The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education

Clinical reasoning in undergraduate nursing education: a scoping review

Abstract OBJECTIVE This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. METHODS A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. RESULTS From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1) the experience of developing critical thinking/clinical reasoning/decision-making process; 2) teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3) measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4) relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5) theoretical development models of critical thinking/clinical reasoning/decision-making process for students. CONCLUSION The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.

Does a 3-week critical research appraisal course affect how students perceive their appraisal skills and the relevance of research for clinical practice? A repeated cross-sectional survey

BACKGROUND

Research utilisation is essential in developing evidence-based practices; although many students may be generally able to adopt such skills, there are reports of barriers related to critical appraisal skills.

OBJECTIVES

To explore how students perceive the relevance of research to future clinical practice and patients, and to what extent they read research (including reading pattern). Additionally, the objective was to explore whether a three-week intensive course in critical appraisal of research could affect these variables.

DESIGN

A cross-sectional survey design, with a pre- and post-test.

SETTINGS

One large university college in Southeastern Norway.

PARTICIPANTS

196 multidisciplinary healthcare students at baseline and 147 after three weeks.

METHODS

A purposely-designed 21 item questionnaire was used to quantify students' attitudes towards using research and critical thinking. The questionnaire was based on themes emerging from prior focus group interviews with 10 nursing and social educator students as well as from the existing literature.

RESULTS

At baseline, 6.1% and 7.1% of respondents perceived the research to be of little or very little importance for their future work and patients, respectively. Furthermore, 83.2% reported that they seldom or very seldom read scientific papers. At baseline, 40 different patterns of reading a scientific paper were identified. Additionally, 7.1% of respondents reported to read the introduction, methods and conclusion in combination. Significantly improved scores were found after completing the three-week course related to a) relevance of research for future work (p<0.01), b) self-perceived skills in critical appraisal (p<0.001), c) ability to find scientific papers (p≤0.01), and d) relevance of research for patients and users (p≤0.001).

CONCLUSIONS

Teaching students' practical critical appraisal skills improved their view of the relevance of research for patients, future work as well as their own critical appraisal skills. Prospective studies are warranted to explore the effects of such teaching modules in the long-term.

Learning to think like a nurse: the development of clinical judgment in nursing students

The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study.

Contribuição do curso especialização, modalidade de residência para o saber profissional

Objetivo: Analisar a contribuição do curso de especialização em Enfermagem, sob a modalidade de residência, para o saber profissional de egressos. Métodos: Pesquisa qualitativa realizada com 40 enfermeiros egressos do curso de especialização sob a modalidade de residência. As entrevistas foram realizadas, transcritas e analisadas conforme análise de conteúdo temático. Resultados: As informações foram agrupadas por similaridade em duas categorias: (1) desenvolvimento do saber profissional e (2) formação dedutiva/indutiva. A primeira permitiu identificar as seguintes contribuições proporcionadas pelo curso: embasamento teórico na realização das práticas, segurança no desenvolvimento do trabalho e identidade profissional. Já a segunda expôs contribuições proporcionadas pelo curso como visão ampliada da assistência para além do biológico e formação de um profissional capacitado. Conclusão: O curso contribuiu para o desenvolvimento do saber profissional dos egressos ao aprofundar o conhecimento técnico-científico de forma racional, crítica e reflexiva, com base na formação dedutiva/indutiva.

Cue-responding during simulated routine nursing care: a mixed method study

BACKGROUND

Failure of nurses to recognize, acknowledge, and/or explore patient cues/concerns may result in patients' unrecognized psychosocial and information needs that could have untoward consequences. With the continuous evidence of the need for nurses to improve their communication, a greater emphasis is needed in the undergraduate nursing curriculum on training students in such skills.

OBJECTIVE

This study is to explore the cue-responding behaviors of nursing students during their routine care of patients in a simulated setting.

DESIGN

A mixed methods approach.

PARTICIPANTS

Senior year students.

METHOD

Data was collected by video-taping the students' cue-responding behavior performance, through individual debriefing interviews, and from the student-patient actors' written comments and the focus group.

RESULTS

Of the 110 cues in the conversation, 47% were acknowledged, only 12% were explored, and 53% were responded to with distancing behavior. Students' cue-responding behavior was a negative 21.8% with more cues being responded to through distancing behaviors than were acknowledged. Their pattern of communication was characterized by a focus on task completion, the use of predominately close-ended questions, and the giving of explanations and information based on unchecked assumptions.

CONCLUSIONS

Learning from their individual video-taped performance and debriefing with facilitators helped the students to not only develop a deeper level of self-awareness and reflection but also caused them to think more about time, the culture of nursing, and the tension between task-focused and patient-centered care. They came to value cue-responding in communication as one way of learning about communicating with patients. Focusing on cue-responding in communication also provided us with insights on the students' understanding of communication and the need for educators to re-emphasize person-centered communication and to deal with issues that go beyond technical skills. Future research is critical to examine its transferability to practice with continuous coaching and role modeling for students in clinical settings.

The identity of the nursing academic: between education and research

This study aimed to analyze how nurses represent their role as nursing academics and their conceptions, strategies and feelings involved in teaching-learning and research in nursing. A qualitative study was conducted. To achieve this goal, a semi-structured interview was carried out with seven nurses who worked as teachers and researchers at a university in Barcelona, Spain. The data were analyzed through categories validated in a previous study with the support of The Atlas Ti program. The results evidenced that nurses are less equipped to develop the researcher role, and that the profession is not justified without a close relationship between nursing theory and practice. The nursing academics look for a balance between teaching and research and they also wish to promote the development of models and theories in their own discipline.

Exploration of the effects of peer teaching of research on students in an undergraduate nursing programme

The use of peer teaching has been recognised as a valuable teaching and learning strategy in higher education. It has been used in nursing as an adjunct to lectures and to support learning in clinical practice. Despite a developing literature there is limited understanding of its use for teaching about research. This educational project aimed to increase understanding of the effects of peer teaching of research in an undergraduate nursing programme. A convenience sample of 151 third year student ‘learners’ were recruited from three campuses across a School of Nursing, Midwifery and Health in Scotland. Students were asked to complete a questionnaire evaluating nine peer teaching sessions delivered by seven separate peer ‘tutor’ presenters, i.e. honours students (two students repeated their presentations). Five peer ‘tutors’ participated in a focus group to discuss their experience of teaching and personal learning. Results indicated that the student learners’ understanding of research and its relevance to clinical practice had been enhanced. These findings resonated with the peer ‘tutors’ intentions of helping other students to make that connection through the presentation of their work. In conclusion, peer teaching of research helped undergraduate nursing students learn about research and it assisted the peer ‘tutors’ to consolidate their learning, develop teaching skills and confidence.

Reading Ella: Using Literary Patients to Enhance Nursing Students’ Reflective Thinking in the Classroom

This action research study was designed to explore, in-depth, how 70 senior nursing students experienced an assignment that involved reading and reflecting on a short story, Ella, and the educator’s experience during the process. Four sources of data were collected: student reflections, field notes, a classroom process recording by an expert educator/observer, and a focus group interview. Four themes emerged: (1) student reflections revealed their inner, often hidden landscapes; (2) Ella prompted clarification of the past and/or triggered future projective thinking; (3) Ella clarified difficult-to-teach concepts; and (4) the interface between students’ thoughts and teacher responses provided a platform of connectivity. I propose that reading well-written stories may enhance students’ clinical reasoning skills and ethical comportment within the confines of a classroom. In addition, when students are introduced to literary patients like Ella, they can dwell with the characters at a more peaceful pace which, in itself, may encourage reflectivity.

Situational analysis of nursing education and work force in India

Nursing care has been mentioned in the Indian culture from the times of the Vedas. However, according to World Health Organization, the nursing workforce in India is still insufficient to meet the needs of the country. The purpose of this article is to examine the status of nursing education and the nursing workforce in India and the challenges faced by the profession. Data supporting the statements made in the article were obtained from the Nursing Council of India, the Ministry of Health and Family Welfare, the Government of India Web sites, printed journals and communication with experts in the field. In India, there is a need to train approximately a million nurses to meet the current shortfall of health workers in the country. The nursing "brain drain" suggests that it may be one of the factors responsible for this shortfall. Further, nursing education faces challenges, such as streamlining nursing education, enriching the curriculum, strengthening faculty development and increasing the use of innovative teaching and learning techniques.