Browsing by Author "Dreifuerst, Kristina Thomas"

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    Debriefing For Meaningful Learning: Fostering Development of Clinical Reasoning Through Simulation
    (2011-02-25) Dreifuerst, Kristina Thomas; Jeffries, Pamela R.; Horton-Deutsch, Sara L.; McNelis, Angela M.; Pesut, Daniel J.
    There is a critical need for faculty, a shortage of clinical sites, and an emphasis on quality and safety initiatives that drive increasing use of simulation in nursing education. Debriefing is an essential component of simulation, yet faculty are not consistently prepared to facilitate it such that meaningful learning, demonstrated through clinical reasoning, occurs from the experience. The purpose of this exploratory, quasi-experimental, pre-test-post-test study was to discover the effect of the use of a simulation teaching strategy, Debriefing for Meaningful Learning (DML), on the development of clinical reasoning in nursing students. Clinical reasoning was measured in 238 participant students from a Midwestern university school of nursing taking an adult health course that uses simulation. Participants were assigned to either the experimental or control group where the DML was compared to customary debriefing using the Health Sciences Reasoning Test (HSRT) before and after the debriefing experience, and the Debriefing Assessment for Simulation in Healthcare©–Student Version (DASH©–SV) with four supplemental questions about the DML (DMLSQ) process, during the post-debriefing assessment. This research sought to understand if the DML debriefing strategy positively influenced the development of clinical reasoning skills in undergraduate nursing students, as compared to usual and customary debriefing. The data revealed that there was a statistical difference between total mean test scores measured by the HSRT. There was, additionally, statistical significance in the change in scores between pre-test and post-test for those who used the DML as compared to the control. There was also a difference in the student’s perception of the quality of the debriefing measured by the DASH©–SV with the DML rated statistically higher than usual debriefing. Finally, there was a significant correlation, demonstrated through regression analysis, between the change in HSRT scores and students’ perception of quality debriefing and the use of the DML. This study contributes to the growing body of knowledge about simulation pedagogy, provides tools for use in debriefing, and informs faculty on best practices in debriefing.
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    An evaluation of the impact of an intercultural service learning experience on the development of transcultural self-efficacy of nursing students
    (2014-11-06) Schmidt, Lynn Marie; McNelis, Angela; Dreifuerst, Kristina Thomas; Horton-Deutsch, Sara; Lay, Kathy
    The increase in diverse populations with unique, culturally specific needs, along with the lack of diverse healthcare providers to deliver culturally competent care, has escalated the need for non-diverse practitioners to gain the knowledge, skills, and attitudes to deliver culturally competent care. Culturally competent care cannot be offered to patients unless nurses understand how cultural values, attitudes, and beliefs impact patients' response to care. Nurses must develop cultural competence to accurately access, develop, and implement effective nursing interventions. The purpose of this exploratory, quasi-experimental, pretest-posttest study was to explore the impact of an intercultural service learning experience (domestic or international) on pre-licensure nursing students' perceived development of transcultural self-efficacy. A convenience sample of senior semester nursing students enrolled in a private, faith-based, baccalaureate degree nursing program in the Midwest United States completed the Transcultural Self-Efficacy Tool (TSET), Cultural Competence Clinical Evaluation Tool-Student Version (CCCET-SV), and reflective journals. All students were immersed in an intercultural service learning experience. Eighteen students traveled domestically and 38 traveled internationally. The data revealed that there was not a statistical difference in TSET scores based on location of the intercultural experience. However, there was a statistically significant difference from pretest to posttest for perceived Cognitive, Practical, and Affective dimensions of transcultural self-efficacy, in change scores (pretest to posttest), and pretest to posttest for pre-licensure BSN students’ perceived clinical competence behaviors (culturally sensitive and professionally appropriate attitudes, values, and beliefs) following an intercultural service learning experience.
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    Examining the relationship between clinical judgment and nursing action in baccalaureate nursing students
    (2016-07-29) Fedko, Andrea Lauren; Dreifuerst, Kristina Thomas; Ironside, Pamela M.; Reising, Deanna; Wonder, Amy Hagedorn
    Clinical judgment provides the basis for nurses’ actions and is essential for the provision of safe nursing care. Tanner’s Clinical Judgment Model and its associated instrument, the Lasater Clinical Judgment Rubric (LCJR) have been used in the discipline of nursing, yet it is unclear if scores on the rubric actually translate to the completion of an indicated nursing action. This is important because clinical judgment involves identifying and responding to patient situations through nursing action, and then evaluation of such actions. The purpose of this observational study was to explore the relationship between clinical judgment, as measured by the LCJR, and the completion of an indicated nursing action, as measured by a nursing action form. The clinical judgment and completion of an indicated nursing action was measured in 92 participant students at a Midwestern university school of nursing who were enrolled in an adult medical/surgical nursing course that included simulation and debriefing during which scoring occurred. This study explored whether clinical judgment, as measured by the LCJR, was related to the completion of an indicated nursing action. In addition, this study evaluated whether Responding, as measured by the LCJR was related to the completion of an indicated nursing action. The data revealed that a very weak relationship was present between clinical judgment, as measured by the LCJR, and the completion of an indicated nursing action; however, these findings were not statistically significant. The data also revealed that a very weak relationship was present between the dimension Responding, and the completion of an indicated nursing action; however, these findings were also not statistically significant. This study expands upon previous clinical judgment research in nursing and identifies a need for additional methods of evaluating clinical judgment in baccalaureate nursing students including action appraisal so that deficiencies are established and targeted for improvement.
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    Experiences of African American students in pre-licensure schools of nursing: a qualitative descriptive study
    (2015-12-17) White, Barbara Jean; Ironside, Pamela M.; Dreifuerst, Kristina Thomas; Crowder, Sharron J.; Mutegi, Jomo W.
    Despite more than 40 years of research and governmental support, African Americans continue to be underrepresented in the nursing profession compared to the population it serves. Though some progress has been made over the past 20 years, the American Nurses Association (ANA), American Association of Colleges of Nursing (AACN), National Black Nurses Association (NBNA) and Institute of Medicine (IOM) continue to identify increasing diversity as a disciplinary priority. Further understanding of the experiences of African American nursing students is needed to inform decisions about recruitment, retention and successful matriculation of these students. This qualitative descriptive study focused on understanding the experiences, and the meaning those experiences had, for African American students who attended predominately European American schools of nursing. Data were collected through semi-structured interviews with fourteen African American nurses who shared their experiences in pre-licensure nursing programs. Thematic analysis revealed two salient themes: "Standing out" and "It's not just about me." The findings from this study shed new light on this persistent issue and inform faculty members and nursing school administrators about the strategies and ways of framing the educational experience that may create environments that are welcoming to African American students to address the retention of African American students in pre-licensure nursing programs.
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    Exploring faculty preparation for and use of debriefing with the debriefing for meaningful learning inventory
    (2016-07-19) Bradley, Cynthia Diane; Dreifuerst, Kristina Thomas; Ironside, Pamela M.; Wonder, Amy Hagedorn; Friesth, Barbara Manz; Jeffries, Pamela R.
    Debriefing is the most significant component of simulation, yet the impact of debriefer training for this critical time of learning has not been reported. Although training of debriefers in the use of a structured debriefing method has been recommended by nursing organizations and regulating bodies, a description of the impact of training on the understanding and application of debriefing within nursing programs is largely unknown. Debriefing for Meaningful Learning© (DML) is a structured, evidencebased debriefing method that promotes the development of clinical reasoning among prelicensure nursing students. DML has been adopted for use across the curriculum throughout nursing education. However, little is known regarding how debriefers are trained in this method and how that training impacts their understanding and application of the method. The DML Inventory (DMLI), was developed and tested for this research study, and used to assess and document 234 debriefers’ understanding of the central concepts of DML and subsequent application of DML behaviors during simulation debriefing with prelicensure baccalaureate nursing students. Statistically significant differences were found between those debriefers who had and had not been trained in DML. Statistically significant differences were also found in the understanding of the DML central concepts, and in the application of DML based on the types of training the debriefers received. viii The data indicate that DML trained debriefers consistently apply more DML behaviors than those who had not received training, and that multiple sources of training resulted in a more consistent application of DML debriefing behaviors. Furthermore, understanding the central concepts of DML resulted in debriefers consistently applying more debriefing behaviors consistent with the DML design. This study contributes to the growing body of knowledge of debriefing in nursing education and training in evidence-based debriefing methods, by providing a tested instrument that can be used to assess debriefers using DML. The findings also demonstrate the impact of the type of training on how structured debriefing methods are then implemented in teaching-learning environments, which can be used to improve future training.