ENHANCING CLINICAL REASONING: TEACHING skills using the Debriefing for Meaningful Learning ......
Transcript of ENHANCING CLINICAL REASONING: TEACHING skills using the Debriefing for Meaningful Learning ......
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Item type Presentation
Format Text-based Document
Title Enhancing Clinical Reasoning: Teaching ThinkingThrough Debriefing
Authors Forneris, Susan G.; Neal, Diana Odland; Meyer, Heidi;Tiffany, Jone; Myers, Lynnea; Pivec, Cynthia R.; Kuehn,Mary Beth; Blazovich, Linda
Downloaded 16-May-2018 05:44:55
Link to item http://hdl.handle.net/10755/304530
ENHANCING CLINICAL
REASONING: TEACHING
THINKING THROUGH
DEBRIEFING
Susan Forneris, PhD, RN, CNE, CHSE
Diana Odland Neal, PhD, RN
Mary Beth Kuehn, EdD, RN, PHN
Jone Tiffany, DNP, MA, RNC
Cynthia R. Pivec, MA, RN, CNE
Lynnea Myers, MSN, RN, PHN, CPNP
Linda Blazovich, DNP, RN, CNE
Heidi Meyer, MSN, RN
A BIG THANK YOU FOR SUPPORT TO:
*STTI CHI-AT-LARGE CHAPTER
RESEARCH GRANT
*INACSL
DEBRA SPUNT MINI-RESEARCH AWARD.
IT IS MUCH APPRECIATED!
LEARNING OUTCOMES
…describe the use of the DML tool as a methodology
for debriefing
…discuss the outcomes of the DML methodology and
the implications for nursing education.
Susan Gross Forneris, PhD, RN, CNE
Linda Blazovich, DNP, RN, CNE
Cynthia Pivec, MA, RN CNE
Heidi Meyer, MSN, RN
Lynnea Myers, MSN, RN, PHN, CPNP
Diana Odland Neal, PhD, RN
Mary Beth Kuehn, Ed.D, RN, PHN
Jone Tiffany, DNP, MA, RNC
The search for evidence…
Clinical Reasoning
…Explore strategies that integrate
content knowledge with
knowledge of the context creating
dialogue that invites questions in a
reflective and critical manner.
WHY DO A PILOT?
To confirm a multi-site approach with consistency re:
instructions & procedures
To obtain a rough estimate of effect size & variability
in the measures
To examine the reliability & validity of results in
comparison to Dreifuerst’s
To determine challenges in preparation for a full scale
study
MCNER MULTI-SITE PILOT STUDY
Pilot Study:
Quasi-experimental, pre-test-post-test, repeated measure research design
Purpose:
To determine if undergraduate nursing students demonstrate a positive change in clinical reasoning skills using the Debriefing for Meaningful Learning (DML) model
DEBRIEFING FOR MEANINGFUL
LEARNING ©
Active Learning Approach
Form of clinical teaching
Constructivist learning
Promotes active learning
Incorporates Guided
Reflection
Schon’s work –
Reflection in-on-action
Driefuerst added ‘beyond-
action’
Dreifuerst, K.T. (2010). Debriefing for meaningful learning: Foster development of clinical reasoning through simulation.
Retrieved from Proquest Dissertations and Theses.
General Information
Type of Instrument Self-administered, multiple choice
Date of Publication 2006, 2008, & 2011
Available Languages Arabic, Chinese Simplified or
Traditional Characters, Dutch,
English, Farsi, Korean, Spanish
Reliability .77-.83
Administration Information
Time to Administer 45-50 minutes
Administration Types Online or Paper-and-Pencil
Results
• Total score of critical thinking
scales; and
• 5 scale scores
• Analysis and Interpretation
• Inference
• Evaluation and Explanation
• Deductive Reasoning
• Inductive Reasoning
HEALTH SCIENCES REASONING TEST (HSRT)
Does the use of the DML
debriefing strategy
positively impact the
development of clinical
reasoning skills in
undergraduate nursing
students?
RESEARCH QUESTION/
change in clinical reasoning as measured by improved scores
on the HSRT exemplifies meaningful learning from the
simulation experience.
METHODOLOGY
Paired Samples T-Test
Paired Differences t df Sig. (2-tailed)
Mean Std. Deviation
Std. Error Mean
95% Confidence Interval of the Difference
Lower Upper
Pair 1
OverallPost - OverallPre .66667 3.02100 .55156 -.46139 1.79473 1.209 29 .237
Paired Samples Statistics
Mean N Std. Deviation
Std. Error Mean
Pair 1 OverallPost 21.4333 30 3.83885 .70088
OverallPre 20.7667 30 3.63587 .66382
Paired T-Tests
Wilcoxon Signed Ranks Test
MCNER
Test Statistics
Driefuerst
Test Statistics
OverallPost – OverallPre
OverallPost – OverallPre
Z -1.162 Z -6.059
Asymp. Sig. (2-tailed) .245 Asymp. Sig. (2-
tailed) .000
Dreifuerst concluded:
There was no statistical difference between the experimental and control HSRT data,
except when change in total score was compared.
Dreifuerst’s raw scores illustrated a positive change in clinical reasoning skills with use of the DML debriefing model.
Statistically significant
N=238
Use of a control group
MCNER Pilot also illustrated a positive change in the raw scores in clinical reasoning, however,
Not statistically significant
Pilot sample size only 30
No control group
WHAT DO THE RESULTS REALLY TELL US:
WHAT WE LEARNED
*A full-scale study is realistic &
achievable
*Timeliness and Timing vital
*Consistency across sites is key
*Data analysis techniques vital
*Move to a full-scale study
*Include a larger sample size
*Use multiple measures
*Add a control group
*Further strengthen consistency
of debriefing
FORGING AHEAD
Implications are clear…
Engage an active learner-centered approach to
teach thinking within the context of patient care
FACULTY RESOURCES
Hartford Institute for
Geriatric Nursing
NLN ACES
NLN SIRC (Simulation
Innovation Resource
Center)
http://consultgerirn.org/resources
http://www.nln.org/facultyprograms/facultyreso
urces/ACES/index.htm
http://sirc.nln.org/
Faculty Development
Barton, A. J., Armstrong, G., Preheim, G., Gelmon, S. B., & Andrus, L. C. (2009). A national Delphi to
determine developmental progression of quality and safety competencies in nursing education.
Nursing Outlook, 57, 313-322. doi: 10.1016/j.outlok.2009.08.003
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P…Warren, J. (2007).
Quality and safety education for nurses. Nursing Outlook, 55, 122-131.
doi:10.1016/j.outlook.2007.02.006
Facione, N. C., & Facione, P. A. (2006). The Health Sciences Reasoning Test. Millbrae, CA: The California
Academic Press.
Forneris, S. G., Crownover, J. G., Dorsey, L. E., Leahy, N., Maas, M. A., Wong, L., Zabriskie, A., and
Zavertnik, J. E. (2012). Integrating QSEN and ACES: An NLN simulation leader project. Nursing
Education Perspectives, 33(3), 184-187.
Forneris S.G. & Peden-Mcalpine C. (2007). Evaluation of a reflective learning intervention to improve
critical thinking in novice nurses. Journal of Advanced Nursing 57(4), 410–421.
Forneris S.G. & Peden-Mcalpine C. (2009). Creating context for critical thinking in practice: the role of the
preceptor. Journal of Advanced Nursing 65(8), 1715–1724.
Insight Assessment. Health Science Reasoning Test (HSRT). Retrieved February 19, 2012, from
http://www.insightassessment.com/Products/Critical-Thinking-Skills-Tests/Health-Science-
Reasoning-Test-HSRT
Jeffries, P. R. (2007). Simulation in nursing education. From conceptualization to evaluation. New York,
NY: National League for Nursing.
National League for Nurses (2013). Simulation Innovation Resource Center. Retrieved from
http://sirc.nln.org/
Reese, C. R. (2010). ACES Case #1: Millie Larsen. Developed by the National League for Nursing,
Simulation Team Advancing Gerontological Education Strategies (STAGES). Retrieved from
http://www.nln.org/facultydevelopment/facultyresources/aces/millie.htm
QUESTIONS?????
THANK YOU FOR YOUR KIND ATTENTION!!!