Nursing Student's Clinical Reasoning during Simulation

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CONFERENCE: Beyond the Boundaries: Evolving Simulation & Skills to the Next Generation of Healthcare

Beyond the Boundaries: Evolving Simulation & Skills to the Next Generation of Healthcare

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Jensen, Rebecca S
simulation; nursing; debriefing; clinical reasoning; Nursing; Other Nursing
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Statement of problem While debriefing is considered essential for student understanding of the concepts embedded in a simulation, the measurement of clinical reasoning before and after debriefing has been minimally published. Students typically rate their performance as better than ratings by faculty, and the largest disparity is between self and faculty ratings for poorer performing students (Davis et al., 2006). Debriefing may be a method of attenuating students’ self-assessment by explicating their actions and reasoning during the simulation (Dreifuerst, 2012).Hypotheses There will be no difference in student self-ratings and lab personnel ratings of student performance during simulation using the Lasater Clinical Judgment Rubric (LCJR). There will be no difference in student self-ratings of performance during simulation and ratings by leadership students after debriefing using the LCJR. Literature review Nursing students must be introduced to clinical reasoning with adequate opportunities to practice it prior to graduation to be effective, safe practitioners, and patient care simulation is one way to provide such opportunities (Benner et al., 2010). Lasater (2005) developed a rubric (LCJR) for rating student performance of clinical reasoning skills during simulation that uses the categories in Tanner’s (2006) Clinical Judgment Model: noticing, interpreting, responding, and reflecting. Debriefing helps nursing students put their experiences into perspective (Jeffries & Rogers, 2007; Stafford, 2005), augmenting experiential knowledge upon which the students can base future patient care actions (Tanner). One potential concern with self-ratings is that students do not know what they do not know, or students do not have a keen sense of metacognition. Debriefing helps nursing students understand what they did not know in relation to patient care within the simulation event (Dreifuerst, 2012).Methodology Students in three semesters of clinical courses must complete patient care simulations. Debriefing began with videotape review of the simulation. Then, students who were observers and family members responded to open ended questions followed by students portraying nursing staff. Using the LCJR, students rated self-rate performance after debriefing. Lab personnel rated performance of the students as a group. Also, students in the leadership course, who acted as resource nurses for the underclassmen, were asked to evaluate group performance in simulation after debriefing. LCJR data were compared according to the hypotheses.Ethical considerations IRB approval was obtained for the study. Completing the LCJR was voluntary, and students could remove their participation at any time.Results and implications Data collection is ongoing and will be collected through the spring and fall 2013 semesters. Preliminary results will be available after spring 2013 semester.References:Benner, P., Sutphen, M., Leonard, M., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Josey Bass.Davis, D., Maznanian, 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), 1094-1102.Dreifuerst, K. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326-333.Jeffries, P., & Rogers, K. (2007). Theoretical framework for simulation design. In P. Jeffries (Ed.) Simulation in nursing education: From conceptualization to evaluation (pp. 21-33). New York: National League for Nursing.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. 3169414).Stafford, F. (2005). The significance of de-roling and debriefing in training medical students using simulation to train medical students. Medical Education, 39, 1083-1085.Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.