Exploring the Experiences and Understanding of Clinical Judgement of IENs Transitioning to Nursing Practice in Ontario

Clinical judgment is increasingly discussed in the nursing education literature as it is critical to the development of professional knowledge, and it provides a structure for the reasoning necessary for nursing practice today. It is well indicated in the literature that a significant number of novice practitioners in health care do not meet entry-to-practice expectations for clinical judgment and have difficulty transferring knowledge and theory into practice—regardless of educational preparation and credentials. Internationally Educated Nurses (IENs) are also considered novice practitioners in the Ontario health-care environment. The purpose of the study was to explore IENs’ experience and understanding of clinical judgment when engaged in a simulated clinical environment. The research question guiding the study was, What is the experience and understanding of clinical judgment of IENs when engaged in High Fidelity Patient Simulation (HFPS) and stimulated recall and reflective practice? The research employs qualitative descriptive, open-ended exploratory and interpretive methods informed by constructivism and transformative learning theories. Qualitative research seeks to understand and explain participant meaning. The participants in this study were four IENs, aged 27–37, who were attending a university academic bridging program. They participated in a) a preliminary interview to collect data regarding their demographics and information associated with their educational, clinical, and professional background; b) three interactive simulated clinical activities comprising of high-fidelity SimMan™ manikins; and c) three stimulated recall sessions followed by three focus groups. The interactive simulated activities were videotaped and stimulated recall and focus groups were audiotaped. Tanner’s Model of Clinical Judgment was used to guide this process. The thematic analysis uncovered six themes pertaining to IEN’s experience and understanding of clinical judgment: the shift from expert to novice, the need to rethink cultural competence and culturally competent care, the acknowledgement that culture and diversity are integral to understanding clinical judgment, the role of communication as a means to understanding clinical judgment, the recognition of unlearning as a way to understanding clinical judgment, and the phenomenon of unknowing as a dimension of understanding clinical judgment. The concepts of reflection-beyond-action and intercultural fluency emerged as implications for the teaching and learning of IENs.