Date

December 2007

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

The purpose of this study was to examine the construct validity of the Lasater Clinical Judgment Rubric (LCJR) as a method of evaluating clinical judgment. The primary aims of the study were to examine the empirical evidence for two testable theoretical relationships present in the Tanner research-based clinical judgment model. A secondary aspect of the study was the exploration of clinical judgment assessments made by faculty in comparison to those made by students. A baccalaureate nursing program requiring two years of upper division course work provided the convenience sample. Known-groups methodology was used to compare the clinical judgment performances of graduating seniors (N = 24) to those of end-of-year juniors (N = 22). The setting was a high-fidelity simulation lab with each student participating in three scenarios of increasing complexity. The active component of each simulation and the debriefing was recorded. Nursing faculty raters were blind to the educational status of the student. The first hypothesis, that graduating seniors would demonstrate a higher level of clinical judgment than end-of-year juniors was supported. With performance averaged across all three of the simulation scenarios, the z-score probability interpretation of the effect size difference between these two groups found that 81% of the juniors demonstrated a level of clinical judgment that was less than the average of the senior group. While this study provides strong support for the construct validity of the LCJR, further research needs to be directed toward methods of improving inter-rater agreement, which was modest in this study. The second hypothesis was that as simulation complexity increased, student performance in clinical judgment, as measured on the LCJR, would decrease. This hypothesis was examined through repeated measures ANOVA, and was not supported. The possible explanations for the lack of interaction between complexity and clinical judgment include possible error in the measurement or implementation of complexity, a practice effect as the students went directly from one simulation to the next, or insufficient power in the study design. Future research in this area needs to address our understanding of situational complexity. The third hypothesis examined the relationship between student self-evaluation of clinical judgment and faculty rating. A Pearson r correlation demonstrated significance only in the dimension of noticing. While paired t-test analysis found significant differences between faculty and both groups of students, less difference was present between faculty and senior students. An analysis of variance determined student grouping did not significantly impact the accuracy of self-assessment. Future research should be directed toward improving student awareness of the expected the standard of performance. Conclusion: Preliminary evidence supports the construct validity of the Lasater Clinical Judgment Rubric.

Identifier

doi:10.6083/M4V40S5Q

School

School of Nursing

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