Enhancing Clinical Judgment Competence in Nursing Education: A Mixed-Methods Study in the Philippines

This study utilizes an explanatory sequential mixed-methods design to evaluate the effectiveness of the Philips 66 brainstorming technique, integrated with case-based learning (CBL), in enhancing clinical judgment competence among senior nursing students in the Philippines. The study consists of two phases: a quantitative experimental phase and a qualitative exploratory phase.

The quantitative phase adopts a true experimental pre-test/post-test design, involving 60 senior nursing students who will be randomly assigned to either the intervention group (n=30) or the control group (n=30). The intervention group will undergo CBL sessions facilitated by the Philips 66 technique, while the control group will follow the standard CBL approach. The Philips 66 technique is a structured form of small group brainstorming where participants collaborate in smaller teams, fostering idea generation and peer learning in a timed setting. Clinical judgment competence will be assessed before and after the intervention using the Lasater Clinical Judgment Rubric (LCJR), which measures four dimensions of clinical judgment: noticing, interpreting, responding, and reflecting. Additionally, a researcher-designed questionnaire will be used to measure students' confidence levels in their clinical decision-making abilities.

The qualitative phase will involve focus group discussions (FGDs) with a subset of participants from the intervention group to gain deeper insights into their experiences with the Philips 66 technique. These discussions will aim to explore how the technique influences their critical thinking, decision-making, and collaborative learning processes. Thematic analysis will be applied to identify recurring themes and key experiences.

Statistical analysis for the quantitative component will include descriptive statistics, non-parametric tests (such as the Mann-Whitney U test), and Wilcoxon signed-rank tests to analyze differences in clinical judgment competence and confidence levels between the two groups. For the qualitative component, data from FGDs will be analyzed thematically to provide contextual understanding and support for the quantitative findings.

The study aims to determine whether the integration of the Philips 66 technique with CBL can significantly enhance the development of clinical judgment competence in nursing students, preparing them for the challenges of real-world clinical settings. Future studies may be conducted across different contexts to validate the long-term effects of this intervention.

Inclusion criteria

• BSN students enrolled in their fourth year at a Higher Education Institution in Angeles City, Philippines.
• At least 20 years old.
• Willing to participate in both pre- and post-intervention assessments.

Exclusion criteria

• Undergraduate nursing students who do not meet the criteria and refuse to join the study
• Students with anticipated absences exceeding a certain threshold (e.g., more than two sessions)