Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration

The Clinical Reasoning Evaluation Simulation Tool (CREST) was developed by Liaw et al. and is based on Levett-Jones et al.'s clinical reasoning cycle.

“The Clinical Reasoning Evaluation Simulation Tool (CREST) was developed by Liaw, et al. [25] and is based on Levett-Jones, et al. [4]’s clinical reasoning cycle.”

The original CREST includes 11 items, with the first 10 items grouped under eight domains using a five-point Likert scale (1-5).

“It includes a total of 11 items. Of which the first 10 items are grouped under the eight domains using a five-point Likert scale (1–5).”

As students' clinical experiences increase, their clinical reasoning levels also increase.

“These results demonstrate that as students’ clinical experiences increase, their clinical reasoning levels also increase.”

The original CREST has established construct validity, concurrent validity, and predictive validity, with high internal consistency (Cronbach's alpha 0.92) and interrater reliability (ICC 0.88).

“Construct validity, concurrent validity, and predictive validity have been established, with high internal consistency (Cronbach’s alpha of 0.92) and interrater reliability (intraclass correlation coefficient of 0.88) [25].”

CREST measures students' clinical reasoning level during simulations and provides feedback to students, recognizing and responding to patient condition deterioration.

“CREST measures the students ‘clinical reasoning level during simulations and provides feedback to students, recognizing and responding to patient condition deterioration.”