Incorporating a Clinical Judgment Model Framework to Improve Medication Safety Among Pre-Licensure Nursing Students Author(s): Kristin Fontaine View author profile

Abstract

Pre-licensure nursing students at a local Southern California Community College School of Nursing (SON) lack the experience to analyze data, make necessary clinical judgments, and engage in evidence-based decision-making during medication preparation, administration, and evaluation. The Quality Improvement (QI) project used the National Council State Board of Nursing Clinical Judgment Measurement Model (NCSBN-CJMM) to replace the current task-oriented medication process, thus facilitating clinical judgment and decision-making in all aspects of medication delivery for prelicensure nursing students. The project used the Clinical Judgment Rubric (CJR), Plus/Delta Debriefing Tool (PDDT), and Post-Implementation Survey (PIS) for data collection. Participants were evaluated on clinical judgment categories using a CJR. Following each Medication Simulation, participants completed a PDDT to engage in reflective practice. The PIS provided feedback on project objectives and any medication-related incidents following the simulations. Data analysis from Simulation #1 (pre-test) and Simulation #2 (post-test) were analyzed using parametric repeated-measures t-tests. Additionally, using a confidential PIS, participants were evaluated to see if the medication simulation process and associated interventions assisted them in engaging in clinical judgment and decision-making throughout the medication delivery process. There was a significant increase in Medication Preparation from pre-intervention to post-intervention. There was also a significant increase from pre-intervention to post-intervention for Recognize and Analyze Cues. A nonsignificant change was detected for Medication Error. However, for Dosage Calculation, there was a significant change in the number of participants, going from incorrect to correct. Implementing a standardized framework for medication administration empowers nursing students and fosters the development of clinical judgment and decision-making skills, ultimately reducing medication errors and near misses.