correct answers.
    • Prioritization question: Order steps or actions based on priority what should be done first, second, and so on..
    • Figure or illustration: Answer a question based on a picture, or click on a specific area of the image.
    • Graphic item options: Images or pictures are provided as answer options.
    • Auditory questions: Listen to a sound (e.g., breath sound) and identify it.
    • Unfolding Case Studies (NGN): A case study unfolds with tabs providing additional information, and multiple questions that continue to build off the intial case study are administered based on the information given.