Nursing students' clinical judgment in simulation-based learning: A descriptive cross-sectional study

Abstract

Background Clinical judgment is a cognitive process central to nursing practice. Although it begins during undergraduate education, it requires continuous development. Aim To evaluate the clinical judgment skills of second-year nursing students through simulation-based learning. Methods In this descriptive cross-sectional study, 111 second-year nursing students from a foundation university in Istanbul participated in a simulation scenario involving chronic respiratory failure. Students' clinical judgment was assessed by 2 nursing educators using the Turkish version of the Lasater Clinical Judgment Rubric (LCJR-T) and a debriefing session sheet. Inter-rater agreement was analyzed using the Wilcoxon test, Cohen's kappa, and intraclass correlation coefficient (ICC). Results The mean LCJR-T total score was 22.13 +/- 4.48, indicating a developing level of clinical judgment. Responding had the highest mean score (7.80 +/- 1.84), while interpreting (3.59 +/- 0.91) and reflecting (4.90 +/- 1.11) were the lowest. The ICC for the total score was 0.72 (p < 0.001). Conclusion Second-year students showed underdeveloped clinical judgment, particularly in interpretation and reflection. Longitudinal follow-up is recommended to support their progress in upper years. (c) 2025 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.