Measurement of critical thinking, clinical reasoning, and clinical judgment in culturally diverse nursing students - A literature review

Clinical reasoning skill of nurses working in teaching medical centers in dealing with practical scenarios of King's model concepts

BACKGROUND

The present study was conducted to determine clinical reasoning of nurses working in teaching medical centers in dealing with practical scenarios of King's concepts.

METHODS

The study population in this cross-sectional descriptive-analytical study comprised 133 nurses. Data were collected using scenarios based on the King's model. Data were analyzed in SPSS-16.

FINDINGS

Mean age of the participating nurses was 27.71 ± 8.1 years.The clinical reasoning score was less than average in most participating nurses, and had a significant relationship with education(P < 0.05), service ward(P < 0.001)and organizational position(P < 0.05). In the multivariate analysis of factors relating to clinical reasoning, higher education level (B = 9.5, P = 0.018) and organizational position (B = 4.3, P = 0.017) were predictors of clinical reasoning score.

DISCUSSION

Existing nursing models such as King's, which is closely related to clinical reasoning, can be used more in educational and clinical systems, and as a clinical guide for promoting the clinical reasoning of nurses and students.

The Lasater Clinical Judgment Rubric: 17 Years Later

BACKGROUND

Nearly 17 years ago, the Lasater Clinical Judgment Rubric (LCJR) was published to provide a common language and trajectory of students' development to think like a nurse.

METHOD

This article traces the uses of the LCJR from creation to the present and cites lessons learned from its use.

RESULTS

During the intervening years, the LCJR has been used effectively as a debriefing guide in simulation and as a research instrument, as well as for formative assessment. The LCJR has been translated or is in process in 19 languages besides English.

CONCLUSION

This article provides evidence of the efficacy of the LCJR and discusses important lessons learned. [J Nurs Educ. 2024;63(3):149-155.].

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review

OBJECTIVE

To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice.

DESIGN

Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment.

METHODS

Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics.

RESULTS

Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study.

CONCLUSION

In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

Enhanced Classroom Engagement: Implementation of an Inclusive Teaching Strategy

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic posed challenges to nursing faculties, including transitioning to a virtual teaching platform and ensuring inclusivity, active engagement, and social justice, which are the hallmarks of excellence in nursing education. A three-step teaching strategy called enhanced classroom engagement (ECE-TS) was created.

METHOD

The first step in ECE-TS required groups of students to read the assigned article and share five takeaways before class. The second step required each group to discuss and prepare a presentation using a rubric. The final step required each group to give a presentation to the class.

RESULTS

Students noted ECE-TS promoted (a) individual learning; (b) collective learning; (c) inclusivity; (d) connection among students; (e) change in the classroom environment; and (f) generated proposals for future directions related to ECE-TS.

CONCLUSION

ECE-TS, which is a promising strategy that promotes social justice, must be tested across teaching formats and programs. [J Nurs Educ. 2024;63(2):120-127.].

Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study

BACKGROUND

Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation.

METHODS

A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data.

RESULTS

Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability.

CONCLUSIONS

The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Nursing students' critical thinking and associated factors in Vietnam: A multicenter cross-sectional study

AIMS

This study aimed to evaluate the critical thinking abilities of senior nursing students in Vietnam and determine factors associated with their critical thinking disposition and skills.

BACKGROUND

Assessing critical thinking competence is crucial for determining senior nursing students' preparedness for entering the healthcare workforce and can be used to examine current nursing education's ability to cultivate nursing students' critical thinking. However, little research was found on critical thinking among Vietnamese nursing students.

DESIGN

A multicenter cross-sectional research design.

METHODS

A convenience sample of 533 senior nursing students from six universities in Vietnam participated in this study. All participants completed the online questionnaires, including basic information, a subscale of the Motivated Strategy for Learning Questionnaire (MSLQ), Critical Thinking Disposition Scale (CTDS), and Critical Thinking Self-Assessment Scale (CTSAS).

RESULTS

The mean score for the CTDS was 42.81 (standard deviation (SD) = 5.29), while the mean score for the CTSAS was 168.29 (SD = 44.43). Results of the multiple linear-regression analysis showed that an increase in self-study hours per day (B = 0.41, p = 0.007), higher self-efficacy in learning and performance (B = 0.26, p < 0.001), and a more-supportive environment (B = 0.97, p < 0.001) were predictors of critical thinking disposition. Moreover, an increase in self-study hours per day (B = 4.09, p = 0.001), higher self-efficacy in learning and performance (B = 2.65, p < 0.001), a more-supportive environment (B = 7.74, p < 0.001), and more experience with research (B = 7.03, p = 0.03) were predictors of critical thinking skills.

CONCLUSIONS

This study revealed that senior nursing students in Vietnam possess a moderate level of critical thinking abilities. Those students who dedicate more hours to self-study, demonstrate higher self-efficacy in learning and performance, experience a supportive environment, and engage in more research activities exhibit better critical thinking disposition and skills. The findings highlight the ongoing need to enhance critical thinking disposition and skills of nursing students in Vietnam. It is suggested that nursing faculty members should develop the appropriate strategies to improve nursing students' critical thinking disposition and skills.

Scoring Methods in Script Concordance Tests: An Exploratory Psychometric Study

BACKGROUND

Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods.

METHOD

An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods.

RESULTS

The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods.

CONCLUSION

Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549-555.].

The implementation of Tanner's Clinical Judgment Model and the Indonesian version of the Lasater Clinical Judgment Rubric in the clinical setting

A critical component for nurses to provide safe and quality care with strong patient outcomes is clinical judgment. This study aimed to identify the difference in the clinical judgment score in newly graduated nurses by implementing Tanner's Clinical Judgment Model. This study followed an experimental design with a pretest-posttest and involved thirty-two newly graduated nurses from three private hospitals in Indonesia. The intervention group had a scheduled post-conference with their preceptors using Tanner's Clinical Judgment Model's guidelines with high-level, open-ended questions for two consecutive weeks. Independent samples t-test was used to compare pre-and post-test scores utilizing the valid and reliable Indonesia version of the Lasater Clinical Judgment Rubric. There was no significant difference between the pre-test results of the intervention and control groups, with a significance value of 0.647. The results indicated a significant difference in the mean clinical judgment scores between the intervention and control groups after two weeks of intervention, where the intervention group's scores were higher than the control group's with a significance value of <0.001 with a mean difference of 6.75 and CI of 95 % (4.18-9.31). Tanner's Clinical Judgment Model showed a significant impact in increasing clinical judgment scores. The Indonesia version of the Lasater Clinical Judgment Rubric is a valuable tool for assessing and evaluating the development of clinical judgment and provides detailed targeted areas needing improvement. Preceptors and nursing leaders in the clinical setting should continue to use this model and tools to assist newly graduated nurses in developing clinical judgment skills during their transition period.

Trends and hotspots in critical thinking research over the past two decades: Insights from a bibliometric analysis

Critical thinking has received significant scholarly attention in education over the years. This study conducted a bibliometric analysis of critical thinking during the last two decades (2000-2021) to identify research trends and hotspots of critical thinking. After data processing, 2043 publications related to critical thinking were retrieved from the Web of Science (WOS). Our analysis covers the number of publications per year, most used keywords, most productive countries/regions, institutions and authors, and most cited publications. The results show that critical thinking received increasing interest throughout this period; the research topics of critical thinking were rich and constantly evolving; the publications in western countries/regions have a stronger impact and higher recognition than do those in non-western countries; and critical thinking instruction has become the most popular research topic. This study holds important implications and should serve as a reference for future research.

Assessment of the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale

BACKGROUND

The Critical Thinking Disposition Scale is a valid and reliable tool for assessing an individual's attitudes towards critical thinking. However, it is unclear if the scale can be used with Vietnamese nursing students.

OBJECTIVES

This study aimed to translate the scale into Vietnamese and examine the psychometric properties of the Vietnamese version of the Critical Thinking Disposition Scale (CTDS-V).

SETTINGS

Data were collected from senior nursing students at four universities in southern Vietnam in October and December 2022.

PARTICIPANTS

In total, 398 senior nursing students participated in this study.

METHODS

A cross-cultural adaptation of the CTDS-V was carried out with participants obtained through convenience sampling. Data were collected through an online survey. The study evaluated the validity of the CTDS-V by examining the content validity, concurrent validity, and construct validity, employing both Exploratory and Confirmatory Factor Analyses. The study also reported the internal consistency reliability using Cronbach's alpha and test-retest stability of the CTDS-V.

RESULTS

The CTDS-V had a good content validity index with a score of at least 0.85 for each item and an excellent overall content validity index of 0.96. Exploratory Factor Analysis identified two factors, critical openness, and reflective scepticism, with 11 items. Confirmatory Factor Analysis provided an acceptable fit model and supported the factor structure of the original scale. Cronbach's alpha coefficient of the scale was 0.88, and those of the two subscales were each 0.84. The test-retest stability of the CTDS-V was good with an intraclass correlation coefficient of 0.98 (95 % confidence interval = 0.96, 0.99).

CONCLUSIONS

This study indicated that the CTDS-V is a valid and reliable tool for assessing the critical thinking disposition of nursing students. The scale is short, rendering it feasible for regular use in education and research.

The Outcome-Present State Test Model of Clinical Reasoning to Promote Critical Thinking in Psychiatric Nursing Practice among Nursing Students: A Mixed Research Study

This study determined whether teaching intervention using the outcome-present state test (OPT) clinical reasoning model can effectively improve critical thinking in nursing students during a psychiatry internship. In addition, it evaluates the experiences of the students using this model in clinical practice.

METHODS

In this interventional study, 19 students were taught critical thinking skills using the OPT clinical reasoning model during a psychiatry clinical practice. Work-learning forms were used in daily 1 h individual and group discussions with students. The critical thinking disposition scale was completed by every student before and after the intervention. Moreover, the students were asked to the complete reflection experience forms.

RESULTS

The average critical thinking disposition pre-intervention score was 95.21, whereas the average post-intervention score was 97.05, indicating an increase of 1.84. There was a significant increase in the fourth dimension of open-mindedness (z = -2.80, p < 0.01). The learning experience has been likened to a process of clearing the fog, and it involves the use of limited known conditions, thinking outside the box, and adaptation to complex care issues.

CONCLUSION

Using the OPT clinical reasoning model as a teaching strategy during a psychiatric nursing internship significantly improved the open-mindedness dimension among the students. The student reflective experience of talking to teachers as peers helped students identify clues and reframe problems related to clinical care. Additionally, the students reported that this led to more harmonious interactions with their teachers.

Effects of Blended Simulation on Nursing Students' Critical Thinking Skills: A Quantitative Study

Introduction

Critical thinking is regarded as imperative to healthcare quality and patient outcomes; therefore, effective strategies in nursing education are required to promote students' critical thinking abilities, leading to their success in clinical work. Accordingly, simulation-based education has been suggested as a measure for achieving this goal.

Objective

The aim of this study was to explore whether a nursing education course with blended simulation activities (hands-on simulations with high-fidelity manikins and a web-based interactive simulation program) could increase nursing students' critical thinking skills.

Method

A quasiexperimental, one-group pretest and post-test design was utilized. Data were collected through premeasurement and postmeasurement using a critical thinking questionnaire and were analyzed using paired sample t-tests, independent sample t-tests, and the nonparametric Wilcoxon signed-rank test. The effect size was calculated using Cohen's d formula.

Results

Sixty-one nursing students (57 women and four men, mean age 30 years) participated in the study. Findings of the paired sample t-test showed a significantly higher mean score for posteducation than pre-education, indicating a significant change in nurses' critical thinking capabilities (p < .001). The results for Cohen's d formula ( - 0.87) of the mean scores between pre-education and posteducation indicated a large effect size. The Wilcoxon signed-rank test also showed a statistically significant increase in the students' critical thinking abilities between pre-education and posteducation measures (p < .001). No statistically significant differences were found in the mean score according to age or sex.

Conclusion

This study concluded that blended simulation-based education can increase nursing students' critical thinking capabilities. As a result, this study builds on the use of simulation as a measure for developing and promoting critical thinking abilities during nursing education.

Engaging the creative heArts of nurse educators: a novel conceptual model

OBJECTIVES

Nurse educators are increasingly challenged in preparing future nurses to be creative thinkers. The purpose of this innovative quality improvement initiative is to share nursing students' interpretations of the value arts-based pedagogy (ABP) brings to their nursing practice.

METHODS

Braun and Clarke's approach to thematic analysis was utilized to identify and report patterns of ideas within learners' interpretations of engaging in an ABP assignment.

RESULTS

The analysis of students' interpretations led to the creation of a novel conceptual model to encourage and support nurse educators in the use of innovative ABP approaches.

CONCLUSIONS

ABP can be seamlessly integrated within teaching and learning methodologies to cultivate meaningful student learning.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

The intent of the conceptual model is to encourage and support nurse educators in the use of innovative ABP approaches designed for engaging nursing students in active, creative, and challenging learning environments.

Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students

ABSTRACT

This article describes how an unfolding case study can be used to promote the development of clinical reasoning through students' self-reported perceptions, although at the same time facilitating collaboration among providers from various specialties. An unfolding case (evolving case) provides sequential information about a patient's illness trajectory as they experience the illness and related symptomology. An unfolding case study was implemented during a college skills laboratory immersion experience for 33 nurse practitioner (NP) students who were in their final year of the NP program. Students were invited per email to complete a confidential REDCap survey after the case presentation and discussion. Twenty-three students completed the survey. More than half of the students (52%) stated the review of the unfolding case offered "significant learning value" and 78% rated the unfolding case as being "very to extremely" helpful in creating opportunities for critical thinking and engagement in clinical reasoning. Implementing unfolding case studies in NP student program curricula promotes critical thinking, clinical reasoning, and allows opportunities to engage in interprofessional collaboration.

Development and application of an online learning platform for nursing ethics: A teaching practice research

BACKGROUND

It is crucial to diversify the methods for clinical nurses to continue learning nursing ethics in that ethical decision-making ability in nursing is regarded as one of the core competencies in nursing practice.

OBJECTIVE

In response to nurses' learning needs for nursing ethics, this study built an online learning platform for the pertinent topic, and tested its effect on improving nurses' ethical decision-making ability and critical thinking ability.

DESIGN

A qualitative method was adopted to develop interventions, which were designed as a teaching practice research consisting of a study group and a control group.

PARTICIPANTS

A total of 93 nurses, including 20 interviewees and 30 in the study group and 43 in the control group.

METHOD

Qualitative methods were employed to understand the learning needs of nurses. The judgment about nursing decisions and the critical thinking disposition inventory, learning effectiveness questionnaire and learning software quality evaluation scale were used as research tools in this teaching practice research. The SPSS 25.0 was adopted to analyze data by paired sample t-test and independent sample t-test.

RESULTS

In the measurement of the judgment about nursing decisions scale, the study group scored higher than the control group. The critical thinking disposition inventory scale identified a similar result in the total score incorporating the four dimensions, including analyticity, systematicity, critical thinking self-confidence, inquisitiveness. There is a correlation between learning software quality and learning effect, with a correlation coefficient of 0.640.

CONCLUSION

The online learning platform of nursing ethics built in this study has positive learning effects, and it demonstrates effectiveness to improve nurses' abilities in nursing ethics, decision-making and critical thinking. It is expected to be a viable way to improve the continuity of nurses' study of ethics.

A scoping review of clinical reasoning research with Asian healthcare professionals

Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

Development and evaluation of clinical reasoning using 'think aloud' approach in pharmacy undergraduates - A mixed-methods study

Introduction

Given the widespread use of clinical reasoning (CR) in the healthcare practice, it is essential to inculcate the CR practice in undergraduate pharmacy education which can not only facilitate their clinical education and clinical rotations but can also help them become better clinical pharmacists. There is very limited CR employed in the pharmacy curriculum and practice in the Middle East countries. This study aimed to develop and evaluate CR practice in pharmacy undergraduates in one college of pharmacy in Saudi Arabia.

Methods

We employed a mixed-methods methodology that included two phases. In Phase I, students were introduced to CR practice ('think aloud' method) and given geriatric clinical cases which they used in two sessions together with a tutor. This was followed by the writing of SOAP notes using the tutor feedback and completion of a survey that included a self-reflection about their experience of using the CR method. Phase II included face-to-face semi-structured interviews involving selected students that were recruited via convenience sampling to further explore the issues identified in Phase I of the study.

Results

Of the 155 students who completed the survey (response rate 94%), the majority of them agreed that CR using the 'think aloud' method was useful in gathering (92%) and interpreting (95%) relevant patient information, identifying medication-related problems (95%), exploring therapeutic options for the problem(s) (93%) and formulating a treatment plan for the patient (90%). Qualitative data analysis of the 12 interviews was consistent with these findings. Furthermore, it provided an insight into the challenges faced by the students in applying this CR method.

Conclusions

Students found the practice of CR using the 'think aloud' method helpful in working through given cases and taking clinical decisions. This method can be widely employed in pharmacy education and practice.

Subjective and objective nutritional assessment: nurses' role and the effect of cultural differences

BACKGROUND

Even though the nutritional assessment of chronically ill patients has a significant effect on outcomes, nurses' time constraints in clinical encounters may make the process impractical. Also, cultural background has an effect on nutritional assessment. Patient nutritional self-assessment can ease some of the nurses' workload.

OBJECTIVES

To compare tools for subjective and objective nutritional assessment and to examine cultural differences in nutritional assessment between Jews and Arabs living in Israel.

METHODS

The research design was cross-sectional; data were collected from Jews and Arabs with chronic illnesses living in the community during their visit to a public health clinic. The admitting nurse performed an objective nutritional assessment (Mini Nutritional Assessment (MNA)) after the patients completed the Subjective Nutritional Assessment (SANS). The data were analyzed using descriptive statistics, Pearson's correlation coefficients were calculated to test the relationships between the variables, and independent student t-tests were used to compare the means and differences between groups. The diagnostic accuracy of the MNA and of the SANS was determined using the area under the curve (AUC) analysis of receiver operating characteristic (ROC) curves. The agreement between the MNA and SANS measurements was estimated by a Bland Altman plot. The level of significance employed throughout the analysis was 0.05.

RESULTS

The sample was a convenience sample of 228 chronically ill patients, consisting of 121 Arabs and 107 Jews. A significant correlation was found between the subjective and objective nutritional assessments. The Bland-Altman plot demonstrated that the SANS and the MNA have a high level of agreement. Using the area under the curve (AUC) analysis of receiver operating characteristic (ROC) curves, showed an moderate diagnostic accuracy (73 % sensitivity and 30 % specificity).

CONCLUSIONS

Since the patient-completed nutritional assessment requires minimal time investment by nurses and we found a significant correlation and evidence for the accuracy and agreement of the objective and subjective assessments, further studies should assess and validate the possibility of replacing the objective nutritional assessment by the subjective assessment. Cultural background has a significant effect on patients' nutritional self-assessment; hence, culture should be considered as part of the nutritional assessment.

Clinical judgment performance of undergraduate Nursing students

Objective:

to evaluate the reported performance regarding clinical judgment by undergraduate Nursing students.

Method:

a cross-sectional study with the application of the Lasater Clinical Judgment Rubric-Brazilian Version in 166 undergraduate Nursing students from a Brazilian public university. The data were analyzed descriptively and analytically (by comparing the level of clinical judgment among students from the initial, intermediate, and concluding groups). The following tests were applied: Chi-square, Fisher’s Exact and Kruskal-Wallis, and a p-value of 0.05 was adopted. The reliability of the global instrument (Cronbach’s alpha) was 0.786.

Results:

of the 166 students, 65.7% evaluated themselves as proficient in relation to the reported performance on clinical judgment. Of the rubric’s 11 dimensions (focused observation, recognizing deviations from expected patterns, information seeking, prioritizing data, making sense of data, calm and confident manner, clear communication, well-planned intervention/flexibility, being skillful, evaluation/self-analysis, and commitment to improvement), only four groups did not present significant differences among them (p<0.05): focused observation, information seeking, prioritizing data, and calm and confident manner.

Conclusion:

the performance on clinical judgment reported as proficient was pointed out by 65.7% of the students and a significant statistical difference was verified in seven dimensions, among beginners, intermediate, and concluding students, compatible with the evolution of learning.

Effects of blended versus offline case-centred learning on the academic performance and critical thinking ability of undergraduate nursing students: A cluster randomised controlled trial

OBJECTIVE

This study aimed to compare the effect of blended and offline case-centred learning on medical nursing education for undergraduate nursing students.

BACKGROUND

Technological advancements are rapidly changing nursing education in higher educational settings. Educational reform, especially regarding methods of teaching, has been the focus of nursing educators in recent years.

DESIGN

The research was conducted between September 2018 and July 2019 in China.

METHODS

Second-year undergraduate nursing students in two classes were enrolled for this study by cluster sampling. The study outcomes were academic performance and critical thinking ability, measured using the Critical Thinking Disposition Inventory-Chinese Version.

RESULTS

Students in the experimental class showed significantly higher improvements in academic performance than those in the control class. Compared with the control class, the pre-post difference in competency in critical thinking self-confidence in the experimental class was significantly greater (p = 0.037). In the experimental class, there was a significant improvement over the baseline in the dimension of critical thinking self-confidence (p = 0.022). In the control class, there was a significant improvement over the baseline in the total score (p = 0.029) and two of the seven dimensions: truth-seeking (p = 0.016) and systematicity (p = 0.005).

CONCLUSIONS

The use of blended case-centred learning showed promising results in improving students' academic performance. Both blended and offline case-centred learning were indicated to be effective educational approaches to improve the critical thinking ability of undergraduate nursing students and could be implemented for other nursing subjects in the future.

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate

BACKGROUND

Nursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession.

PURPOSE

Using a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs.

METHOD

This was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI).

RESULTS

Scores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (β = 0.93, p < .01), CCTIDI (β = 0.13, p < .001), and class climate (β = 5.20, p < .01). An intraclass correlation coefficient was 55.48%.

CONCLUSION

This study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.

An academic-practice partnership during COVID-19 pandemic: Transitioning from a clinical to virtual fellowship

Aims

Discuss the needed modifications that occurred to the academic–practice oncology partnership during the COVID‐19 pandemic.

Background

To meet the workforce needs of nurses who care for adults with cancer, an academic–practice partnership was created in 2016. The University of North Carolina at Chapel Hill School of Nursing, North Carolina Cancer Hospital and UNC Lineberger Comprehensive Cancer Center collaborated to provide structured clinical and didactic practice experiences for undergraduate nursing students interested in oncology nursing. With COVID‐19, nursing students were not permitted to be in the clinical setting.

Design

Discursive paper.

Method

An innovative and collaborative partnership created reflective and interactive activities. The majority of the learning activities were created at the revised Bloom's taxonomy level of application or higher, with some encompassing multiple levels. Students engaged in a variety of meaningful experiences requiring multiple learning processes that promoted professional development in the interpersonal and critical thinking domains.

Conclusions

Despite the challenges of COVID‐19, the delivery of oncology nurse fellowship was successful because of innovative virtual strategies.

Relevance to Clinical Practice

Our academic–practice partnership allowed the nursing students to develop their interpersonal and critical thinking skills without entering the clinical site. This is an approach encouraged by the authors for other schools of nursing.

This manuscript is submitted as a Special Issue Discursive Article, and thus, the authors declare that an EQUATOR Checklist has not been used.

Development and Effects of Leukemia Nursing Simulation Based on Clinical Reasoning

While the effects of simulation education and the importance of the clinical reasoning process have been well-reported, an acute myelocytic leukemia (AML) patient-care simulation program has yet to be formulated exclusively for the clinical experience of students. This study developed and subsequently applied a simulation program based on clinical reasoning for AML to improve the learning outcomes and describe the learning experience for nursing students. Following a mixed-methods framework, the program’s effects on students’ knowledge were quantitatively measured, while their learning experience was qualitatively measured using self-reflection through journal writing. Differences in the pre- and post-scores between the experimental and control groups were statistically significant for theoretical knowledge and clinical performance. In addition, content analysis of both groups’ journals revealed three themes: (1) transformation into a self-directed learner for understanding the clinical situation, (2) increased awareness of clinical reasoning ability, and (3) embodiment of the clinical reasoning process. Standardizing the developed program’s scenarios prompted the participants’ compliance and engagement, and effectively achieved the learning outcomes. This simulation program aided the assessment of nursing intervention’s effectiveness and suggested objective criteria according to clinical reasoning. Similar programs involving other clinical cases, not exclusive to leukemia, should be developed and evaluated.

Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: Protocol for a Mixed Methods Systematic Review

BACKGROUND

Critical thinking is an essential skill that nursing students need to develop. Technological tools have opened new avenues for technology-supported guidance models, but the challenges and facilitators of such guidance models, as well as how they stimulate the development of critical thinking, remain unclear.

OBJECTIVE

We developed a protocol for a mixed methods systematic review to investigate the use of technology-supported guidance models that stimulate the development of critical thinking in nursing education clinical practice.

METHODS

A convergent integrated design following the Joanna Briggs Institute Manual for Evidence Synthesis will be employed. A pair of authors will select the articles by screening titles and abstracts, and the methodological quality of the articles included in the review will be assessed by a pair of authors according to checklists for specific study designs. The data will be extracted using the standardized Joanna Briggs Institute mixed methods data extraction form and following a convergent integrated approach. The thematic synthesis for data transformation will be used.

RESULTS

Development of a comprehensive systematic search strategy was completed in October 2020. The database searches were performed on October 21, 2020. As of January 2021, analysis and synthesis is ongoing. Completion of this review is expected by January 2021.

CONCLUSIONS

By combining evidence from studies with varied methodological approaches, the results should provide broad insight into the use of technology-supported guidance models for clinical practice in nursing education with a focus on the development of nursing students' critical thinking. The results of this mixed methods systematic review can also be used to develop or improve current technology-supported guidance models for clinical practice in nursing education.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/25126.

Nurse Educators' Perspectives on Implementing Culturally Sensitive and Inclusive Nursing Education

BACKGROUND

Nurse educators must be equipped to teach diverse students using culturally sensitive and inclusive nursing education (CSINE). The purpose of this study was to explore associate degree nurse educators' perceptions on implementing CSINE.

METHOD

This was a descriptive exploratory study. Associate degree nurse educators in a midwestern state completed an open-ended question survey that included dichotomous response questions to help participants self-reflect and respond. Follow-up interviews added further depth to the findings.

RESULTS

Four major categories emerged that helped answer the research questions: personalize approaches, consider resources, promote cultural diversity broadly, and use active teaching methods and strategies. In addition, participants provided descriptive comments about beginning benefits and outcomes of CSINE and gaining needed education regarding CSINE.

CONCLUSION

Participants indicated that learning about CSINE was an ongoing and necessary process for nurse educators. Categories emerging from the data provide guidance for educators in developing and sharing CSINE educational resources to promote positive outcomes for students and their patients. [J Nurs Educ. 2020;59(3):126-132.].

Case-based learning combined with science, technology, engineering and math (STEM) education concept to improve clinical thinking of undergraduate nursing students: A randomized experiment

Aims

The present study was conducted to apply and examine case-based learning (CBL) and Science, Technology, Engineering, and Math (STEM) education concept in the training of nursing student's clinical thinking.

Design

A randomized experimental design with non-equivalent group pretest-posttest.

Methods

Participants were requested to participant in either of the two programmes: traditional education programme as a control group or CBL combined with STEM education concept (the STEM group). Questionnaires of critical thinking, self-directed learning, self-efficacy were administered before and after the experiment.

Results

Differences between the STEM group and control group were observed in critical thinking, self-directed learning, self-efficacy and career choice over one semester. Accordingly, CBL combined with STEM education concept enhanced the nursing student's clinical thinking.

The impact of simulation-based triage education on nursing students' self-reported clinical reasoning ability: A quasi-experimental study

Few studies have comprehensively examined the effectiveness of simulation-based triage education on clinical reasoning of nursing students. This study evaluated the impact of a simulation-based triage exercise on nursing students' self-reported clinical reasoning ability. Three cohorts of third-year nursing students were divided into intervention group a (IG a, n = 62), intervention group b (IG b, n = 57), and a control group (CG, n = 53). Students in IG a and IG b participated in a simulation-based triage education consisting of 2 h of multiple patient triage simulations and an hour of structured debriefing. The CG participated in a traditional didactic triage course consisting of a 3-h lecture. Self-reported clinical reasoning ability in pre and post-triage education was measured by the Nurses Clinical Reasoning Scale. There was no significant difference in mean clinical reasoning ability scores between the three groups in pre-test (p > 0.05). Clinical reasoning ability scores in post-test among students in IG a and IG b were significantly higher than those in CG (p < 0.001). Nursing students exposed to a simulation-based triage education had more improvement in self-reported clinical reasoning ability as compared with students who participated in a lecture-based triage education program.

Critical Thinking With Diverse Students: The Effects of a Concurrent RN-BSN Program and Nursing Residency

Critical thinking is an analytical attribute for nurses to make accurate clinical decisions. This study examined critical thinking progression though a concurrent RN-BSN program and nursing residency for a diverse cohort of associate degree graduates. A pretest/posttest design revealed improvement in scores; however, no statistical significance was established. There was a statistically significant (p = .015) reduction in scores for a bilingual subset group in the subcategories of Prioritization of Care and Ethical Dilemmas. Future research is warranted to assess critical thinking progression and critical thinking test construction with diverse students.

Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

BACKGROUND

Critical thinking has been identified as one of the standards for nursing school accreditation and a long-standing outcome of nursing education and nursing practice. High-fidelity simulation is one method currently used by nursing programs to increase critical thinking in nursing students. Despite these expectations, there is limited empirical evidence which compares the effects of simulation to other teaching strategies.

OBJECTIVES

The purpose of this study was to examine whether statistically significant differences existed in mean critical thinking skill scores within groups (pretest to posttest) and between groups (simulation versus written case studies).

DESIGN

A quantitative causal-comparative methodology with a pretest/posttest design.

SETTING

A private university in the midwestern United States which offers a four-year Bachelor of Science Nursing program.

PARTICIPANTS

Baccalaureate junior nursing students (N = 69) were recruited from a convenience sample and divided into two groups which consisted of a simulation group (n = 36) and a written case studies comparison group (n = 33).

METHODS

This research study consisted of a pretest, three weeks of being in either the simulation group or the written case studies group, and a posttest. The Health Science Reasoning Test (HSRT) was the instrument used for the pretest and posttest to measure critical thinking skills of all participants.

RESULTS

A repeated measures mixed analysis of variance (ANOVA) indicated there was no statistically significant difference in participants' mean critical thinking scores within groups (pretest to posttest) or between groups (simulation versus written case studies).

CONCLUSIONS

The use of high-fidelity simulation as a teaching strategy versus written case studies to increase critical thinking skills of nursing students was not supported.

Education Strategies Supporting Internationally Educated Registered Nurse Students With English as a Second Language in Canada

INTRODUCTION

The purpose of this literature synthesis is to highlight some of the challenges faced by internationally educated nurses with English as a second language when integrating into the Canadian health-care environment and to suggest educational strategies that work to support these diverse learners to acculturate and fill gaps.Methodology: A search of Google Scholar, PubMed, CINAHL, MEDLINE, and ProQuest Nursing and Allied Health databases, as well as reference lists, conference presentations, and gray literature produced pertinent research studies and commentary published between 2008 and 2018.

RESULTS

Common themes in the literature include challenges relating to communication, cultural competence, and critical thinking.

DISCUSSION

Some strategies that should be included in bridging education programs to address these challenges are evolving case studies, simulation and role-play, and practice performing multiple-choice tests. Research is needed examining the effectiveness of experiential techniques in preparing internationally educated nurses for nursing in the Canadian context.

Nurse Preceptor Role in New Graduate Nurses' Transition to Practice

The transition to practice period is a challenging and demanding time for new graduate nurses. Leaving the structured environment of nursing school and entering professional practice can cause reality and transition shock for the new nurse resulting in unsafe patient care, as well as intention to leave their position or the profession. Successful transition to practice depends on the new nurse building confidence and gaining essential clinical reasoning abilities while orienting to their role. In critical care settings, patient care is more complex and fast-paced, which adds another dimension of overall stress to the new graduate. Structured orientation programs with trained preceptors have been found to be the most successful means of preparing new graduate nurses for clinical practice. Ensuring preceptors are provided with education related to the development of clinical reasoning is essential to successfully assist new nurses in their transition to practice. Safe and effective patient care, especially in the critical care unit, is dependent upon having nurses who are well prepared for their role through being provided guidance and support from trained preceptors.

A Review for Concept Clarification of Critical Thinking, Clinical Reasoning, and Clinical Judgment in Nursing Education

Purpose: This article is a comprehensive review for concept clarification of critical thinking, clinical reasoning, and clinical judgment, which still lack a consensus and are of mixed use. Methods: Norris's method of concept clarification was used to review concepts that have no clear definition or conceptualization yet. Results: This review summarized literature from various disciplines, classified each concept based on similarities and differences, and provided hypothetic conceptual schema. Conclusion: Clinical reasoning and clinical judgment are clinical situation specific concepts, while critical thinking is a concept applied in general situations. Critical thinking is a broader concept and serves as a foundation for clinical reasoning and clinical judgment. Clinical reasoning precedes clinical judgment. Clinical judgement implies the end point or conclusion of clinical reasoning. Each of critical thinking, clinical reasoning, and clinical judgment is a cognitive and affective process not a psychomotor process. The concept of clinical competency involves action taken after the cognitive processes of clinical reasoning and clinical judgment.

The effectiveness of a clinical reasoning teaching workshop on clinical teaching ability in nurse preceptors

AIM

To explore the effectiveness of a clinical reasoning teaching workshop (CRTW) in preceptors' teaching ability, self-efficacy of clinical reasoning teaching.

BACKGROUND

Preceptors' teaching skills are crucial for training novice nurses. How to enhance preceptors' teaching ability is a pertinent concern in clinical practice.

METHODS

This study comprised two stages. At stage I, we administered a pre- to post-test single group with 33 participants to investigate the changes in preceptors' knowledge and self-efficacy in clinical reasoning teaching after clinical reasoning teaching workshop. At stage II, a quasi-experimental design was adopted to assess the effectiveness of the clinical reasoning teaching workshop by comparing the preceptors' teaching ability by novice nurses. There were 22 nurses' preceptors who underwent the clinical reasoning teaching workshop and 70 nurses with preceptors who did not undergo clinical reasoning teaching workshop and matched with preceptors' age and working experience.

RESULTS

After clinical reasoning teaching workshop, preceptors' knowledge and self-efficacy of clinical reasoning teaching ware increased significantly. Novice nurses (study group) scored their preceptors' teaching ability significantly higher than nurses' (control group).

CONCLUSION

The clinical reasoning teaching workshop can enhance preceptors' teaching ability and confidence, thereby improving their teaching ability.

IMPLICATIONS FOR NURSING MANAGEMENT

A well-designed workshop with appropriated teaching method can allow preceptors to learn effectiveness. Clinical reasoning teaching workshop can be used in the training of preceptors.

Practice and effectiveness of "nursing case-based learning" course on nursing student's critical thinking ability: A comparative study

BACKGROUND

Case-based Learning was an effective and highly efficient teaching approach that was extensively applied in education systems across a variety of countries. Critical thinking ability is an important indicator for access the study ability for baccalaureate nursing education.

OBJECTIVES

The study aimed to explore the effect of "nursing case-based learning" course on the critical thinking ability of nursing student.

PARTICIPANTS

A total of 80 students who were in Junior were included in this study. The experimental group included 40 students who selected "nursing case-based learning" course. The control group included 40 students who selected the traditional teaching course.

METHODS

The critical thinking disposition inventory (CTDI-CV) was used to evaluate the effects of the critical thinking abilities during the 1st week (pre-test), the 9th week (mid-test), and the 18th week (post-test).

RESULTS

There are no statistically significant differences between two groups in the pre-test thinking abilities (P > 0.05). After nine weeks, the critical thinking abilities of experimental group were significantly higher than control group (P < 0.05). Three obtained time-points had statistically significant differences of control and experimental group (P < 0.05).

CONCLUSION

The "nursing case-based learning" was an effective course to develop the critical thinking abilities of nursing students. Strict instructional design was the guarantee for the smooth implementation of "nursing case-based learning" course.