Doctor of Nursing Practice , Case Western Reserve University, 2016, School of Nursing

Due to the high acuity of patients today, it is imperative that nurses quickly and appropriately respond to patient deterioration. Appropriate clinical judgment is key to early detection of deterioration. However, nurse managers indicate that the majority of new graduates lack clinical judgment skills. To overcome this critical barrier to providing safe patient care, nurse educators suggest better training of student nurses regarding clinical judgment skills. One way to teach clinical judgment is to deliberately provide cues to guide the student into making the correct decision. The purpose of this randomized control pilot study was to evaluate the effectiveness of using the National Early Warning Score (NEWS) as a deliberate set of cues during high-fidelity simulation to guide the student in the development of clinical judgment, and the early detection of patient deterioration. A single convenience sample of 57 junior level baccalaureate nursing students was recruited. Twenty-eight students were randomized into the treatment group and 29 into the control group. The students were then randomly placed into teams of 2-3 students each, resulting in an N of 14 in both the treatment and control groups. The treatment group was educated on the use of the NEWS tool. The research evaluated the differences in clinical judgment scores and speed of detection of patient deterioration during high-fidelity simulation between students trained in the use of the NEWS tool versus those who were not. No significant differences in elapse of time or clinical judgment were detected between the treatment and control groups; however, the data was suggestive of a trend towards increasing clinical judgment. Findings from this study confirm the need for further research to be done in this area to determine if utilizing the NEWS tool during high-fidelity simulation can enhance clinical judgment, resulting in early detection of patient deterioration.

Committee: Celeste Alfes (Committee Chair); Mary Dolansky (Committee Member); Joann Sullivan-Mann (Committee Member) Subjects: Educational Evaluation; Higher Education; Nursing

PHD, Kent State University, 2022, College of Education, Health and Human Services / School of Teaching, Learning and Curriculum Studies

Research literature provides evidence that new graduate nurses are often deficient in clinical judgment (CJ). One way to increase CJ is by using simulations. However, the literature is replete with descriptions of the high anxiety that simulation triggers. It is not currently known how anxiety in simulation affects clinical judgment for undergraduate nursing students. Therefore, the purpose of this study was to explore the effect of different types of anxiety on the clinical judgment of undergraduate nursing students in simulation. This research project used a one-group repeated measures quantitative design to answer the research questions using the conceptual framework of Tanner's (2006) model of clinical judgment. A convenience sample of 45 sophomore-level undergraduate nursing students participated in a study to explore how state and trait anxiety impacted their clinical judgment within an introductory simulation. The results indicated that anxiety did not have a significant impact on clinical judgment. When controlling for baseline state and trait anxiety, pre-simulation anxiety level did not significantly predict scores on the Lasater Clinical Judgment Rubric (LCJR) within the simulation. State anxiety did change significantly between the three time measurements, going up to significantly high levels at pre-simulation. These anxiety levels remained high at post-simulation. The findings imply a changed focus to reframe how anxiety is thought about and its effects. Some anxiety is good and facilitative, and therefore, faculty should not be so worried about reducing anxiety for all students. Rather, nursing educators should help students function despite anxiety, in order to prepare them for real world nursing practice.

Committee: Richard Ferdig (Committee Chair); Aryn Karpinski (Committee Member); Debra Shelestak (Committee Member) Subjects: Education; Nursing; Technology

Doctor of Psychology (Psy.D.), Xavier University, 2015, Psychology

Abstract The present study investigated the relationship among explicit biases against Arabs/Arab Americans, diagnosis, prognosis, and perceived cultural competence. Individuals of Arab descent are at heightened risk for prejudice and discrimination due to events such as those that occurred on September 11, 2001 (Moradi & Hasan, 2004; The Leadership Conference on Civil Rights Education Fund, 2009). The participants for this study included 161 advanced psychology graduate students and predoctoral interns. For participants who were of the traditional age (25-34 years old) for advanced graduate psychology training, a small negative relationship was found between perceived cultural competence and less explicit biases towards Arab individuals in the predicted direction. This negative relationship between perceived cultural competence and explicit biases towards Arabs was also found within the ethnic minority participants. Higher perceived cultural competence predicted a lower severity of diagnosis of a hypothetical Arab client, but only for the 25-34 years old participants. Higher levels of explicit biases against Arabs predicted a better prognosis of a hypothetical Arab client, but only for the male participants. This relationship had a small effect size and it was not in the predicted negative direction. These results contribute to the current literature, as this topic has previously been unexamined in the literature. These findings may offer implications for diversity education for graduate programs and internships.

Committee: Anna Ghee Ph.D. (Committee Chair) Subjects: Clinical Psychology; Counseling Psychology; Mental Health; Middle Eastern Studies; Psychology; Psychotherapy; Social Psychology

Doctor of Nursing Practice , Case Western Reserve University, 2022, School of Nursing

Clinical judgment (CJ) is widely considered an essential nursing skill, yet many new graduate nurses (NGNs) lack the CJ skills needed to safely care for patients. Transformation is needed in clinical nursing education to improve the preparation of NGNs for the delivery of safe and effective patient care. This study aims to fill a gap in the literature and provide evidence on the effectiveness of teaching methods in clinical nursing education. The purpose of this study was to examine the effect of active learning strategies (ALS) on the CJ of nursing students and learners' perspectives regarding CJ development. A quasi-experimental, two-group, longitudinal study was conducted using a convenience sample of 92 senior BSN students from a midwestern state university school of nursing. Approximately one-half of students participated in standard post-conference activities (N=42) with the other half (N=50) participating in ALS with structured faculty debriefing. Data was collected using the Lasater Clinical Judgment Rubric (LCJR) by students for self-evaluation and by faculty for assessment of student performance at three times during the semester: pre-intervention (week 3), midterm (week 8), and post-intervention (week 14). Total LCJR scores were used to reflect overall CJ with subscale scores for noticing, interpreting, responding, and reflecting. Analysis included descriptive statistics; independent samples t-tests; repeated measures ANOVA, and a two-way mixed ANOVA. Both groups demonstrated improvement in LCJR total and subscale scores over time (p < .001), with control group faculty rating students higher than intervention group faculty at baseline, midterm, and post-intervention (p < .05). Students self-assessment scores for both groups were similar at baseline (p > .05), but control group students began scoring themselves higher at weeks 8 and 14 (p < .05). There was no interaction effect between time and LCJR Total scores for intervention and control gro (open full item for complete abstract)

Committee: Deborah Lindell (Advisor); Amy Weaver (Committee Member); Molly Jackson (Committee Member) Subjects: Education; Nursing

PHD, Kent State University, 2021, College of Education, Health and Human Services / School of Teaching, Learning and Curriculum Studies

The intent of this interpretive study was to explore students' experiences of using a concept-based approach to learning, understanding, and applying pharmacology concepts in an asynchronous online pharmacology course and how students demonstrate meaningful learning of pharmacology using unfolding case studies in an online classroom. Varied teaching approaches, difficulty with drug nomenclature, and the sheer number of medications on the market make it difficult to prepare students for safe medication administration. Using a concept-based approach to teaching pharmacology may help to manage the amount of content students receive and improve clinical judgment and clinical reasoning skills that can be applied in the clinical setting. The main sources of data for this study were participant concept-maps, unfolding case studies, and reflective journals. Meaningful learning was determined by participant's ability to apply pharmacology concepts in a real-world context. This study found that some participants had gaps in knowledge with regards to pathophysiology. Concept-mapping and case study assignments made these knowledge gaps apparent and created teaching moments. Concept-based structure in the asynchronous online classroom helped participants to think in a logical manner and improved clinical reasoning and clinical judgment.

Committee: Alicia Crowe Dr. (Committee Chair); Jennifer Walton-Fisette Dr. (Committee Co-Chair); Albert Ingram Dr. (Committee Member); Andrew Wiley Dr. (Other) Subjects: Curriculum Development; Education; Nursing

PHD, Kent State University, 2017, College of Education, Health and Human Services / School of Teaching, Learning and Curriculum Studies

The purpose of this qualitative study was to investigate and describe nursing students' and clinical instructors' understandings of critical thinking and to discover which clinical experiences were significant in allowing students to develop critical thinking abilities. Interpretive qualitative methodology was used to explore students' and instructors' perceptions of critical thinking experiences that occurred during clinical education. Data were obtained from 11 student participants and 4 instructor participants using responses to prompts defining critical thinking experiences and follow-up interviews. There were three overarching findings from this study: (a) students and instructors described similar characteristics of clinical experiences that were significant in developing critical thinking including complex situations warranting independent identification, interpretation, and decision making by students; (b) students and instructors described critical thinking as the ability to process an unclear situation, understand the significance of the context, and know what to do next; and (c) students and instructors revealed a disconnect regarding instructor significance and role during clinical experiences. The findings of this study have demonstrated the importance of clinical experiences and preparing for them and debriefing after them for students and the development of their critical thinking. Implications for nursing education include the need to implement certain strategies that maximize critical thinking experiences in the clinical setting, the need for education and training for clinical instructors, and the need for improved discourse between students and instructors regarding clinical experiences.

Committee: William Kist (Committee Chair); Alicia R. Crowe (Committee Member); Susan Stocker (Committee Member) Subjects: Education; Nursing

Doctor of Philosophy, University of Akron, 2010, Counselor Education and Supervision

The present study examined the influence of client socioeconomic status (SES) on counselors' cognitive (attributional biases) and emotional (objective countertransference) reactions. The purpose of the study was to better understand how counselors respond cognitively and emotionally to clients of different SES backgrounds when other demographic and clinical characteristics remain unchanged. A national sample of 141 participants included licensed professional counselors, marriage and family counselors, social workers, counseling psychologists, addiction counselors and counselor-trainees. Data was collected through an internet survey using an analogue-style design employing a client video simulation of the same actor portraying a higher versus lower SES client with the same clinical presentation. Attributional bias was measured by the Clinical Attribution Scale (CAS) (Chen, Froehle, & Morran, 1997) and objective countertransference was measured by the Impact Message Inventory-Circumplex (Brief Version) (IMI-C) (Kiesler & Schmidt, 2006). ANOVA results revealed no significant main effect for participant attributional bias for the lower versus higher SES client simulation. MANOVA results for the IMI-C subscales revealed a statistically significant difference on the Dominant IMI-C subscale. Participants viewing the higher SES client simulation rated the client as interpersonally impacting them in a dominant way compared to those viewing the lower SES client. Using a clinical judgment questionnaire, exploratory follow-up t-tests revealed that participants viewing the higher SES client believed he manifested significantly less severe life problems than the lower SES client. Findings indicate that client SES can impact counselor emotions (objective countertransference) and clinical judgments. Recommendations for counselor education and supervision, counseling theory, and future research are summarized.

Committee: Robert Schwartz Dr. (Advisor); Paul J. Hartung PhD (Committee Member); Kruse D. Sharon PhD (Committee Member); Cynthia A. Reynolds PhD (Committee Member); James A. Rogers PhD (Committee Member) Subjects: Mental Health; Minority and Ethnic Groups; Multicultural Education; Psychology; Psychotherapy; Social Psychology; Therapy

EdD, University of Cincinnati, 2012, Education, Criminal Justice, and Human Services: Counselor Education

In this study, mental health therapists' (n = 42) perceptions about the personal characteristics essential to a client's successful therapeutic experience were examined to determine whether traditional gender role stereotyping was operative in the therapists' perceptions of clients. The client's sex and the therapist's sex, age, and years of experience in the field were investigated to determine whether these variables affected the therapists' perceptions of the personal characteristics necessary for success in therapy. An electronic survey for either a hypothetical male or female client composed of the Bem Sex Role Inventory (BSRI) (1974) 60 personal characteristics and 12 demographic questions was sent to participants. The participants were asked to rate the BSRI personal characteristics as to whether the characteristic was “essential,” “very useful, but not essential,” “somewhat useful, but not essential,” or “not necessary” for the specified hypothetical client to have a successful therapeutic experience. Findings indicated therapists in this study did not endorse traditional gender role stereotypes for a hypothetical male or female client. There was no significant interaction found between item type and therapist gender or client gender, and neither therapist age nor therapist years of experience appeared to have an appreciable moderating effect on the therapists' ratings of item types. Lawshe's content validity analysis identified both “essential” personal characteristics for a client to have a successful therapeutic experience and personal characteristics judged to be “not necessary.” Limitations of the study are discussed and suggestions for future research are offered.

Committee: Ellen Piel Cook PhD (Committee Chair); Frederick Robert Wilson PhD (Committee Member); Geoffrey Yager PhD (Committee Member) Subjects: Mental Health