RES 6512 Module 5 Dissertation Concept Paper Example

Debriefing for Meaningful Learning and Observed Clinical Judgment in Associate Degree Nursing Students: A Dissertation Concept Paper

Student Name

American College of Education

RES6512: Research Concept Paper

Module 5 Assignment

Instructor Name

November 9, 2026

Background

Clinical judgment, the capacity to recognize what a patient's situation requires and to act on it, is now measured directly on the licensure examination for registered nurses, through case-based items modeled on the licensing body's clinical judgment framework (Dickison et al., 2019). Nursing programs have long relied on simulation to give students safe practice in that kind of thinking, and a national multisite trial reported no loss in outcomes when simulation took the place of up to half of clinical hours when debriefing followed a theory-based approach led by prepared faculty (Hayden et al., 2014). The debriefing that follows a scenario is therefore more than a wrap-up. It is where students are expected to examine their own reasoning, and the quality of that examination may decide how much a scenario teaches.

Problem Statement

At a two-campus public community college in Arizona, associate degree nursing students take part in high-fidelity simulation every semester, yet the debriefing they receive afterward follows no shared method. A spring faculty survey showed that most simulation faculty used their own approach and that debriefing time for one scenario ranged from under ten minutes to nearly three quarters of an hour. Nationally, assessments of newly hired nurses have found that fewer than a quarter reached the expected entry level in clinical reasoning (Kavanagh & Szweda, 2017). Structured debriefing has improved students' scores on a written test of reasoning (Dreifuerst, 2012; Forneris et al., 2015), but whether it improves judgment as observed in performance, among associate degree students in a setting like this one, is unknown.

Purpose of the Study

This quantitative, quasi-experimental study will compare observed clinical judgment, scored with the Lasater Clinical Judgment Rubric, between second-year associate degree nursing students who are debriefed with Debriefing for Meaningful Learning and those who receive the program's existing debriefing, after adjustment for each student's score on an early-semester scenario. The comparison will use two consecutive semesters at the Arizona college.

Research Questions and Hypotheses

RQ1 asks whether end-of-semester total rubric scores differ by debriefing condition once early-semester scores are taken into account. Its null hypothesis predicts no difference in adjusted means, and its alternative predicts a difference in either direction.

RQ2 asks the same question separately for the rubric's dimensions of noticing, interpreting, responding and reflecting, each adjusted for its own baseline. Each of the four null hypotheses predicts no difference, and each will be tested at an alpha of .0125 to hold the familywise error rate near .05.

Theoretical Framework

The framework is the model of clinical judgment that Tanner (2006) drew from studies of how practicing nurses reason. In that model a nurse notices, interprets, responds and reflects, and reflection after an episode adds to the knowledge and expectations that govern what the nurse notices the next time. Debriefing for Meaningful Learning is a disciplined version of that after-the-fact reflection, in which facilitators keep asking students to articulate the reasons behind their actions and to carry lessons forward (Dreifuerst, 2015). The rubric was derived from the same model (Lasater, 2007), so its four dimensions measure the activities the framework describes. The framework predicts that the benefit of structured debriefing should show up in a later scenario's noticing and interpreting, not only in how well students talk about reflection.

Nature of the Study

Whole semesters, rather than individual students, form the comparison groups, because students in one course share simulation days and a method used with some of them would quickly reach the rest. Roughly 72 students enroll in the target medical-surgical course each semester; an a priori estimate for analysis of covariance with one covariate, a medium effect, alpha of .05 and power of .80 called for 128 participants (Faul et al., 2007), and a third semester is approved if consent falls short. Students will be recorded in a baseline scenario in week 3 and an outcome scenario in week 14. Two external raters, trained until their agreement on calibration videos reaches an intraclass correlation of .75 or higher (Koo & Li, 2016), will score recordings without knowing the semester. Debriefing faculty in the intervention semester will complete training in the method, and observers will check their fidelity, and comparison-semester debriefings will be logged. Analysis of covariance will test both questions, with assumption checks and effect sizes reported.

Protection of Participants

Both the community college's research committee and ACE's own review board will need to approve the study before any recording begins. My role as simulation coordinator creates a risk that students feel obliged to join, so recruitment and consent will be handled by a colleague who neither grades nor supervises the course, and I will learn who took part only after grades are final. Anyone who says no still completes every scenario and debriefing, since both methods are accepted teaching practice, and their videos will simply not be scored. Recordings will carry numeric codes, sit on an encrypted college server and be deleted three years after the study closes.

Significance

The findings will inform a decision the program faces now: whether to require one debriefing method and pay for the faculty development it needs. Because many of the newly licensed nurses hired in rural parts of the state hold associate degrees, evidence from a community college setting may also be useful to sister programs that share simulation resources. For the wider literature, the study adds an observed performance outcome and an associate degree population to a body of debriefing research that has mostly used written reasoning tests and baccalaureate students.

Definitions of Key Terms

Clinical judgment: deciding what a patient's situation calls for and whether and how to act on it, including adjustments made as the patient responds (Tanner, 2006). Debriefing for Meaningful Learning: a structured, reflective debriefing method organized in phases that move students from describing what happened to explaining their reasoning and applying it to new situations (Dreifuerst, 2015). Usual debriefing: post-scenario discussion conducted in each faculty member's customary way. Observed clinical judgment: the total and dimension scores assigned on the Lasater rubric by trained raters reviewing a recorded scenario.

Assumptions, Limitations and Delimitations

The study assumes that students will perform in recorded scenarios as they would otherwise, that raters will apply the rubric consistently after training and that faculty in the intervention semester will use the method as taught. Its main limitation is the absence of random assignment: the semesters may differ in ways that early-semester scores miss, and faculty may grow more skilled over the year. Results from one college may not transfer to other programs. The study is delimited to second-year students in one medical-surgical course, to one outcome scenario and to a single semester of exposure, and it does not examine licensure results, student perceptions or faculty outcomes.

Summary

This concept paper proposes a practical test of a theoretically grounded idea: that disciplined reflection after simulation improves how nursing students judge the next patient. The problem is documented locally and nationally, the purpose and questions follow from it, the framework explains why an effect is expected and the methods are matched to a working program's constraints. With approval, the next steps are the literature review and the full methodology chapter.

References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03

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

Dreifuerst, K. T. (2015). Getting started with debriefing for meaningful learning. Clinical Simulation in Nursing, 11(5), 268-275. https://doi.org/10.1016/j.ecns.2015.01.005

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). GPower 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39*(2), 175-191. https://doi.org/10.3758/BF03193146

Forneris, S. G., Neal, D. O., Tiffany, J., Kuehn, M. B., Meyer, H. M., Blazovich, L. M., Holland, A. E., & Smerillo, M. (2015). Enhancing clinical reasoning through simulation debriefing: A multisite study. Nursing Education Perspectives, 36(5), 304-310. https://doi.org/10.5480/15-1672

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4

Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nursing Education Perspectives, 38(2), 57-62. https://doi.org/10.1097/01.NEP.0000000000000112

Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155-163. https://doi.org/10.1016/j.jcm.2016.02.012

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04

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