Academic journal article Nursing Education Perspectives

Simulation Evaluation Using a Modified Lasater Clinical Judgment Rubric

Academic journal article Nursing Education Perspectives

Simulation Evaluation Using a Modified Lasater Clinical Judgment Rubric

Article excerpt

R E S E A R C H

ABSTRACT

Aim. the purpose of this study was to describe the process of evaluating senior nursing students in the simulation laboratory using a modified lasater clinical judgment rubric (LCJR).

Background. the LCJR is a clinical evaluation tool used to measure outcomes in simulated learning settings. the LCJR was revised to provide numeric grading and clarity regarding expectations of clinical competency.

Method. the study was conducted over two years with students enrolled in their final bachelor of science in nursing semester (Phase 1, n = 86; Phase 2, n = 102) using high-fidelity simulation.

Results. the modified rubric measured student performance more holistically than a procedural checklist and provided objective criteria for evaluation.

Conclusion. a well-constructed rubric provides a mechanism to evaluate student performance in simulation by focusing on clinical reasoning essential for patient safety and allowing numeric evaluation of performance.

Key Words simulation - evaluation - rubric - lcjr - clinical reasoning

EDUCATORS STRUGGLE WITH THE ELLUSIVE CONCEPT OF HOW TO TEACH AND EVALUATE CLINICAL JUDGMENT. Benner's seminal novice-to-expert model (Benner, 1984; Benner, Tanner, & Chesla, 1996), along with Tanner's continuing work on clinical judgment, provides a model of "thinking in action" that focuses on four phases: noticing, interpreting, responding, and reflecting. This model served as the basis for development of the Lasater Clinical Judgment Rubric (LCJR), which has been used to evaluate single patient encounters requiring clinical judgment using simulation (Lasater, 2007a). Because simulation is a teaching method frequently used in schools of nursing, effective feedback is essential for student performance improvement.

Recent advances in high-fidelity simulation make prospective evaluation with more stringent criteria feasible using tools like the LCJR. Simulation has long been used to teach and evaluate psychomotor skills but is now being recognized for its utility in exploring critical and reflective thinking in a "safe" environment. The purpose of this study was to describe the process of evaluating senior nursing students in the simulation laboratory using a modified LCJR. Two research questions were asked: 1) What is the student clinical judgment profile for LCJR dimensions during formative and summative evaluations? 2) Is there a difference in student clinical judgment dimension scores between formative and summative evaluations?

Review of the Literature Advanced patient simulators assist faculty to teach critical and reflective thinking while allowing learners to assess, prioritize, and provide care, evaluate clinical outcomes, and practice communication in a controlled setting. Simulation fosters the development of student self-confidence because application of theoretical knowledge occurs without risk and allows immediate feedback for performance improvement (Beyea & Kobokovich, 2004; Comer, 2005; Rauen, 2004). Radhakrishnan, Roche, and Cunningham (2007) linked transfer of nursing knowledge from simulation to clinical. Simulation, using high-fidelity simulators and well-planned scenarios with reflection, can be used to evaluate clinical judgment, reflective thinking, and development of psychomotor skills (Decker, 2007; Dillard et al., 2009; Lasater, 2007b).

The desired outcome for teaching and evaluating critical and reflective thinking in students is a graduate nurse who provides safe and effective care. The Nursing Executive Center reports that "nearly 90% of academic leaders believe their nursing students are fully prepared to provide safe and effective care, compared with only 10% of hospital and health system nurse executives" (Berkow, Virkstis, Stewart, & Conway, 2009, p. 17). Because of this chasm, educators need to evaluate students' ability to deliver safe and effective care. Simulation provides a method of evaluation, but a well-constructed rubric is needed to assess competency. …

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