Table Of ContentAN INTEGRATIVE REVIEW OF
EDUCATIONAL STRATEGIES THAT
PROMOTE THE CLINICAL JUDGEMENT
ABILITY OF STUDENTS IN HEALTH
CARE
Nora Frances Olivier
July 2014
x
AN INTEGRATIVE REVIEW OF EDUCATIONAL
STRATEGIES THAT PROMOTE THE CLINICAL JUDGEMENT
ABILITY OF STUDENTS IN HEALTH CARE
By
Nora Frances Olivier
Dissertation submitted in accordance with the requirements for the
degree
Magister Societatis Scientiae in Nursing
in the
Faculty of Health Sciences
School of Nursing
University of the Free State
Bloemfontein
Supervisor: Prof. Y. Botma
July 2014
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I certify that the dissertation hereby submitted by me for the MSocSc (Nursing)
degree at the University of the Free State is my independent effort and had not
previously been submitted for a degree at another university/faculty. I furthermore
waive copyright of the dissertation in favour of the University of the Free State.
________________________
Nora Frances Olivier
July 2014
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LETTER OF SUBMISSION APPROVAL BY STUDY LEADER
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ACKNOWLEDGEMENTS
Nielen, as always. Your continued support, care and friendship served as
encouragement to complete the work.
Annemarie Joubert, once again, you proved to be the special person you are, thank
you for all you time and insight. I am honoured to know you and have you as friend.
Anna-Marie Welman, thank you for all the phone calls and help.
Annamarie du Preez, without your diligent searches and help in the library the
research would not have seen the light, thank you.
Cecilna Grobler, there is no adequate manner in which to thank you for all you have
done but do accept my heartfelt thanks. Thank you for the formatting of the
dissertation. You are a wonderful friend.
Thank you to all my colleagues at the School of Nursing, the many times I received
encouragement and words of advice. Among you there is a special person receiving
special thanks.
Magda Mulder, I am glad you also had a part in the work, thank you for the Afrikaans
translation.
The two people who did the language editing, Ella and Christo, thank you for
patching my quilt.
Last but never the least, Yvonne Botma. Thank you for accompanying me on this
journey as mentor, colleague and friend. Thank you for coping with my demanding
habits and being available to provide the necessary help.
Finally. Thank You for listening to all my prayers, specifically those sent to You at
three o’clock at night!
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SUMMARY
The plethora of literature available on the practice-theory gap, learning transfer and
the continuous search for better methods of educating healthcare students
emphasises the fact that an educational problem exists. The best available evidence
informs clinical practice, and educators in healthcare should base educational
decisions on the best evidence supporting educational strategies.
The purpose of the study is to determine the educational strategies that promote
clinical judgement of students in healthcare through an integrative literature review of
studies published from January 2000 to October 2013.
Multiple databases and search methods were used to identify studies that met the
inclusion criteria for an integrative literature review. The search strategies identified
897 records of which seven were identified for critical appraisal according to the
inclusion criteria. Three researchers independently critically appraised the articles
according to the standardised CASP and QaulSyst, appraisal tools. Four of the
seven studies were used for analysis. Although an integrative review allows for
qualitative studies, all four articles were randomised control studies.
This review was unable to provide conclusive evidence regarding appropriate
educational techniques promoting clinical judgement. All four studies differed
regarding sample size, duration, type of interventions and the outcome measurement
tools. The four trials used high fidelity simulation, case-based learning and web-
based learning as educational strategies. Shared educational design factors of the
educational strategies were found, such as authenticity, active student engagement,
cooperative learning, learner focussed and scaffolding, providing a shared base for
educational strategies improving learning transfer and clinical judgement. Two of the
studies indicated sequencing of the interventions improved clinical judgement.
Due to the paucity of evidence, no conclusion as to which educational strategies
promote clinical judgment could be made. However, there is evidence suggesting
that high fidelity simulation, case-based learning and web-based learning may
promote transfer of learning.
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Recommendations for further research include a standardised measurement of
clinical judgement and that more educational strategies should be tested for their
ability to promote transfer of learning.
Keywords
Clinical judgement
Educational strategies
Educational design factors
Healthcare
Learning transfer
Theory-practice gap
Integrative literature review
Simulation
Web-based learning
Case-based learning
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OPSOMMING
Die oorvloed van beskikbare literatuur wat oor die teorie-praktyk gaping, die oordrag
van leer en die deurlopende navorsing vir beter onderrigmetodes van
gesondheidsorgstudente handel, beklemtoon die feit dat daar ‘n opvoedkundige
probleem bestaan. Die beste beskikbare bewyse rig die kliniese praktyk en
opvoedkundiges in gesondheidsorg moet hul besluite baseer op die bewyse wat hul
opvoedkundige strategieë ondersteun.
Die doel van die studie is om die opvoedkundige strategieë te identifiseer wat
studente se kliniese oordeel bevorder deur ‘n volledige literatuuroorsig te doen van
studies wat vanaf Januarie 2000 tot Oktober 2003 gepubliseer was.
Veelvuldige databasisse en soekmetodes is gebruik om studies te identifiseer wat
aan die insluitingskriteria van ‘n volledige literatuuroorsig voldoen. Die
soekstrategieë het 897 rekords opgelewer waarvan sewe vir kritiese waardering
geïdentifiseer is volgens die vereistes van die insluitingskriteria. Drie navorsers het
onafhanklik van mekaar die artikels volgens die gestandaardiseerde CASP en
QaulSyst instrumente waardeer. Vier van die sewe studies is vir analise gebruik.
Alhoewel ‘n omvattende oorsig vir kwalitatiewe studies voorsiening maak, was al vier
studies gerandomiseerde toevallige kontrole studies.
Hierdie oorsig was nie daartoe in staat om onweerlegbare bewys te lewer van
toepaslike opvoedkundige tegnieke wat kliniese oordeel bevorder nie. Al vier studies
het verskil met betrekking tot steekproefgrootte, duur van studie, tipe van
tussentrede en die instrumente wat gebruik is om die uitkomste te meet. Die vier
studies het simulasie , geval- en webgebaseerde leer as opvoedkundige strategieë
gebruik. Die opvoedkundige strategieë het die volgende ontwerpfaktore soos
outentisiteit, aktiewe studentbetrokkenheid, samewerkende leer, leerder
gesentreerdheid en stellasies van kognitiewe denke bevat. Dit voorsien ‘n gedeelde
basis vir opvoedkundige strategieë wat leeroordrag en kliniese oordeel bevorder.
Twee van die studies het aangetoon dat die opeenvolging van tussentredes ook
kliniese oordeel bevorder het.
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Weens die gebrekkige bewyse kan geen gevolgtrekkings gemaak word oor watter
opvoedkundige strategieë kliniese oordeel bevorder nie. Nietemin, daar is bewyse
wat voorstel dat hoë getrouheid-simulasie, geval-gebaseerde leer en web-
gebaseerde leer die oordrag van leer kan bevorder.
Aanbevelings vir verdere navorsing sluit gestandaardiseerde meting van kliniese
oordeel in en dat meer opvoedkundige strategieë se vermoë om oordrag van leer te
bevorder, getoets moet word.
Kliniese oordeel
Opvoedkundige strategieë
Opvoedkundige ontwerpfaktore
Gesondheidsorg
Oordrag van leer
Teorie-praktykgaping
Volledige literatuuroorsig
Simulasie
Web-gebaseerde leer
Geval-gebaseerde leer
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ACRONYMS
ACS Acute Coronary Syndrome
CASP Critical Appraisal Skills Programme
CBL Case-based learning
eDerm Web-based learning
HPS Human patient simulation
OSCE Objective structured Clinical Examination
PASW Statistical software version 17.0
PBL Problem-based learning
RCT Randomised control trial
SIM Simulator based learning
SPSS Statistical software version 14.0
QualSyst Critical appraisal tool
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Description:based teaching is defined as “the conscientious, explicit, and judicious use of current best evidence in making There is a global search for means to integrate students' theoretical knowledge into effective nursing Development System demonstrated that although nurses had content knowledge.
