Reflecting on diagnosis: The Metacognitive Diagnostic Reasoning Model©

BACKGROUND

Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research.

PURPOSE

To present a model of the factors of diagnostic reasoning in Advanced Practice Registered Nurses (APRNs), based on a review of the literature supporting the Metacognitive Diagnostic Reasoning (MDR) Model©.

METHODOLOGY

A review of the literature through systematic database search, historical articles, texts, and documents was conducted from inception through August 2023 (N = 41).

RESULTS

The MDR model depicts the following concepts: (1) metacognition is viewed as the driving force of diagnostic reasoning; (2) dual cognitive processing and knowledge representations are used; (3) once a diagnosis, treatment plan, and evaluation are complete, APRNs use metacognition for the next patient encounter, using repetition for improvement of the process.

CONCLUSIONS

The model combines key concepts of diagnostic reasoning, providing a framework for researchers to develop and test, and faculty to teach and evaluate this complex process in learners.

IMPLICATIONS

The MDR model provides research opportunities to validate its usefulness and effectiveness and a framework to guide educational research, contributing to the body of evidence-based practice in nursing. In addition, it may foster ongoing education and training that could lead to more accurate diagnoses and treatment plans, ultimately improving patient care by reducing diagnostic errors.

The NLN/Jonas Ten-Year Story: Perceptions of Nurse Educator Scholars

ABSTRACT

The aim of the NLN/Jonas Scholars Program is to support doctoral nursing students whose program of research focuses on research in nursing education. As a 10-year review, 23 nursing students pursuing a doctorate participated in focus groups with the goal of describing the influence of a year-long mentoring program on their career trajectory. Analysis of the data revealed two themes: having someone believe in me and my research topic and being mentored and learning to mentor others. The findings support that being skilled in conducting pedagogical research with mentorship advances nursing education practice, scholarship, and leadership.

Grit as a Predictor of Academic Success Among Associate Degree Nursing Students

AIM

The purpose of this study was to explore whether grit is a predictor of success in associate degree nursing (ADN) programs.

BACKGROUND

A question that challenges admission decision-making in nursing programs is "Who will succeed?" This question is particularly relevant in ADN programs, which often have higher attrition rates than baccalaureate programs.

METHOD

This longitudinal, mixed-methods study was conducted with 451 ADN students across nine programs, including interviews with seven unsuccessful students and nine successful students.

RESULTS

Short Grit Scale scores were not found to be statistically significant as a predictor of academic success; however, themes that emerged from the interviews do align with the theory of grit.

CONCLUSION

Further research is needed to explore whether recognizing the level of grit in students during admission processes would help identify students who are likely to succeed.

The Impact of Single-Dose Debriefing for Meaningful Learning Training on Debriefer Quality, Time, and Outcomes: Early Evidence to Inform Debriefing Training and Frequency

AIM

This study evaluated the impact of a single dose of training in Debriefing for Meaningful Learning (DML) on learner knowledge outcomes and time spent in debriefing.

BACKGROUND

Regulatory bodies recommend that faculty who debrief receive training and competence assessment to ensure positive student learning outcomes, yet there is little literature describing the training needed. There is also little understanding of the impact of a single training on the length of debriefing, debriefer skill, and learner outcomes.

METHOD

Following training, debriefers submitted a recorded debriefing for assessment by experts; their learners completed knowledge assessment tests at three time points.

RESULTS

Longer debriefing time led to higher DML Evaluation Scale scores. Learner knowledge scores improved and later decayed.

CONCLUSION

The results of this study contribute to the evidence about the importance of training to debrief well, the impact of training on the length of debriefing time, and subsequent learner outcomes.

Testing the Impact of an Asynchronous Online Training Program With Repeated Feedback

BACKGROUND

Learning to effectively debrief with student learners can be a challenging task. Currently, there is little evidence to support the best way to train and evaluate a debriefer's competence with a particular debriefing method.

PURPOSE

The purpose of this study was to develop and test an asynchronous online distributed modular training program with repeated doses of formative feedback to teach debriefers how to implement Debriefing for Meaningful Learning (DML).

METHODS

Following the completion of an asynchronous distributed modular training program, debriefers self-evaluated their debriefing and submitted a recorded debriefing for expert evaluation and feedback using the DML Evaluation Scale (DMLES).

RESULTS

Most debriefers were competent in DML debriefing after completing the modular training at time A, with DMLES scores increasing with each debriefing submission.

CONCLUSION

The results of this study support the use of an asynchronous distributed modular training program for teaching debriefers how to implement DML.

Debriefing for Meaningful Learning: Implementing a Train-the-Trainer Program for Debriefers

Debriefing for Meaningful Learning (DML) is a method of debriefing grounded in the theory of reflection used following a simulation or clinical learning experience to engage participants in an interactive dialogue aimed at examining and evaluating their thinking and decision-making processes. With increasing adoption of DML worldwide, a sustainable training program for nurse educators is needed. Attending conferences and workshops that provide training is challenging for many nurse educators because of time and cost constraints. One promising solution is the train-the-trainer (TTT) model. In this article, the development and implementation of a TTT model of DML debriefer training, adaptable to both academic and clinical nursing professional development, is described. [J Contin Educ Nurs. 2022;53(7):321-327.].

Lack of pediatric mental health clinical experiences among FNP students

BACKGROUND

Mental health disorders accounted for approximately 5% of outpatient child and adolescent visits between 2008 and 2011, and 34.8% of these children were seen by a primary care provider. As primary care providers, family nurse practitioners (FNP) are positioned to address mental health issues across the lifespan; however, they require appropriate training and experience.

AIM

The study examined pediatric mental health assessment clinical experiences in a national survey of FNP students.

METHODS

A secondary analysis was performed on a data set of FNP students (N = 3940). Frequencies and chi-square analyses were performed to examine pediatric mental health assessment clinical experiences.

RESULTS

Nearly 30% (n = 1118) of FNP students reported experiencing two or fewer pediatric mental health assessments during their clinical rotations. More than half (53%) of these students were required to set up their own preceptors and clinical sites.

CONCLUSION

Despite the growing need for mental health care in the U.S, students reported lacking pediatric mental health assessment clinical opportunities. Moreover, students who set up their own clinical sites and preceptors were even less likely to assess pediatric patients' mental health. FNP educators and programs are encouraged to provide students with the support and opportunity for adequate pediatric practice, including mental health assessment.

Debriefing: A Place for Enthusiastic Teaching and Learning at a Distance

The current pandemic has required a quick response to the unprecedented suspension of face-to-face instruction in higher education worldwide. The rapid conversion of didactic, laboratory, and clinical courses to distance learning has been challenging, requiring integration of screen-based virtual simulations and other innovative learning activities. The importance of a robust debriefing of these learning opportunities is often neglected, which could be to the detriment of the students. Debriefing is based on strong narrative pedagogy, requiring an engaging and enthusiastic dialog. Despite long days of screen time, it is even more imperative to connect with students to create meaningful learning through a rich verbal debriefing.

Exploring Grit Among Black Prelicensure Nursing Students

Unequal representation of black nurses in the workforce continues to plague the nursing profession. Preconceptions and understandings of the discipline are underpinned by the dominant white racial makeup, which may challenge ethnically diverse nursing students' perceptions of their ability for success. The need for a diverse nursing workforce includes the challenge of enticing minority students into and successfully through prelicensure programs. This study of attributes of grit in the lived experiences of black nursing students revealed evidence including consistent efforts and perseverance to reach goals in the participants' stories.

The essentials of debriefing in simulation learning: a concept analysis

Debriefing is essential element of simulation; however, practices vary greatly. Common elements include critique, correction, and evaluation of student performance and discussion of the experience. Learning occurs in simulation through contextual task training and repetition, but significant learning occurs when deep insight is made explicit through reflection during debriefing. The value of the student's learning is in the student's ability to engage in reflection that translates into actionable knowledge. Facilitating debriefing emphasizing reflection is an essential competency, yet little research and resources are available to guide best practices in debriefing. This article analyzes the concept of debriefing and identifies essential components. Examples that demonstrate defining attributes of debriefing are included. This work supports the identification of best practices and future research agendas to enable nurse educators to master the knowledge and strategies needed to provide students with significant learning during simulation.