대한간호학회지 (Journal of Korean Academy of Nursing)

한국간호과학회 (Korean Society of Nursing Science)
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간호사의 임상판단 측정도구 개발

Development of Nursing Clinical Judgment Scale

  • 투고 : 2023.03.13
  • 심사 : 2023.09.14
  • 발행 : 2023.12.31
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초록

Purpose: This study aimed to develop a nursing clinical judgment scale (NCJS) and verify its validity and reliability in assessing the clinical judgment of nurses. Methods: A preliminary instrument of the NCJS comprising 38 items was first developed from attributes and indicators derived from a literature review and an in-depth/focus interview with 12 clinical nurses. The preliminary tool was finalized after 7 experts conducted a content validity test based on a data from a preliminary survey of 30 hospital nurses in Korea. Data were collected from 443 ward, intensive care unit, emergency room nurses who voluntarily participated in the survey through offline and online for the verification of the construct validity and reliability of the scale. Results: The final scale comprised 23 items scored on a 5-point Likert scale. Six factors - integrated data analysis, evaluation and reflection on interventions, evidence on interventions, collaboration among health professionals, patient-centered nursing, and collaboration among nurse colleagues - accounted for 64.9% of the total variance. Confirmatory factor analysis supported the fit of the measurement model, comprising six factors (root mean square error of approximation = .07, standardized root mean square residual = .04, comparative fit index = .90). Cronbach's α for all the items was .92. Conclusion: The NCJS is a valid and reliable tool that fully reflects the characteristics of clinical practice, and it can be used effectively to evaluate the clinical judgment of Korean nurses. Future research should reflect the variables influencing clinical judgment and develop an action plan to improve it.

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과제정보

This study was supported by Hanmaeum Scholarship of the Seoul Nurses Association in 2018.

참고문헌

  1. Manetti W. Sound clinical judgment in nursing: A concept analysis. Nursing Forum. 2019;54(1):102-110. https://doi.org/10.1111/nuf.12303 
  2. Shim KK, Shin HY, Rim DH. Analysis of students' clinical judgment process during nursing simulation. Journal of the Korea Academia-Industrial Cooperation Society. 2018;19(9):130-138. https://doi.org/10.5762/KAIS.2018.19.9.130 
  3. Kavanagh JM, Sharpnack PA. Crisis in competency: A defining moment in nursing education. The Online Journal of Issues in Nursing. 2021;26(1):2. https://doi.org/10.3912/OJIN.Vol26No01Man02 
  4. Lasater K, Nielsen AE, Stock M, Ostrogorsky TL. Evaluating the clinical judgment of newly hired staff nurses. Journal of Continuing Education in Nursing. 2015;46(12):563-571. https://doi.org/10.3928/00220124-20151112-09 
  5. Burdeu G, Lowe G, Rasmussen B, Considine J. Clinical cues used by nurses to recognize changes in patients' clinical states: A systematic review. Nursing & Health Sciences. 2021;23(1):9-28. https://doi.org/10.1111/nhs.12778 
  6. Chaboyer W, Harbeck E, Lee BO, Grealish L. Missed nursing care: An overview of reviews. Kaohsiung Journal of Medical Sciences. 2021;37(2):82-91. https://doi.org/10.1002/kjm2.12308 
  7. Dickison P, Haerling KA, Lasater K. Integrating the national council of state boards of nursing clinical judgment model into nursing educational frameworks. Journal of Nursing Education. 2019;58(2):72-78. https://doi.org/10.3928/01484834-20190122-03 
  8. Lasater K, Holloway K, Lapkin S, Kelly M, McGrath B, Nielsen A, et al. Do prelicensure nursing students' backgrounds impact what they notice and interpret about patients? Nurse Education Today. 2019;78:37-43. https://doi.org/10.1016/j.nedt.2019.03.013 
  9. Connor J, Flenady T, Massey D, Dwyer T. Clinical judgement in nursing - An evolutionary concept analysis. Journal of Clinical Nursing. 2023;32(13-14):3328-3340. https://doi.org/10.1111/jocn.16469 
  10. Lee DS, Park JY. A review for concept clarification of critical thinking, clinical reasoning, and clinical judgment in nursing education. Journal of Korean Academic Society of Nursing Education. 2019;25(3):378-387. https://doi.org/10.5977/jkasne.2019.25.3.378 
  11. Betts J, Muntean W, Kim D, Jorion N, Dickison P. Building a method for writing clinical judgment items for entry-level nursing exams. Journal of Applied Testing Technology. 2019;20(S2):21-36. 
  12. Tanner CA. Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education. 2006;45(6):204-211. https://doi.org/10.3928/01484834-20060601-04 
  13. Cappelletti A, Engel JK, Prentice D. Systematic review of clinical judgment and reasoning in nursing. Journal of Nursing Education. 2014;53(8):453-458. https://doi.org/10.3928/01484834-20140724-01 
  14. Jenkins HM. Improving clinical decision making in nursing. Journal of Nursing Education. 1985;24(6):242-243. https://doi.org/10.3928/0148-4834-19850601-07 
  15. Facione PA, Facione NC. The California critical thinking skills test: CCTST: test manual. Millbrae (CA): California Academic Press; 1994. p. 1-48. 
  16. Lasater K. Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education. 2007;46(11):496-503. https://doi.org/10.3928/01484834-20071101-04 
  17. Kawase Y, Miyashita M, Okayasu M, Hirai Y. Development of a clinical judgment scale for Japanese nurses. Journal of Continuing Education in Nursing. 2021;52(8):383-391. https://doi.org/10.3928/00220124-20210714-08 
  18. Strickland HP, Cheshire MH, March AL. Clinical judgment during simulation: A comparison of student and faculty scores. Nursing Education Perspectives. 2017;38(2):85-86. https://doi.org/10.1097/01.NEP.0000000000000109 
  19. Vreugdenhil J, Spek B. Development and validation of Dutch version of Lasater Clinical Judgment Rubric in hospital practice: An instrument design study. Nurse Education Today. 2018;62:43-51. https://doi.org/10.1016/j.nedt.2017.12.013 
  20. DeVellis RF. Scale development: Theory and applications. 4th ed. Los Angeles (CA): Sage Publications Inc.; 2017. p. 105-151. 
  21. Schwartz-Barcott D, Kim HS. An expansion and elaboration of the hybrid model of concept development. In: Rodgers BL, Knafl KA, editors. Concept Development in Nursing: Foundations, Technqiues, and Applications. 2nd ed. Philadelphia: W.B. Saunders; 2000. p. 129-159. 
  22. Choi GH. Understanding of hybrid model by SchwartzBarcott & Kim. Journal of Korean Association for Qualitative Research. 2019;4:40-50. https://doi.org/10.48000/KAQRKR.2019.4.40 
  23. Elo S, Kyngas H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62(1):107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x 
  24. Jang DH, Cho SK. Is the mid-point of a Likert-type scale necessary?: Comparison between the scales with or without the mid-point. Survey Research. 2017;18(4):1-24. https://doi.org/10.20997/SR.18.4.1 
  25. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. 8th ed. Philadelphia (PA): Lippincott Williams & Wilkins, Wolters Kluwer; 2008. p. 458-486. 
  26. Hinkin TR. A brief tutorial on the development of measures for use in survey questionnaires. Organizational Research Methods. 1998;1(1):104-121. https://doi.org/10.1177/109442819800100106 
  27. Costello AB, Osborne JW. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation. 2005;10(7):1-9. https://doi.org/10.7275/jyj1-4868 
  28. Anderson JC, Gerbing DW. Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin. 1988;103(3):411-423. https://doi.org/10.1037/0033-2909.103.3.411 
  29. Song JJ. SPSS/AMOS statistical analysis method. Rev. ed. Paju: 21Century; 2015. p. 146-482. 
  30. Hair JF Jr, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. Upper Saddle River (NJ): Pearson Education; 2010. p. 109-136. 
  31. Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods. 1996;1(1):16-29. https://doi.org/10.1037/1082-989X.1.1.16 
  32. Kim SE, Jeong KH, Heo YH, Woo JH, Kim KH. Thesis passed at once: Application of AMOS structural equations and advanced analysis of SPSS. Seoul: Hanbit Academy; 2018. p. 366. 
  33. Bae BR. Structural equation modeling with Mplus 7.0. Seoul: Chungram Publishing; 2016. p. 39. 
  34. Nibbelink CW, Brewer BB. Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing. 2018;27(5-6):917-928. https://doi.org/10.1111/jocn.14151 
  35. Jessee MA. An update on clinical judgment in nursing and implications for education, practice, and regulation. Journal of Nursing Regulation. 2021;12(3):50-60. https://doi.org/10.1016/S2155-8256(21)00116-2 
  36. Lee MK, Jang KS. Reflection-related research in Korean nursing: A literature review. Journal of Korean Academy of Nursing Administration. 2019;25(2):83-96. https://doi.org/10.11111/jkana.2019.25.2.83 
  37. Miraglia R, Asselin ME. Reflection as an educational strategy in nursing professional development: An integrative review. Journal for Nurses in Professional Development. 2015;31(2):62-72; quiz E6. https://doi.org/10.1097/NND.0000000000000151 
  38. Lee MK, Jang KS. The significance and application of reflective practice in nursing practice. Nursing and Health Issues. 2018;23(1):1-8. 
  39. Choi EJ, Hwang JH, Jang IS. Effects of nursing practice environment and self-esteem on critical thinking disposition among clinical nurses. Journal of Korean Academy of Nursing Administration. 2017;23(2):161-169. https://doi.org/10.11111/jkana.2017.23.2.161 
  40. Yen PY, Kelley M, Lopetegui M, Rosado AL, Migliore EM, Chipps EM, et al. Understanding and visualizing multitasking and task switching activities: A time motion study to capture nursing workflow. AMIA Annual Symposium Proceedings. 2017;2016:1264-1273. 
  41. Han MR, Kang EH, Lee YS, Chang EJ, Lee SJ, Heo YA, et al. Factors influencing the activation time of the rapid response team. Journal of Korean Clinical Nursing Research. 2020;26(2):198-206. https://doi.org/10.22650/JKCNR.2020.26.2.198 
  42. Ang RJ. Use of content management systems to address nursing workflow. International Journal of Nursing Sciences. 2019;6(4):454-459. https://doi.org/10.1016/j.ijnss.2019.09.012 
  43. Lee MJ, Lee YM, Shin SY, Cho JH. Experience of the collaborative practice among health professionals in Korea. Journal of Korean Critical Care Nursing. 2022;15(1):47-57. https://doi.org/10.34250/jkccn.2022.15.1.47 
  44. Yoo JY. Shared decision-making in patients with chronic disease: Concept analysis. Journal of the Korea Convergence Society. 2019;10(11):543-555. https://doi.org/10.15207/JKCS.2019.10.11.543 
  45. Pursio K, Kankkunen P, Sanner-Stiehr E, Kvist T. Professional autonomy in nursing: An integrative review. Journal of Nursing Management. 2021;29(6):1565-1577. https://doi.org/10.1111/jonm.13282 
  46. Jakimowicz S, Perry L, Lewis J. An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit. Journal of Clinical Nursing. 2017;26(23-24):4153-4171. https://doi.org/10.1111/jocn.13957 
  47. Kim KJ, Kim CO, Park JW. The prospect of geriatric medicine - Road to comprehensive elderly care. Korean Journal of Medicine. 2021;96(2):65-75. https://doi.org/10.3904/kjm.2021.96.2.65 
  48. Lee SO, Kim MJ. Health perception and family support as influencing factors on depression in hospitalized elderly patients. The Korean Journal of Health Service Management. 2015;9(4):145-155. https://doi.org/10.12811/kshsm.2015.9.4.145 
  49. Cederwall CJ, Plos K, Rose L, Dubeck A, Ringdal M. Critical care nurses management of prolonged weaning: An interview study. Nursing in Critical Care. 2014;19(5):236-242. https://doi.org/10.1111/nicc.12092 
  50. Hyun SI, Lee TW. Effects of professional autonomy and teamwork on clinical performance of nurses in tertiary hospitals. Journal of Korean Academy of Nursing Administration. 2021;27(5):301-310. https://doi.org/10.11111/jkana.2021.27.5.301