Clinical Decision-Making in Undergraduate Nursing Students’ Medication Management: A Verbal Protocol Study

AIM: To investigate second-year undergraduate nursing students' clinical decision-making (CDM) in medication administration using a verbal protocol. BACKGROUND: CDM requires metacognitive ability. Little is known about the cognitive and metacognitive strategies employed by nursing students when administering medications. METHOD: A concurrent mixed-methods design employed a verbal protocol, a high-fidelity simulated medication administration scenario recorded on video and audio, and debriefing. Fourteen students participated in the study. RESULTS: The quantitative data included 14 procedural and conceptual areas of knowledge to identify strengths and gaps in CDM. The qualitative data showed a higher proportion of cognitive than metacognitive operators, with greater evidence of metacognitive use in the debriefing. CONCLUSION: There is a need to investigate the characteristics of students who exhibit maladaptive cognitive and metacognitive processing and to shift from a task-focused approach to training toward methods that accelerate cognitive and metacognitive expertise.