The effect of a clinical judgment model based educational intervention for international nurses on their critical thinking skills and nclex-rn® practice exam performance



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Critical thinking and clinical judgment skills are essential for entry-level nurses in the United States and evaluated through the National Council Licensure ExaminationRN® (NCLEX-RN). Unfortunately, internationally educated Indian nurses (IEINs) taking the NCLEX-RN have shown a low (34%) first-time pass rate. This study developed a Clinical Judgment Measurement Model (CJMM)-based educational intervention for IEINs and examined 1) the effects of the intervention on their critical thinking skills and NCLEX-RN practice exam and 2) the relationship between critical thinking skills and NCLEX-RN practice exam. This quasi-experimental, one-group, pretest-posttest study had a convenience sample of 34 IEINs, who participated in the interactive live educational sessions and completed pre-and post-critical thinking skill tests and NCLEXRN practice exams. Student feedback was collected. Data were analyzed using paired sample t-test, ANCOVA, and Pearson correlation. The intervention significantly improved overall critical thinking skills of participants (p = .02), explanation skills (p = .01), and deductive reasoning (p = .02). This study did not show significant effect on the IEINs’ NCLEX-RN practice exam reported as overall HESI score. However, the IEINs showed more correct answers in the practice exam at posttest regarding the following Client Needs categories: Health promotion and maintenance (p < .01) and physiological integrity (p < .01). Also, there were significant increases in the percentages of correct answers in the following nursing process components: Assessment (Recognizing Cues) (p < .01), Analysis (Analyze Cues and Prioritize Hypotheses) (p < .01), and Planning (Generate Solutions) (p = .01). The IEINs’ NCLEX-RN practice exam scores were not significantly affected by participants’ age, gender, education, years since graduation, years of working experience, clinical specialty, and the number of previous NCLEX-RN attempts. There was a significant moderate positive association between the critical thinking scores and the NCLEX-RN practice exam scores after the intervention (r = .45, p =.01). All participants were very satisfied with the intervention and desired to extend the duration of the intervention with accommodation for global time zones. The study findings can be applied by global nursing educators to revise the existing curricula and teaching modalities to enhance critical thinking and clinical judgment skills of IEINs.