USING CRITICAL THINKING VIGNETTES TO Evaluate Student Learning.

ABSTRACT Nursing skills have traditionally been evaluated using laboratory demonstration. The reality, however, is that skill performance does not occur in isolation in the practice setting. Nurses demonstrate skills while functioning within several nursing roles. Following an examination of the relationship of educational outcomes focusing on critical thinking, communication ability, and therapeutic nursing interventions, faculty at a two-year associate degree nursing program formulated Critical Thinking Vignettes as a method of assessing student outcomes. Students role-play a nurse-client interaction using a case study prompt. Student performance outcomes in skills demonstration, communication, teaching, problem solving, critical thinking, identification of resources, and response to environmental cues are evaluated. Preliminary reliability and inter-rater reliability studies suggest that this method provides a controlled method of assessing nursing outcomes reflective of actual practice.

THE SAFE APPLICATION OF SKILLS IS FUNDAMENTAL TO NURSING PRACTICE. Traditionally, nursing skills have been taught in a simulated laboratory setting, where emphasis is placed on the practice and step-by-step demonstration of skills applicable to each procedure. The satisfactory demonstration of skills in the simulated laboratory has been a prerequisite for performance in the clinical setting. > DESPITE INTENSE LABORATORY INSTRUCTION, HOWEVER, STUDENTS INCONSISTENTLY DEMONSTRATE SKILL MASTERY IN THE CONTEXT OF ACTUAL CLIENT INTERACTIONS. As faculty in a two-year associate degree nursing program engaged in curriculum revision, we considered the relationship of skill demonstration in the context of nursing role's with an emphasis on critical thinking, communication ability, and therapeutic nursing interventions. The faculty worked collaboratively to design a series of Critical Thinking Vignettes that could be used to evaluate student skills in a case study simulation consistent with the scope of actual nursing practice.

Development of the Concept The National League for Nursing Accrediting Commission (NLNAC) has revised its standards to include a greater emphasis on student outcomes, addressing the relationship between skill demonstration and critical thinking within the context of clinical judgment (1). In developing a critical thinking multiple-choice assessment examination, the National League for Nursing Department of Assessment and Evaluation formulated a definition of critical thinking that addresses a logical, context-sensitive, reflective reasoning process to guide the nurse in generating, implementing, and evaluating effective approaches to client care. This definition emphasizes the need for …