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Abstract: Background: Paper based simulated patients are widely used to analyse nurses’ clinical judgements. However, developments in the physical simulation of clinical environments offer exciting, but relatively underexploited, opportunities for exploring nurses’ judgements. Critical event risk assessment is an element of acute care practice which lends itself well to simulation and in which more clinical experience is often assumed to lead to better quality judgements. Objectives: To model nurses’ judgements of critical event risk using physical and paper simulation and to examine whether improving fidelity via physical clinical simulation impacts on the apparent benefits of clinical experience on nurses’ judgement performance. Design: A comparative clinical judgement analysis. Setting: A university in Northern England. Methods: Sixty-three nursing students and 34 experienced nurses made dichotomous risk assessment judgements (“at risk” or “not at risk”) in response to 25 paper and physical simulated scenarios. These were randomly generated from a dataset of real patient case records. Clinical outcomes (the judgement criteria) for a ‘correct’ judgement were derived from the same case records. Logistic regression models were constructed to derive statistics for each nurse representing various measures of judgement performance: achievement (r a ), consistency (R s ) and clinical information use (G). These statistics were known as Lens Model statistics (from the psychological theory of Brunswik''s Lens Model of judgement). Performance measures for novice and experienced nurses were compared. Results: No significant differences in judgemental achievement (r a ) between experienced nurses and students were observed in either paper or high fidelity clinical simulations. Similarly, there were no significant differences in the nurses’ abilities to correctly match the ways they synthesised clinical information with the optimum synthesis required by the task (policy matching) (G). When faced with “paper patients” experienced nurses exercised more cognitive control/consistency (R s ) than students (P =0.04). However, this heightened control in experienced nurses was absent when those same nurses made judgements in the higher fidelity clinical simulation environment. Conclusion: Clinical experience made no difference to nurses’ judgement achievement (accuracy) in either the lower fidelity paper scenarios or the higher fidelity setting of the clinical simulation unit. The significant impact of clinical experience on judgement consistency was negated by the increases in fidelity offered through clinical simulation. [Copyright &y& Elsevier]

Background Venous leg ulcer management in the UK varies significantly. Judgements made by nurses contribute to this variability and it is often assumed that specialist nurses make better judgements than non-specialist nurses. This paper compares the judgements of community tissue viability specialist nurses and community generalist nurses; specifically, the ways they use clinical information and their levels of accuracy. Objectives To compare specialist and non-specialist UK community nurses’ clinical information use when managing venous leg ulceration and their levels of accuracy when making diagnoses and judging the need for treatment. Design Judgement analysis. Setting UK community and primary care nursing services. Participants 18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Methods Data were collected in 2011 and 2012. 18 community generalist nurses and 18 community tissue viability specialist nurses made diagnostic and treatment judgements on 110 clinical scenarios and indicated their confidence in each of their judgements. Scenarios were generated from real patient cases and presented online using text and photographs. An expert panel made judgements, and reached consensus on the same scenarios. These judgements were used as a standard against which to compare the participants. Logistic regression models and correlational statistics were used to generate various indices of judgement “performance”: accuracy, consistency, confidence calibration and information use. Differences between groups of nurses with different levels of characteristics linked to expertise were explored using analysis of variance. Results Specialist nurses had similar cue usage to the generalist nurses but were more accurate when making diagnostic and treatment judgements. Conclusion It is not obvious why the tissue viability specialist nurses were more accurate. One possible reason might be the greater opportunities for ‘deliberate practice’ afforded to specialists. However, restricting aspects of practice only to specialist nurses is likely to hinder the judgement performance of generalists. [ABSTRACT FROM AUTHOR]