| Description |
Reliable and valid measures for assessing clinical nursing judgment are needed for performance evaluation and research. The purpose of the study was to develop and formatively evaluate a computer assisted interactive video patient simulation useful for assessing clinical nursing judgment performance. The patient and the majority of feedback were presented with full motion video. Participants' interactions with the simulation were stored in a data file as a verbal protocol and analyzed using qualitative methods. Evaluation triangulated participants' knowledge, experience, and clinical nursing judgment performance. The research questions addressed differentiation of performance and use of the verbal protocol technique, as well as feasibility, fidelity, reliability, and criterion-relation validity of the simulation. Sixty nurses, students, and laypersons representing a broad range of knowledge and experience relative to the simulated patients problem participated in the evaluation. It was possible to differentiate performance on the simulation as evidenced by the range (21-107) and standard deviation (21.9) of the total simulation scores. Although the relationships between diagnosis and assessment were weaker than expected, correlation and multiple regressions demonstrated that participants with more knowledge and experience performed better on the simulations. Use of the verbal protocol technique in a "type aloud" fashion was satisfactory although participants' typing skill affected its success. The cost of developing the simulation was $3878 and the cost of equipment was $5620 for a total of $9498. Participants spent an average of two hours time engaged in the study. The simulation was rated as having mid-range fidelity by the participants. Evidence for moderate to high criterion-referenced reliability was found in correlations between the simulation scores and knowledge, experience, and an independent rater. The simulation was just to have moderate to high content validity. Construct validity evidence for the simulation was also found. Knowledge and experience were expected to influence clinical judgment performance. Multiple regressions indicated knowledge and experience explained 12% to 49% of the variance in the diagnosis, assessment, intervention, and outcome scores as well as 45% of the variance in the total clinical judgment score. Recommendation for revision of the simulation and further development of the method were made. |
