Clinical Judgment and Transfer of Learning from Simulation

Friday, 26 July 2013: 8:30 AM

Elizabeth Johnson, PhD, RN
School of Nursing, Ball State University, Muncie, IN
Kathie Lasater, EdD, RN, ANEF
School of Nursing, Oregon Health & Science University, Portland, OR
Patricia K. Ravert, PhD, RN, ANEF, FAAN
College of Nursing, Brigham Young University, Provo, UT
Doris Rink, MSN, RN
Portland Community College, Portland, OR

Learning Objective 1: The learner will be able to describe the effect of role modeling on the clinical judgment development of student nurses.

Learning Objective 2: The learner will be able to describe early evidence for transfer of learning from the simulation laboratory to clinical settings.

Purpose: An international multi-site mixed methods study was conducted at five nursing programs to determine the effect of expert role modeling as described by Bandura on nursing students’ clinical judgment in the care of a geriatric surgical patient. Qualitative findings reported here expand upon significant between-group findings regarding the effect of an expert role model on students’ clinical judgment and explore the question of transfer of learning from simulation to bedside. 

Methods: Immediately after the simulation, students from treatment and control groups (N = 275) responded to guided reflection questions based on the 11 dimensions of the Lasater Clinical Judgment Rubric. After caring for an older adult surgical patient, a subset (N = 134) reflected on the same questions plus one question addressing transfer of learning.  Data were reviewed using thematic and content analysis. Consensus was reached through group discussion and verified by each researcher.

Results: Differences between groups were most noticeable immediately after the simulation. Themes from students exposed to modeling included (a) decreased anxiety and (b) having a frame of reference for care. The treatment group had a higher level of noticing and described more of a calm/confident manner. Both groups were empathetic, but indicators of ageism were present. Developmentally, students were unsure how to proceed or how to evaluate their care against standards. In 4-week data, minimal differences between treatment and control group reflections were found. Notable themes included: (a) increased awareness of priorities, (b) confidence, and (c) transfer of learning from simulation to clinical practice. Their actions were informed by strategies including simulation and role modeling.

Conclusion: Qualitative data suggest that simulation and role modeling contribute to clinical judgment development and provide early evidence for transfer of learning from laboratory to bedside. Findings provide direction for further exploration of intentional role modeling to facilitate student development.