Although internal consistency for total scale and subscales indicate acceptable reliability, few researchers reported the psychometric properties of the instrument, a reported limitation of the Skoronksi (2018) study. Other factors include nurses' values and perceptions of quality of practice, culture and patterns of care on the unit, and complexity of the environment. Study the impact of using high-fidelity simulation (HFS) on the development of clinical judgment and motivation for academic achievement among Lebanese nursing students. Goodwin, L. D. & Leech, N. L. (2006). For example, secondary students assessing the patient, as when taking vital signs, could think aloud their interpretations, which could influence intervention planning by the primary nurse. Burbach, B. E. & Thompson, S. A. Once nurses notice and grasp the situation, Interpreting and Responding, the second and third phases, require one or more reasoning patterns. Subsequently, students in both groups participated in real-life care experiences. This article describes an exploratory study that originated and pilot tested a rubric in the simulation laboratory to describe the development of clinical judgment, based on Tanner's Clinical Judgment Model. Evaluate the effectiveness of grand rounds as an educational strategy to develop critical thinking and clinical judgment skills in baccalaureate nursing students. Clinical judgment skills in one episode in time does not necessarily translate to all situations. Any adaptations to the LCJR should continue to follow Tanner's model to ensure the instrument maintains validity. However, a noted limitation of several studies indicated that poor interrater training (McMahon, 2013), inconsistent scores (McMahon, 2013; Rodriguez, 2014), and subjectivity (Ferguson, 2012; Kulju, 2013) could have affected the study results. At the end of the study time frame, a focus group of 8 of the observed students was convened to further test the findings. Cappelletti, A., Engel, J. K. & Prentice, D. (2014). If more than one rater will be scoring the students, inter-rater reliability training and regular reliability checks are essential to improve and maintain consistency in scores and be fair to students (Pufpaff et al., 2015), particularly if a consensus approach is not used. Adamson, K. A., Gubrud, P., Sideras, S. & Lasater, K. (2012). As students progress through clinical courses and specialty courses where patient scenarios become more complex, dimensions in prioritizing and making sense of data, along with well-planned interventions and reflection-in-action, should be added. This model served as the basis for the Lasater Clinical Judgment Rubric (LCJR) that was developed to evaluate a single patient encounter requiring clinical judgment using simulation. Examine the effect of the learning framework How People Learn (HPL) impact development of clinical judgment. From there, 44 studies were examined in their entirety. Clinical judgment development: Using simulation to create an assessment rubric. Internal consistency for individual scores ranged between .80 to .97 (Fawaz et al., 2016; Kulju, 2013; Mariani et al., 2013; Rodriguez, 2014). Evaluate the effectiveness of simulation alone or in combination with traditional clinical experiences on the development of clinical judgment for all nursing students and for Hispanic nursing students specifically, Mixed-methods, experimental, Sequential, exploratory. Students assigned to two groups. All can be useful methods to evaluate clinical judgment; however, adaptation of the LCJR rubric is required. & Noell, D. (2016). When the Lasater Clinical Judgment Rubric (LCJR) was introduced in 2007, it provided a common evaluative language for assessment of clinical judgment but had limited support of its validity and reliability. Structured debriefing and students' clinical judgment abilities in simulation. Nonetheless, the LCJR shows promise in providing nursing education with a much-needed tool to standardize language and evaluation. Selected four subscale items; recognizing deviations from expected patterns, information seeking, prioritizing data, and clear communication. Commonly during group simulations, students take turns as the primary nurse in the scenario, acting as the team leader to direct others' actions. 3519868) [Doctoral dissertation, University of the Pacific]. Determine if the implementation of an objective structured clinical examination (OSCE) had an effect on senior baccalaureate nursing students' clinical self-competence scores. A crisis in critical thinking. Search terms included nurse, student, clinical judgment, and Lasater Clinical Judgment Rubric in Scopus, ERIC, and CINAHL with EBSCOhost databases. ProQuest. Examine the impact of using community voluntary children on physical assessment abilities and comfort levels among undergraduate pediatric nursing students. All 151 abstracts were examined. The Lasater Clinical Judgment Rubric, a validated, evidence-based clinical judgment rubric, is described as a tool that offers a common language for students, nurse educators, and preceptors and a trajectory for students' clinical judgment development. Newly graduated nurses show lacking skills and competences regarding the ability to make appropriate clinical assessment of acute, complex care situations. Patient care is complex, and students should be educationally prepared to handle complex scenarios. Yet, Victor-Chmil and Larew (2013) reported that at the time of their review, reliability and validity of the LCJR had been reported exclusively in research in the simulation environment and in group simulation settings. Lasater, K. (2007b). A., Hawkins, K. S., Parsons, M. E. & Hercinger, M. (2008). Fawaz, M. A. Individual Versus Group Evaluations. High-fidelity nursing simulation: Impact on student self-confidence and clinical competence. All potential raters should train together by scoring scenarios and then comparing results. The interest in nursing graduates’ training and the need to use instruments for performance evaluation of the teaching-learning process, explains the choice for the Lasater Clinical Judgment Rubric (LCJR). The development of a quantitative evaluation tool for simulations in nursing education. After rating scenarios, faculty can come to consensus. If through the pilot process adjustments are needed to the LCJR, these can be implemented before full study data are collected. Scoring novice students during complex scenarios could result in low scores, resulting in a floor effect (Adamson et al., 2012). Faculty scored clinical judgment during a group simulation pre- and postintervention. Quantitative, quasi-experimental pre/posttest. This is difficult to do in the simulation environment when group simulations are the norm. Under the clear communication dimension of the Responding domain, students were asked to give an example of their best communication with the patient. Nursing students' clinical judgment in high-fidelity simulation based learning: A quasi-experimental study. Faculty scored clinical judgment during an individual pretest entry-level pain management simulation and an individual posttest complex pain management simulation. Other active-learning methods could assist educators in evaluating clinical judgment outside the simulation laboratory, including case studies, reflective journals, and debriefing interviews. Consensus scoring reduces bias and inconsistencies (Polit & Beck, 2017). Four were experimental studies, 12 were quasi-experimental, and four were mixed-methods. Nurse educators must answer the call to improve patient safety. Internal consistency for subscales ranged between .89 to .93 (Gubrud-Howe, 2008). Lasater Clinical Judgment Rubric (LCJR). Bussard, M. (2015). However, clinical judgment was evaluated through nondirect observation activities including written case studies, recordings of case study discussions, reflective journaling, and a self-assessment survey. Empirically test and compare the clinical judgment of students who participated in structured debriefing sessions using Debriefing of Meaningful Learning (DML) and of students who received unstructured debriefing. Da, NCLEX-RN Content Review Guide-Kaplan Publishing.pdf, Passaic County Community College • NURSING NUR 101. Blum, C. A., Borglund, S. & Parcells, D. (2010). Berkow, S., Virkstis, K., Stewart, J. However, in this review, nine of the 20 research teams evaluated students' clinical judgment in group activities, of which eight of the nine were through simulations. That is, validity assessment such as content validity should be considered. Qualitative (part of mixed-methods study), thematic and content analysis. NLN Simulation Design Effectiveness Tool nln-instrument_simulation-design-scale . A tutorial on pilot studies: The what, why and how. Clinical judgment development: Using simulation to create an assessment rubric. However, Coram (2016) postulated that the nonsignificant results in her study could have been related to inadequate training of students in how to use the instrument. All students then completed clinical training for patients with heart failure. Tanner, C. A. The nature of clinical judgment development in reflective journals. Cue recognition by undergraduate nursing students: An integrative review. Students were randomly assigned from clinical groups to receive the intervention (DNT model during clinical post conference) or control (standard clinical post conference). Therefore, clinical reasoning is the process, whereas clinical judgment is the outcome. Many research teams evaluated clinical judgment in group settings, in a single complex scenario, and through nondirect observation activities, which could influence the reliability and validity of results. The search began with a keyword search using the Scopus®, ERIC™, and CINAHL® with EBSCOhost databases without date limits. Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L. P., Robson, R., Thabane, M., Giangregorio, L. & Goldsmith, C. H. (2010). Coram, C. (2016). Degree programs of the samples included two associate, 11 baccalaureate, and two diploma programs. Six of the 18 quantitative research teams reported an internal consistency ranging from .80 to .97 for the total scale (Blum et al., 2010; Fawaz & Hamdan-Mansour, 2016; Kulju, 2013; Mariani et al., 2013; Marcyjanik, 2016; Rodriguez, 2014). Clinical judgment is critical to excellent patient care decisions and outcomes. Kubin, L. & Wilson, C. E. (2017). Examine the effects of high-fidelity patient simulation (HFPS) on the development of BSN students' knowledge, attitudes, and clinical judgment regarding pain management. Douglass, K. (2014). del Bueno, D. (2005). This is a decrease of 25% to 35% from the previous decade (del Bueno, 2005). Problems and Challenges in Evaluating the Clinical … The Creighton Simulation Evaluation Instrument (C-SEI™; Todd et al., 2008) evaluates clinical judgment, assessment, patient safety, and communication skills during simulation. Clinical judgment is the conclusion drawn from the reasoning process and results in a planned response to the clinical situation (Tanner, 2006). However, educators should remember that without evaluating all domains, only clinical reasoning processes are being evaluated. Clinical judgment is a skill every nurse needs, but nurse educators sometimes struggle with how to present it to students and assess it. First- or second-semester students were seemingly involved in complex patient care scenarios including cardiac arrhythmias, congestive heart failure, postoperative hemorrhage, and ruptured diverticula. Transforming prelicensure nursing education: Preparing the new nurse to meet emerging health care needs. Case studies, reflective journaling, discussion recordings, individual interviews, and self-assessment surveys are nondirect observation activities. Clinical judgment tools with support for reliability and validity are needed to facilitate clinical judgment development. Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain. Students assigned to control and treatment groups before a simulation experience. Seventeen of the 20 research teams recruited students from a single site. Geriatrics in simulation: Role modeling and clinical judgment effect. Experiences that connect theory to practice have emerged as a key factor in the development of clinical judgment (Ashley & Stamp, 2014; Cappelletti et al. Thinking like a nurse: A research-based model of clinical judgment in nursing. Scenarios involved diabetic ketoacidosis, leg fracture, pneumonia with ischemic stroke, and bowel obstruction with a PE. Both groups participated in a health care dilemma case study. Faculty scored for clinical judgment during the 1. (2010) used a condensed version of the rubric, assessing only the following four subscale dimensions: “expected patterns” and “information seeking” in Noticing, “prioritizing data” in Interpreting, and “clear communication” in Responding. Clinical judgment is imperative for safe practice (Manetti, 2019), and health care providers expect new graduates to be proficient in clinical judgment (Berkow et al., 2009). Explore the nature of clinical judgment development as revealed in students' reflective journals after participating in four progressive high-fidelity simulation (HFS) scenarios, Qualitative (part of mixed-method study), interpretive description. the Lasater clinical judgment rubric: Three approaches. Faculty scored clinical judgment during the simulation scenarios. Students assigned to an intervention group (participated individually in a three-station OSCE) and control group (no OSCE participation). To determine the ability of the adapted instrument to collect quality data, pilot studies should be planned before study data are collected (Thabane et al., 2010). The vpLCJR is designed to assess nursing students’ clinical reasoning processes when encountering virtual patients (Georg et al., 2018). Nine of the 20 research teams had sample sizes less than 50, raising concern that many were underpowered to control for a type II error. Students in University A were assigned the intervention (individual simulation training on one congestive heart failure scenario) while students at university B were assigned to the control (traditional-method demonstration) group. For the dimension calm or confident manner, students were asked to rate themselves on a 10-point Likert scale, with 10 being the highest score. Concern with patient safety necessitates valid and reliable measures to evaluate clinical judgment. Internal consistency, for total scale and subscales, should be at a minimum of .70 if used in research and greater than .90 if used for educational purposes (Gadermann et al., 2012). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Clinical judgment was faculty scored during each simulation. Psychometric properties of the lasater clinical judgment rubric. Furthermore, raters should have adequate time to focus on each rating and to practice using the LCJR. Quantitative, quasi-experimental, posttest only. Tanner's (2006) clinical judgment model provides a framework to facilitate learning and evaluation of clinical judgment skills in nursing. Each group participated in five simulations. Because experience is required to master clinical judgment skills (Tanner, 2006), it is understandable that nursing students, with their lack of clinical experience, are still developing this skill. Pufpaff, L. A., Clark, L. & Jones, R. E. (2015). They found differences in clinical judgment skills between novice and more experienced students, suggesting the importance of experience in patient care situations. Interpreting requires nurses to give meaning to the data (Tanner, 2006, p. 208). Interrater reliability, reported as percent agreement, was variable among the six reporting research teams (Coram, 2016; Gubrud-Howe, 2008; Kulju, 2013; Mann, 2010; McMahon, 2013; Rodriguez, 2014; Yuan et al., 2014). Students in the intervention group received a faculty-led grand rounds activity and follow up interview as an educational strategy while completing the case study. Determine the effect of expert role modeling on nursing students' clinical judgment in the care of a simulated geriatric hip fracture patient. Results of this review indicate that the LCJR can be used to evaluate clinical judgment, but educators need to consider inter- and intrarater reliability, individual versus group evaluation, clinical judgment scenarios, and adapting the rubric for nondirect observation activities. For example, under the Noticing domain, a performance that scores as “beginning” in the observation dimension indicates the student was confused by the situation, was disorganized in collecting data, potentially missed some data, and/or made assessment errors. Additional assessments may need to be performed to intervene appropriately. Both groups participated in the same 4 simulation scenarios in student groups. The Lasater Clinical Judgment Rubric (LCJR; Lasater, 2007a) is emerging as an effective tool to directly measure clinical judgment based on a standardized language specific to … Students randomly assigned to control group (interactive case study) and treatment (one scenario HFPS) after didactic teaching on pain management. This study aimed to compare a simulation-teaching model with a traditional teaching method in … When the Lasater Clinical Judgment Rubric (LCJR) was introduced in 2007, it provided a common evaluative language for assessment of clinical judgment but had limited support of its validity and reliability. Seacrist, M. J. The Lasater Clinical Judgment Rubric (LCJR) was de-veloped to evaluate simulation experience based on Ben-ner’s seminal novice-to-expert model [1, 17] and Tanner’s clinical judgment model [1]. Scenarios used to evaluate clinical judgment ranged from basic health assessments to critically deteriorating patients. Expert role modeling effect on novice nursing students' clinical judgment. 2021;60(2):67–73.]. In addition, a limited range in scores would likely reduce correlations between variables (Goodwin & Leech, 2006), a noted limitation in the Mariani et al. This article describes an exploratory study that originated and pilot tested a rubric in the simulation laboratory to describe the development of clinical judgment, based on Tanner's Clinical Judgment Model. The LCJR was originally developed to directly observe and evaluate individual students' ability to make a clinical judgment in a single clinical situation (Lasater, 2007b). Ten of the studies were published, eight were dissertations, and two were Doctor of Nursing Practice projects (Table B; available in the online version of this article).
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