Next Generation questions will be included in the NCLEX nursing exams as early as 2023. In this article, we break down the components of the clinical judgment measurement model that should be included when writing patient care case studies and scenarios for Next Generation questions.
Next Generation questions are meant to prepare nurses to think critically when providing care by presenting real-world patient scenarios that require analysis, judgment and assessment skills by the student.
According to the NCSBN, the definition of clinical judgment (CJ) is the observed outcome of critical thinking and decision making1.
To meet the Next Generation question requirements, each case study and scenario must include components that are aligned with the clinical judgment model.
These components include iterative processes that use knowledge observed and assessed in a real-world patient care scenarios or case studies. From these observations and assessments, the nursing student must be able to identify a prioritized patient problem or concern, and establish an evidence-based solution that will deliver safe patient care.
Components of a Next Gen scenario are broken down into six parts. Questions can be written for each part of the case study/scenario, or the scenario can be freestanding, though typically written as part of the scenario.
- Part 1 – Patient Introduction, Background and Cues
Student Action Needed – Recognize Cues
- Part 2 – Analyzation of Cues
Student Action Needed – Assess and Analyze Cues
(Nursing Process – Assessment)
- Part 3 – Prioritize Hypotheses
Student Action Needed – Analyze & Diagnose Cues
(Nursing Process – Analysis/Diagnosis)
- Part 4 – Generate Solutions
Student Action Needed – Identify Solutions
(Nursing Process – Planning)
- Part 5 – Take Action
Student Action Needed – Implement Actions
(Nursing Process – Implementation)
- Part 6 – Evaluation of Outcomes
Student Action Needed – Evaluate Outcomes
(Nursing Process – Evaluation)
Part 1 – Assist the student in seeing the whole client. The introduction must include recognizable cues to the patient’s medical diagnosis, condition, and situation. These cues may include nurses’ notes, vital signs, lab results, health history, etc., as well as any time considerations. The goal of a Next Generation-compliant study or scenario is to provide the nursing student with enough vital patient information that they are able to answer the questions presented.
Part 1 should include:
- Client observations (Normal/Abnormal findings)
- Nurses Notes/Vital Signs/Lab Results
- Environmental information such as where the client is located
- Client demographics
- Client history
- Special equipment the client or nurse is using
- Time considerations
Your nursing students must be answer these questions:
What is relevant?
What is most important?
What is of immediate concern, etc.?
Part 2 – Include in the scenario/case study the patient’s condition, what impact the data has on required nursing actions, and what pathophysiology related to clinical information will be required for the student to analyze the cues. Potential complications should also be included in this part of the scenario. Also, include any additional patient information that the student will need to be able to analyze presented cues.
Part 3 – The nursing student can now begin prioritizing a hypothesis from the patient’s situation. This part should include information that requires the student to make a judgment about the patient’s condition. Students must be able to prioritize patient needs, identify resources needed, and determine how the situation may impact the patient. Students must be able to recognize demographics that may change, and review facts in the client history that might play a role in patient care.
Nursing students should be able to answer these questions:
What are the client’s priority needs?
What are the other needs?
What is the impact of the needs on resources, demographics, history, etc.?
Part 4 – Students must generate solutions for the patient’s situation. Solutions should include needed and appropriate interventions, and how the interventions may impact the patient’s situation. The student must also be able to identify resource and demographic changes that may affect the patient’s situation.
Part 5 – Students must now prioritize and implement actions based on the analysis and prioritization taken in the previous parts of the scenario. Questions may include what impacts a chosen action may have on the patient or resources needed. Again, demographics or the client’s situation might change.
Question components to include are:
What actions should the nurse take?
What actions should be done first, second, etc.?
How do the actions impact resources, patient demographics or history, etc.?
Part 6 – The scenario must include expected outcomes, changes in the situation of the client, evaluation components, and if the client needs to be reassessed.
Questions that a student must answer are:
Are outcomes expected and were the outcomes achieved?
Are there other resources needed to meet the outcomes?
What should be assessed or reassessed, etc.?
Dr. Phil Dickison from the NCSBN has stated that the number of questions the student would need to answer on the typical NCLEX-RN exam can vary based on the tester level of skill since the exam will still be adaptive. There will probably be between two and five vignettes (cases/scenarios). A vignette will measure all six components of the clinical judgment measurement model. Therefore, if there are two vignettes, each with six components, there would be twelve questions on the exams. Alternatively, if there are five vignettes, there would be thirty questions on the exam2.(Excerpt: ATI https://atitesting.com/educator/blog/knowledge/2019/11/01 /prepare-for-ngn-with-these-crucial-insights-from-ncsbn).
1 Currier, Jacklyn (2019). Exam Operations, Next Generation NCLEX (NGN). Retrieved from https://www.ncsbn.org/13534.htm
2 ATI. (November 1, 2019). How many test items will be on the Next Gen NCLEX and how will it be graded? [Blog Post]. Retrieved from https://atitesting.com/educator/blog/knowledge/2019/11/01/prepare-for-ngn-with-these-crucial-insights-from-ncsbn