Evaluating Undergraduate Nursing Students

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Evaluating Undergraduate Nursing Students
Critical Thinking in Clinical Practice

• Kathleen Ohman, EdD, MS, RN, CCRN
• College of St. Benedict/St. Johns University
• St. Joseph, MN USA

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• The basis for utilizing any teaching and testing
  strategy lies in the associated critical thinking
  component.
• So What is this?

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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).

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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)

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Measuring Critical Thinking

• Standardized exams
• Case scenarios
• Problem-based learning
• Clinical exams

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How Can You Objectively Evaluate Students
Critical Thinking in Clinical Practice?

• You didnt 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?

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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

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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

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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

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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

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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)

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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.

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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

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Least Complex to Develop Example 2 Med
Administration

• Faculty developed situations of administering
  medications
• Student role play situation
• Teaching Assistant (TA) videotaping

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Most Complex to Develop

• Example 4 Video Vignettes

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Adding On-line Resources to the Exam

• Heart Sounds http//www.med.ucla.edu/wilkes/intro.
  html
• Scenes
• http//thatwasrandom.com/video/no_seatbelt.php
• Guy Doesn't Wear Seatbelt - Shocking footage of
  in-car accident

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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

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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

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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 students
  clinical performance
• Display of confidence and efficiency often
  misinterpreted as good clinical judgment and
  critical thinking by student

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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

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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

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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

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Students and faculty are HAPPY!!
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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.