Enhancing Clinical Reasoning: Teaching Thinking Through Debriefing

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1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Authors Presentation Text-based Document Enhancing Clinical Reasoning: Teaching Thinking Through Debriefing Forneris, Susan G.; Neal, Diana Odland; Meyer, Heidi; Tiffany, Jone; Myers, Lynnea; Pivec, Cynthia R.; Kuehn, Mary Beth; Blazovich, Linda Downloaded 26-Apr :01:53 Link to item

2 Susan Forneris, PhD, RN, CNE, CHSE Diana Odland Neal, PhD, RN Mary Beth Kuehn, EdD, RN, PHN Jone Tiffany, DNP, MA, RNC Cynthia R. Pivec, MA, RN, CNE Lynnea Myers, MSN, RN, PHN, CPNP Linda Blazovich, DNP, RN, CNE Heidi Meyer, MSN, RN ENHANCING CLINICAL REASONING: TEACHING THINKING THROUGH DEBRIEFING

3 A BIG THANK YOU FOR SUPPORT TO: *STTI CHI-AT-LARGE CHAPTER RESEARCH GRANT *INACSL DEBRA SPUNT MINI-RESEARCH AWARD. IT IS MUCH APPRECIATED!

4 LEARNING OUTCOMES describe the use of the DML tool as a methodology for debriefing discuss the outcomes of the DML methodology and the implications for nursing education.

5 The search for evidence Susan Gross Forneris, PhD, RN, CNE Linda Blazovich, DNP, RN, CNE Cynthia Pivec, MA, RN CNE Heidi Meyer, MSN, RN Lynnea Myers, MSN, RN, PHN, CPNP Diana Odland Neal, PhD, RN Mary Beth Kuehn, Ed.D, RN, PHN Jone Tiffany, DNP, MA, RNC

6 Clinical Reasoning

7 Explore strategies that integrate content knowledge with knowledge of the context creating dialogue that invites questions in a reflective and critical manner.

8 WHY DO A PILOT? To confirm a multi-site approach with consistency re: instructions & procedures To obtain a rough estimate of effect size & variability in the measures To examine the reliability & validity of results in comparison to Dreifuerst s To determine challenges in preparation for a full scale study

9 MCNER MULTI-SITE PILOT STUDY Pilot Study: Quasi-experimental, pre-test-post-test, repeated measure research design Purpose: To determine if undergraduate nursing students demonstrate a positive change in clinical reasoning skills using the Debriefing for Meaningful Learning (DML) model

10 DEBRIEFING FOR MEANINGFUL LEARNING Active Learning Approach Form of clinical teaching Constructivist learning Promotes active learning Incorporates Guided Reflection Schon s work Reflection in-on-action Driefuerst added beyondaction Dreifuerst, K.T. (2010). Debriefing for meaningful learning: Foster development of clinical reasoning through simulation. Retrieved from Proquest Dissertations and Theses.

11 HEALTH SCIENCES REASONING TEST (HSRT) General Information Type of Instrument Self-administered, multiple choice Date of Publication 2006, 2008, & 2011 Available Languages Reliability Administration Information Time to Administer Administration Types Arabic, Chinese Simplified or Traditional Characters, Dutch, English, Farsi, Korean, Spanish minutes Online or Paper-and-Pencil Results Total score of critical thinking scales; and 5 scale scores Analysis and Interpretation Inference Evaluation and Explanation Deductive Reasoning Inductive Reasoning

12 RESEARCH QUESTION/ METHODOLOGY Does the use of the DML debriefing strategy positively impact the development of clinical reasoning skills in undergraduate nursing students? change in clinical reasoning as measured by improved scores on the HSRT exemplifies meaningful learning from the simulation experience.

13 Mean Std. Deviation Paired T-Tests Paired Samples T-Test Paired Differences t df Sig. (2- tailed) Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair 1 OverallPost - OverallPre Paired Samples Statistics Mean N Std. Deviation Std. Error Mean Pair 1 OverallPost OverallPre

14 Wilcoxon Signed Ranks Test MCNER Test Statistics OverallPost OverallPre Driefuerst Test Statistics OverallPost OverallPre Z Z Asymp. Sig. (2- tailed).245 Asymp. Sig. (2- tailed).000 Dreifuerst concluded: There was no statistical difference between the experimental and control HSRT data, except when change in total score was compared.

15 WHAT DO THE RESULTS REALLY TELL US: Dreifuerst s raw scores illustrated a positive change in clinical reasoning skills with use of the DML debriefing model. Statistically significant N=238 Use of a control group MCNER Pilot also illustrated a positive change in the raw scores in clinical reasoning, however, Not statistically significant Pilot sample size only 30 No control group

16

17 WHAT WE LEARNED *A full-scale study is realistic & achievable *Timeliness and Timing vital *Consistency across sites is key *Data analysis techniques vital

18 FORGING AHEAD *Move to a full-scale study *Include a larger sample size *Use multiple measures *Add a control group *Further strengthen consistency of debriefing Implications are clear Engage an active learner-centered approach to teach thinking within the context of patient care

19 Faculty Development FACULTY RESOURCES Hartford Institute for Geriatric Nursing NLN ACES NLN SIRC (Simulation Innovation Resource Center) urces/aces/index.htm

20 Barton, A. J., Armstrong, G., Preheim, G., Gelmon, S. B., & Andrus, L. C. (2009). A national Delphi to determine developmental progression of quality and safety competencies in nursing education. Nursing Outlook, 57, doi: /j.outlok Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, doi: /j.outlook Facione, N. C., & Facione, P. A. (2006). The Health Sciences Reasoning Test. Millbrae, CA: The California Academic Press. Forneris, S. G., Crownover, J. G., Dorsey, L. E., Leahy, N., Maas, M. A., Wong, L., Zabriskie, A., and Zavertnik, J. E. (2012). Integrating QSEN and ACES: An NLN simulation leader project. Nursing Education Perspectives, 33(3), Forneris S.G. & Peden-Mcalpine C. (2007). Evaluation of a reflective learning intervention to improve critical thinking in novice nurses. Journal of Advanced Nursing 57(4), Forneris S.G. & Peden-Mcalpine C. (2009). Creating context for critical thinking in practice: the role of the preceptor. Journal of Advanced Nursing 65(8), Insight Assessment. Health Science Reasoning Test (HSRT). Retrieved February 19, 2012, from Reasoning-Test-HSRT Jeffries, P. R. (2007). Simulation in nursing education. From conceptualization to evaluation. New York, NY: National League for Nursing. National League for Nurses (2013). Simulation Innovation Resource Center. Retrieved from Reese, C. R. (2010). ACES Case #1: Millie Larsen. Developed by the National League for Nursing, Simulation Team Advancing Gerontological Education Strategies (STAGES). Retrieved from

21 QUESTIONS????? THANK YOU FOR YOUR KIND ATTENTION!!!

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