Confiabilidade e validade da Lasater Clinical Judgment Rubric – Brazilian Version

Resumo Objetivo Avaliar a confiabilidade e validade da Lasater Clinical Judgment Rubric – Brazilian Version em uma amostra de estudantes de enfermagem. Métodos Pesquisa com delineamento metodológico, realizado em uma instituição pública de ensino superior da região sudeste do Brasil. Preliminarmente, foi analisada a clareza dos comportamentos descritos em cada nível das 11 dimensões do instrumento, por oito estudantes. A seguir, deu-se a coleta de dados relativos a avaliação das propriedades psicométricas com auto aplicação a 179 estudantes. Os participantes foram agrupados em iniciantes (1ª e 2ª séries n=115) e concluintes (3ª e 4ª séries n=64). Foram analisadas as propriedades psicométricas: validade discriminante, a fidedignidade e a dimensionalidade. Resultados A versão brasileira da rubrica diferenciou os dois grupos de estudantes (p-valor <0,05) nas 11 dimensões avaliadas. A estabilidade foi verificada pelo teste-reteste (ICC de 0,88). A consistência interna foi obtida para o instrumento global (alpha de Cronbach, de 0,889) e para as fases de reconhecimento (α=0,75), interpretação (α=0,64), resposta (α=0,78) e reflexão (α=0,63). Validade da dimensionalidade pela análise fatorial confirmatória (AFC) obteve resultados de confiabilidade composta (CC) acima de 0,7 e a variância média extraída (AVE) superiores a 0,5, em todas as fases. A validade discriminante do modelo fatorial pelo critério de Fornell-Larcker e pelas cargas cruzadas confirmaram a estrutura teórica da versão original da rubrica. Conclusão A avaliação das propriedades psicométricas da versão brasileira da rubrica mostrou evidências de confiabilidade e validade de construto do instrumento para medir o desenvolvimento do julgamento clínico do estudante de enfermagem.

Self-Evaluation in a Clinical Setting to Develop Nursing Students’ Clinical Judgment

Background: The Lasater clinical judgment rubric is based upon Tanner’s clinical judgment model for developing clinical judgment and the incorporation of the Benner Novice to Expert theory. The Lasater clinical judgment rubric has been used in nursing programs at the baccalaureate level and with simulation exercises.Method: In this study, the Lasater clinical judgment rubric was used to compare instructor and associate degree nursing students’ evaluations in an acute care setting during their first nursing care rotation. Data analysis included a split-plot ANOVA with repeat measures. A sample size of 16 students yielded an effect size of .40 with a = .001.Results: There was no significant difference in mean scores between the five administrations of the assessment with different groups.Conclusion: The interactions between the evaluator and the scores over time were consistent between groups. Development of student’s ability to use self-evaluation, introspection, and self-awareness skills are foundational for thinking that is more complex.

Simulation-based Clinical Judgment and Performance Ability for Tracheal Suction in Nursing Students

Purpose: This study was conducted to explore the relationship between simulation-based clinical judgment and performance ability for tracheal suction in nursing students. Methods: With a convenience sampling, 207 nursing students participated in this descriptive study. Lasater clinical judgment rubric was used for self-reported clinical judgment in addition to observe the skill of tracheal suction using a checklist. Data were analyzed by descriptive statistics, t-test and Pearson's correlation coefficients using the SPSS/WIN 22. Results: A scenario with pneumonia patient was developed to observe the skill of tracheal suction during simulation-based practices. Then self-reported clinical judgment was scored. The mean score of total sum of clinical judgment, total mean of clinical judgment, and performance skill were $36.44{pm}4.82$, $13.44{pm}1.71$, and $42.32{pm}5.05$, respectively. Statistically, students having good skills in suction showed significant differences in clinical judgment of interpreting (p=.031) compared to students having fair skills. Conclusion: The results of this study show that a structured debriefing method utilizing Lasater clinical judgment rubric is helpful. Also, simulation-based practice related to adult nursing in the respiratory system was useful for increasing the core basic skills among nursing students.