Date of Project


Document Type

Honors Thesis

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Bev Bone MSN, RN

Second Advisor

Dr. Kelly Ruppel PhD, RN


Background: There is longstanding discussion concerning the competency of novice nurses who passed the National Council Licensure Exam (NCLEX) and their ability to practice safely. Nursing clinical judgment (CJ), also known as critical thinking or clinical decision-making, accounts for more than 46% of daily tasks nurses perform in their first year (Hensel, 2020, p. 128). Guided reflective journaling is one active learning strategy that encourages students to reflect on what they have learned, anticipate future needs, and enhance clinical judgment skills (Meijer, 2021, p. 9, 11). This qualitative pilot study follows one nursing student throughout a student nurse extern program (SNEP) utilizing guided reflection questions based on the Tanner Clinical Judgment Model, Situated Clinical Decision-Making Framework (SCDMF), and a previous qualitative study (Smith, 2020) to determine the effectiveness and feasibility of guided writing to develop clinical judgment. Results: The four themes across all reflection responses were: 1) organization of basic nursing care; 2) prioritization attempts; 3) recognition of common protocols; 4) increased confidence. The most significant finding was the change in reflection writing from haphazardly utilizing the steps of the SCDMF and Tanner Clinical Judgment Model to systematically following each process, also accounting for the dynamic properties of the CJ models. Conclusion: Findings from this study could benefit new nurses as the National Council of State Board of Nursing clinical judgment model has similar reasoning phases as the Tanner Clinical Judgment Model and SCDMF, of which the reflection questions are based upon. By answering guided reflection questions, a form of active learning, based on the Tanner Clinical Judgment Model and SCDMF during a SNEP experience, it can be concluded that guided reflection writing is one form of active learning that promotes clinical judgment development.

Included in

Nursing Commons