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Bussard ME, Jessee MA, El-Banna MM, Cantrell MA, Alrimawi I, Marchi NM, Gonzalez LI, Rischer K, Coy ML, Poledna M, Lavoie P. Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review. NURSE EDUCATION TODAY 2024; 134:106078. [PMID: 38184981 DOI: 10.1016/j.nedt.2023.106078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.
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Affiliation(s)
- Michelle E Bussard
- School of Nursing, Bowling Green State University, 924 Ridge St., Bowling Green, OH 43403, USA.
| | - Mary Ann Jessee
- School of Nursing, Vanderbilt University, 461 21(st) Avenue South, Nashville, TN 37240, USA.
| | - Majeda M El-Banna
- School of Nursing, George Washington University, 45085 University Drive, Innovation Hall, Ashburn, VA 20147, USA.
| | - Mary Ann Cantrell
- College of Nursing, Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA.
| | - Intima Alrimawi
- School of Nursing, Georgetown University, St. Mary's Hall, 3700 Reservoir Rd. NW, Washington, DC 20057, USA.
| | - Nadine M Marchi
- Inova Health System, 3300 Gallows Road, Falls Church, VA 22042-3300, USA.
| | - Lisa I Gonzalez
- College of Southern Maryland, 8730 Mitchell Rd, La Plata, MD 20646, USA.
| | - Keith Rischer
- KeithRN, 6417 Penn Ave S, Ste 8, iPMB 1383, Minneapolis, MN 55423, USA.
| | - Michelle L Coy
- Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mari Poledna
- Arizona State University, 411 North Central Ave, Phoeniz, AZ 85004, USA.
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
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Ramazanzadeh N, Ghahramanian A, Zamanzadeh V, Valizadeh L, Ghaffarifar S. Development and psychometric testing of a clinical reasoning rubric based on the nursing process. BMC MEDICAL EDUCATION 2023; 23:98. [PMID: 36750822 PMCID: PMC9904873 DOI: 10.1186/s12909-023-04060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To facilitate the development of clinical reasoning skills in nursing students, educators must possess the ability to teach and evaluate them. This study aimed to describe the development and validation process of an analytic rubric of clinical reasoning skills based on the nursing process in undergraduate nursing students. METHODS A seven-step method was used for rubric development. The initial validation process of the rubric of clinical reasoning was performed with the participation of key stakeholders to assess its face and content validity as well as applicability in the classroom and bedside. An initial pilot test was performed based on scenario-based examinations in the nursing process training course so that convergent validity was used to show how closely the new scale is related to the previous measure for evaluating students' tasks. Internal consistency and inter-rater correlation coefficient measurement for reliability were assessed. RESULTS The rubric to assess clinical reasoning skills was developed into eight categories according to the five stages of the nursing process. Content and face validity of the rubric were done qualitatively and resulted in a clear, simple rubric relevant to clinical reasoning skills assessment. The convergent validity was confirmed by the conventional method. The reliability was approved by a high inter-rater correlation coefficient based on the assessment by two random independent raters. CONCLUSION The clinical reasoning meta-rubric developed in this study meets the purpose of the study. This analytical rubric can be applied to guide teaching and learning as well as evaluate clinical reasoning based on the findings. Testing the applicability confirmed its validity and reliability for assessing clinical reasoning skills in nursing process education during the undergraduate nursing program.
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Affiliation(s)
- Nargess Ramazanzadeh
- Students’ Research Committee, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Redmond C, Jayanth A, Beresford S, Carroll L, Johnston ANB. Development and validation of a script concordance test to assess biosciences clinical reasoning skills: A cross-sectional study of 1st year undergraduate nursing students. NURSE EDUCATION TODAY 2022; 119:105615. [PMID: 36334475 DOI: 10.1016/j.nedt.2022.105615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/05/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Developing evaluative measures that assess clinical reasoning remains a major challenge for nursing education. A thorough understanding of biosciences underpins much of nursing practice and is essential to allow nurses to reason effectively. A gap in clinical reasoning can lead to unintended harm. The Script Concordance test holds promise as a measure of clinical reasoning in the context of uncertainty, situations common in nursing practice. The aim of this study is to develop and validate a test for first year undergraduate nursing students that will evaluate how bioscience knowledge is used to clinically reason. METHODS An international team, teaching biosciences to undergraduate nurses constructed a test integrating common clinical cases with a series of related test items: diagnostic, investigative and treatment. An expert panel (n = 10) took the test and commented on authenticity/ambiguities/omissions etc. This step is crucial for validity and for scoring of the student test. The test was administered to 47 first year undergraduate nursing students from the author sites. Students rated educational aspects of the tool both quantitatively and qualitatively. Statistical and content analyses inform the findings. FINDINGS Results indicate that the test is reliable and valid, differentiating between experts and students. Students demonstrated an ability to identify relevant data, link this to their bioscience content and predict outcomes (mean score = 50.78 ± 8.89). However, they lacked confidence in their answers when the scenarios appeared incomplete to them. CONCLUSION Nursing practice is dependent on a thorough understanding of biosciences and the ability to clinically reason. Script concordance tests can be used to promote both competencies. This method of evaluation goes further than probing factual knowledge. It also explores capacities of data interpretation, critical analysis, and clinical reasoning. Evaluating bioscience knowledge and real-world situations encountered in practice is a unique strength of this test.
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Affiliation(s)
- Catherine Redmond
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland.
| | - Aiden Jayanth
- Brighton & Sussex Medical School, University of Sussex, UK.
| | | | - Lorraine Carroll
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland.
| | - Amy N B Johnston
- School of Nursing, Midwifery & Social Work, The University of Queensland, Australia; Department of Emergency Medicine, Metro South Health, Woolloongabba, QLD 4102, Australia.
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Walker SB, Rossi DM. Personal qualities needed by undergraduate nursing students for a successful work integrated learning (WIL) experience. NURSE EDUCATION TODAY 2021; 102:104936. [PMID: 33965846 DOI: 10.1016/j.nedt.2021.104936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND International research has shown that during work integrated learning (WIL) undergraduate nursing students may experience stress, self-doubt, and coping issues, however personal qualities these students bring to their WIL journey or those needed to succeed during WIL remain unknown. OBJECTIVE To describe the views of students midway through their Bachelor of Nursing program regarding personal qualities they bring to and need for WIL success. DESIGN This article reports on a descriptive study that used an electronic questionnaire to collect the data. SETTINGS AND PARTICIPANTS Bachelor of nursing students (n = 421), who were studying fulltime or part time equivalent, at a regional university in Queensland Australia, were invited to complete the anonymous electronic questionnaire that was developed by the research team following an extensive review of literature. Inclusion criteria required participants to have completed at least one WIL experience and be midway through their three-year Bachelor of Nursing program. METHODS Data were collected during January and February 2017. The electronic questionnaire consisted of demographic, forced choice questions, and open-ended questions. This paper presents the qualitative analysis of responses to two of the open-ended questions that focused on personal strengths and work integrated learning experiences. Data were analysed using the inductive content analysis approach. RESULTS Six personal qualities were identified including: enthusiasm to succeed, commitment to learning, self-motivation, confidence, effective communication skills, and compassion. CONCLUSIONS Pre-entry screening of applicants to bachelor level nursing programs and the delivery of learning opportunities that encourages both reflection and debriefing may assist in describing personal qualities needed to succeed in WIL.
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Affiliation(s)
- Sandra B Walker
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton 4702, Queensland, Australia.
| | - Dolene M Rossi
- School of Nursing Midwifery and Social Sciences, Central Queensland University, Bruce Highway, Rockhampton 4702, Queensland, Australia
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