Comparison of clinical judgment of first year baccalaureate nursing students with and without cognitive support from a clinical preceptor during immersive simulation

[摘要] English: Clinical judgment is a skill that all nurses need in order to deliver safe patient care. It is a complex process and nursing students should be taught how to apply clinical judgment in practice as soon as possible. The first year baccalaureate nursing students at a nursing school of a university in Central South Africa, are taught from the first semester of their training what clinical judgment entails. Tanner's Clinical Judgment Model is used to support this process and was also used as conceptual framework in this study. However, students need to be assessed on clinical judgment in order to determine whether training is effective. Lasater's Clinical Judgment Rubric, based on Tanner's Clinical Judgment Model, was used to assess the application of clinical judgment in simulation by first year nursing students.A quantitative, experimental pre-test/post-test control group design was used to describe first year nursing students' application of clinical judgment during an immersive simulation session and to compare it with those students that received cognitive support by a preceptor and those who did not.All first year nursing students participated in this study because it was part of their curriculum and would add to their knowledge in both theory and clinical practice. Students participated in a pre-test simulation scenario that was recorded on digital video cameras. Thereafter, students were allocated to the clinical setting for at least five weeks in order to gain clinical experience. During this period of the study, the participating students were randomly divided into two groups. The students from the experimental group received cognitive support and feedback on their performance in the simulation session via the preceptors trained specifically for this process. The post-test took place, again in simulation, and was digitally recorded. The control group also received cognitive support, and feedback from the preceptors, but only after the post-test took place. Sixty five first year nursing students gave consent for footage analysis for the purpose of this study.A biostatistician, who was consulted during the planning of the study, made use of Statistical Analyses Software (SAS) to analyse the collected data. Numerical and categorical variables were summarised by frequencies and percentiles and differences between groups were assessed on a 95% confidence interval for unpaired data. The researcher made use of figures and tables to describe and present the data. Students in the experimental group gained higher marks in the upper developmental levels in the post-test than those in the control group. This indicates that students did benefit from receiving cognitive support and feedback on individual performance during simulation.Recommendations focused on the refinement of Lasater's Clinical Judgment Rubric to be used in the School of Nursing for future studies on footage with other nursing student year groups. Cognitive support proved to be beneficial, although better results might be obtained if this kind of support could be extended over longer periods of time.

[发布机构] University of the Free State