Refining clinical judgment competence in nursing education in the Philippines: A mixed-methods study on the impact of the Philips 66 brainstorming technique in case-based learning

Background: Clinical judgment is crucial for nurses in complex healthcare settings. In the Philippines, nursing students must develop critical thinking and decision-making skills to handle resource-limited environments and challenging patient care. However, existing educational methods often fail to engage students and fully promote diverse perspectives.

Objective: This study aimed to examine the effect of integrating the Philips 66 technique into Case-Based Learning (CBL) on enhancing clinical judgment competence among Filipino nursing students.

Methods: This study utilized an explanatory sequential mixed methods design. The quantitative phase involved a true experimental pre-test/post-test design with 60 senior nursing students randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group participated in the Philips 66 technique with CBL, while the control group followed standard CBL. Clinical judgment competence was assessed using the Lasater Clinical Judgment Rubric (LCJR) and a researcher-designed/validated questionnaire to measure confidence. Focus group discussions (FGDs) with a subset of the intervention group explored their experiences with the Philips 66 technique. Data were analyzed using descriptive statistics and non-parametric tests for the quantitative component, while thematic analysis was applied to qualitative data.

Results: The intervention group significantly outperformed the control group in both self-reported confidence and overall clinical judgment abilities. The Philips 66-CBL group showed significant improvements (p <0.005, r (effect size) = 0.66 - 0.71) in all areas, while the control group demonstrated significant improvements in information seeking, evaluation/self-analysis, and commitment to improvement (p <0.001, Cohen's d = 0.54 - 0.617). Qualitative data from FGDs highlighted the value of Philips 66 in fostering teamwork, rapid knowledge sharing, and increased efficiency in addressing clinical scenarios, which are essential skills for nursing practice.

Conclusion: The combination of the Philips 66 technique with CBL significantly improves the clinical judgment abilities of Filipino nursing students in a shorter timeframe compared to conventional approaches. Insights from qualitative data highlight its effectiveness in fostering collaborative learning and preparing students for the challenges of dynamic clinical settings. Further research with larger, more diverse samples across different contexts is essential to confirm these findings and explore the long-term influence of Philips 66-CBL on nursing students' clinical judgment development worldwide.

Trial registry number: NCT06646068 [clinicaltrias.gov].

Philippine health research registry: PHRR241010-007605 [registry.healthresearch.ph].