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College of Nursing Dissertation Defense
|Category:||College Of Nursing|
|Date & Time:||
Tuesday , 11/20/2012
from 01:00 PM to 03:00 PM
|Location:||Charlton College of Business room 115|
Marilyn Asselin PhD
Effectiveness of a Problem-Based Learning Intervention on the Clinical Judgment Abilities and Ambiguity Tolerance of Baccalaureate Nursing Students During High-Fidelity Simulation
Michelle McMahon MS, RN, PhD(c), College of Nursing
Purpose: To assess both feasibility and effectiveness of a problem-based learning (PBL) intervention on clinical judgment (CJ) in baccalaureate nursing (BSN) students when evaluated during high-fidelity simulation (HFS). Additional aims were to examine if individual student tolerance for ambiguity (TA) was related to CJ ability during HFS and to determine if a group PBL intervention could moderate low TA in student nurses.
Background: The use of CJ in healthcare delivery is a nurse expectation and especially vital when the context surrounding a clinical situation is complex, or the nurse interprets the situation as ambiguous. Best educational practices for facilitating CJ in BSN students have yet to be determined. However, PBL and HFS are methods that show promise for enhancing student CJ. Tanner’s (2006) CJ model provided the theoretical framework for this study.
Method: A quasi-experimental pre-post design, employing both quantitative and qualitative methods, was used. Nineteen senior-level students completed either an independent preparation (Control n=10) or a 4-week on-line PBL intervention (PBL n=9) as a pre-HFS activity. Group CJ outcomes, based on the Lasater Clinical Judgment Rubric (LCJR), were compared using t-tests. In addition, TA, measured by the Multiple Stimulus Types Ambiguity Tolerance scale II (MSTAT-II) was examined by paired t-tests and two-way ANOVA. Feasibility of the PBL intervention was assessed by qualitative descriptive analysis.
Results: Quantitatively, no statistically significant differences were found between groups in regard to CJ or TA. In addition, results did not support PBL for improving low TA in student nurses. However, qualitative analysis of data yielded findings, which indicate benefits and challenges of both the PBL and HFS experience. PBL transcripts demonstrated that participant comments encompassed all aspects of the Tanner CJ model.
Conclusion & Implications: Clinical judgment and PBL were found to have congruency, supporting PBL’s potential to facilitate CJ in student nurses. Future research with a larger sample is needed to determine CJ outcomes when PBL is done in a greater dose, over longer duration, and/or in an alternate format. It is also acknowledged that cost-benefit analysis is needed before justifying curriculum integration of PBL.