NUR 5194 Module 6 Scholarly Project Paper and Reflection Example

Restructuring Clinical Post-Conference Around Clinical Judgment: A Scholarly Project Report From a Junior-Level Adult Health Course, With a Reflection on Becoming a Nurse Educator

Student Name

American College of Education

NUR5194: Capstone Practicum for Role of the Nurse Educator

Module 6 Assignment

Instructor Name

December 12, 2028

Background and Problem

Clinical post-conference is the part of clinical education reserved for students to make sense of what they experienced on the unit, yet studies of its conduct find that faculty often ask low-level questions and organize the time around tasks rather than reasoning (Hsu, 2007). In a composite junior-level adult health course with eight clinical groups at a public university, a needs assessment found that 71% of instructors' post-conference questions asked students to remember or understand and 11% asked them to analyze or evaluate, that students spoke for about 38% of conference time, that most students rated post-conference as useful only sometimes or rarely, and that interpretation of patient data was the weakest item on students' clinical evaluations. Instructors, mostly part-time, had received no preparation for leading post-conference. The project asked whether a simple structure grounded in a clinical judgment model, with brief instructor preparation, would raise the level of post-conference discussion and support students' development in interpreting patient data.

Intervention and Methods

The intervention, One Patient, Four Questions, organized each post-conference around one student's patient and four group questions corresponding to the phases of the clinical judgment model described by Tanner (2006): what did you notice, what could explain it, what would you do and watch for, and what would you do differently. A what-if question changed one finding to extend the reasoning, and each student closed by noting one cue to watch for next time. Four instructors who volunteered attended a 90-minute workshop co-led by a colleague who already used a similar approach, and led structured post-conferences in their groups for six weeks, twice a week. The other four groups continued their usual practice.

Evaluation repeated the needs assessment's methods at the end of implementation: observation of two conferences per group with every question coded by cognitive level and student talk time estimated, a second rater coding a subset, a student survey and de-identified midterm and final clinical evaluation scores. Fidelity was measured with a five-element adherence checklist based on a published framework for implementation fidelity (Carroll et al., 2007). The university's review board determined that the project was an educational quality improvement activity.

Results

Adherence to the structure averaged 83% and rose over the six weeks. In the intervention groups, 38% of instructors' questions were at the analyze level or above, compared with 12% in the comparison groups and 11% at baseline, and students spoke for 58% of conference time, compared with 40%. Interrater agreement on question coding was 86%. The mean rating for interpreting patient data rose by 0.6 points on a four-point scale in the intervention groups and by 0.3 points in the comparison groups. Nearly three quarters of intervention students (74%) found post-conference useful most or all of the time, against 41% in comparison groups. All four intervention instructors said they would continue the structure. The structure changed what instructors asked and how much students reasoned aloud; whether it changed clinical judgment itself is a question for a stronger study.

Discussion and Recommendations

The project suggests that a short, theory-based structure, supported by brief preparation and a respected colleague, can change the character of clinical post-conference within a single semester. The change in question level was large and consistent, and it was achieved by part-time instructors who had asked for exactly this kind of support, echoing the experience described by Harvey (2015) with guided questions. They also fit with a quasi-experimental finding that a structured debriefing method produced larger gains in clinical reasoning after simulation than customary debriefing (Dreifuerst, 2012). The design's limits, volunteer instructors, non-random groups, an evaluator who knew group assignment and clinical ratings given by the instructors themselves, mean the improvement in clinical ratings should be read as promising rather than proven.

Three recommendations follow, and the course faculty adopted the first two at their December meeting. First, use the structure in all clinical groups from the start of next semester, with the workshop added to clinical instructor orientation and the one-page guide and model video in the course's instructor materials. Second, continue collecting question-level and talk-time observations each semester as a simple quality measure for post-conference. Third, test the structure more rigorously by randomly assigning groups to start in the first or second half of a semester and by having clinical judgment rated on a rubric by assessors blind to group assignment, a design the mentor has offered to lead with the author's help.

Implications Beyond This Course

Although the project was local, its lessons may apply to other programs. Post-conference is universal in prelicensure clinical education, and most programs rely on part-time clinical instructors with little preparation for leading it. The project suggests three transferable points. First, a structure does not need to be elaborate to change practice; four questions on a pocket card, tied to a model students were already learning, were enough to shift the level of discussion. Second, the messenger matters: the change spread because an existing instructor already practiced something like it and could vouch for it, which suggests that programs looking to improve post-conference should first look for the instructors whose conferences already work and ask them to lead. Third, simple measures such as the proportion of higher-level questions and the share of time students speak can be collected by any course coordinator without special tools, and they give a program a way to monitor post-conference quality over time, much as units monitor process measures in quality improvement. The author plans to submit a short report of the project to a nursing education journal's teaching strategies section, with the mentor as coauthor, so that other programs can adapt the structure and, ideally, test it with a stronger design.

Reflection on Becoming a Nurse Educator

At the start of the practicum, the author's self-assessment against the nurse educator core competencies (Halstead, 2019) showed strength in facilitating learning one to one and weakness in evaluating learners formally, understanding curriculum and designing changes that could be evaluated with evidence. The end-of-practicum self-assessment, completed with the same statements, shows the largest growth in leading change and in scholarship. The author now knows how to build a case for a teaching change from data, implement it with colleagues and evaluate it honestly, and has learned that the honest part, stating what the data cannot prove, earns more trust from faculty than an overstated result would have. Growth in evaluating learners was real but smaller; writing midterm evaluations that were specific enough to guide a struggling student took several drafts and the mentor's coaching, and remains a skill to build. The most surprising lesson was about group facilitation. Leading eight tired students through a hard question and then waiting, silently, for someone to answer is a skill quite different from precepting one new nurse, and it was learned in the same weeks as the project that asked other instructors to learn it. The author intends to pursue a clinical instructor position next year and to take the structure, and the habit of measuring what it does, into that role.

References

Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, Article 40. https://doi.org/10.1186/1748-5908-2-40

Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326-333. https://doi.org/10.3928/01484834-20120409-02

Halstead, J. A. (Ed.). (2019). NLN core competencies for nurse educators: A decade of influence. National League for Nursing.

Harvey, G. (2015). Connecting theory to practice: Using guided questions to standardize clinical postconference. Journal of Nursing Education, 54(11), 655-658. https://doi.org/10.3928/01484834-20151016-08

Hsu, L.-L. (2007). Conducting clinical post-conference in clinical teaching: A qualitative study. Journal of Clinical Nursing, 16(8), 1525-1533. https://doi.org/10.1111/j.1365-2702.2006.01751.x

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04