evaluating undergraduate nursing students’ critical thinking in clinical practice

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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

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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 Presentation

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Page 1: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 3: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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).

Page 4: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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)

Page 5: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

Measuring Critical Thinking Standardized exams Case scenarios Problem-based learning Clinical exams

Page 6: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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?”

Page 7: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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”

Page 8: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 9: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 10: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 11: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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)

Page 12: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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.”

Page 13: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 14: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

Least Complex to Develop Example 2: Med Administration

Faculty developed situations of administering medications

Student role play situation

Teaching Assistant (TA) videotaping

Page 15: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

Most Complex to Develop Example 4: Video Vignettes

Page 16: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice
Page 17: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 18: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 19: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 20: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 21: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 22: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 23: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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

Page 24: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

Students and faculty are HAPPY!!

Page 25: Evaluating Undergraduate Nursing Students’ Critical Thinking in Clinical Practice

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.