Vreugdenhil Jettie, Spek Bea
Amstel Academie VU medical center, Amsterdam, The Netherlands.
Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, University of Amsterdam, The Netherlands.
Nurse Educ Today. 2018 Mar;62:43-51. doi: 10.1016/j.nedt.2017.12.013. Epub 2017 Dec 23.
Clinical reasoning in patient care is a skill that cannot be observed directly. So far, no reliable, valid instrument exists for the assessment of nursing students' clinical reasoning skills in hospital practice. Lasater's clinical judgment rubric (LCJR), based on Tanner's model "Thinking like a nurse" has been tested, mainly in academic simulation settings.
The aim is to develop a Dutch version of the LCJR (D-LCJR) and to test its psychometric properties when used in a hospital traineeship context.
A mixed-model approach was used to develop and to validate the instrument.
Ten dedicated educational units in a university hospital.
A well-mixed group of 52 nursing students, nurse coaches and nurse educators.
A Delphi panel developed the D-LCJR. Students' clinical reasoning skills were assessed "live" by nurse coaches, nurse educators and students who rated themselves. The psychometric properties tested during the assessment process are reliability, reproducibility, content validity and construct validity by testing two hypothesis: 1) a positive correlation between assessed and self-reported sum scores (convergent validity) and 2) a linear relation between experience and sum score (clinical validity).
The obtained D-LCJR was found to be internally consistent, Cronbach's alpha 0.93. The rubric is also reproducible with intraclass correlations between 0.69 and 0.78. Experts judged it to be content valid. The two hypothesis were both tested significant, supporting evidence for construct validity.
The translated and modified LCJR, is a promising tool for the evaluation of nursing students' development in clinical reasoning in hospital traineeships, by students, nurse coaches and nurse educators. More evidence on construct validity is necessary, in particular for students at the end of their hospital traineeship. Based on our research, the D-LCJR applied in hospital traineeships is a usable and reliable tool.
患者护理中的临床推理是一项无法直接观察到的技能。到目前为止，尚无可靠、有效的工具来评估护理专业学生在医院实习中的临床推理能力。基于 Tanner 的“像护士一样思考”模型的 Lasater 临床判断量表（LCJR）主要在学术模拟环境中进行了测试。
旨在开发 LCJR 的荷兰语版本（D-LCJR），并在医院实习环境中使用时测试其心理测量特性。
采用混合模型方法来开发和验证该工具。
一所大学医院的十个专门教育单元。
52 名护理专业学生、护士教练和护士教育工作者组成的混合良好的群体。
一个德尔菲小组开发了 D-LCJR。护士教练、护士教育工作者和学生本人对学生的临床推理能力进行“现场”评估。在评估过程中测试的心理测量特性包括可靠性、可重复性、内容效度和结构效度，通过检验两个假设：1）评估总分与自我报告总分之间的正相关（收敛效度）和 2）经验与总分之间的线性关系（临床效度）。
获得的 D-LCJR 被发现具有内部一致性，Cronbach's alpha 为 0.93。该量表的类内相关性在 0.69 至 0.78 之间，也具有可重复性。专家们认为它具有内容效度。两个假设均经检验具有显著性，为结构效度提供了支持证据。
翻译和修改后的 LCJR 是一种有前景的工具，可供学生、护士教练和护士教育工作者评估护理专业学生在医院实习中临床推理能力的发展。需要更多关于结构效度的证据，特别是对于医院实习末期的学生。基于我们的研究，应用于医院实习的 D-LCJR 是一种可用且可靠的工具。
