Advertisement

Describing Learners’ Clinical Judgment Trajectory After Observing Expert Modeling Videos: A Mixed Methods Study

Published:September 02, 2022DOI:https://doi.org/10.1016/j.ecns.2022.08.001

      Highlights

      • Assigning expert-modeled simulation observations increased clinical judgment.
      • Asynchronous simulation observations helped low, medium, and high performers.
      • Observation reflections revealed differences in knowledge, thinking, and approach.
      • Time spent responding to prompts favorably influenced clinical judgment scores.

      Abstract

      Background

      Novice nurses have clinical judgment (CJ) deficiencies leading to errors.

      Method

      We used mixed methods to describe learners’ CJ trajectory after observing eight expert-modeled videos (EM) asynchronously over a semester. Learners responded to CJ prompts after observing EMs and were scored using Lasater Clinical Judgment Rubric (LCJR). Learners were assigned to low, medium, or high-performance groups based on cumulative LCJR rankings. Next, we analyzed whether background variables related to LCJR scores. Finally, we used Framework Method to describe characteristics of written responses for select low, medium, and high performers.

      Results

      Sixty-three junior-level nurses participated. Observing eight EMs increased CJ significantly over time, F (5.514, 341.858) = 24.18, p < .001, ηp2 = 0.28. Furthermore, all three performance groups significantly increased CJ over time. Longer time spent responding to prompts predicted whether learners were high versus low performers. Qualitative analysis revealed low, medium, and high performers nursing knowledge, thinking, and approach differs.

      Conclusions

      Assigning EM observations and CJ prompts increased CJ development. Assigning EM observations and reflections allows educators to track CJ and overcome variable clinical experiences.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Simulation In Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adamson K.A.
        • Gubrud P.
        • Sideras S.
        • Lasater K.
        Assessing the reliability, validity, and use of the Lasater Clinical Judgment Rubric: Three approaches.
        Journal of Nursing Education. 2012; 51: 66-73https://doi.org/10.3928/01484834-20111130-03
        • Adamson K.A.
        • Parsons M.E.
        • Hawkins K.
        • Manz J.A.
        • Todd M.
        • Hercinger M.
        Reliability and internal consistency findings from the C-SEI.
        Journal of Nursing Education. 2011; 50: 583-586https://doi.org/10.3928/01484834-20110715-02
        • Al-Moteri M.
        • Cooper S.
        • Symmons M.
        • Plummer V.
        Nurses’ cognitive and perceptual bias in the identification of clinical deterioration cues.
        Australian Critical Care: Official Journal Of The Confederation Of Australian Critical Care Nurses. 2019; https://doi.org/10.1016/j.aucc.2019.08.006
        • Aronson B.
        • Glynn B.
        • Squires T.
        Effectiveness of a role-modeling intervention on student nurse simulation competency.
        Clinical Simulation in Nursing. 2013; 9: e121-e126https://doi.org/10.1016/j.ecns.2011.11.005
        • Baldwin A.
        • Mills J.
        • Birks M.
        • Budden L.
        Role modeling in undergraduate nursing education: An integrative literature review.
        Nurse Education Today. 2014; 34: e18-e26https://doi.org/10.1016/j.nedt.2013.12.007
        • Benner P.
        • Sutphen M.
        • Leonard V.
        • Day L.
        Educating nurses : A call for radical transformation.
        1st ed. Josey-Bass, San Fancisco, CA2009
        • Burbach B.E.
        • Thompson S.A.
        Cue recognition by undergraduate nursing students: An integrative review.
        The Journal of Nursing Education. 2014; 53: S73-S81https://doi.org/10.3928/01484834-20140806-07
        • Bussard M.
        The nature of clinical judgment development in reflective journals.
        Journal of Nursing Education. 2015; 54: 451-454https://doi.org/10.3928/01484834-20150717-05
        • Bussard M.E.
        Evaluation of clinical judgment in prelicensure nursing students.
        Nurse Educator. 2018; 43: 106-108https://doi.org/10.1097/NNE.0000000000000432
        • Cazzell M.
        • Anderson M.
        The impact of critical thinking on clinical judgment during dimulation with senior nursing students.
        Nursing Education Perspectives. 2016; 37: 83-90https://doi.org/10.5480/15-1553
        • Cheng A.
        • Kessler D.
        • Mackinnon R.
        • Chang T.P.
        • Nadkarni V.M.
        • Hunt E.A.
        • et al.
        Reporting guidelines for health care simulation research.
        Simulation in Healthcare. 2016; 11: 238-248https://doi.org/10.1097/SIH.0000000000000150
        • Del Bueno D.
        A crisis in critical thinking.
        Nursing Education Perspectives. 2005; 26: 278-282
        • Fedko A.S.
        • Dreifuerst K.T.
        Examining the relationship between clinical judgment and nursing actions in prelicensure students.
        Nurse Educator. 2017; 42: 47-50https://doi.org/10.1097/NNE.0000000000000290
        • Franklin A.E.
        • Lee C.S.
        Effectiveness of simulation for improvement in self-efficacy among novice nurses: A meta-analysis.
        Journal of Nursing Education. 2014; 53: 607-614https://doi.org/10.3928/01484834-20141023-03
        • Fraser K.
        • Peets A.
        • Walker I.
        • Tworek J.
        • Paget M.
        • Wright B.
        • et al.
        The effect of simulator training on clinical skills acquisition, retention and transfer.
        Medical Education. 2009; 43: 784-789https://doi.org/10.1111/j.1365-2923.2009.03412.x
        • Gale N.K.
        • Heath G.
        • Cameron E.
        • Rashid S.
        • Redwood S.
        Using the framework method for the analysis of qualitative data in multi-disciplinary health research.
        BMC Medical Research Methodology. 2013; 13https://doi.org/10.1186/1471-2288-13-117
        • Gwet K.L.
        Computing inter-rater reliability and its variance in the presence of high agreement.
        British Journal of Mathematical and Statistical Psychology. 2008; 61: 29-48https://doi.org/10.1348/000711006X126600
        • Hallin K.
        • Bäckström B.
        • Häggström M.
        • Kristiansen L.
        High-fidelity simulation: Assessment of student nurses’ team achievements of clinical judgment.
        Nurse Education in Practice. 2016; 19: 12-18https://doi.org/10.1016/j.nepr.2016.03.010
        • Hendry C.
        • Walker A.
        Priority setting in clinical nursing practice: Literature review.
        Journal of Advanced Nursing. 2004; 47: 427-436https://doi.org/10.1111/j.1365-2648.2004.03120.x
        • Hickerson K.A.
        • Taylor L.A.
        • Terhaar M.F.
        The preparation–practice gap: An integrative literature review.
        Journal of Continuing Education in Nursing. 2016; 47: 17-23https://doi.org/10.3928/00220124-20151230-06
        • Johnson E.A.
        • Lasater K.
        • Hodson-Carlton K.
        • Siktberg L.
        • Sideras S.
        • Dillard N.
        Geriatrics in simulation: Role modeling and clinical judgment effect.
        Nursing Education Perspectives. 2012; 33: 176-180https://doi.org/10.5480/1536-5026-33.3.176
        • Kavanagh J.
        • Sharpnack P.
        Crisis in competency: A defining moment in nursing education.
        OJIN: The Online Journal of Issues in Nursing. 2021; 26https://doi.org/10.3912/OJIN.VOL26NO01MAN02
        • Lasater K.
        Clinical judgment development: Using simulation to create an assessment rubric.
        Journal of Nursing Education. 2007; 46: 496-503https://doi.org/10.3928/01484834-20071101-04
        • Lasater K.
        Clinical judgment: The last frontier for evaluation.
        Nurse Education in Practice. 2011; 11: 86-92https://doi.org/10.1016/j.nepr.2010.11.013
        • Lasater K.
        • Holloway K.
        • Lapkin S.
        • Kelly M.
        • McGrath B.
        • Nielsen A.
        • et al.
        Do prelicensure nursing students’ backgrounds impact what they notice and interpret about patients?.
        Nurse Education Today. 2019; 78: 37-43https://doi.org/10.1016/j.nedt.2019.03.013
        • Lee J.
        • Oh P.J.
        Effects of the use of high-fidelity human simulation in nursing education: A meta-analysis.
        Journal of Nursing Education. 2015; 54: 501-507https://doi.org/10.3928/01484834-20150814-04
        • LeFlore J.L.
        • Anderson M.
        • Michael J.L.
        • Engle W.D.
        • Anderson J.D.
        Comparison of self-directed learning versus instructor-modeled learning during a simulated clinical experience.
        Simulation in Healthcare. 2007; 2: 170-177https://doi.org/10.1097/SIH.0b013e31812dfb46
        • Parsons M.E.
        • Hawkins K.S.
        • Hercinger M.
        • Todd M.
        • Manz J.A.
        • Fang X.
        Improvement in scoring consistency for the creighton simulation evaluation instrument ©.
        Clinical Simulation in Nursing. 2012; 8: e233-e238https://doi.org/10.1016/j.ecns.2012.02.008
        • Price A.
        • Zulkosky K.
        • White K.
        • Pretz J.
        Accuracy of intuition in clinical decision-making among novice clinicians.
        Journal of Advanced Nursing. 2017; 73: 1147-1157https://doi.org/10.1111/jan.13202
        • Rogers B.
        • Baker K.A.
        • Franklin A.E.
        Learning outcomes of the observer role in nursing simulation: A scoping review.
        Clinical Simulation in Nursing. 2020; 49: 81-89https://doi.org/10.1016/j.ecns.2020.06.003
        • Selle K.M.
        • Salamon K.
        • Boarman R.
        • Sauer J.
        Providing interprofessional learning through interdisciplinary collaboration: The role of “modelling.
        Journal of Interprofessional Care. 2008; 22: 85-92https://doi.org/10.1080/13561820701714755
        • Sharpnack P.A.
        • Goliat L.
        • Baker J.R.
        • Rogers K.
        • Shockey P.
        Thinking like a nurse: Using video simulation to rehearse for professional practice.
        Clinical Simulation in Nursing. 2013; 9: e571-e577https://doi.org/10.1016/j.ecns.2013.05.004
        • Shinnick M.A.
        Validating eye tracking as an objective assessment tool in simulation.
        Clinical Simulation in Nursing. 2016; 12: 438-446https://doi.org/10.1016/j.ecns.2016.06.001
        • Shinnick M.A.
        • Cabrera-Mino C.
        Predictors of nursing clinical judgment in simulation.
        Nursing Education Perspectives. 2021; 42: 107-109https://doi.org/10.1097/01.NEP.0000000000000604
        • Stubbings L.
        • Chaboyer W.
        • McMurray A.
        Nurses’ use of situation awareness in decision-making: An integrative review.
        Journal of Advanced Nursing. 2012; 68: 1443-1453https://doi.org/10.1111/j.1365-2648.2012.05989.x
        • Tanner C.A.
        Thinking like a nurse: A research-based model of clinical judgment in nursing.
        Journal of Nursing Education. 2006; 45: 204-211https://doi.org/10.3928/01484834-20060601-04
        • Victor-Chmil J.
        • Larew C.
        Psychometric properties of the Lasater Clinical Judgment Rubric.
        International Journal of Nursing Education Scholarship. 2013; 10: 1-8https://doi.org/10.1515/ijnes-2012-0030
        • White A.
        • Maguire M.B.R.
        • Brannan J.
        • Brown A.
        Situational awareness in acute patient deterioration.
        Nurse Educator. 2021; 46https://doi.org/10.1097/nne.0000000000000968
        • Zulkosky K.D.
        • White K.A.
        • Price A.L.
        • Pretz J.E.
        Effect of simulation role on clinical decision-making accuracy.
        Clinical Simulation in Nursing. 2016; 12: 98-106https://doi.org/10.1016/j.ecns.2016.01.007
      1. NLN. (2021). Eugene Shaw. Retrieved August 26, 2022 from: https://www.nln.org/education/teaching-resources/professional-development-programsteaching-resourcesace-all/ace-v/unfolding-cases-e5e9b65c-7836-6c70-9642-ff00005f0421/eugene-shaw-c031c65c-7836-6c70-9642-ff00005f0421.