the impact of critical thinking upon clinical judgment ... · the impact of critical thinking upon...
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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
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Acknowledgements
Funding for this study:
• 2012 NLN Foundation for Nursing Education Fund
Kathie Lasater, EdD, RN, ANEF
Carol Howe, RN, MSN, PhD(c)
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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
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Purpose
Examine the impact of components of critical thinking upon clinical judgment during a pediatric medication administration OSCE with senior-level nursing students
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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
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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
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Methods
Sampling
• 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
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Methods: Independent Variables
Study Measures:
1. Student Demographic Survey
2. Tower of Hanoi (Welsh & Huizinga, 2001)
3. Health Science Reasoning Test (Insight
Assessment, 2011)
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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
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Results: Demographic Data
85% female
Median age: 23 years (Range 20-62 yrs)
Ethnicity:
• 42% Caucasian
• 25% Asian
• 16% Hispanic
• 11% African American
GPAs: 2.5-3.0 (46%) & 3.0-3.5 (43%)
49%: previous healthcare experience
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Results: TOH & HSRT
Tower of Hanoi:
• Average 7 moves over minimum/task
• Did better in earlier easier vs. later more complex tasks
•>70% required 1-15 moves in Tasks 11-15
Health Science Reasoning Test
• Average score: 25.31 (out of total 38)
• Induction highest scores (7.26)
• Inference lowest scores (2.90)
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Results: Lasater Clinical Judgment Rubric
• Total scores: 30.74 (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: 10.41 (SD 1.52)
•Out of possible 16 points
• Reflecting: 5.77 (SD 0.77)
• Out of possible 8 points
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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
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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
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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 http://www.insightassessment.com/CT-Resources/Research-Health-Sciences-and-Critical-Thinking.
Lasater, K. (2007). Clinical judgment development: Using simulation to create a rubric. Journal of Nursing Education, 46,496-503.
McAnarney, E. R. (2008). Adolescent brain development: Forging new links. Journal of Adolescent Health, 42, 321-323.
Pesut, D. J. & Herman, J. (1999). Clinical reasoning: The art and science of critical and creative thinking. Albany, NY: Delmar Publishers.
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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), 569-577.
Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28, 78-106.
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment. Journal of Nursing Education, 45, 204-211.
Welsh, M. C. & Huizinga, M. (2001). The development and preliminary validation of the Tower of Hanoi-Revised. Assessment, 8(2), 167-176.