Psychometric properties of the lasater clinical judgment rubric.

Simulation is integrated into nursing curricula as a means of developing and evaluating clinical judgment, but there are few valid and reliable tools available and evaluation is not consistently theory based. When the Lasater Clinical Judgment Rubric (LCJR) was introduced in 2007, it provided a common evaluative language for assessment of clinical judgment but had limited support of its validity and reliability. Based on Tanner's Model, the LCJR organized nursing actions into eleven dimensions and four behavioral categories and defined specific actions in each which are typical of developmental phases (Lasater, 2007). The LCJR has been adopted by many nursing programs with limited support of its validity and reliability. This article attempts to organize current knowledge available on the LCJR in an effort to assess its use as a valid and reliable measurement tool, and to identify specific needs for continued testing of the instrument.

Innovations in clinical simulation: Application of Benner's theory in an interactive patient care simulation.

This article introduces the University of Maryland Baltimore School of Nursing clinical simulation protocol structure and lessons learned while using this protocol in a mandatory learning experience for over 190 adult health students. Students use a SimMan manikin in a high-fidelity, interactive clinical simulation to provide care to "unstable patients." Benner's concepts regarding the performance characteristics and learning needs of nurses with varying levels of clinical competency were incorporated into the development of the simulation. The simulation provides a positive learning experience in which students refine their patient management skills and collaborate with multidisciplinary team members to resolve common postoperative problems.

Effects of an Experiential Learning Simulation Design on Clinical Nursing Judgment Development.

Simulation design should be theory based and its effect on outcomes evaluated. This study (1) applied a model of experiential learning to design a simulation experience, (2) examined how this design affected clinical nursing judgment development, and (3) described the relationship between clinical nursing judgment development and student performance when using the experiential learning design. Findings suggest that using an experiential learning simulation design results in more highly developed nursing judgment and competency in simulation performance.

Strengthening role clarity in acute care nurse case managers: application of the synergy model in staff development.

PURPOSE OF STUDY: The purpose of this quality improvement study was to evaluate the impact of a novel educational intervention on nurse case managers' (NCMs') perceived role ambiguity, role conflict, and use of nursing competencies. Specific aims were to apply the American Association of Critical-Care Nurses Synergy Model for Patient Care to determine the use of the model's nurse competencies in acute care case management, to pilot test the feasibility of using widely available basic computer technologies to facilitate NCMs' orientation in acute care settings, and to establish the foundation for future work in developing an evidence-based orientation program for new NCMs based on a nursing conceptual framework. PRIMARY PRACTICE SETTINGS: Two acute care community hospitals in northeastern Ohio, both part of a large national hospital corporation. METHODOLOGY AND SAMPLE: The sample consisted of NCMs who were actively employed in 1 of 2 acute care hospitals and voluntarily agreed to participate in this quality improvement study. Data on perceived role conflict and role ambiguity, perceived use of nurse competencies in bedside nursing and in case management, demographics, and evaluative feedback were collected using Google Docs. The intervention consisted of a series of four self-paced computer-based learning modules that provided participants with an introduction to acute care nursing case management based on the American Association of Critical-Care Nurses Synergy Model. RESULTS: Four of the 6 role ambiguity subscale item scores revealed reductions in role ambiguity after the educational intervention. A statistically significant decrease in one role conflict item was observed. Participants rated the use of all nurse competencies as higher in case management than in bedside nursing practice; the variance between the two further increased after the intervention. Statistically significant differences in the use of clinical judgment, advocacy/moral agency, and caring practices were identified. Participants reported that the educational content would be valuable for new NCMs transitioning from bedside clinical practice. The addition of case studies or clinical scenarios illustrating each nurse competency was suggested. Testing of the Synergy Model-based education modules with novice case managers actively transitioning from the bedside to a case management role will be the next step in the development of this program. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: : The use of widely available computer technologies to deliver introductory case management orientation content is feasible, although conversion to a web-based platform is recommended. Evidence-based strategies to prepare NCMs for expanded competency in clinical judgment, advocacy/moral agency, and caring practices are needed.