Using a Cognitive Aide with a Robust Electronic Medical Record as Simulation Preparation to Increase Learners’ Clinical Judgment

Abstract : In order to plan holistic nursing care, learners must seek, retrieve, and analyze salient patient data. However, traditional clinical sites often limit learners’ access to electronic medical records (EMR). Our project, guided by NLN/Jeffries Simulation Theory and the NCSBN Clinical Judgment Measurement Model, aimed to make simulation preparation more authentic by empowering learners to abstract data from a robust, commercial EMR and plan holistic nursing care. Eighty simulation-naïve (second clinical semester) learners used a robust EMR for simulation preparation. We shared historical vital signs, shift notes, diagnostics, and lab values for a total of 13 patients across a semester. Cognitive aides helped learners navigate the EMR and consider salient points. Learners prepared independently at home (30 minutes per patient) then developed consensus around priorities with their simulation group (15 minutes). Learners presented their priorities, and facilitators used scripted probing questions to explore salient points during prebriefing (10 minutes). Anecdotal feedback from end of semester surveys highlighted how using the EMR helped learners navigate patient data, analyze labs, recognize trends, prioritize interventions, and organize care. Facilitators observed learners developed broader plans, including generating solutions and taking action to address salient physiological and psychosocial concerns. This presentation will help educators use an EMR as simulation preparation along with a cognitive aide to intentionally develop learners’ clinical judgment.