{"id":733,"date":"2022-09-13T20:07:24","date_gmt":"2022-09-13T20:07:24","guid":{"rendered":"https:\/\/sites.rutgers.edu\/changing-course\/?p=733"},"modified":"2022-10-10T18:53:44","modified_gmt":"2022-10-10T18:53:44","slug":"growing-clinical-judgement-with-trees","status":"publish","type":"post","link":"https:\/\/sites.rutgers.edu\/changing-course\/growing-clinical-judgement-with-trees\/","title":{"rendered":"Growing Clinical Judgment with Trees"},"content":{"rendered":"<h4>In this issue of <em>Changing Course, <\/em>we will examine how to grow clinical judgment with trees. The change to the Next Generation NCLEX (NGN) is quickly approaching and students currently enrolled in nursing programs must be ready to pass the redesigned licensing exam. Clinical judgment must be cultivated at the onset of the educational journey to ensure success on the NGN, but more importantly to graduate nurses that are ready for practice. The <strong><em>Tree of Inquiry<\/em><\/strong> builds on an existing strategy to foster clinical judgment through deep thinking, decision making, and demonstration of nursing competencies.<\/h4>\n<h4><\/h4>\n<h4>The <em><strong>Tree of Inquiry<\/strong> <\/em>is based on the <em>Tree of Impact<\/em> decision tree tool. It was presented in 2001 as a nursing education strategy by Lowenstein et al. and subsequently modified by Assessment Technologies Institute (ATI) (2015). I was first introduced to the <em>Tree of Impact<\/em> at the <em>2022 ATI National Nurse Educator Summit. <\/em>The <em><strong>Tree of Inquiry<\/strong> <\/em>has a foundation in the Nursing Clinical Judgment Measurement Model (NCJMM). It also supports Universal Design for Learning principles through:<\/h4>\n<ul>\n<li>\n<h4><em>Multiple Means of Engagement:<\/em> it is an individual or collaborative activity that can be used in the classroom, laboratory, or clinical setting<\/h4>\n<\/li>\n<li>\n<h4><em>Multiple Means of Representation:<\/em> students use visual, textual, and auditory means to complete the activity<\/h4>\n<\/li>\n<li>\n<h4><em>Multiple Means of Action and Expression:<\/em> it can be typed or handwritten and supports strategy development and the use of executive functions<\/h4>\n<\/li>\n<\/ul>\n<h4>(CAST, 2022).<\/h4>\n<h4><\/h4>\n<h4>Using the <em><strong>Tree of Inquiry<\/strong><\/em> as an educational strategy is easy to do. It is designed to be used with patient scenarios and can be applied to currently used case studies, simulations, and clinical practice. When used repeatedly as a teaching strategy across the curriculum, the <em><strong>Tree of Inquiry<\/strong><\/em> can reframe student thinking patterns. The <em><strong>Tree of Inquiry<\/strong> <\/em>is pictured below.<\/h4>\n<h4><\/h4>\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-740 aligncenter\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-1.png\" alt=\"Tree of Inquiry\" width=\"570\" height=\"425\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-1.png 784w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-1-300x224.png 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-1-768x573.png 768w\" sizes=\"(max-width: 570px) 100vw, 570px\" \/><\/p>\n<h4>With the <em><strong>Tree of Inquiry<\/strong><\/em>, students:<\/h4>\n<ol>\n<li>\n<h4>Identify and prioritize patient <strong>Cues<\/strong><\/h4>\n<\/li>\n<li>\n<h4>Identify priority nursing <strong>Problems<\/strong><\/h4>\n<\/li>\n<li>\n<h4>Plan and Implement nursing <strong>Activities<\/strong><\/h4>\n<\/li>\n<li>\n<h4>Evaluate the <strong>Outcomes<\/strong> of the implemented activities<\/h4>\n<\/li>\n<\/ol>\n<h3><strong>Cues<\/strong><\/h3>\n<p>&nbsp;<\/p>\n<h4><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-765 alignleft\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.12.11-PM.png\" alt=\"Cues roots of tree\" width=\"243\" height=\"152\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.12.11-PM.png 542w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.12.11-PM-300x187.png 300w\" sizes=\"(max-width: 243px) 100vw, 243px\" \/>According to the National Council of State Boards of Nursing (NCSBN) (2019), <strong>cues<\/strong> are relevant and key information gathered from different sources. In the <strong><em>Tree of Inquiry<\/em><\/strong>, the cues form the roots of the tree and are the foundation from which the tree, or <em>plan of care<\/em>, grows. Students analyze the cues to identify and hypothesize <strong>problems<\/strong> to address. Examples of <strong>cues<\/strong> include assessment findings, laboratory or testing data, psychosocial and medical history, and background information.<\/h4>\n<h4><\/h4>\n<h3><strong>Problems<\/strong><\/h3>\n<h4><strong><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-766 alignright\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.14.01-PM.png\" alt=\"trunk problems\" width=\"133\" height=\"161\" \/>Problems <\/strong>deal with human responses to actual and potential health issues and life processes and fall within the nursing scope of practice (American Nurses Association [ANA], 2021). After <strong>problems<\/strong> are identified and prioritized, they are placed in the trunk of the tree. The trunk serves as the main structure of the tree, facilitating transport of water and nutrients from the roots to the leaves and sugar from the leaves to the roots (Arbor Day Foundation, 2022). In the <strong><em>Tree of Inquiry<\/em><\/strong>, the trunk serves as the in-between point for the <strong>cues<\/strong> and the <strong>activities<\/strong>, as the <strong>problems<\/strong> are directly related to the <strong>cues<\/strong> and the <strong>activities<\/strong> are directly related to the <strong>problems<\/strong>. The trunk is where solutions are generated and pushed up through the branches to become <strong>activities<\/strong>. Examples of <strong>problems<\/strong> include risk for injury, pain, anxiety, and impaired skin integrity.<\/h4>\n<h3><\/h3>\n<h3><strong>Activities<\/strong><\/h3>\n<h4><strong><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-768 alignleft\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.17.03-PM.png\" alt=\"branches activities\" width=\"316\" height=\"164\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.17.03-PM.png 540w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.17.03-PM-300x156.png 300w\" sizes=\"(max-width: 316px) 100vw, 316px\" \/>Activities<\/strong> are the solutions, or actions, that address the highest priorities (NCSBN, 2019). <strong>Activities<\/strong> are placed on the branches as they produce the <strong>outcomes<\/strong>, which are the leaves. Examples of <strong>activities<\/strong> include administering medications, turning a patient and providing education.<\/h4>\n<p>&nbsp;<\/p>\n<h4><\/h4>\n<h3><\/h3>\n<h3><strong>Outcomes<\/strong><\/h3>\n<h4><strong><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-769 alignright\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.18.54-PM.png\" alt=\"leaves outcomes\" width=\"386\" height=\"117\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.18.54-PM.png 580w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Screen-Shot-2022-09-08-at-2.18.54-PM-300x91.png 300w\" sizes=\"(max-width: 386px) 100vw, 386px\" \/>Outcomes<\/strong> are the patient&#8217;s response to the activities (NCSBN, 2019). Observed or potential <strong>outcomes<\/strong> should be evaluated and compared to expected <strong>outcomes<\/strong>. Students are prompted to anticipate <strong>outcomes<\/strong> that indicate the patient&#8217;s condition is getting better, worse, or remaining the same. <strong>Outcomes<\/strong> are placed on the leaves of the tree, as the leaves are dependent on the branches like <strong>outcomes<\/strong> are dependent on the <strong>activities<\/strong>.<\/h4>\n<h4>You can download a <a href=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-Handout-PDF.pdf\">Tree of Inquiry Handout<\/a> here.<\/h4>\n<h3><\/h3>\n<h3><strong>Examples<\/strong><\/h3>\n<h4>Here are four <em><strong>Tree of Inquiry<\/strong><\/em> assignments that I have implemented with success. Please feel free too use and share with proper attribution.<\/h4>\n<h4><\/h4>\n<h4><strong>Health Equity and Social Determinants of Health<\/strong><\/h4>\n<h4>This activity was used in a beginning nursing course during a discussion about health equity and social determinants of health.<\/h4>\n<h4><strong>Case:<\/strong> <span class=\"hotkey-layer \"><span class=\"hotkey-layer preview-overlay is-preview-sidebar-visible\">The nurse in a clinic is caring for a 32 week pregnant patient. The patient is 24 years old and has 3 children at home. This is the patient&#8217;s first prenatal visit. Physical assessment findings are within normal limits except for high blood pressure. The nurse is concerned.<\/span><\/span><\/h4>\n<h4><strong>Instructions:\u00a0<\/strong><\/h4>\n<ul>\n<li>\n<h4>Complete the <em><strong>Tree of Inquiry<\/strong><\/em> using the provided case.<\/h4>\n<ul>\n<li>\n<h4>Cues<\/h4>\n<ul>\n<li>\n<h4>Individually, identify and prioritize &#8220;Cues&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Collaboratively, discuss &#8220;Cues&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Report out to class and discuss<\/h4>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<h4>Problems<\/h4>\n<ul>\n<li>\n<h4>Individually, identify and prioritize &#8220;Problems&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Collaboratively, discuss &#8220;Problems&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Report out to class and discuss<\/h4>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<h4>Activities<\/h4>\n<ul>\n<li>\n<h4>Individually, identify &#8220;Activities&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Collaboratively, discuss &#8220;Activities&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Report out to class and discuss<\/h4>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<h4>Outcomes<\/h4>\n<ul>\n<li>\n<h4>Individually, identify &#8220;Outcomes&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Collaboratively, discuss &#8220;Outcomes&#8221;<\/h4>\n<\/li>\n<li>\n<h4>Report out to class and discuss<\/h4>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<h4>Recommendations: set time limits as appropriate, draw tree on a whiteboard with each stage<\/h4>\n<\/li>\n<\/ul>\n<h4 style=\"text-align: center\"><strong>Sample Tree<\/strong><\/h4>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-796 aligncenter\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Social-Det-Tree-of-Inquiry.png\" alt=\"Tree of Inquiry completed\" width=\"1280\" height=\"796\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Social-Det-Tree-of-Inquiry.png 1280w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Social-Det-Tree-of-Inquiry-300x187.png 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Social-Det-Tree-of-Inquiry-1024x637.png 1024w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Social-Det-Tree-of-Inquiry-768x478.png 768w\" sizes=\"(max-width: 1280px) 100vw, 1280px\" \/><\/p>\n<h4><strong>Clinical Activity<\/strong><\/h4>\n<h4>This activity is completed during clinical, as the student develops, implements, and evaluates the plan of care for the patient.<\/h4>\n<h4><strong>Instructions:<\/strong><\/h4>\n<div class=\"description user_content teacher-version enhanced\">\n<ul>\n<li>\n<h4><span lang=\"EN-US\" data-contrast=\"auto\">A <em><strong>Tree of Inquiry<\/strong><\/em> template must be completed for each assigned patient.<\/span><\/h4>\n<\/li>\n<li>\n<h4><span lang=\"EN-US\" data-contrast=\"auto\">It is encouraged that students complete this template during the clinical day. <\/span><\/h4>\n<\/li>\n<li>\n<h4><span lang=\"EN-US\" data-contrast=\"auto\">The information in this template will be discussed during post-conference.<\/span><\/h4>\n<\/li>\n<li>\n<h4><span lang=\"EN-US\" data-contrast=\"auto\">Completed templates must be uploaded to the assignment within 48 hours of the clinical day.<\/span><\/h4>\n<\/li>\n<\/ul>\n<h4 style=\"text-align: center\"><strong>Student Samples<\/strong><\/h4>\n<\/div>\n<h3><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-803\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree.jpeg\" alt=\"Student Sample 1 Tree\" width=\"2540\" height=\"1987\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree.jpeg 2540w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree-300x235.jpeg 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree-1024x801.jpeg 1024w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree-768x601.jpeg 768w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree-1536x1202.jpeg 1536w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Kayla-Corcoran-tree-2048x1602.jpeg 2048w\" sizes=\"(max-width: 2540px) 100vw, 2540px\" \/><\/h3>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-802\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Leah-Meacham-Tree-1.jpg\" alt=\"Student Sample 2 Tree\" width=\"1883\" height=\"1466\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Leah-Meacham-Tree-1.jpg 1883w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Leah-Meacham-Tree-1-300x234.jpg 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Leah-Meacham-Tree-1-1024x797.jpg 1024w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Leah-Meacham-Tree-1-768x598.jpg 768w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Leah-Meacham-Tree-1-1536x1196.jpg 1536w\" sizes=\"(max-width: 1883px) 100vw, 1883px\" \/><\/p>\n<h4><\/h4>\n<h4><strong>Data Mining Activity<\/strong><\/h4>\n<h4>This activity can be used during class or clinical. Students are provided with an electronic or paper medical record to review, then grow a plan of care using the <em><strong>Tree of Inquiry<\/strong><\/em>.<\/h4>\n<h4 style=\"text-align: center\"><strong>Student Sample<\/strong><\/h4>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-822 aligncenter\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM.png\" alt=\"Pneumonia tree\" width=\"812\" height=\"627\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM.png 2396w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM-300x232.png 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM-1024x791.png 1024w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM-768x593.png 768w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM-1536x1186.png 1536w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Pneumonia-tree-PM-2048x1581.png 2048w\" sizes=\"(max-width: 812px) 100vw, 812px\" \/><\/p>\n<p>&nbsp;<\/p>\n<h4><strong>Disease\/Disorder Activity<\/strong><\/h4>\n<h4>This activity can be used during class or clinical. Students are given a disease\/disorder, then grow a plan of care using the <em><strong>Tree of Inquiry<\/strong><\/em>.<\/h4>\n<h4 style=\"text-align: center\"><strong>Sample Tree: RSV<br \/>\n<\/strong><\/h4>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-825 aligncenter\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV.png\" alt=\"RSV Tree\" width=\"909\" height=\"655\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV.png 2062w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV-300x216.png 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV-1024x738.png 1024w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV-768x553.png 768w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV-1536x1107.png 1536w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/RSV-2048x1476.png 2048w\" sizes=\"(max-width: 909px) 100vw, 909px\" \/><\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Mastery Demonstration<\/strong><\/h3>\n<h4>The <em><strong>Tree of Inquiry<\/strong><\/em> provides a means for educators to assess mastery of nursing competencies and supports meeting the American American Association of Colleges of Nursing\u2019s (AACN) <em>Essentials<\/em> (AACN, 2021) competencies across many domains. Mastery is linked to the assigned content. For example, using the Tree of Inquiry with a health equity and social determinants of health<span data-usefontface=\"false\" data-contrast=\"none\"> case crosses several domains (Table 1).<\/span><\/h4>\n<h4><strong>Table 1<br \/>\n<\/strong><\/h4>\n<table data-tablestyle=\"MsoTableGrid\" data-tablelook=\"1696\">\n<tbody>\n<tr>\n<td data-celllook=\"0\"><b><span data-contrast=\"auto\">Domain<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><b><span data-contrast=\"auto\">Competency (Subcompetency)<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Knowledge for Nursing Practice<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">1.1b,d; 1.2a,c,d; 1.3a,b,c<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Person-Centered Care<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">2.1a,b,c; 2.2a,b,f; 2.3f; 2.4a,b,c,d,e; 2.5a,b,d,e,g; 2.6d; 2.7a,b,c; 2.8a,c,e; 2.9a,b,c,d,e<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Population Health<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">3.2b,c; 3.3a,b<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Interprofessional Partnerships<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">6.1a; 6.2c,d; 6.3a,b; 6.4d<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Systems-Based Practice<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">7.2f; 7.3d<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Professionalism<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">9.1a; 9.3g; 9.5a<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Personal, Professional, and Leadership Development<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">10.2f<\/span><span data-ccp-props=\"{&quot;335551550&quot;:1,&quot;335551620&quot;:1,&quot;335559740&quot;:240}\">\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h4>(AACN, 2021)<\/h4>\n<p>&nbsp;<\/p>\n<h4>Here is an example using the data mining activity (Table 2).<\/h4>\n<h4><strong>Table 2<br \/>\n<\/strong><\/h4>\n<table data-tablestyle=\"MsoTableGrid\" data-tablelook=\"1696\">\n<tbody>\n<tr>\n<td data-celllook=\"0\"><b><span data-contrast=\"auto\">Domain<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><b><span data-contrast=\"auto\">Competency (Subcompetency)<\/span><\/b><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Knowledge for Nursing Practice<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">1.1b,d; 1.2a,c,d; 1.3a,b,c<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Person-Centered Care<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">2.1a,b,c; 2.2a,b,f; 2.3f; 2.4a,b,c,d,e; 2.5a,b,d,e,g; 2.6d; 2.7a,b,c; 2.8a,c,e; 2.9a,b,c,d,e<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Population Health<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">3.2b,c<\/span><span data-ccp-props=\"{}\"><br \/>\n<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Interprofessional Partnerships<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">6.1a; 6.2c,d; 6.3a,b; 6.4d<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Systems-Based Practice<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">7.2f<br \/>\n<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Informatics and Healthcare Technologies <\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">8.1a,c; 8.2c; 8.3a,c,e; 8.4a,b,c<\/span><\/td>\n<\/tr>\n<tr>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">Professionalism<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/td>\n<td data-celllook=\"0\"><span data-contrast=\"auto\">9.5a<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h4>(AACN, 2021)<\/h4>\n<p>&nbsp;<\/p>\n<h4>Competence mastery through the <em><strong>Tree of Inquiry<\/strong><\/em> can be assessed with a rubric, giving students the opportunity to be observed, for their work to be measured, and to receive feedback. Here is a sample <strong><a href=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-Nursing-Care-Plan-Rubric.pdf\">Tree of Inquiry Rubric<\/a>. <\/strong>Whether used as an activity with real-time clarification of thought processes or as a graded assignment with a rubric, the <strong><em>Tree of Inquiry <\/em><\/strong>provides a means for educators to assess mastery of nursing competencies.<\/h4>\n<h3><\/h3>\n<h3><strong>Try it!<\/strong><\/h3>\n<h4>There are many ways to integrate the <em><strong>Tree of Inquiry<\/strong><\/em> into your teaching toolkit. Here is a\u00a0<strong><a href=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/Tree-of-Inquiry-Handout-PDF.pdf\">Tree of Inquiry Handout<\/a> <\/strong>to get you started. Watch as your students&#8217; clinical judgment grows with trees!<\/h4>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-815 aligncenter\" src=\"http:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-scaled.jpg\" alt=\"Tall Trees\" width=\"911\" height=\"607\" srcset=\"https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-scaled.jpg 2560w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-300x200.jpg 300w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-1024x683.jpg 1024w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-768x512.jpg 768w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-1536x1024.jpg 1536w, https:\/\/sites.rutgers.edu\/changing-course\/wp-content\/uploads\/sites\/805\/2022\/09\/pexels-felix-mittermeier-9570241-2048x1365.jpg 2048w\" sizes=\"(max-width: 911px) 100vw, 911px\" \/><\/p>\n<h4><\/h4>\n<h4>Coming up in the next edition of <em>Changing Course<\/em> . . . <em>Making Priorities a Priority!<\/em><\/h4>\n<p>&nbsp;<\/p>\n<h4><strong>References<\/strong><\/h4>\n<h5>American Association of Colleges of Nursing (AACN). (2021). The Essentials: Core competencies for professional nursing education. <a href=\"https:\/\/www.aacnnursing.org\/Portals\/42\/AcademicNursing\/pdf\/Essentials-2021.pdf\">https:\/\/www.aacnnursing.org\/Portals\/42\/AcademicNursing\/pdf\/Essentials-2021.pdf<\/a><\/h5>\n<h5>American Nurses Association (ANA). (2021). Nursing: Scope and Standards of Practice (4th ed.). Washington, D.C.: American Nurses Publishing.<\/h5>\n<h5>Arbor Day Foundation. (2022). Anatomy of a tree. <a href=\"https:\/\/www.arborday.org\/trees\/treeguide\/anatomy.cfm\">https:\/\/www.arborday.org\/trees\/treeguide\/anatomy.cfm<\/a><\/h5>\n<h5>Assessment Technologies Institute (ATI). (2015). Tree of impact. ATI Nursing Education. <a href=\"https:\/\/cdn.ymaws.com\/www.ohioleaguefornursing.org\/resource\/resmgr\/oln_fall_conference\/Tree_of_Impact.pdf\">https:\/\/cdn.ymaws.com\/www.ohioleaguefornursing.org\/resource\/resmgr\/oln_fall_conference\/Tree_of_Impact.pdf<\/a><\/h5>\n<h5><span data-usefontface=\"false\" data-contrast=\"none\">CAST. (2022). About Universal Design for Learning <\/span><span data-usefontface=\"false\" data-contrast=\"none\">(UDL).\u00a0 <\/span><a href=\"https:\/\/www.cast.org\/impact\/universal-design-for-learning-udl\"><span data-usefontface=\"true\" data-contrast=\"none\">https:\/\/www.cast.org\/impact\/universal-design-for-learning-udl<\/span><\/a>\u200b<\/h5>\n<h5>Lowenstein, Bradshaw, M. J., &amp; Fuszard, B. (2001). <em>Fuszard\u2019s innovative teaching strategies in nursing (3rd, rev. ed.)<\/em>. Aspen Publishers.<\/h5>\n<h5>National Council of State Boards of Nursing (NCSBN). (Winter 2019). Clinical judgment measurement model.<em> Next Generation NCLEX News. <a href=\"https:\/\/www.ncsbn.org\/NGN_Winter19.pdf\">https:\/\/www.ncsbn.org\/NGN_Winter19.pdf<\/a><\/em><\/h5>\n<h5><\/h5>\n<h4><strong>Disclaimer<\/strong><\/h4>\n<h5><em>I have not been paid to promote any of the products listed and will not receive commission, payment, or gifts of any kind if you click on a link in this blog.<\/em><\/h5>\n<p>&nbsp;<\/p>\n<p><a class=\"btn btn-primary\" href=\"https:\/\/rutgers.us14.list-manage.com\/subscribe?u=f473183d1e92454cb3c8e994f&amp;id=5ad1231fef\" target=\"_self\" rel=\"noopener\">Subscribe<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In this issue of Changing Course, we will examine how to grow clinical judgment with trees. The change to the Next Generation NCLEX (NGN) is quickly approaching and students currently &hellip; <a href=\"https:\/\/sites.rutgers.edu\/changing-course\/growing-clinical-judgement-with-trees\/\" class=\"\">Read More<\/a><\/p>\n","protected":false},"author":2064,"featured_media":712,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[12,18,42,35,32,11,33,43,44,45,47,10,17],"tags":[13,7,9],"class_list":["post-733","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aacn-essentials","category-clinical-judgment","category-informatics-and-healthcare-technologies","category-interprofessional-partnerships-aacn-essentials","category-knowledge-for-nursing-practice-aacn-essentials","category-next-generation-nclex-ngn","category-person-centered-care-aacn-essentials","category-personal-professional-and-leadership-development","category-population-health","category-professionalism","category-systems-based-practice","category-teaching-strategies","category-universal-design","tag-aacn-essentials","tag-next-generation-nclex","tag-teaching-strategies"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Growing Clinical Judgment with Trees - Changing Course: Innovative Ideas for Nurse Educators<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sites.rutgers.edu\/changing-course\/growing-clinical-judgement-with-trees\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Growing Clinical Judgment with Trees - Changing Course: Innovative Ideas for Nurse Educators\" \/>\n<meta property=\"og:description\" content=\"In this issue of Changing Course, we will examine how to grow clinical judgment with trees. 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I obtained my BSN from Widener University, my MSN in nursing education and administration and my DNP specializing in nursing education from Duquesne University. I am a Certified Nurse Educator and am additionally certified in Low-risk Neonatal Intensive Care Nursing, Online Teaching, and Lifelong Learning in Inclusive and Equitable Teaching. My specialties include maternal-child and critical care nursing with both neonates and adults, and I have practiced clinically in both Philadelphia and South Jersey. My academic experience spans over 16 years. Presently, I teach in the accelerated and traditional undergraduate programs at Rutgers University-Camden School of Nursing; however, I started teaching nursing as an adjunct instructor at La Salle University in 2005, and progressed to full-time faculty at Holy Family University in 2007.\u00a0 My courses at Rutgers include Foundations of Nursing Theory, Nursing Care of Children and Adolescents Theory, Research and Evidence-Based Practice and Seminar in Professional Nursing. My scholarly areas of expertise include curriculum mapping, assessment, testing and outcomes, evidence-based nursing education, technology in teaching and learning, clinical education, and innovative teaching strategies. I have presented my work with nursing education at several national and international nursing conferences. 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I obtained my BSN from Widener University, my MSN in nursing education and administration and my DNP specializing in nursing education from Duquesne University. I am a Certified Nurse Educator and am additionally certified in Low-risk Neonatal Intensive Care Nursing, Online Teaching, and Lifelong Learning in Inclusive and Equitable Teaching. My specialties include maternal-child and critical care nursing with both neonates and adults, and I have practiced clinically in both Philadelphia and South Jersey. My academic experience spans over 16 years. Presently, I teach in the accelerated and traditional undergraduate programs at Rutgers University-Camden School of Nursing; however, I started teaching nursing as an adjunct instructor at La Salle University in 2005, and progressed to full-time faculty at Holy Family University in 2007.\u00a0 My courses at Rutgers include Foundations of Nursing Theory, Nursing Care of Children and Adolescents Theory, Research and Evidence-Based Practice and Seminar in Professional Nursing. My scholarly areas of expertise include curriculum mapping, assessment, testing and outcomes, evidence-based nursing education, technology in teaching and learning, clinical education, and innovative teaching strategies. I have presented my work with nursing education at several national and international nursing conferences. I look forward to sharing my time and talent with the nursing education community.","sameAs":["https:\/\/nursing.camden.rutgers.edu\/profile\/rachelderr","https:\/\/www.linkedin.com\/in\/rachel-derr-dnp-msn-rnc-lrn-cne-14730734\/rac","https:\/\/x.com\/rderrrnc"],"url":"https:\/\/sites.rutgers.edu\/changing-course\/author\/rsd93\/"}]}},"_links":{"self":[{"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/posts\/733"}],"collection":[{"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/users\/2064"}],"replies":[{"embeddable":true,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/comments?post=733"}],"version-history":[{"count":93,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/posts\/733\/revisions"}],"predecessor-version":[{"id":857,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/posts\/733\/revisions\/857"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/media\/712"}],"wp:attachment":[{"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/media?parent=733"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/categories?post=733"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sites.rutgers.edu\/changing-course\/wp-json\/wp\/v2\/tags?post=733"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}