As nurse educators continue to address research highlighting new graduates' limited preparation for entry into practice, assessment of clinical judgment remains critical to ensure students graduate with adequate skills.1,2 The National Council of State Boards of Nursing (NCSBN) has introduced higher-level clinical judgment assessment into the NCLEX-RN examination using NCSBN Clinical Judgment Measurement Model (NCJMM) alternate-format assessment items.2,3 To better prepare students for practice and the Next Generation NCLEX-RN (NGN), the BSN program at one campus of a large health care-focused university developed a collaborative approach to support faculty, staff, and leadership with innovative methods to integrate the NCJMM into learning activities, simulations, and assessments.

NGN items present complex problems with increased cues to promote analytic rather than intuitive decisions.2 According to Betts et al,2 it can be time-consuming even for experienced subject matter experts to develop items that assess clinical judgment using the NCJMM. In response to limited peer-reviewed resources to support NGN integration in early 2021, campus leadership formed a collaborative committee made up of faculty, leadership, and student learning specialists (SLS: registered nurses who facilitate simulations, provide professional tutoring, and help students bridge the gap between skills and critical thinking). Three committee workgroups addressed NGN in (1) assessment items, (2) case studies and classroom activities, and (3) simulations. The workgroups used the university's learning management system (LMS) to develop an NGN resource course (NGN Cookbook), which had a cooking theme to keep the content light, relatable, and engaging. The subsequent sections discuss some of these resources.

NGN Workgroup Perspectives

Question/Assessment Item Workgroup: Creating Recipes

The NGN question workgroup focused on helping colleagues understand NGN questions and apply questions using high-technology examples (techniques with software or technology) and low-technology/hands-on examples (such as tactile objects, discussions, and written activities). After introducing faculty and staff to NGN items via a short presentation, the committee spent around 2 months developing a module in the NGN Cookbook to support self-paced learning. The module included an introduction, step-by-step instructions for writing NGN questions, and "recipes" for each NGN item type (extended multiple response, extended multiple-choice, drop-down, drag-and-drop, highlight/enhanced hot spot, and stand-alone: bowtie and trend) as well as item subtypes.

The instructions for writing NGN questions expanded on 4 steps: identifying outcomes and/or objectives; outlining the unfolding case study; writing the 4 item parts (introduction statement of the location of client care, chart excerpt, question stem, and answer choices); and reviewing each item. A reference table correlated most effective NGN question types and key definitions from NCSBN with the 6 NCJMM cognitive functions. Subsequent LMS module pages ("recipes") included the item description, relevant NCJMM cognitive functions, an item example, tips for writing and implementing the item type/subtype (high-technology and low-technology/hands-on), and links to question templates. Supplemental Digital Content, Figure 1 (available at: http://links.lww.com/NE/B276) provides an example of tips given for writing and implementing multiple response matrix questions.

The NGN question templates were created manually in Microsoft Word and PowerPoint to appear similar to questions provided by NCSBN. Templates were created using Word and PowerPoint tables with 1 row and 2 columns. The first column (cell) was for the chart excerpt, and the second column (cell) was for the NGN question in a side-by-side format. The committee also included relevant tips for question formatting and writing item prompts. Supplemental Digital Content, Figure 2 (available at: http://links.lww.com/NE/B277) is a template of a multiple-response matrix item and example using the template.

After the "recipes" for each item type, the workgroup provided short formative assessments ("taste-tests") with example NGN-style questions and reflection questions asking how learners could apply the questions to their courses. The workgroup shared the module to faculty, SLS, and leadership in September 2021.

Case Study Workgroup: Adding Spice to Learning

The case study workgroup focused on creating an example interactive NGN case study and template using Microsoft PowerPoint. The case study included an electronic medical record (EMR) template to mimic client charts associated with NGN questions. The EMR template was made of hyperlinked presentation software slides that appear to the student to be one slide with clickable EMR tabs (hyperlinks to each portion of the chart, such as vital signs, laboratory test results, provider orders, medication administration record, nurses' notes, and history and physical) (see example slide in Supplemental Digital Content, Figure 3, available at: http://links.lww.com/NE/B278). The workgroup used the EMR template with an unfolding NGN-style 6-question pediatric case study example. The EMR template and step-by-step video instructions ("spices") for creating the EMR and case study were added as a module in the NGN Cookbook. The template was created using PowerPoint but can also be made using other presentation software such as Google Slides. Slides in the EMR must be linked together and shared in the presenter view mode or published as a slideshow, depending on the software.

Simulation Workgroup: Cooking in the NGN Kitchen

The simulation workgroup modified a short simulation followed by NCJMM-based activities with a client who could be adapted later to clinical courses through the program. The simulation scenario was a client with postoperative cholecystectomy used in the nursing fundamentals course. To prepare faculty and SLS for the activity, an informational video was created by the workgroup and was shared in August 2021. After the short simulation for students to evaluate the client, faculty facilitated hands-on activities, followed by debriefing. The activities and debriefing were completed within 1 hour. Activities included identifying assessments requiring follow-up; identifying appropriate photographs of food to provide the client; highlighting abnormal laboratory values and identifying appropriate actions if indicated; and matching appropriate nurse's responses to client questions such as "Am I going to die?" and "Am I going to feel a lot of pain?"

Discussion and Conclusion

The collaborative approach to integrate the NCJMM and NGN into the curriculum led to the development of resources and templates; creative collaboration by faculty, SLS, and leadership; and development of diverse content experts. Through 2022 into 2023, the "NGN Cookbook" has been shared with campuses nationally, and the NGN committee continued to collaborate with faculty from different courses each month on individualized areas of development related to NGN. One key lesson learned is the importance of being creative and keeping an open mind, even if a case study or question is not perfect. This campus's experiences may be of help to nursing leadership, faculty, and staff who are exploring innovative methods to teach and assess clinical judgment.

References