Document Type


Date of Award


Degree Name

Doctor of Philosophy (PhD)


Health Science

First Advisor

Haifa AbouSamra


Clinical judgment among nurses is imperative to assure quality, safe healthcare to all. The licensure exam for registered nurses has been criticized for not adequately measuring the clinical judgment needed by entry-level nurses. The National Board of State Boards of Nursing (NCSBN) responded to this criticism by developing a new Clinical Judgment Measurement Model (CJMM) with measurable cognitive processes, including cue recognition, to be used as a framework for item development on the new licensure exam. Nursing programs must evaluate current teaching and evaluation modalities for alignment with the new CJMM measurable cognitive processes to prepare entry-level nurses for successful completion of the licensure exam and practice. A concept analysis of cue recognition determined the defining attributes, antecedents, and consequences most commonly depicted medical, nursing, occupational therapy, and physical therapy literature. Cue recognition was more clearly defined resulting in an operational definition of cue recognition. The operational definition of cue recognition informs nurse educator of specific measurable criteria to include on student evaluations in areas such as clinical and simulation. In addition, question items on exams can be created on cue recognition using cue recognition defining attributes, antecedents, and consequences. The second paper investigated the effect of using classroom quizzing on the short and long-term cue recognition retrieval of previously learned client cues. Classroom quizzing, a retrieval-based learning strategy, was given to baccalaureate nursing students prior to watching a simulated patient scenario. The posttest scores of the group receiving the classroom quizzing scored lower than the group whom did not receive the classroom quizzing. There was no significant difference in long-term cue recognition ability as measure by retention questions one week after the intervention. The final study examined nurse educators’ knowledge of cue recognition and factors that affect the knowledge of cue recognition. The results revealed a knowledge deficit among nurse educators. Factors that affected the cue recognition knowledge level included years in the educator role, age, and confidence in using cue recognition as a teaching strategy.

Subject Categories

Education | Health and Physical Education


Cue recognition development, Clinical judgment

Number of Pages



University of South Dakota