Date of Award

11-2019

Rights

© 2019 David K. Wells

Document Type

Dissertation

Degree Name

Doctor of Education (EdD)

Department

Educational Leadership

First Advisor

William Boozang

Second Advisor

Jennifer Galipeau

Third Advisor

Sharon Metcalfe

Abstract

The purpose of this study was to determine if clinical judgment could be assessed in baccalaureate nursing students during a 15 to 20-minute embedded (live patient) simulation scenario using role play. Graduate nurses are expected to apply critical reasoning and be clinically competent when caring for patients when they enter the nursing profession. The use of simulation scenarios is an approved and effective supplement to the clinical experience of nursing students. This study was conducted due to the sparsity of evidence referencing clinical judgment in live patient simulation scenarios. This study used a convenience sample (n=22) of baccalaureate nursing students in their final semester of a nursing program. The study used a mixed-method (quantitative/qualitative) approach to assess clinical judgment. It was framed on Khalili’s clinical simulation practise framework. The clinical judgment section of Creighton’s Competency Evaluation Instrument (C-CEI®) measured observed clinical decision making based on nine dimensions or competencies. A self-assessment pretest/posttest utilized a five-point Likert scale and an open response to record participant’s perceptions of applied clinical judgment. Fisher’s exact test returned a p-value of .02 (α = .05) for the C-CEI dimensions and was considered statistically significant. Only two of the nine observed competencies met or exceeded a score of 77% (the passing grade for this program). The Likert scale mode of ‘4’ was self-reported on the pretest, while the posttest reported a mode of ‘3’ for clinical judgment. A Wilcoxon Signed-Ranks test showed a statistically-significant difference between the two exams (W Statistic = 8 and W Critical = 66). Open and axial coding identified two major themes (judgment, and scenario time) and three subcategories (emotions, task priorities, and missed opportunities). For this study, clinical judgment could not adequately be observed during short, live patient, simulation scenarios. Students did not report an increase in perceived clinical judgment following the scenario. Longer scenario times and the use of the entire C-CEI instrument (or other valid rubric) should be considered for future studies.

Comments

Ed.D. Dissertation

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