Sezer Esra, Çelik Hilal Yıldız, Karabacak Ükke, Lasater Kathie
Department of Nursing, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, İstanbul, Türkiye.
BMC Nurs. 2025 Jan 20;24(1):70. doi: 10.1186/s12912-024-02679-1.
Gaining clinical judgment competence among student nurses is a significant outcome of nursing education. In this education process, an assessment tool based on observable behaviors is needed for evaluating students' clinical judgment skills.
This study aimed to evaluate the validity and reliability of the Turkish version of the Lasater Clinical Judgment Rubric, which assesses student nurses' stages of clinical judgment competency in simulation-based education.
This study was conducted using a cross-sectional methodological design between April and August 2024. For the cultural adaptation and psychometric evaluation of the rubric, simulation videos of 3rd and 4th-year nursing students from a foundation university were used. The language validity of the rubric was performed according to the 10-step translation and cultural adaptation guide of the International Society for Pharmacoeconomics and Outcomes Research; expert opinions were obtained for content validity. The final version of the rubric comprises four stages of the Tanner Model of Clinical Judgment (noticing, interpreting, responding, and reflecting) and 11 dimensions. Four levels of achievement describe the development of each of the 11 dimensions. Sixty-four scenario records of the simulation-based education of 4th -year students in the nursing undergraduate program of a foundation university were examined, and the students were evaluated by two independent observers using the Turkish version of the rubric. The construct validity of the scale was examined using confirmatory factor analysis, and reliability was measured using Cronbach's alpha coefficient. Interobserver agreement was analyzed using the kappa and intraclass correlation coefficients. Moreover, the discrimination of the rubric was evaluated using an independent samples t-test between the lower and upper 27% groups.
Confirmatory factor analysis revealed that the scale formed a four-factor structure of noticing, interpreting, responding, and reflecting in accordance with the original rubric. Furthermore, confirmatory factor analysis showed that the four-factor structure model had an acceptable and generally good fit and was statistically significant and valid. The fit indices for the model were calculated as χ2/df = 1.70, root mean square error of approximation = 0.06, comparative fit index = 0.94, and root mean square residual = 0.03. Kappa values ranged between 0.72 and 0.92, indicating a significant fit for all the items. The intraclass correlation coefficient values ranged between 0.70 and 0.90 and were statistically significant for all the items. The Cronbach's alpha value of the rubric was 0.91 and ranged between 0.80 and 0.84 in its subdimensions.
Therefore, the Turkish version of the rubric is a valid and reliable tool for evaluating student nurses' clinical judgment competency in simulation-based training.
培养学生护士的临床判断能力是护理教育的一项重要成果。在这个教育过程中，需要一种基于可观察行为的评估工具来评估学生的临床判断技能。
本研究旨在评估土耳其语版的拉萨特临床判断量表的有效性和可靠性，该量表用于评估基于模拟教育的学生护士临床判断能力的阶段。
本研究采用横断面方法设计，于2024年4月至8月进行。为了对该量表进行文化适应和心理测量评估，使用了一所基础大学三、四年级护理专业学生的模拟视频。该量表的语言效度按照国际药物经济学和结果研究学会的10步翻译和文化适应指南进行；通过专家意见获得内容效度。该量表的最终版本包括临床判断的坦纳模型的四个阶段（注意、解释、反应和反思）和11个维度。四个成就水平描述了11个维度中每个维度的发展情况。对一所基础大学护理本科专业四年级学生基于模拟教育的64个情景记录进行了检查，并由两名独立观察员使用土耳其语版量表对学生进行评估。使用验证性因子分析检验量表的结构效度，使用克朗巴哈α系数测量信度。使用kappa系数和组内相关系数分析观察者间的一致性。此外，使用独立样本t检验对量表的下限和上限27%组之间的差异进行评估。
验证性因子分析表明，该量表按照原始量表形成了注意、解释、反应和反思的四因子结构。此外，验证性因子分析表明，四因子结构模型具有可接受且总体良好的拟合度，具有统计学意义且有效。该模型的拟合指数计算为χ2/df = 1.70，近似均方根误差 = 0.06，比较拟合指数 = 0.94，均方根残差 = 0.03。kappa值在0.72至0.92之间，表明所有项目的拟合度都很高。组内相关系数值在0.70至0.90之间，所有项目均具有统计学意义。该量表的克朗巴哈α值为0.91，其子维度在0.80至0.84之间。
因此，土耳其语版量表是评估基于模拟训练的学生护士临床判断能力的有效且可靠的工具。
