Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain

Background: The clinical judgment and decision-making abilities of nurses can influence many health outcomes, hence the importance of addressing these qualities in university studies. In this respect, clinical simulation is a commonly employed teaching method. The evaluation of simulation activities requires standardised instruments, such as the Lasater Clinical Judgment Rubric, which is widely used for this purpose, although a culturally adapted and validated version in Spain is not available. Aims: To obtain a Spanish culturally adapted and validated version of the rubric for undergraduate students of nursing. Design, Participants and Setting: Cultural adaptation and psychometric validation study carried out with undergraduate nursing students in the simulation laboratories at the University of Malaga (Spain). Methods: A process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. The rubric was empirically evaluated in standardised scenarios with high and medium fidelity simulators. Each student took part in two different simulation sessions, led by two instructors. In each simulation, the data were collected by two independent observers. Results: 152 observations were obtained from 76 students. The interobserver reliability was high, with an intraclass correlation coefficient of 0.93 (95% CI 0.92-0.95) (p = 0.0001) and Cronbach's alpha of 0.93. According to the confirmatory factor analysis, the fit of the model was satisfactory in all indices, with a chi(2)/df value of 1.08, GFI 0.96, TLI 0.99, NFI 0.97 and RMSEA 0.24 (90% CI 0.000-0.066). Conclusions: The rubric obtained is culturally adapted to the Spanish educational context, and is valid and reliable for nursing students. Further prospective studies should be undertaken to evaluate the responsiveness, potential for transfer to clinical practice and cost-benefit ratios of different simulation designs.