Evaluating Clinical Judgment in a Nursing Capstone Course

Transcription

1 Indiana University - Purdue University Fort Wayne Opus: Research & Creativity at IPFW Nursing Faculty Presentations Department of Nursing Fall Evaluating Clinical Judgment in a Nursing Capstone Course Rebecca S. Jensen Indiana University-Purdue University Fort Wayne, jensenr@ipfw.edu Follow this and additional works at: Part of the Other Nursing Commons Opus Citation Rebecca S. Jensen (2010). Evaluating Clinical Judgment in a Nursing Capstone Course Assessment Institute.Presented at 2010 Assessment Institute, Indianapolis, IN. This Presentation is brought to you for free and open access by the Department of Nursing at Opus: Research & Creativity at IPFW. It has been accepted for inclusion in Nursing Faculty Presentations by an authorized administrator of Opus: Research & Creativity at IPFW. For more information, please contact admin@lib.ipfw.edu.

2 Evaluating Clinical Judgment in a Nursing Capstone Course R E B E C C A J E N S E N, M S, R N Background Graduating Nursing Students Demonstrate adequate Clinical Reasoning (CR) skills Patient care arenas not amenable to CR evaluation Human Patient Simulation (HPS) better environment Clinical Reasoning Competency Evaluation (CRCE) LCJR Summative assessment of nursing students CR skills in a simulated patient care environment Evaluated by nursing faculty using Lasater Clinical Judgment Rubric (LCJR) LCJR Simulation Based on Lasater s Interactive Model of Clinical Judgment Development Which is based in part on Tanner s Clinical Judgment Model LCJR measured this aspect of Lasater s Model Tanner s Clinical Judgment Model (2006) Skill Experience Clinical Judgment Aptitude Confidence 1

3 LCJR Dimensions of LCJR Developed with 4 subscales: Noticing Interpreting Responding Reflection Each area has 2 4 dimensions developed with which to evaluate students Noticing Interpreting Responding Reflection LCJR Dimensions Focused observation Recognizing deviations from expected patterns Information seeking Prioritizing data Making sense of data Calm, confident manner Clear communication Well-planned intervention, flexibility Being skillful Evaluation/self-analysis Commitment to improvement 4 - Levels for Each Dimension Reliability of LCJR Beginning (1) Developing (2) Accomplished (3) Exemplary (4) Possible score range of Cronbach alphas not reported from development of instrument Current study: LCJR total scale (α =.95) Each subscale noticing (α =.88) interpreting (α =.88) responding (α =.88) reflecting (α =.86) Structure of CRCEs (Simulation) CRCEs continued 20-minute simulation 2 students care for 4 patients in a Progressive Coronary Care Unit Have opportunities to review charts and patient information sheets (Kardex) examine surroundings and equipment Listen to taped report of current patient conditions Simulation starts when students have finished listening to the report One faculty assigned to each of the 2 students Students and faculty rated the performance when the simulation was finished in separate rooms Then, students debriefed about experience and provided faculty s decision about outcome Pass Pass with remediation Fail and repeat CRCE after remediation 2

4 CRCEs continued Open Houses If failed, completed second CRCE Second round 4 different patients Same type of unit Same basic structure: 20 minutes, taped report, etc. 1 st semester anxiety seemed to interfere with performance for some students 2 nd semester offered optional Open Houses Learned about basic structure of CRCE Could perform in example patient care simulation of 1 patient with a crisis Some students actively participated and some observed simulation examples Results of 2 Semesters of CRCEs CRCE Outcomes Across 2 Semesters Program AS 62 (70.5%) BS 26 (29.5%) Semester Fall (43%) Spring (56.8%) Attend Open House Yes 42 (84%) No 8 (16%) Times attended Open House 2 nd semester (24/50 48%) 1 6 (25%) 2 11 (46%) 3 4 (17%) 4 1 (4%) 5 1 (4%) 6 1 (4%) CRCE Outcomes Semester 1 Semester 2 First Round Second Round First Round Second Round Pass 16 (42.1%) 9 (64.3%) 34 (38.6%) 19 (58.3%) Remediation 7 (18.4%) 3 (21.4%) 22 (25%) 9 (29%) Fail 15 (39.5%) 2 (14.3%) 17 (34%) 1 (5.9%) Total Statistical Analyses LCJR Score Comparisons Between programs, AS/BS, and rounds, 1 st /2 nd Compared outcomes with Attend/not attend Open Houses Program AS/BS Relationship between student ratings and faculty ratings across all dimensions and total LCJR scores Program AS vs. BS BS (M = 34.33; SD = xx) > AS (M = 30.90; SD = xx ) significantly (p =.01; Cohen s d =.65) Rounds 2 nd round (M = 35.88; SD = xx) greater mean scores than 1 st round (M = 31.86; SD = xx) significantly (p =.005; Cohen s d =.12)???Practical significance??? 3

5 Relationships Between Student and Faculty Ratings Nonsignificant Findings Of the 11 dimensions over 2 semesters, only 2 were significant & both were during the 1 st round of CRCEs: Calm, confident manner (r (72) =.27; p =.021; 95% Confidence Interval [CI] = ) Well planned intervention (r (72) =.28; p =.019; 95% CI = ) No differences, using Chi Square, between categories of CRCE outcomes and Open House attendance Type of Program Online Survey 2 nd Semester Limitations 9 Respondents (50 students potentially in the 2 nd semester 18% response rate) 66% - Open Houses helpful in preparing for CRCEs 22% - Open Houses helpful overall 55% - CRCE was a good evaluation of patient care skills 78% - able to make sound clinical judgments during the CRCE Average of 2.4 Open Houses with respondents CRCE s were described by one respondent as: some of the best learning experiences I had in the program Single site study No interrater reliability among faculty for use of LCJR Facutly using new clinical judgment rating instrument and simulation procedure Reasons for differences in ratings weren t explored Unknown if skills learned during the CRCE are transferred to actual patient care Implications References Rating students with the LCJR did differentiate between students with varying decision making skills Student anxiety needs to be managed in some way so that skills can be assessed Future research Multi site Interrater reliability assessed Determine reason for few student/faculty rating relationships Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Stanford, CA: The Carnegie Foundation for the Advancement of Teaching. Davis, D., Mazmanian, P., Fordis, M., Harrison, R., Thorpe, K., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. Journal of American Medical Association, 296(9), Doyle, T., & Leighton, K. (2011). A curriculum for the pre-licensure nursing program. In W. Nehring & F. Lashley (Eds.). High-fidelity patient simulation in nursing education (pp ). Sudbury, MA: Jones and Bartlett Publishers. Dubose, D., Sellinger-Karmel, L., & Scoloveno, R. (2010). Baccalaureate nursing education. In W. Nehring & F. Lashley (Eds.) High-fidelity patient simulation in nursing education (pp ). Sudbury, MA: Jones and Barlett Publishers. Ironside, P., Jeffries, P., & Martin, A. (2009). Fostering patient safety competencies using multiple-patient simulation experiences. Nursing Outlook, 57,

6 References References Jeffries, P., & McNelis, A. (2010). Evaluation. In W. Nehring & F. Lashley (Eds.). High-fidelity patient simulation in nursing education (pp ). Sudbury, MA: Jones and Bartlett Publishers. Jeffries, P., & Rogers, K. (2007). Theoretical framework for simulation design. In P. Jeffries (Ed.) Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing. Kardong-Edgren, S., Adamson, K., & Fitzgerald, C. (2010). A review of currently published evaluation instruments for human patient simulation. Clinical Simulation in Nursing, 6, e25-e35. Lasater, K. (2005). The impact of high fidelity simulation on the development of clinical judgment in nursing students: An exploratory study. Dissertation Abstracts International, 66(03), 1936B. (UMI No ). Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11) Nehring, W. (2011). A synthesis of theory and nursing research using high-fidelity patient simulation. In W. Nehring & F. Lashley (Eds.). High-fidelity patient simulation in nursing education (pp.27-56). Sudbury, MA: Jones and Bartlett Publishers. Rauen, C. (2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care Nurse, 24(3), Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), Tanner, C. (2007). Nursing education: Current themes, puzzles and paradoxes. Communicating Nursing Research, 40(15), Contact Information Becky Jensen, MS, RN jensenr@ipfw.edu 5