evaluating undergraduate nursing students’ critical thinking in clinical practice
DESCRIPTION
Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice. Kathleen Ohman, EdD, MS, RN, CCRN College of St. Benedict/St. John’s University St. Joseph, MN USA. The basis for utilizing any teaching and testing strategy lies in the associated critical thinking component. - PowerPoint PPT PresentationTRANSCRIPT
Evaluating Undergraduate Nursing Students’ Critical
Thinking in Clinical Practice
Kathleen Ohman, EdD, MS, RN, CCRN College of St. Benedict/St. John’s
UniversitySt. Joseph, MN USA
The basis for utilizing any teaching and testing strategy lies in the associated critical thinking component.
So… What is this?
Now….What does this have to do with critical thinking?
Analysis (examining ideas, identifying arguments, analyzing arguments)
Inference (querying evidence, alternatives, drawing conclusions)
Interpretation (categorizing, decoding, clarifying meaning)
Explanation (stating results, justifying presenting arguments)
Self-regulation (self-examination, self-correction).
Literature: Evaluating Critical Thinking in Clinical
Situations Commercial critical-thinking
instruments are not specific to nursing (Simpson & Courtney, 2002)
Difficulty measuring critical thinking in clinical because changing clinical situations (Oermann, 1998; Staib, 2003)
A variety of ways to measure critical thinking outside of clinical practice (Brunt, 2005; Simpson & Courtney, 2002 Watson et al, 2002)
Measuring Critical Thinking Standardized exams Case scenarios Problem-based learning Clinical exams
How Can You Objectively Evaluate Student’s Critical Thinking in Clinical
Practice?
“You didn’t see all the great things I did with my patient.”
“How can you evaluate me, you hardly saw me all morning?”
“My patient had so many meds and procedures, how can you expect me to be finished on time?”
Develop A Clinical Exam Away from the Clinical
Environment!!! Measures course outcomes Is objective Tests comparable situations for which
each student has prepared Is administered in a controlled
environment Removes “situational cognition”
Rationale for Clinical Exam Away from the Clinical Site
Clinical should be an opportunity for LEARNING
Anxiety is inherent in the clinical experience
Students need to see faculty as their “safety net” not their evaluators
Clinical experiences should be formative
Faculty should be able to role model for students
Rationale for Clinical Exam Grading student critical
thinking in clinical courses is difficult Using only paper work
artificially inflates grades Finding equivalent
patient care situations for all students is impossible
Grading actual patient care situations is subjective or based on circumstances
How are Clinical Exams Developed?
The clinical exam is based on the clinical outcomes of the course Example: Interpret objective and
subjective data to identify actual and potential health deviations.
The exam would need to provide the student with objective and subjective data of an actual or potential health problem and ask them to interpret that data
Decide on Methodology to be used for the Clinical
Exam Video tape vignettes of
clinical situations (Example 1: OB Exam)
Student demonstration and role playing (Example 2: med administration)
Simulations with patient mannequins where students respond to a scene (Example 3: lung sounds)
Video Vignettes: Example 4
Adult Health Nursing Vignette “Your first patient is Kim Bronson, a
55- year-old female admitted yesterday for femoral-popliteal bypass. She has a history of PAD and type 1 DM. She smokes 1 PPD.”
Development continued Wrote script for scenarios Made exam setup as much like clinical as
possible Exam timed Student prepares for clinical by reviewing data Students have relevant clinical forms
Kardex (Chart form w/orders noted) Medication Administration Record Teaching record Care plan
Resources available: NIC and NOC books
Least Complex to Develop Example 2: Med Administration
Faculty developed situations of administering medications
Student role play situation
Teaching Assistant (TA) videotaping
Most Complex to Develop Example 4: Video Vignettes
Adding On-line Resources to the Exam Heart Sounds
http://www.med.ucla.edu/wilkes/intro.html
Scenes http://thatwasrandom.com/video/no_seatbel
t.php Guy Doesn't Wear Seatbelt -
Shocking footage of in-car accident
Considerations Faculty time Who will be the actors? Where will it be filmed and who
does the filming? Lighting? Who will edit the scenes?
Time the scenes and the exam How will you correlate the written
exam with the vignettes? Exam on colored paper and sequenced
Grading of the Exam Exam is keyed by each individual
faculty and combined prior to grading the exams
Exams are graded with ID numbers only; no student names
Exam is graded by a group of faculty One faculty member scores the same
items on all exams Questionable responses are discussed
by faculty group and added to the key Exam items often reviewed a second or
third time if additions made to the key
Reliability of Exam Student clinical exam scores are consistent
with other exam scores for students Student exam scores more objective than
faculty professional judgment concerning student’s clinical performance
Display of confidence and efficiency often misinterpreted as good clinical judgment and critical thinking by student
Faculty Evaluation of the Methodology Reviewed aggregated student scores Discussed advantages &
disadvantages of exam Evaluated student responses for
critical thinking and meeting course outcomes
Recommended areas for changes in items or methodology
Faculty Findings Found areas where students as a group
were not meeting course outcomes Phone confidentiality Prioritizing
Environment more controlled and consistent across students
Examination is a summative evaluation in a relatively nonthreatening situation and provides objective data
Student Findings Majority felt it accurately measured
their critical thinking during clinical Majority recommended continuing
with the exam Some felt the clinical situations
should be ones that all students have experienced
Students and faculty are HAPPY!!
Key References Brunt, Barbara A. MA, RN, BC Critical Thinking in Nursing: An
Integrated Review. Journal of Continuing Education in Nursing. 36(2):60-67, March/April 2005.
Feingold, Carol E. MS, RN; Calaluce, Margaret BSN, RN; Kallen, Michael A. PhD, MPH Computerized Patient Model and Simulated Clinical Experiences: Evaluation With Baccalaureate Nursing Students. Journal of Nursing Education. 43(4):156-163, April 2004.
Giddens, Jean PhD, RN; Gloeckner, Gene W. PhD The Relationship of Critical Thinking to Performance on the NCLEX-RN(R). Journal of Nursing Education. 44(2):85-89, February 2005.
Twibell, Renee DNS, RN; Ryan, Marilyn EdD, RN; Hermiz, Mary EdD, RN Faculty Perceptions of Critical Thinking in Student Clinical Experiences. Journal of Nursing Education. 44(2):71-79, February 2005.
Walthew, Patricia J. MEd, RGON Conceptions of Critical Thinking Held by Nurse Educators. Journal of Nursing Education. 43(9):408-411, September 2004.