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  1. Byrne, Deborah PhD, RN, CNE
  2. Blumenfeld, Stephanie MSN, RN, CHSE
  3. Szulewski, Maureen MSN, RN, CNE, CCRN-K
  4. Laske, Rita Ann EdD, RN, CNE


The National Council of State Boards of Nursing plans to update the National Council Licensure Exam for nursing graduates to better measure clinical judgment. It is important that schools of nursing provide opportunities for nursing students to practice and develop clinical judgment skills. Simulation offers nursing students opportunities to use clinical reasoning and clinical judgment to care for patients in a safe environment The purpose of this study was to evaluate an unfolding case study using high-fidelity simulation to develop nursing students' clinical judgment skills across three practice settings: primary care office, acute care hospital, and home healthcare. This was a mixed-method, posttest study design with a convenience sample of 91 nursing students using the Lasater Clinical Judgment Rubric (LCJR) and survey questions. The posttest analysis mean of the LCJR subgroups revealed students felt accomplished following the intervention. Four themes emerged from content analysis of the qualitative data: 1.) increased knowledge of management of diabetes in various clinical settings, 2.) using clinical judgment/critical thinking in the home care setting, 3.) being able to self-reflect on actions, and 4.) a desire for more simulation experiences in the home healthcare setting. The results of the LCJR indicated that students felt accomplished after the simulation experience. This outcome was also evident in the qualitative data, indicating that students felt more confident in managing the care of a patient with a chronic illness using clinical judgment skills in various clinical settings.