Document Type

Report

Publication Date

2017

Date of Final Presentation

3-9-2017

Committee Chair

Dr. Teresa Serratt

Committee Member

Dr. Cara Gallegos

Coordinator/ Chair of DNP Program

Dr. Pam Strohfus

Abstract/ Executive Summary

Background

There is evidence the best practices of simulation, specifically, the use of debriefing, will assist the new graduate nurse’s transition into the profession by increasing their clinical judgment. This quality improvement (QI) project explored the pedagogy of High Fidelity Simulation and Debriefing as a solution for the lag in New Graduate Nurse (NGN) practice readiness. The specific aims of this project were: 1) to teach the NGN residency educators how to implement Standard: Debriefing of the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practices: SimulationSM by focusing on the role of the debriefer; 2) to teach NGN residency educators to use the Promoting Excellence and Reflective Learning in Simulation (PEARLS) (Eppich & Cheng, 2015) methodology of debriefing; and 3) to assess if the Lasater Clinical Judgment Rubric (LCJR) is applicable for measuring NGNs’ clinical judgment development.

Project Design

This QI project examined the use of simulation and reflective debriefing on two groups: the residency educators and the NGN. The project employed two, single-comparison group pre/post testing to evaluate: 1) the effect PEARLS on educators’ debriefing effectiveness; 2) the use of PEARLS on NGN clinical judgment; 3) the applicability of the LCJR for evaluating the NGN development of clinical judgment. Eight NGN residency educators were taught to use PEARLS as a method to implement the INACSL Standard: Debriefing. The DASH instrument was used to for pre/post teaching comparison of educators’ debriefing efficiency and the LCJR was used to compare NGN clinical judgment.

Results

Overall, when compared to baseline scores, the summative DASH scores were higher. Eighty-eight percent of the residency educators advanced in every DASH subscale with two exceptions: two different educators stayed the same on elements five and six, respectively. The LCJR was used to evaluate the NGN’s development of clinical judgment at beginning and end of their residency program. One hundred percent (n = 6) of the summative LCJR scores were higher than baseline. Of the eleven subscales, 33% of the NGN demonstrated progression on all eleven subscales. Fifty percent demonstrated progression on 10 of the 11 subscales. One hundred percent of the NGNs demonstrated progress on four subscales. A questionnaire using a Likert scale found all residency educators strongly agreed the LCJR was applicable for evaluating NGNs’ development of clinical judgment and should be adopted as the standard measurement of NGN readiness for independent practice. Additionally, all strongly agreed the PEARLS method of debriefing should be adopted as the standard measurement of the residency educator’s debriefing efficiency.

Conclusions & Recommendations

The residency educators’ effectiveness at reflective debriefing improved when they used the PEARLS method of debriefing. Based on this improvement, it is recommended that they adopt the PEARLS method as the standard method used in their NGN residency program. Additionally, because all educators strongly agreed in the LCJR’s applicability for measuring NGN clinical judgment, they should adopt and use it as a determinant for NGN readiness for practice.

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