NUR 685 Module 8 Assessment Tool Paper Example

Scoring Clinical Judgment in a Sepsis Simulation: Adapting the Lasater Rubric and Building a Validity Argument

[Student Name]

Southern New Hampshire University

NUR 685: Nurse Educator Capstone

Module Eight Assessment Tool Paper

[Instructor Name]

[Date]

Scoring Clinical Judgment in a Sepsis Simulation: Adapting the Lasater Rubric and Building a Validity Argument

An educator who designs a course but cannot defend how learners were assessed has completed only half the job. The capstone's simulation course will judge new graduate nurses' performance in recognizing and escalating early sepsis with a published clinical judgment rubric, adapted for the scenarios. This paper describes the rubric and its origins, explains the adaptation, sets out a modern view of validity and plans the evidence needed to trust the scores for their intended use.

The Rubric and Its Origins

Tanner (2006) reviewed a large body of research on clinical judgment and proposed a model in which nurses first grasp a situation, then make sense of it, then act and finally look back on how things turned out, with each phase shaped by the nurse's background, relationship with the patient and the unit's culture. Lasater (2007) used this model to develop a rubric by observing nursing students in high-fidelity simulation over several weeks and refining descriptions of what performance looked like at different stages of development. What emerged has a section for each phase of the model and eleven dimensions in all, covering matters like how deliberately the nurse observes, whether unexpected changes are spotted, how data are ranked, how clearly the nurse communicates and whether the nurse works to improve. Every dimension is written out across four stages of growth, from a novice's first attempts to expert performance.

Lasater emphasized that the rubric was meant to make clinical judgment visible and to offer learners and teachers common terms for feedback, and she acknowledged that its measurement properties required further study. Its grounding in a well-known model and its development in simulation make it a sensible starting point for this course.

Adapting the Rubric

The rubric's descriptions are general, which helps across scenarios but leaves raters uncertain in a specific one. The adaptation keeps all eleven dimensions and four levels but adds sepsis-specific anchors to the dimensions most relevant to the gap. For recognizing deviations, the accomplished level states that the resident identifies that screening criteria are met at the first assessment in a borderline case. For communication, it describes a resident who calls the provider inside ten minutes of the patient qualifying, using a structured report including the screening result, trend and request. For commitment to improvement, it describes a resident who, in debriefing, identifies their own decision point and a specific change. The anchors were drafted with two experienced sepsis nurses and reviewed by a hospitalist.

A Modern View of Validity

Downing (2003) explained that validity does not live inside a test or rubric; it describes how well evidence and theory back up a particular way of reading and using its scores. Validity is therefore argued, not declared, and the argument must be rebuilt whenever a tool is used for a new purpose or population. He described five sources of evidence drawn from the educational testing standards. Content evidence shows that the tool represents what it is meant to measure. Response process evidence shows that raters and learners use it as intended, including rater training and data integrity. Internal structure evidence concerns reliability and how items relate to one another. Relations to other variables show that scores behave as expected alongside other measures. And evidence about consequences examines the effects of using the scores.

This view matters here because the rubric is being used with new graduates rather than students, in sepsis scenarios, with added anchors. Its earlier use does not automatically carry over.

Planned Validity Evidence

Table 1 sets out the evidence to be gathered for each source. The strongest planned evidence is for content, through expert review, and for response process, through rater calibration. The most informative test is relations to other variables: if the rubric measures clinical judgment about escalation, residents with higher scores on the communication and recognition dimensions should also have shorter times to call in the same scenario.

Table 1. Validity Evidence Plan

Note. Evidence is proportionate to a single-site educational project.

Rater Training

Rater agreement is often the weakest link in rubric assessment. Before the course, the student and a simulation educator will independently score four recorded scenarios performed by experienced nurses volunteering as residents, compare scores dimension by dimension, discuss disagreements and refine the rater manual. They will repeat the exercise until they agree within one level on at least four of five ratings. During the course, both will score every performance from video without seeing each other's ratings, and a third rater will resolve disagreements of two levels or more.

Consequences and Intended Use

Downing's framework reminds educators that how scores are used is part of validity. The rubric scores in this course will be used only to give residents feedback and to evaluate the course, never for employment decisions or residency completion. This limit protects residents who are already anxious in their first year, supports the psychological safety that debriefing depends on and reflects the modest evidence the project can gather. Residents will receive their scores privately with written comments.

Limitations

With 38 residents and two raters, the project cannot conduct a full psychometric analysis. The comparison with time to call is limited to the same scenario and may reflect scenario difficulty as well as judgment. And the added anchors, while useful, narrow the rubric toward one clinical problem. The validity argument will therefore be described as preliminary and specific to this use.

Conclusion

The adapted Lasater rubric suits the course because it rests on a respected model of clinical judgment and was built in simulation. Treating validity as an argument, and gathering proportionate evidence from each source, allows the educator to use its scores responsibly for feedback and course evaluation.

References

Downing, S. M. (2003). Validity: On the meaningful interpretation of assessment data. Medical Education, 37(9), 830-837. https://doi.org/10.1046/j.1365-2923.2003.01594.x

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