Paper
Sunday, November 4, 2007
101
Using High-Fidelity Simulation to Enhance Reflection on Clinical Judgment
Stephanie Sideras, RN, MSN1, Marsha King-Rosine, RN, MSN, PMCNE1, and Kathie Lasater, EdD, MS, RN2. (1) School of Nursing, Oregon Health Science University, Ashland, OR, USA, (2) School of Nursing, Oregon Health & Science University, Portland, OR, USA
Learning Objective #1: discuss three methods of promoting student clinical judgment performance assessment, including assessment of: active simulation, recorded role model nurse exemplars, and individual performance |
Learning Objective #2: appreciate how clarity of expectations, as demonstrated through role modeling, impacts student reflective activity |
Abstract: Reflective capacity is strongly linked to the development of clinical expertise. Reflection typically requires a triggering event. In the setting of high-fidelity simulation (HFS), triggering events can be planned and structured to the level of ability of the participants. The goal of this project was to promote student metacognition concerning clinical judgment; thus enhancing their ability to accurately self-assess their level of mastery in thinking like a nurse. For students to develop this level of metacognition, a clear conceptual understanding of the clinical judgment process is necessary. The Research-Based Model of Clinical Judgment functioned as the conceptual framework. The Lasater Clinical Judgment Rubric was used to define the level of clinical judgment. Students were introduced to clinical judgment assessment through a structured debriefing guide used with HFS practice cases. To enhance student ability to assess clinical judgment performance, exemplar practice cases were presented via DVD for small group discussion. This discussion prompted reflection on the accomplished level of clinical judgment demonstrated by competent nurses and established a set of goal behaviors for the students. To establish a baseline level of clinical judgment performance, students were asked to self-assess their global performance. Subsequently, each student was provided with a DVD of their performance in HFS and asked to self-assess clinical judgment based on this specific performance. The following quarter another HFS case exemplar was presented for evaluation and group discussion. Each student was then scheduled for two HFS clinical practice cases for solo demonstration and asked to self-evaluate clinical judgment performance. Outcomes measures included tracking changes in student self-assessment of clinical judgment and a questionnaire addressing their confidence in understanding clinical judgment, satisfaction with using the rubric as a self-assessment guide as well as the utility of HFS case exemplars to clarify expectations and trigger self-reflection.