The Impact of Critical Thinking upon Clinical Judgment during Simulation with Senior Nursing Students. Cazzell, Mary A.

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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 The Impact of Critical Thinking upon Clinical Judgment during Simulation with Senior Nursing Students Cazzell, Mary A.; Anderson, Mindi Downloaded 19-Jul :28:39 Link to item

2 The Impact of Critical Thinking upon Clinical Judgment during Simulation with Senior Nursing Students Mary Cazzell, RN, PhD Mindi Anderson, PhD, RN, CPNP-C, CNE, CHSE-A, ANEF

3 Acknowledgements Funding for this study: 2012 NLN Foundation for Nursing Education Fund Kathie Lasater, EdD, RN, ANEF Carol Howe, RN, MSN, PhD(c)

4 Problem Confusion among nurse educators regarding which high quality student outcomes to facilitate in didactic, clinical, and simulation settings: Critical thinking Clinical reasoning Clinical judgment

5 Purpose Examine the impact of components of critical thinking upon clinical judgment during a pediatric medication administration OSCE with senior-level nursing students

6 Background/Significance Challenge: Radical transformation of nursing education (Benner, Sutphen, Leonard, & Day, 2010) Numerous interchangeable and overlapping definitions Profetto-McGrath (2003): critical thinking: process of logical reasoning with prudent judgment Pesut & Herman (1999): clinical reasoning: process of critical thinking, reflection, and creativity used to make judgments

7 Theoretical Framework 1. Clinical Judgment Model (Tanner, 2006) a) Noticing b) Interpreting c) Responding d) Reflecting e) Lasater Clinical Judgment Rubric (Lasater, 2007) 2. Neurodevelopment of critical thinking (McAnarney, 2008; Steinberg, 2008) Guided choice of independent study variables

8 Sampling Methods Convenience sample 160 Senior 1 pre-licensure baccalaureate nursing students Fall 2012 and Spring 2013 semesters University ranks in nation s top 10% for racial diversity Research Design Quantitative descriptive correlational study

9 Methods: Independent Variables Study Measures: 1. Student Demographic Survey 2. Tower of Hanoi (Welsh & Huizinga, 2001) 3. Health Science Reasoning Test (Insight Assessment, 2011)

10 Methods: Dependent Variable Pediatric Medication Administration OSCE Videotaped performances scored Lasater Clinical Judgment Rubric 11-items based on Tanner (2006) model Perfect score = 44 points 4 dimensions of effectiveness Beginning Developing Accomplished Exemplary

11 Results: Demographic Data 85% female Median age: 23 years (Range yrs) Ethnicity: 42% Caucasian 25% Asian 16% Hispanic 11% African American GPAs: (46%) & (43%) 49%: previous healthcare experience

12 Tower of Hanoi: Results: TOH & HSRT Average 7 moves over minimum/task Did better in earlier easier vs. later more complex tasks >70% required 1-15 moves in Tasks Health Science Reasoning Test Average score: (out of total 38) Induction highest scores (7.26) Inference lowest scores (2.90)

13 Results: Lasater Clinical Judgment Rubric Total scores: (SD 2.41) Out of possible 44 points Noticing: 8.60 (SD 1.07) Out of possible 12 points Interpreting: 5.98 (SD 0.17) Out of possible 8 points Responding: (SD 1.52) Out of possible 16 points Reflecting: 5.77 (SD 0.77) Out of possible 8 points

14 Results: Regression Analyses 4 critical thinking variables predicted clinical judgment 1. Gender: females scored higher than males 2. Ethnicity: African Americans had significantly lower scores on LCJR 3. HSRT deduction score: higher score predicted higher LCJR score 4. HSRT analysis score: higher score predicted lower LCJR score

15 Implications for Nurse Educators Critical thinking and clinical judgment: Need separate concise definitions Small overlap between components Develop innovative teaching strategies to address predictors of clinical judgment Attention to gender and ethnicity

16 References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco: Jossey- Bass. Insight Assessment. (2011). Research: Health sciences and critical thinking. Retrieved from Resources/Research-Health-Sciences-and-Critical-Thinking. Lasater, K. (2007). Clinical judgment development: Using simulation to create a rubric. Journal of Nursing Education, 46, McAnarney, E. R. (2008). Adolescent brain development: Forging new links. Journal of Adolescent Health, 42, Pesut, D. J. & Herman, J. (1999). Clinical reasoning: The art and science of critical and creative thinking. Albany, NY: Delmar Publishers.

17 References Profetto-McGrath, J. (2003). The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students. Journal of Advanced Nursing, 43(6), Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28, Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment. Journal of Nursing Education, 45, Welsh, M. C. & Huizinga, M. (2001). The development and preliminary validation of the Tower of Hanoi-Revised. Assessment, 8(2),