Clinical Judgment Model-Based Critical Reflection Program for Newly Graduated Nurses: A Nonrandomized Controlled Trial.

Abstract

This study evaluated the effects of a critical reflection program utilizing the Lasater Clinical Judgment Rubric (LCJR) reflective questions based on the Clinical Judgment Model (CJM) on newly graduated nurses' clinical judgment skills. A total of 153 newly graduated nurses scheduled for on-site training in a ward nursing unit were divided into a control group (receiving only the usual on-site training with preceptorship) and an experimental group (receiving the developed program with the same on-site training with preceptorship as the control group). Data were collected at baseline, 6 weeks, and 3 months after the intervention. A comparison of the scores of the two groups at each measurement time point revealed that the experimental group showed significantly higher scores than the control group in clinical judgment (z = 3.25, p = 0.003) and stage of noticing (z = 2.78, p = 0.015) at 6 weeks postintervention. Clinical reasoning competence (experimental χ² = 24.57, p < 0.001; control χ² = 41.12, p < 0.001) and clinical judgment (experimental χ² = 12.74, p = 0.002; control χ² = 10.54, p = 0.005) significantly improved scores across the three time points in both groups. The change in scores in the responding stage of clinical judgment from preintervention to 6 weeks postintervention showed a significant difference between the two groups (z = -2.44, p = 0.045). A critical reflection program based on the CJM can help newly graduated nurses enhance their clinical judgment over a short period during the early stages of clinical adaptation.