William Henry V Sim Clinical Packet With Answers

vSIM CLINICAL REPLACEMENT PACKET FOR STUDENTS STUDENT I NSTRUCTIONS FOR Est. Time: 4-6 Hours V IRTUAL CLINICAL REPLACEMENT This activity packet is intended to be used with your assigned virtual patient found in vSim. The Six Step learn flow in vSim is to be followed as instructed below. Once you have completed the Six Steps, in addition to this Clinical Replacement Activity Packet, submit for grading as instructed in your syllabus. LEARN F LOW - STEP O NE  Finish     the Suggested Readings, then complete the following four activities: Clinical Worksheet Plan of Care Concept Map Pharm4Fun Worksheet (one per medication) ISBAR Worksheet LEARN F LOW – STEP T WO  Take the Pre-Simulation Quiz  Student may take several times using the answer key to provide immediate remediation prior to the virtual simulation. Quiz is recorded as complete. LEARN F LOW – STEP T HREE  Launch the virtual simulation  Suggest student complete the vSim Tutorial prior to launching Step Three.  Each clinical experience in the simulation lasts a maximum of 30 minutes.  Student is to complete the simulation as many times as it takes to meet an 80% benchmark. LEARN F LOW – STEP F OUR  Complete the Post-Quiz  The answer key is not visible to the student until after they have submitted the quiz.  The quiz grade is recorded as a percentage LEARN F LOW – STEP F IVE  Document  The student documents the clinical events that occurred during the simulation using the information contained in step five.  If using DocuCare, the instructor assigns the same vSim patient which can be found in DocuCare cases. LEARN F LOW – STEP SIX  Reflection Questions  Students are to complete the reflection questions and submit to instructor post clinical replacement (see syllabus for details).  The quiz grade is recorded as a percentage CONCEPT MAP/ PLAN OF CARE Est. Time: 30 Minutes This activity creates an opportunity for you to organize the nursing care required for the patient care presented in your assigned vSim. STUDENT LEARNING O UTCOMES At the end of this activity, student will be able to: 1. Describe pathological events associated with the patient’s disease process or condition. 2. Create a plan of care and prioritized nursing interventions based on patient care needs. 3. Identify anticipated diagnostic and physical assessment findings related to the identified condition or disease process. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with Nursing Care, Diagnostics, and Pharmacology found in the suggested reading area. 4. Create the following “concept map”. List the pathophysiology associated with the patient’s disease process or condition, the anticipated physical assessment findings, vital signs, diagnostics, specific nursing interventions, and other patient information associated with the patient situation. 5. Utilize the smart sense links throughout the vSim to complete the worksheet. 6. Submit your concept map for review. CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) Chronic Obatructive Pulmonary Disease (COPD)- is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma or both. The airflow limitation or obstruction in COPD is not fully reversible. Most patients with COPD present with overlapting signs and symptoms of emphysema or chronic bronchitis, which are two distince disease processes. COPD is the chronic destruction of the lungs resulting in decreased gas exchange, leading to chronic air trapping and high CO2 in the body. In Emphysema damage to the alveoli result in loss of lung elasticity and loss of inflammation of lung tissue, resulting in loss of lung recoil and air trapping. In Chronic Bronchitis inflammation of the bronchi and excessive mucus production results in a chronic hacking cough and recurrent infections. COPD accentuates and accelerates these phyiologic changes. DIAGNOSTIC TESTS (Reason for Test and Results) Pulmonary function studies are used to help confirm the diagnosis. Spirometry is used to evaluate airflow obstruction. ABG lab test will show baseline oxygenation and gas exchange. Chest x-ray is maintained to exclude alternative diagnosis. CT is not routine but may be obtained in diagnosis of COPD but High resolution CT may help differential the diagnosis. Screening for alpha1 ANTICIPATED PHYSICAL FINDING PATIENT INFORMATION Henry Williams, 69 yo retired engenieer. Only son died 10 years ago, Married. History of smoking, recurrent colds, bronchitis, asthma, COPD, HTN, Anxiety, Dyspnea, hyperlipidemia. Has active case manager/ social worker working with him for placement in an apartment with assistive living. Cyanosis from hypoxemia. Cough with productive sputum Unusual lung sounds- crackles, wheeses, rales Edema peripherally- due to poor cirucaltion ANTICIPATED NURSING INTERVENTIONS Elevate HOB, teach oral hygiene before meals to wake up tastebuds, eat small frequent meals, eat high calorie and protein meals, avoid eating high amounts of carbohydrates, avoid exercise 1 hour prior to meals, conserve oxygen for chewing and swallowing, avoid gassy foods, no carbonated drinks, no high fiber foods (broccoli or beans). Increase fluid intake (8 glasses per day/ 2-3L/day) to thin mucus, avoid drinking while eating, Reportincreased sputum, fever, worsinging dyspnea. Vaccine Pneumococcal every 5 years, Flu every year. Educate Albuterol if short of breath to vasodilate the lungs and allow more airflow. For heavy mucus: Before bed mobilize secretions, take Guaifenesin, use a cool mist humidifeier at tnight to make breathing easier. Breathing: pursed lip breathing: inhale 2 seconds via nose (closed mouth) exhale 4 seconds with pursed lips. Educate on Huff Cough Technique: 1. Sit upright in a chair, feet shoulder width apart and lean forward 2. Deep slow inhalation through mouth using diaphragm muscle, 3.Hold breath for 2-3 seconds and then forcefully exhale. ISBAR ACTIVITY Est. Time: 30-60 Minutes This ISBAR activity assists you in building the skill of communicating pertinent information when caring for a patient. Appropriate actions you should do to complete this activity include finding appropriate data to provide a thorough ISBAR report. STUDENT LEARNING O UTCOMES At the end of this activity, student will be able to: 1. Identify pertinent data from the patient information area of the vSim suggested reading section. 2. Communicate pertinent information for a patient using ISBAR. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information area of the suggested reading section. 3. Review the smart sense links found within the Nursing Care, Diagnostics and Pharmacology areas of the suggested reading. 4. Navigate and fill out the data in the following document using the patient information provided in the suggested reading area. 5. Submit for review. VSIM ISBAR ACTIVITY INTRODUCTION Student Worksheet Jenn Phinney, RN, Respiratory Unit Your name, position (RN), unit you are working on SITUATION Patient’s name, age, specific reason for visit BACKGROUND Patient’s primary diagnosis, date of admission, current orders for patient ASSESSMENT Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs. RECOMMENDATIO N Any orders or recommendations you may have for this patient Henry Williams, 69 year old male, Admitted durning the night for shortness of breath, O2 was 82% on room air, Hx of COPD, hard of hearing- O2 88% on 2L via nasal cannula respirations between 24-30/min bp- 134/88, rr- 28, hr-112 ALLERGIES: PCN COPD, admitted during the night, orders bed rest with bathroom privileges, regular low fat diet, I & O, Respiratory Treatment- Albuterol nebulizer treatment 2.5 mg, ipratropium bromide 0.5mg in 3 ml of normal saline q 20 min X3, followed by albuterol 2.5mg, ipratropium bromide 0.5mg in 3L normal saline q2 hours (decrease frequency as tolerated). Oxygen per nasal cannula 2L/min. Lactated Ringers IV at 50 ml/h, CBC, BNP, BMP, ABG’s, Chest xray, There is increased respiratory effort, other than that there is nothing to find on head to toe assessment. There is normal skin turgor, other than that his skin is cool and he is very sweaty. Lung sounds= a lot of audible wheezes bilaterally, heart sounds normal, bowel sounds active Vital signs= Temp= 99.0, BP= 132/90, RR= 29, HR= 111- regular, SPO2= 82% via n/c Recommend sitting up, keeping head of bed elevated at or above 30 degrees, conserving energy to eat, resting, increasing fluid intake to thin mucus, take medications as ordered by physician, call physician if symptoms worsen PHARM4FUN Est. Time: 30 Minutes (per medication) This activity provides you with the opportunity to create pertinent patient education on the pharmacological agents associated with the vSim activity. You will utilize this worksheet for each drug listed under the pharmacology area of the suggested reading section. STUDENT L EARNING O UTCOMES At the end of this activity, student will be able to: 1. Explain purpose for taking the identified pharmacological agents. 2. Discuss pertinent patient education related to all the listed pharmacological agent. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your Learning Management System (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Pharmacological agents found in the suggested reading area. 4. Use the smart sense link to complete the following “patient education” worksheet for each pharmacological agent listed in the Pharmacology are of the suggested reading section. 5. Submit for review.. PATIENT EDUCATION WORKSHEET NAME OF M EDICATION , C LASSIFICATION AND I NCLUDE PROTOTYPE MEDICATION: ALBUTEROL SULFATE CLASSIFICATION: ALBUTEROL SULFATE= ADRENERGIC BETA 2 AGONIST PROTOTYPE: ALBUTEROL SULFATE IS THE PROTOTYPE DRUG FOR ADRENERGIC BETA 2 AGONIST SAFE D OSE OR D OSE R ANGE , S AFE R OUTE Albuterol= aerosol metered-dose inhaler- 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate) powder metered-dose inhaler- 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate); ProAir RespiClick powder metered-dose inhaler with electronic module- 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate); ProAir Digihaler- tablet- 2mg & 4mg- tablet, extended release- 4mg & 8mg- nebulizer solution- 1.25mg/3mL (contains 1.50 mg albuterol sulfate/3 mL)- 0.63mg/3mL (contains 0.75 mg albuterol sulfate/3 mL) syrup 2mg/5m PURPOSE FOR TAKING THIS MEDICATION Albuterol is used to prevent and treat difÏculty breathing, wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases such as asthma and chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways). Albuterol inhalation aerosol and powder for oral inhalation is also used to prevent breathing difÏculties during exercise. Albuterol inhalation aerosol (Proair HFA, Proventil HFA, Ventolin HFA) is used in adults and children 4 years of age and older. Albuterol powder for oral inhalation (Proair Respiclick) is used in children 12 years of age and older. Albuterol solution for oral inhalation is used in adults and children 2 years of age and older. Albuterol is in a class of medications called bronchodilators It works by relaxing and opening air passages to the PATIENT EDUCATION WHILE T AKING THIS M EDICATION Warn patient about risk of paradoxical bronchospasm and advise patient to stop drug immediately if it occurs. Teach patient to preform oral inhalation correctly. If prescriber orders mor than 1 inhalation, tell patient to wait at least 2 minutes before repeating procedure. Tell patient that use of spacer device with appropriate inhaler may improve drug delivery to lungs. If patient is also using corticosteroid inhaler, instruct patient to use bronchodilator first and then to wait about 5 min before using corticosteroid. Tell patient to remove canister and wash aerosol inhaler with warm soapy water at least once a week. Advie patient ot genly wipe it with dry cloth or tissue. Advise patient not to use more than prescribed and not to increase dose or frequency without consulting physician. Fatalities have been reported from excessive use. Instruct patient to report worsening symptoms. Advise patint not to chew or crush extended release tablets or mix them with any food. CLINICAL WORKSHEET This activity creates an opportunity for you to prepare for a virtual clinical experience. This activity provides you with the opportunity to manage patient care, prioritize interventions, and identify aspects of care that could be delegated. STUDENT L EARNING O UTCOMES At the end of this, student will be able to: 1. Describe pathological events associated with the patient’s disease process or condition. 2. Create a plan of care that is prioritized and is based on the patient’s care needs. 3. Identifies path to healing or health and path to death or injury. 4. Describes aspects of care that can be delegated and appropriate personnel to complete delegated tasks. ASSIGNMENT 1. Log into thePoint and launch the assigned vSim, following all instructions posted on your learning management system (LMS). 2. Review the information contained in the patient information. 3. Review the smart sense links associated with the Nursing Care, Diagnostics, and Pharmacology, found in the suggested reading area. 4. Complete all areas of the attached clinical worksheet. 5. Submit the completed worksheet. VSIM Criteria Content Knowledge 5 Points • Follows all requirements for the assignment. • Conveys well-rounded knowledge of the topic. WORKSHEETS GRADING RUBRIC 4 Points • Follows all requirements for the assignment. • Major points of topic are mostly covered in the required assignment areas. • Content well organized, logical. • Content organized, logical • Easy to read and flow. understand throughout all • Easy to read and of worksheet. understand through most of worksheet. Critical Thinking 3 Points • Knowledge of topic is partially covered. • Key information is missing from 2 or more assignment areas. • Worksheet difficult to follow in two or more areas. • Information is incomplete in two or more areas. • Major aspects of the • Explains each content content areas are area. presented, but content • Analyzes information, • Presents information about lacks insight and analysis. connects data points to the topic. • Few data points connected provide accurate, concise to provide information. • Some analysis, insight information. present, some data points • Scholarly work. threaded together. • Concisely explains each content area. 2 Points 1 point • Knowledge of topic is general in more than three areas of the worksheet. • One or more areas of worksheet left blank. • Content unorganized throughout worksheet. • Difficult to understand content of paper. Total Points • Knowledge of topic is general throughout entire worksheet, and/or does not cover all the required assignment areas. • Two or more areas • Left blank on worksheet. • Unable to follow flow of worksheet. • Few aspects of the content • Information is basic. areas presented. • No aspects of the content present in the worksheet. • Few insights presented, lacking analysis. • Lacks insight, analysis, and • Data points not connected conclusions. to information provided. • No understanding from the content presented. • Little Understanding gained from information presented. • Scholarly work. • Some minor errors (1-3 • Frequent errors (4-5 errors) with spelling, errors) with spelling, grammar and/or sentence grammar and/or sentence • Grammar, readability, and structure, not consistent sentence structure is error structure. throughout worksheet. free. • Errors effect ability to • Errors do not interfere with comprehend information the readability or present on worksheet and comprehension of readability. information. Writing Composition • An occasional spelling (Spelling, Grammar, Sentence Structure) error present. • Numerous errors (5-6 errors) with spelling, grammar and/or sentence structure throughout worksheet. • Excessive errors (>6 errors) occur with spelling, grammar and/or sentence structure, throughout worksheet. • Difficult to understand • Unable to understand information presented due to • information presented in the numerous errors. worksheet. TOTAL POINTS: _____ CLINICAL WORKSHEET Dat 07/06/2021 e: Initia HW ls: Ag 69 yo e: M/ male F: Code Status: does not say Assigned vSim: Diagnosis: HCP: Isolation: COPD exacerbation Does not say None Length of Stay: Henry Williams Part 1 IV Type: Critical Labs: Other Services Location: pH- 7.34 pco2-50 hco3-27 pco288 wbc-11,800 hgb-10 none Fall Risk: Does not say Consults: moderate Right wrist/upper hand Allergies: Penicillian None noted Transfer: None noted Fluid/Rate: Lactated ringers 50ml/hr Consults Needed: Respiratory therapy for patient educatin Why is your patient in the hospital (Answer in your own words and include the History of present illness)? From shortness of breath due to complications from COPD. He is unable to exchange gas the way his body needs and is trying to over compensate for the inadequate oxygen exchange. He has a history of COPD, chronic bronchitis, asthma, colds and is a former k History/Comorbidities (that relate to this hospitalization): history of COPD, colds, chronic bronchitis, asthma Health and a former smoker Shift Goals/ Patient Education Needs: 1. Ineffective airway clearance related to thick secretions as evidence by a lot of audiable wheezing, bilaterally. Long Term Goal= Patient will maintain clear open airways as evidence by normal breath sounds without wheezes by date of discharge. 2. Impaired Gas Exhange related to overproduction of secrections as evidence by increased rate of respirations. Short Term Goal= Patient will maintain a optimal gas exchange as evidence by oxygen saturation of 90% or greater by 14:30 on 7/06/2021. 3. Risk for infection related to retained secretions as evidence by cough and shortness of breath. Short Term Goal= Patient remains free of infection by edvidnece of normal temperature by 14:30 on 7/6/2021. Ineffective airway clearance related to smoking as evidence by dyspnea. Longterm goal= Patient will maintain clear open airway as evidence by ability to cough up secretions. 4. Path to Discharge: Auscultate lungs, assess for respiratory rate, depth, and use of assessory muscles. Assess secretions. Send sputum to lab for testing. Assess pulse ox and send labs for ABG testing. Assess lung function with spirometry. Administer medication. Encourage turn, cough, deep breathing exercises. Educate on chest splinting and huff coughing. Assist in mobilizing secretions by adding humidifier to room, administering mucolytic, preform chest physiotherapy, postural drainage, percussion, and vibration. Encourage increased fluid intake. Path to Death or Injury: hypoxemic respiratory failure (low O2), hypercapnic respiratory failure (high CO2), Complications of COPDRcan becomeRlife threateningRbeyond just shortness of breath and limitations of activities to include pneumonia, heart disease, hypertension, cardiac arrhythmias, and congestive heart failure. CLINICAL WORKSHEET Alerts: What are you on Alert for with this patient? (Signs & Symptoms) 1. Cyanosis- blue skin Management of Care: What needs to be done for this Patient Today? 1. Elevate Head of Bed 2. Unusual lung sounds (wheezing) 2. Teach huff cough technique 3. Edema (peripherally) 3. Encourage fluid intake What Assessments will you focus on for this patient? (How will I identify the above signs & symptoms?) 1. Skin assessment- looking for blueish skin 2. 3. Respiratory assessment- ausculatating the lungs 4. Assist in mobilizing secretions- humidifier to room, chest physiotherapy 5. Assess lung sounds, anxiety levels, and vitals 6. Administer medications as prescribed by physician Head to toe assessment- looking for edema List Complications may occur related to dx, procedure, comorbidities: 1. pneumonia Priorities for Managing the Patient’s Care Today 2. 2. 3. congestive heart failure Hypoxemia 1. 3. 4. Getting oxygen levels higher above 90% Lowering respirations within normal limits Getting ABG’s within normal limits Getting wheezing under control What nursing or medical interventions may prevent the above alert or complications? 1. Having patient turn,cough, and deep breath, or use huff cough technique to help remove secretions What aspects of the patient care can be Delegated and who can do it? 1. Giving fluids, PCA- can give ice and water and encourage drinking 2. Administering oxygen to promote circulation and maintain normal blood pressure 2. Oral hygiene- PCA can assist patient in oral hygiene as long as the patient is doing it himself 3. Administer oxygen and humidifier to room and keep head of bed elevated 3. eatting small frequent meals- PCA can assist in small meals and frequent feeding because patient does not have dysphagia. GRADING RUBRIC FOR DOCUCARE ENTRY: VSIM Purpose: This rubric analyzes the components of the electronic health record that students would utilize when documenting the care of a patient during a simulated event. Components: Each criterion contains performance criteria to demonstrate the critical thinking and clinical reasoning utilized during a simulated patient care encounter. The performance criteria describe the traits that are linked to a level of performance. There are four levels of performance as well as a “not applicable” column. The levels of performance indicate the degree to which the student documented the events of the simulated patient care situation. Using the Rubric:  Students: Prior to the simulation experience, the students can use the rubric to prepare for the documentation requirements associated with a simulated experience. The emphasis on thorough, systematic documentation of the nursing care provided during the simulation will facilitate clinical reasoning and critical thinking development. The student can utilize the rubric to perform a self-assessment of their documentation of the simulated events prior to submitting their DocuCare assignment. The rubric provides transparency related to the expectations for documentation and the grading of the student’s submitted work.  Faculty: The simulation documentation is only graded in whole numbers. The minimum accepted score is an 80%. The student will need to resubmit the simulation documentation if the total percentage is less than 80%. The student receives one attempt to remediate and edit their documentation. RUBRIC FOR GRADING VSIM CLINICAL WORKSHEET 5 3 1 0 Patient Information: Demographics, Diagnosis, Allergies, Provider, Consults, Isolation, Fall Risk, Intravenous Therapy, Critical Labs, Services and Needed Consults All documented areas 100% complete and provide thorough information. Three listed areas completed OR documented areas 75% complete. Less than three listed areas completed OR documented areas less than 50% completed. Patient information area blank. Medical History: Why patient is in the hospital, History of present Illness, Past Medical/Surgical History, Comorbidity Factors Patient Education/Goals: 100% of HPI, Past Medical/Surgical History and Comorbidity Factors completed with thorough, relevant information. 75% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information relevant to scenario. 50% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information basic and lacks relevancy. Thorough and detailed patient education. Patient shift. goals are SMART, relevant, and detailed goals. 100% of worksheet area is complete. Provides patient education but lacks thoroughness or details. Patient shift goals missing 1-2 components of SMART goals. 75% of information needed for worksheet area present. Patient education lacks thoroughness and details. Patient shift goals missing 3 – 4 components of SMART goals. 50% of the information needed for worksheet area present. 25% of HPI, Past Medical/Surgical History and Comorbidity Factors completed. Information not relevant, or content areas left blank Missing patient education and/or patient shift goals. Patient shift goals lack all components of SMART goals. 25% of the information needed for Disease Progression: Pathway to Death or Injury Pathway to Health Pathway to death and health is identified with detail. Information is concise, relevant, accurate and portraits appropriate timeframe for occurrence. 100% of the information needed for worksheet present. Pathway to death and health is identified. Information is relevant and accurate. Missing timeframe for occurrence. 75% of information needed for worksheet area present. Missing over 50% of needed information for worksheet area present. Pathway to death and health identified but content either not relevant or accurate for situation present in scenario. Pathway to death and health contains information not relevant or accurate to the scenario or section left blank. AACIP: Alerts, Assessments, Complications, Interventions and Prevention Alerts, Assessments, Complications and Interventions/Preventions identified thoroughly. Answers relevant to scenario. 100% of the information needed is present. Alerts, Assessments, Complications and Interventions/Preventions identified. Most answers relevant to scenario. 75% of the information needed for worksheet area present. Missing 2 – 3 areas on worksheet. Answers not relevant to scenario. 50% of the information needed is present. Missing 4 or more areas on worksheet. Answers not relevant to scenario. 25% of the information needed for worksheet area is present. Nursing Care Plan: Management of Care, Priorities for Patient Care, Delegation Management of Care is relevant to case scenario and detailed. Priorities for scenario are identified. Identifies all aspects of care that can be delegated and identifies appropriate personnel to delegate activities to. Answers detailed Critical thinking is evident. Management of Care, Priorities or delegation sections relevant to scenario. Answers generic to situation. Some evidence of critical thinking present. Missing relevant data in one or more categories (management of care, prioritization, delegation). Answers basic without detail. Little to no evidence of critical thinking present. Information provided not relevant to scenario. Answers are basic without detail. No evidence of critical thinking. Missing answers in one or more area. Shift Goals, Patient Education Needs TOTAL POINTS: LASATER CLINICAL JUDGMENT RUBRIC FOR VSIM FOR NURSING Purpose: This rubric analyzes the components of the stages of clinical judgment formation. It identifies multiple criterion and sub-criterion associated with the different levels of clinical judgement formation. The Lasater Clinical Judgment Rubric allows faculty to analyze student performances and identify what level of clinical judgment formation the student is exhibiting. Components: Each criterion contains performance criteria to demonstrate the clinical judgment level of performance related to the actions taken by the student during the vSim for Nursing simulated event. The performance criteria describe the traits that are linked to a level of performance. There are four levels of performance: Beginning, Developing, Accomplished and Exemplary. The levels of performance indicate the degree to which the student utilized clinical judgment during the vSim for Nursing activity. Using the Rubric:  Students: Prior to the simulation experience, the students can use the rubric to review the different levels of clinical judgment and the defining characteristics for the subcriterion found within the rubric. The student can utilize the rubric to perform a selfassessment of their clinical judgment skills after completing the vSim for Nursing activity. This self-assessment then can be compared with the instructor’s assessment of the student’s clinical judgment formation.. The rubric provides transparency related to the defining characteristics of the different levels of clinical judgment. LASATER CLINICAL JUDGMENT RUBRIC FOR VSIM FOR NURSING Dimension Effective Noticing Effective Interpreting Effective Responding Effective Reflecting TOTAL Exemplary (20-25) Accomplished (13-19) Developing (7-12) Regularly recognizes subtle changes and obvious changes in patient’s objective and subjective data Recognizes most obvious patterns and deviations in data; may miss the most subtle Identifies obvious patterns and deviations in data; missing some important information Focuses on the most relevant and important data; able to make sense of patterns, justify interventions Interventions are tailored for the individual patient; monitors patient and is able to adjust treatment as indicated; demonstrates safety at all times Evaluates and analyzes performance, elaborating on alternatives; accurately identifies strengths and weaknesses and develops specific plans to eliminate weaknesses Generally focuses and interprets the most important data but also attends to less pertinent data Completes interventions on the basis of relevant data; monitors patient but does not expect to have to change treatments; could improve accuracy Evaluates and analyzes performance, alternatives are identified; identifies strengths and weaknesses; could be more systematic in evaluating weaknesses Makes an effort to prioritize data and interpret, but attends to less relevant or useful data Completes interventions on the basis of the most obvious data; monitors progress but unable to make adjustments as indicated by the patient’s response Demonstrates awareness of the need for ongoing improvement; makes some effort to learn from experience but tends to state the obvious Beginning (0-6) Fails to collect important subjective and objective data; misses most patterns and deviations from expectations Appears not to know which data are most important; has difficulty interpreting or making sense of data Focuses on a single intervention; some monitoring may occur; unable to select interventions; demonstrates unsafe practice Appears uninterested in improving performance; is uncritical or overly critical of self; unable to see flaws or need for improvement Score /25 /25 /25 /25 /100