An Integrative Review of Clinical Reasoning Teaching Strategies and Outcome Evaluation in Nursing Education

Debriefing to nurture clinical reasoning in nursing students: A design-based research study

BACKGROUND

Students' clinical reasoning can be stimulated by guiding them to use their experiences with patients to develop own illness scripts. Debriefing during hospital shifts invites students to put patient experiences into words, link them to previously acquired knowledge and make connections.

OBJECTIVES

To develop, implement and evaluate a debriefing procedure for nursing internships based on illness script theory and generate corresponding design principles.

DESIGN

Qualitative design-based research.

SETTING

Clinical education in dedicated educational hospital units.

PARTICIPANTS

Nurse educators, nursing students.

METHODS

From a collaboration between nurse educators and a researcher, a short, peer-debriefing procedure was designed, tested and enacted through four cycles of planning, action, evaluation and reflection. Students drew mind maps about patients. Nurse educators and students joined focus group discussions to evaluate outcomes and processes. Mind map and iterative thematic analysis were applied to these data.

RESULTS

An adjusted design and more extensive design principles resulted. Differences in mind maps were evident over time. Three themes in the process evaluation were established: trigger to reason; energy giving and taking; and form follows function.

CONCLUSIONS

This design-based investigation displays how nurse educators could design and implement a debriefing procedure to facilitate students' clinical reasoning skills and how students could learn from this. This method integrates research, innovation and collaboration. The design and enactment under real-life hospital conditions generated design principles for educators and researchers which may be useful for those seeking to improve teaching and learning clinical reasoning in practice. More clarification is needed about the path from design through enactment to real change in practice.

Promoting Safe Practice in New Graduate Nurses: The Key Role of Support

This article reports research that examined how registered nurses in practice develop clinical judgment in new graduate nurses (NGNs) and how NGNs respond. Teaching themes were setting the tone for learning, use of cognitive-focused teaching-learning strategies, including mentoring thinking, debriefing and reflection, and using real-life scenarios. NGN responses were learning focused, emotional, or resistant. Recommendations to support development of clinical thinking are made.

Beliefs and experiences of educators when involved in the design of a Learning-by-concordance tool: A qualitative interpretative study

BACKGROUND

Based on the involvement of qualified educators in its design, the Learning-by-Concordance tool aims to promote the learning of reasoning in contexts of uncertainty. However, data are still scarce on the experience of educators in terms of sharing and exposing their reasoning processes using this tool.

PURPOSE

This study sought to explore the beliefs and experiences of educators when involved in the design of a Learning-by-Concordance tool.

METHOD

This research used a descriptive qualitative design. Four dialogue groups were conducted with educators with different roles and responsibilities while designing a Learning-by-Concordance tool. A descriptive interpretative analysis of educators' verbatim quotes was done.

FINDINGS

A total of 14 participants took part in the study. The results show the discomfort of educators despite their recognized expertise. Three themes emerged: 1- the need to be reassured by the opinions of colleagues; 2-feeling like impostors; and 3- concerns for the quality of instructional supports.

CONCLUSIONS

The role taken by educators for teaching reasoning in contexts of uncertainty is to draw on practical experience where different types of knowledge intersect and are mobilized, to overcome feelings of insecurity, and to engage in close and authentic conversation with learners.

Teaching and Learning Clinical Reasoning in Nursing Education: A Student Training Course

Clinical reasoning is an essential component of nursing. It has emerged as a concept that integrates the core competencies of quality and safety education for nurses. In cooperation with five European partners, Instituto Politécnico de Setúbal (IPS) realized the "Clinical Reasoning in Nursing and Midwifery Education and Practice" project as part of the Erasmus+ project. As a partner, our team designed a multiplier event-the student training course. The aim of this report is to describe the construction and development of this clinical reasoning training course for nursing students. We outline the pedagogical approach of an undergraduate training course on clinical reasoning in 2023, which we separated into four stages: (i) welcoming, (ii) knowledge exploration, (iii) pedagogical learning, and (iv) sharing experience. This paper presents the learning outcomes of the collaborative reflection on and integration of the clinical reasoning concept among nursing students. This educational experience fostered reflection and discussion within the teaching team of the nursing department regarding the concept, models, and teaching/learning methods for clinical reasoning, with the explicit inclusion of clinical reasoning content in the nursing curriculum. We highlight the importance of implementing long-term pedagogical strategies in nursing education.

Evaluating a Shared Reflective Practice to Develop Nursing Student Clinical Judgment

BACKGROUND

Self-reflection is a valuable method that nurse educators can use to develop clinical judgment skills among prelicensure nursing students. Little research exists on improving clinical judgment in second-degree nursing students in the clinical setting.

PURPOSE

To determine the implications of increasing clinical judgment skills in prelicensure nursing students using a shared structured reflection teaching innovation within a required baccalaureate clinical course.

METHODS

This educational innovation used qualitative descriptive methods to evaluate its effectiveness in the clinical setting among students in the final semester of an accelerated prelicensure nursing program.

RESULTS

Students reported increased accountability for their learning, a sense of intentionality with their nursing practice, and a deeper sense of community with their peers.

CONCLUSIONS

Shared reflective practices in the clinical setting show promise for increasing clinical judgment and supporting a competency-based curriculum.

Comparative study of clinical reasoning competence and self-directed learning competence in nurses across varied years of experience

OBJECTIVES

To compare and analyse the differences in the clinical reasoning competence of nurses with different working years and their relationship with self-directed learning competence.

METHODS

A cross-sectional survey design (online investigation) was used. A total of 376 nurses were recruited from four independent hospitals in China. Online questionnaires collected data on nurses' demographic characteristics and assessed their clinical reasoning and self-directed learning competence. Pearson correlation analysis, t-test, analysis of variance (ANOVA) and multivariate regression analysis were used.

RESULTS

Clinical reasoning competence scores of nurses with working years >10 years were higher than those of other nurses. Self-directed learning competence scores of nurses with working years of <1 year and (from ≥1 year to <3 years) were lower than those of nurses with working years of 6-10 years and >10 years. Self-directed learning competence scores of nurses with working years of 3-5 years were lower than those of nurses with working years of >10 years. There was a positive correlation between clinical reasoning competence, self-directed learning competence and each dimension among nurses of different working years. There are differences in the influence of different dimensions of self-directed learning competence on clinical reasoning competence among different working years.

CONCLUSION

There were differences in clinical reasoning and self-directed learning competence among nurses with different working years. Self-directed learning competence is a positive predictor of nurses' clinical reasoning competence, which applied to nurses with all working years; however, the specific effect of self-directed learning competence on clinical reasoning competence differed among nurses with different working years.

IMPLICATION FOR NURSING MANAGERS

Nursing managers should pay attention to the development characteristics of clinical reasoning competence and self-directed learning competence of nurses with different working years and determine effective intervention strategies according to specific influencing factors.

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

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.

An integrative review of teaching strategies to support clinical judgment development in clinical education for nurses

OBJECTIVES

Historically, emphasis on task-completion and lack of intentional approaches that develop students' thinking skills have dominated clinical education. One contributing factor may be the limited literature about teaching to develop clinical reasoning and clinical judgment in the clinical environment. This integrative review accessed available literature to answer the question, What strategies are used to develop clinical judgment in the clinical education environment?

DESIGN

The Whittemore and Knafl approach framed the integrative review. The framework includes the following steps 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation.

DATASOURCES

The data bases CINAHL Plus with Full Text, OVID, and ProQuest were searched through the period of January 2000 through July of 2022.

REVIEW METHODS

The PRISMA protocol informed review and screening of the literature. Authors assessed articles for eligibility via first screening by abstract review, followed by review of the full text. Both authors reviewed the articles, assessing qualification for inclusion and evaluating the content. Data from eligible articles were analyzed and synthesized to answer the research question.

RESULTS

Of the initial 427 articles, a total of 20 articles met inclusion criteria for final analysis. Five general themes emerged for clinical judgment during clinical education. The findings identified the teaching strategies nurse educators use. Many of the teaching methods include deliberateness and intentionality in planning and implementing the strategies. In addition to evaluating clinical judgment, nurse educators guided and mentored student thinking. Finally, this review identified reported outcomes and results of the teaching strategies and methods.

CONCLUSIONS

A limited number of articles describing teaching for clinical judgment in clinical environment were found. The articles analyzed found that nurse educators used a variety of teaching strategies for the purpose of developing students' clinical judgment. More research is needed to guide best-practices in clinical education. We must move the science forward to transform and leverage clinical education more deliberately to teach thinking in practice and decision-making about patient care.

Psychometric properties of the persian version of the nursing clinical reasoning scale

AIM

The aim of this study was to translate the Nursing Clinical Reasoning Scale (NCRS) into Persian and evaluate its psychometric properties.

DESIGN

This study was a methodological and cross-sectional study.

METHODS

This methodological study was conducted in 2020 in a teaching hospital. After obtaining necessary permission from its developers, NCRS was translated into Persian through the method proposed by the World Health Organization. Then, its face, content, and construct validity and reliability were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 300 nurses (two 150-nurse samples), who had randomly been selected, completed the instrument. Reliability also assessed through the internal consistency and the stability methods. Data were analysed using the SPSS (v. 20.0) and the AMOS (v. 5.0) software.

RESULTS

The content validity indices of NCRS and its items were 0.97 and more than 0.79, respectively. Exploratory factor analysis revealed an assessment and confirmation factor and an implementation and reflection factor for the scale which together explained 57.30% of the total variance. Confirmatory factor analysis also confirmed this two-factor structure (χ2 /df = 2.11, NNFI = 0.952, RMSEA = 0.053, CFI = 0.91, GFI = 0.94, IFI = 0.95, and NFI = 0.96). The Cronbach's alpha and the intraclass correlation coefficient values of the scale were 0.96 and 0.94, respectively.

PUBLIC CONTRIBUTION

The Persian NCRS can help nursing policy makers and mentors identify the need for developing nurses' and nursing students' CR skills and implement need-based educational courses to improve these skills. Moreover, it helps determine whether the educational programmes are effective in improving nurses' CR skills and clinical competence.

Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

BACKGROUND

Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students.

METHODS

A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies.

RESULTS

Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies.

CONCLUSIONS

This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students' reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students' learning and improve their clinical reasoning and cognitive skills.

Transformation and Articulation of Clinical Data to Understand Students' and Health Professionals' Clinical Reasoning: Protocol for a Scoping Review

BACKGROUND

There are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence.

OBJECTIVE

The aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals' transformation and articulation of clinical data.

METHODS

This scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions.

RESULTS

After removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024.

CONCLUSIONS

By synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners' developing competencies and educational progress.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50797.

"Learning a Way of Thinking"-World Café on Clinical Reasoning in Nursing and Midwifery Education and Practice across Five European Union Countries

Clinical reasoning is a key attribute of nursing and midwifery professionals. As a part of the Erasmus plus project, we designed a study with the aim of exploring the understanding of clinical reasoning as a concept, experiences of teaching clinical reasoning and practices related to using clinical reasoning in nursing and midwifery. A qualitative study was carried out using the World Café method, involving 44 participants from five European countries. The participants represented diverse professional backgrounds, including nurses, midwives and lecturers. Our analytical approach was based on a thematic analysis. We categorized the data into three main categories, namely, "Spiral of thinking", "The learning and teaching of a way of thinking" and "Clinical reasoning in real life", all under an overarching theme, "Learning a way of thinking". This study highlighted areas of learning and teaching which can be improved in current nursing and midwifery education. Furthermore, it identified barriers, facilitators and practices from five European countries which can be used in the further development of nursing and midwifery curricula and courses with the aim of enhancing clinical reasoning competence and ultimately improving patient care.

Effects of electronic fetal monitoring simulation with problem-based learning on nursing students' performance confidence, clinical judgment, and knowledge

AIM

This study aimed to determine the effects of an electronic fetal monitoring simulation with problem-based learning (EFM SPBL) program based on the Clinical Judgment Model.

METHODS

Third-year nursing students were randomly allocated to the control (n = 46) or experimental groups (n = 46). The control group participated in the conventional clinical practice, while the experimental group participated in the EFM SPBL program. The students completed a structured questionnaire on Google surveys.

RESULTS

Nursing performance confidence (t = 10.72, p < .001) and clinical judgment (t = 2.53, p = .015) increased significantly in the experimental group.

CONCLUSIONS

This study recognized improvement in students' clinical judgment in the context of learning transfer. A standardized SPBL with various cases is recommended.

The impact of tutoring on nursing students' clinical judgment: A quasi-experimental study

BACKGROUND

Nurses' lack of clinical judgment often leads to adverse patient outcomes due to failure to recognize clinical deterioration, intervene, and manage complications. Teaching clinical judgment through a nursing process can help nursing students provide safe and competent patient care with improved health outcomes and to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

AIMS

The aim of this study was to examine the effect of tutoring on clinical judgment of undergraduate nursing students utilizing Lasater's Clinical Judgment Rubric (LCJR). This study also compared the clinical judgment of male and female nursing students and students from different semester levels.

METHODS

This quasi-experimental study utilized a single group pretest, posttest design. A convenience sample of n = 40 undergraduate nursing students from the Los Angeles County College of Nursing and Allied Health participated in the study. The participants underwent a pretest simulation, four sessions of the Clinical Judgment Model (CJM)-based tutoring, and a posttest simulation.

RESULTS

The posttest clinical judgment scores (35.70 ± 3.6) were significantly different from the pretest scores (25.78 ± 5.20). The tutoring had a significant effect on the clinical judgment of nursing students t(39) = -11.64, n = 40, p < .001, at 95% CI of the mean difference.

LINKING EVIDENCE TO ACTION

Enhancing nursing students' clinical judgment is crucial to provide high-quality, safe patient care with improved health outcomes. The CJM-based tutoring is an effective strategy for developing clinical judgment in nursing students. This new teaching approach can train students to critically think, develop clinical judgment, and prepare for the complex healthcare environment. Therefore, nurse educators should focus on integrating clinical judgment into the prelicensure nursing program curriculum as a priority.

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.].

Educational strategies used in master's and doctoral nursing education: A scoping review

BACKGROUND

Advanced practice nurses and future nursing researchers must be adequately educated with the best available evidence. However, we know little about educational strategies and their characteristics used explicitly to educate advanced practice nurses and future researchers.

METHOD

A scoping review was used to map the latest educational strategies used in master's and doctoral nursing education between 2011 and 2021. Components of educational strategies were extracted based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching and the Saskatchewan Education Department Framework of Professional Practice. The New World Kirkpatrick Model was used to categorize the associated learning outcomes. A narrative description approach was used to synthesize the findings.

RESULTS

A total of 56 studies were included. Several information was missing regarding the theoretical foundations of the educational strategies. A total of 158 educational strategies were identified. Individual work (e.g., homework) was the most popular educational strategy. Most studies assessed learning outcomes related to reactions (e.g., satisfaction) or learning (e.g., knowledge).

CONCLUSION

More studies should be done using interactive instruction or multimodal approaches, while the authors should better describe intervention components. A systematic review of effectiveness needs to be conducted to evaluate the best educational strategies in the master's and doctoral nursing education.

Effects of simulation with problem-based learning (S-PBL) on nursing students' clinical reasoning ability: based on Tanner's clinical judgment model

BACKGROUND

Clinical reasoning ability, a complex cognitive and metacognitive process, is a crucial core competency required in nursing practice. Therefore, undergraduate nursing students should be provided with nursing education to strengthen their clinical reasoning ability based on real-life nursing scenarios.

METHODS

This study was conducted using a quasi-experimental single-group pretest-posttest design. Three sessions (lasting three hours each) of Simulation with Problem-Based Learning (S-PBL) using high-risk obstetrics-gynecology scenarios were provided to 71 third-year nursing students of a university. The sessions were conducted from September to December 2022, and they aimed to strengthen their clinical reasoning ability. For data collection, an online survey was conducted using Rubric for Clinical Reasoning and learning satisfaction evaluation tool. Data were analyzed using descriptive statistics and repeated measures analysis of variance in SPSS.

RESULTS

The mean score of clinical reasoning ability significantly increased from 29.42 (standard deviation: 4.62) out of 40 points in the pre-test to 32.28 (4.36), 33.44 (5.35), and 33.80 (5.91) after the first, second, and third S-PBL sessions, respectively (F = 61.668, p < .001). The learning satisfaction score was as high as 107.04 (12.66) out of 120 points.

CONCLUSION

This S-PBL program is an effective nursing education strategy to strengthen nursing students' clinical reasoning ability. Future studies must examine learner variables and standardize the S-PBL design and operation process by comparison to a traditional teaching approach and a higher range of clincal reasoning ability.

Development and psychometric testing of a clinical reasoning rubric based on the nursing process

BACKGROUND

To facilitate the development of clinical reasoning skills in nursing students, educators must possess the ability to teach and evaluate them. This study aimed to describe the development and validation process of an analytic rubric of clinical reasoning skills based on the nursing process in undergraduate nursing students.

METHODS

A seven-step method was used for rubric development. The initial validation process of the rubric of clinical reasoning was performed with the participation of key stakeholders to assess its face and content validity as well as applicability in the classroom and bedside. An initial pilot test was performed based on scenario-based examinations in the nursing process training course so that convergent validity was used to show how closely the new scale is related to the previous measure for evaluating students' tasks. Internal consistency and inter-rater correlation coefficient measurement for reliability were assessed.

RESULTS

The rubric to assess clinical reasoning skills was developed into eight categories according to the five stages of the nursing process. Content and face validity of the rubric were done qualitatively and resulted in a clear, simple rubric relevant to clinical reasoning skills assessment. The convergent validity was confirmed by the conventional method. The reliability was approved by a high inter-rater correlation coefficient based on the assessment by two random independent raters.

CONCLUSION

The clinical reasoning meta-rubric developed in this study meets the purpose of the study. This analytical rubric can be applied to guide teaching and learning as well as evaluate clinical reasoning based on the findings. Testing the applicability confirmed its validity and reliability for assessing clinical reasoning skills in nursing process education during the undergraduate nursing program.

Current Practices for Teaching Clinical Judgment: Results From a National Survey

BACKGROUND

Safe patient care is closely linked to clinical judgment. Concerns about inadequate practice readiness and the impending inclusion of clinical judgment items on the NextGen NCLEX have resulted in increasing interest and publications about teaching clinical judgment. However, little is known about actual current practices for teaching this skill.

PURPOSE

This research describes findings about current strategies to teach clinical judgment used in US prelicensure nursing programs.

METHODS

Cross-sectional methodology was used to survey program deans and directors across the United States.

RESULTS

Programs are using multiple strategies to teach clinical judgment. The most common strategies used include case studies and simulation. Participants believed strategies have a positive impact on student thinking, practice readiness, and program outcomes. They described insights into implementation of teaching for clinical judgment.

CONCLUSION

The results of this research provide foundational data to inform current teaching practices and further research for this essential skill.

A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula

AIM

This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment.

BACKGROUND

Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used.

METHOD

A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models.

RESULTS

Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation.

CONCLUSION

Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.

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.

Implementation science in nursing education research: An exemplar

INTRODUCTION

Using evidence-based teaching approaches can improve nursing students' learning. However, variation in how - or if - these approaches are implemented by faculty and nursing educators is prevalent. A thorough, applied understanding of how evidence-based teaching approaches can best be implemented in the educational setting is lacking.

OBJECTIVES

The purpose of this project was to use an implementation science framework to implement and evaluate the quality of a doctor of nursing practice (DNP) course before and after implementing evidence-based revisions to course delivery and composition.

DESIGN

A pre/post design was used to evaluate course outcomes following implementation of evidence-based teaching approaches.

SETTING

A small, private university in the southeastern United States.

PARTICIPANTS

Students who enrolled in a DNP healthcare quality improvement course.

METHODS

An implementation science framework for integrating evidence-based teaching approaches was used to guide this project. Revisions were made to a DNP course, with evidence-based teaching approaches implemented using strategies including a dedicated course facilitator, faculty education, interactive assistance to course faculty, and detailed rubrics to ensure consistency in grading between sections. Outcomes included course evaluation scores, qualitative student comments, and student engagement measured via the average number of discussion board posts authored and read.

RESULTS

After using the implementation science framework to translate evidence-based teaching approaches, there was a statistically significant improvement in three course evaluation questions and the overall course mean. Qualitative comments showed that students found the revisions beneficial to their learning. There was no change in student engagement.

CONCLUSIONS

Using a structured implementation science framework and plan to translate and evaluate evidence-based teaching approaches resulted in significant improvements in course outcomes. Nurse educators should consider using an implementation framework to guide course revisions.

Development of a script concordance test to assess clinical reasoning in a pharmacy curriculum

INTRODUCTION

Clinical reasoning is a vital skill for student pharmacists in the provision of patient-centered care, but these skills are often difficult to assess in the didactic curriculum. A script concordance test (SCT) is an innovative assessment method that can be used to assess clinical reasoning skills. The objective of this study was to develop and refine an SCT to assess clinical reasoning skills of third year student pharmacists (P3s).

METHODS

An SCT was written and administered to P3s. Pharmacy practice faculty members served as the expert group. The SCT was scored and Rasch analysis was performed.

RESULTS

The SCT included 20 case vignettes and 60 questions. Test reliability was 0.34 with mean square values for all items between 0.7 and 1.3. Forty-two questions had a difficulty score between 0 and - 1 logits, indicating there were multiple questions with similar difficulty levels. Two case vignettes and 43.3% of questions (n = 26) were revised to enhance clarity and decrease ambiguity.

CONCLUSIONS

The SCT is a tool to assess clinical reasoning in the didactic curriculum. Faculty can create the SCT and use statistical methods such as Rasch analysis to assess validity and reliability of the SCT.

Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study

INTRODUCTION

Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills.

AIM

The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU.

DESIGN

A qualitative design was used.

METHODS

This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring.

RESULTS

The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively.

CONCLUSION

This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.

Improving the recognition and management of hemorrhage: A scoping review of nursing and midwifery education

BACKGROUND

Hemorrhage is a frequent complication that nurses and midwives must recognize and manage to avoid life-threatening consequences for patients. There is currently no synthesis of evidence on educational interventions in nursing and midwifery regarding hemorrhage, thus limiting the definition of best practices.

OBJECTIVE

To map the literature on nursing and midwifery education regarding the recognition and management of hemorrhage.

DESIGN

Scoping review based on the Joanna Briggs Institute guidelines.

DATA SOURCES

Quantitative studies evaluating the effect of educational interventions with students, nurses, or midwives published in English or French, with no time limit.

REVIEW METHODS

Study selection, data extraction, and quality assessment were conducted by two independent reviewers. We characterized educational interventions based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching. We categorized learning outcomes using the New World Kirkpatrick Model. Methodological quality appraisal was performed with tools from the Joanna Briggs Institute. Findings were synthesized using descriptive statistics and graphical methods RESULT: Most of the 38 studies used a single-group design (n = 26, 68%) and were conducted with professionals (n = 28, 74%) in hospital settings (n = 20, 53%). Most were of low (n = 14; 37%) or moderate (n = 18, 47%) methodological quality. Most interventions focused on postpartum hemorrhage (n = 34, 89%) and combined two or more teaching strategies (n = 25, 66%), often pairing an informational segment (e.g., lecture, readings) with a practical session (e.g., workshop, simulation). Learning outcomes related to the management (n = 27; 71%) and recognition of hemorrhage (n = 19, 50%), as well as results for patients and organizations (n = 9, 24%).

CONCLUSION

Considerable heterogeneity in interventions and learning outcomes precluded conducting a systematic review of effectiveness. High-quality, controlled studies are needed, particularly in surgery and trauma. Reflection on the contribution of nurses and midwives to the detection, monitoring, and management of hemorrhage could enrich the content and expected outcomes of hemorrhage education.

Does Self-Directed Learning with Simulation Improve Critical Thinking and Motivation of Nursing Students? A Pre-Post Intervention Study with the MAES© Methodology

Motivation and critical thinking are fundamental for the development of adequate learning. The purpose of the present study was to assess the motivation for learning and critical thinking among nursing students before and after self-directed simulation-based training using the MAES© methodology. A cross-sectional and descriptive quantitative study was conducted with a sample of third-year nursing students. The instruments utilized were the Spanish-adapted version of the Motivated Strategies for Learning Questionnaire (MSLQ-44), and the Critical Thinking for Nursing Professionals Questionnaire (CuPCPE). The students improved their levels both of motivation components, (such as self-efficacy, strategy use, self-regulation) and critical thinking components (such as personal characteristics, intellectual and cognitive abilities, interpersonal abilities and self-management, and technical abilities). These improvements could be a result of the intrinsic characteristics of the MAES© methodology (as a team-based, self-directed, collaborative and peer-to-peer learning method).

Effect of a guide for clinical reasoning on Nursing students' diagnostic accuracy: A clinical trial

Objective

to evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate Nursing students.

Method

a randomized, parallel and double-blind (researchers and outcome evaluators) clinical trial, carried out with undergraduate Nursing students. Validated case studies were applied in two phases to identify the patient’s Nursing diagnosis/problem, etiology and clues, using the Guide with the intervention group in the second phase. The outcomes - diagnostic and etiological accuracy and number of clues - were evaluated using validated rubrics. Descriptive statistics were used to analyze demographic data; Fisher’s exact test for similarities in prior education and confidence; Mann-Whitney’s test for age; and non-parametric ANOVA test in the evaluation of the hypothesis of differences in performance.

Results

final sample composed of 24 students in the control group and 27 in the intervention group; no difference as to gender, age and schooling. There was a difference in diagnostic (p=0.041) and etiological (p=0.0351) accuracy in the intervention group, showing a negative effect of using the Guide.

Conclusion

the one-time self-instruction was not effective in impacting the diagnostic accuracy of students solving case studies. Repeated application of the Guide as a teaching tool can be effective in improving such outcome. REBEC: RBR-4bhr78.

The Effectiveness of the Real-case Online-based Learning on Nursing Care Plan Self-efficacy

BACKGROUND: Online learning has become a new thing that is adapted and supports the learning process, including in nursing education during the COVID-19 pandemic. However, various studies report that there are limitations to conduct the online learning. AIM: The objective of the study was to identify the effectiveness of the real-case online-based learning in understanding the nursing care plan process and, self-efficacy from the students’ perspective. METHODS: Mix methods; explanatory sequential designs. One-hundred and fifty-seven respondents participated in the quantitative approach (64 students in the intervention group and, 93 students in the control group). Six students among the quantitative approach were participated in the qualitative approach. Mann-Whitney’s statistical approach was used for the quantitative approach, while Colaizzi’s method of data analysis was used for the qualitative approach. RESULTS: There was no significant difference between the control and treatment groups in the nursing care plan (p = 0.13) and student self-efficacy (p = 0.45). In addition, there were five themes identified by the students’ perspectives regarding the real case online learning, including; 1) opinions on learning, 2) the feelings experienced during the learning, 3) learning benefits, 4) learning barriers, and 5) expectations of learning. CONCLUSION: The real case online learning provides a different atmosphere including more interesting class, interactive interaction with the patients directly and providing positive experience for the students in the form of seeing the real cases online. The infrastructure/facilities (internet availability and stability) are important factors in the online learning process. The real case online learning is recommended as an alternative of learning that is more interesting and interactive involving the patients, students, and direct supervisors. Further research on the learning process of nursing care with a mixed system; limited offline and online cases with real, comprehensive, and interdisciplinary approaches are recommended.

Simulation-Based Learning Supported by Technology to Enhance Critical thinking in Nursing Students: Protocol for a Scoping Review (Preprint)

Background

Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students.

Objective

The proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students.

Methods

The proposed scoping review will use the framework established by Arksey and O’Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized.

Results

The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023.

Conclusions

The results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students’ reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students’ firsthand experiences and further development of successful teaching strategies in nursing education.

International Registered Report Identifier (IRRID)

DERR1-10.2196/36725

Challenges experienced by nursing students during the COVID-19 pandemic

PURPOSE

This study was conducted to assess the challenges faced by nursing students during the pandemic and to examine the factors affecting these challenges.

DESIGN AND METHODS

This qualitative study involved 344 nursing students at a university in eastern Turkey.

FINDINGS

Five main themes, each with its own subthemes, indicated the psychological difficulties experienced by students, insufficiencies and uncertainties regarding education, restrictions regarding social life, family conflicts, and the possibility to turn crises into opportunities.

PRACTICE IMPLICATIONS

The themes emphasizing the lives of nursing students showed that there was a need for important measures, such as psychosocial support, determination of best practices for online education, supporting students with telemental applications by university counseling centres, and organization of action courses.

Cross-cultural adaptation for Brazil and validity of a guide to assist nursing students' clinical reasoning

PURPOSE

To assess the validity of a Written Clinical Reasoning Prompt (WCRP) to help nursing students' clinical reasoning (CR).

METHOD

This is a methodological study of translation and cross-cultural adaptation into Brazilian Portuguese of instruments that aim to promote CR improvement, composed of (1) WCRP; (2) two case studies; (3) a questionnaire about students' perceptions during decision-making in case studies; (4) a scoring rubric for correcting case studies. For translation and cross-cultural adaptation, stages 1-8 of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Consortium Network were adopted. Agreement values among experts >80% and content validity coefficient (CVC) > 0.8 were considered satisfactory. For the pretest, a randomized clinical trial was carried out with 24 nursing students (intervention group, n = 14, using the WCRP to solve case studies; control group, n = 10, without using the WCRP).

FINDINGS

The WCRP was translated and adapted into Brazilian Portuguese, requiring minimal adjustments to obtain agreement among the judges above 80% and CVC above 0.80. Regarding face validation, an adequate agreement was obtained in the assessment by students. There was no difference in the accuracy of nursing diagnoses between the intervention and control groups in the pretest.

CONCLUSION

The WCRP was translated and adapted into Brazilian Portuguese and had adequate face and content validity estimates; however, there was no association with improving nursing students' diagnostic accuracy.

IMPLICATIONS FOR NURSING PRACTICE

The translated and adapted versions of all instruments into Brazilian Portuguese had adequate evidence of content and face validity. The use of WCRP was not associated with a significant improvement in nursing students' diagnostic accuracy. New studies with larger samples, a sample power of at least 80%, and a level of significance of 5% are needed.

Reasoning like a doctor or like a nurse? An integrative review protocol

INTRODUCTION

Clinical reasoning, a major competency for all health professionals, has been defined and studied 'within' each profession. We do not know if content, process and outcomes are comparable 'between' physician and nursing clinical reasoning. This paper aims to set up a protocol for an integrative review to analyse and synthesise the scientific nursing and medical clinical reasoning literature. It builds on the history of nursing and medical clinical reasoning research and aims to create a higher level of conceptual clarity of clinical reasoning, to increase mutual understanding in collaboration in patient care, education and research.

METHODS AND ANALYSIS

This integrative review follows stepwise the methods described by Whittmore and Knafl: problem identification, literature search, data evaluation, data analysis and presentation.The initial systematic and comprehensive search strategy is developed in collaboration with the clinical librarian and is performed in electronic databases, PubMed, CINAHL, PsycInfo and Web of Science from 30 March 2020 to 27 May 2020. Empirical and theoretical studies are included. This search will be accompanied by ancestry searching and purposeful sampling. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart will summarise the selection process. The quality of eligible studies will be evaluated with a checklist, suitable for diverse study methods.The data analysis is inspired by concept analysis of Walker and Avant and layered analysis of an intervention of Cianciolo and Regehr. We will extract the data of the included studies conforming these layers and features, to capture the multifaceted nature of clinical reasoning in both professions. The data will be presented in a validity matrix to facilitate comparing and contrasting.

ETHICS AND DISSEMINATION

Ethics approval is not required. The outcomes will be disseminated through conference presentations and publications.

Psychometric properties of a clinical reasoning assessment rubric for nursing education

Background

Clinical reasoning is a vital competency for healthcare providers. In 2014, a clinical reasoning assessment rubric (CRAR) composed of analysis, heuristics, inference, information processing, logic, cognition and meta-cognition subdomains was developed for osteopathy students.

Methods

This study was conducted to verify the validity and reliability of the CRAR in nursing education. A total of 202 case vignette assessments completed by 68 students were used for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s α coefficient of the CRAR was calculated.

Results

The content validity indices ranged from 0.57 to 1.0. The EFA resulted in three factors: assessment in nursing, nursing diagnosis and planning, and cognition/meta-cognition in nursing. The CFA supported a 3-factor model. The Cronbach’s α coefficient of the CRAR was 0.94. This study confirmed the content validity, construct validity, and reliability of the CRAR. Therefore, the CRAR is a useful rubric for assessing clinical reasoning in nursing students.

Conclusions

The CRAR is a standardized rubric for assessing clinical reasoning in nurses. This scale will be useful for the development of educational programs for improving clinical reasoning in nursing education.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00695-z.

Developing Students' Clinical Reasoning Skills: A Faculty Guide

BACKGROUND

Safe patient care relies on the ability of nurses to make timely, sound clinical judgments, yet new nurse graduates are underprepared. Nurse educators must take action with teaching to develop students' clinical reasoning skills and ultimately their clinical judgment. One first step is to consider strategies that integrate clinical judgment and clinical reasoning skills into nursing curriculum.

METHOD

The literature was reviewed to uncover what is known about teaching strategies that intentionally teach clinical reasoning skills and are focused on the development of students' clinical judgment.

RESULTS

Although not exhaustive, this guide for faculty discusses first steps when considering integrating clinical reasoning and judgment into nursing curriculum, presents teaching strategies, and provides ideas for implementation within nursing curriculum.

CONCLUSION

Teaching clinical reasoning skills, using a framework, and incorporating teaching strategies such as concept-learning, high-order questioning, and reflection focused on developing clinical reasoning skills may prove useful in developing students' clinical judgment. [J Nurs Educ. 2021;60(9):485-493.].

Virtual pedagogical strategies and HESI student outcomes in response to COVID-19

BACKGROUND

To maintain curricular integrity in response to COVID-19, nurse educators are increasingly required to transition from traditional (face-to-face) to virtual pedagogy.

OBJECTIVES

The purpose of this analysis was to compare the HESI scores based on a traditional pedagogy with the HESI scores following implementation of virtual pedagogy during Spring 2020.

METHODS

Student (n = 115; 81% female; mean age = 25.71 years) HESI scores were compared after each eight-week session using the Mann Whitney U test, permutation test and Wilcoxon rank test. Logistic regression was used to identify students achieving at least 850. Chi-square test was used to determine the relationship between pedagogy and students meeting 850 HESI scores. Fall 2019 Exit HESI scores were also compared with Spring 2020 Exit HESI scores.

RESULTS

Students from diverse backgrounds (53.9% White; 27.8% Hispanic; 10.4% Asian; 5.2% Black; 1% Unknown) increased (p = 0.022) M_HESI scores following virtual pedagogy in Fundamentals, although no difference was found in Maternity (p = 0.311), Psychiatric (p = 0.129) or Medical Surgical Nursing (p = 0.692). Wilcoxon rank test revealed significant differences in M_HESI scores in same cohort of students between traditional (Psychiatric) and virtual strategies (Medical-Surgical) (p < 0.01); and traditional (Medical-Surgical) and virtual (Psychiatric) strategies (p = 0.023). White students' M_HESI scores were higher than Asian students', as revealed by Logistic regression with no differences based on gender. Spring 2020 and Fall 2019 Exit HESI scores were comparable (p = 0.499). Chi-square analysis revealed no relationship between pedagogy and achieving at least 850 on HESI (χ² = 0.027, p = 0.871).

CONCLUSIONS

Based on the exit HESI scores, virtual pedagogy was as effective as traditional pedagogy for maintaining student competency in a community college associate degree nursing program. Future analyses of the effectiveness of virtual pedagogy in meeting curricular outcomes is warranted, regardless of exit degree option.

Using Board Games to Foster Clinical Reasoning Among New Graduate Nurses

Gamification has gained popularity among clinical nurse educators as a method to engage novice and experienced nurses in higher-level thinking. Classic board games can be cost-effectively transformed into educational games; however, it is important to use a clinical reasoning framework to ensure that learning outcomes focus on stimulating higher-level thinking. This article describes the development of a game as an innovative approach to designing new methods that better prepare new graduate nurses for current nursing practice. [J Contin Educ Nurs. 2021;52(9):413-416.].

Illness scripts in nursing: Directed content analysis

Aims

To explore the possible extension of the illness script theory used in medicine to the nursing context.

Design

A qualitative interview study.

Methods

The study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data.

Results

Through the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems.

Conclusion

The knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain.

Impact

Illness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.

The Effects of Computer-Based Simulation Game and Virtual Reality Simulation in Nursing Students' Self-evaluated Clinical Reasoning Skills

Research has shown that nursing students can learn clinical reasoning skills by engaging in simulation games. However, there has been no research regarding the effects of simulation games on clinical reasoning skills when nursing students also engage in virtual reality simulations. Furthermore, by engaging in simulation games, neither game metrics nor their impact on students' self-evaluated clinical reasoning skills has been studied. The purpose of this study was to evaluate the effects of these two kinds of simulation games using a one-group pretest-posttest design. Forty nursing students self-evaluated their clinical reasoning skills in three phases using the Clinical Reasoning Skills scale. Furthermore, the game metrics of the simulation games were analyzed, and the results clearly showed that students' self-evaluated clinical reasoning skills were systematically improved. There was a systematic association between better playing scores and better self-evaluated clinical reasoning skills in playing both kinds of simulation games. Moreover, students engaged more time in the virtual reality simulation than the computer-based simulation game. Overall, the results suggest that the use of a combination of both kinds of simulation games is an effective way for nursing students to learn clinical reasoning skills.

Three learning modalities' impact on clinical judgment and perceptions in newly graduated registered nurses: A quasi-experimental study

Newly graduated registered nurses face numerous challenges stemming from high patient workload, complicated interpersonal relationships, and a lack of nursing competence, which can lead to transitional shocks. Clinical judgment and confidence are well-known keys to successful role transitions for these nurses. Simulation training is proposed as a new modality for enhancing comprehensive clinical competence of nurses, but current evidence on the impact of different simulations on nurses' clinical judgment and confidence are still limited or inconsistent. This study compared the impact of three types of learning modalities on newly graduated registered nurses' clinical judgment, perceptions of self-confidence, and evaluations of the design features of the learning modalities. A quasi-experimental design was used. Fifty-nine participants were randomly assigned to three groups: (1) high-fidelity simulation, (2) virtual simulation, and (3) case study. Scales were used after the simulation. The virtual simulation group showed a higher level of clinical judgment. The high-fidelity simulation group felt more confident than the virtual simulation and case study groups. Both the high-fidelity simulation group and virtual simulation group reported higher scores in the domain of fidelity.

Assisting Learners to Understand and Incorporate Functions of Clinical Judgment Into Nursing Practice

BACKGROUND

Mastering clinical judgment (CJ) skills is an essential competency for nurses in all health care environments.

PROBLEM

Complexities of the health environment combined with the intricacies of nursing practice can pose potential risks to client safety.

APPROACH

Over a 2-year period, a 3-phased approach using (1) survey results from nurses in education and practice, (2) discussion forums, and (3) a series of think tanks that comprised nurse educators resulted in the development of the Guide for CJ.

OUTCOMES

The Guide for CJ provides nurse educators with an evidence-based resource to promote CJ skills in nursing students. The environmental and individual factors and expected nurse responses and behaviors contained in the Guide are well-aligned with the cognitive operations contained in the National Council of State Boards of Nursing Action Model.

CONCLUSIONS

Educators may use the Guide to support faculty development and operationalize CJ to develop a variety of learning strategies for use in multiple learning environments.

Script Concordance and the Think-Aloud Approach Through the Lens of Cognitive Apprenticeship Theory

BACKGROUND

Script concordance (SC) and the think-aloud (TA) approach informed by cognitive apprenticeship theory can promote clinical reasoning.

PURPOSE

The purpose of this study was to determine whether SC with the TA approach based on the tenets of cognitive apprenticeship theory facilitated clinical reasoning in senior-level prelicensure nursing students in a baccalaureate program.

METHODS

This study was executed in a didactic pediatric nursing course using a quantitative, nonexperimental design. Creation of the SC/TA learning activity was grounded in cognitive apprenticeship theory and based on the SC testing/TA testing method.

RESULTS

Repeated-measures analysis of variance revealed a difference (P = .001 and .003) between earlier and later SC scores for the fall 2018 cohort.

CONCLUSION

The SC/TA teaching/learning activity informed by cognitive apprenticeship theory offers a leveled approach to foster clinical reasoning in prelicensure nursing education.

Nursing students on the frontline: Impact and personal and professional gains of joining the health care workforce during the COVID-19 pandemic in Spain

BACKGROUND

Final-year nursing students in Spain augmented the health care workforce during the COVID-19 pandemic.

PURPOSE

To understand the lived experience of nursing students who joined the health care workforce during the first wave of the COVID-19 outbreak (March-May 2020).

METHOD

Qualitative content analysis of the reflective journals of 40 nursing students in Spain.

FINDINGS

The analysis identified four main themes: 1) Willingness to help; 2) Safety and protective measures: Impact and challenges; 3) Overwhelming experience: Becoming aware of the magnitude of the epidemic; and 4) Learning and growth.

DISCUSSION

The wish to help, the sense of moral duty, and the opportunity to learn buffered the impact of the students' lived experience. Despite the challenges they faced, they saw their experiences as a source of personal and professional growth, and they felt reaffirmed in their choice of career. Promoting opportunities for reflection and implementing adequate support and training strategies is crucial for building a nursing workforce that is capable of responding to future health crises.

BASIC LIFE SUPPORT: KNOWLEDGE ASSESSMENT CONSIDERING THE ARTICULATION OF ACTIVE TEACHING STRATEGIES

ABSTRACT Objective: to assess the effect of an educational intervention called “Basic Life Support with the use of the automated external defibrillator” on knowledge development in Nursing professionals, considering the articulation of active teaching and learning strategies. Method: a quasi-experimental intervention study, without a control group and of before-and-after type, carried out with 113 nurses working in the Urgency and Emergency Network of an inland city in the state of São Paulo, through a course presented between March and June 2019 on cardiopulmonary resuscitation with Basic Life Support and use of automated external defibrillator. Three active teaching and learning strategies were articulated: inverted classroom, video lesson, and clinical simulation. Knowledge was assessed by applying a pre- and post-test, and the paired t test was used for the analysis. Results: the best performance regarding knowledge development was presented by the nurses from the hospital area, identifying a mean of 11.90 points in the pre-test and of 16.9 points in the post-test. In general, better scores of knowledge regarding Basic Life Support were obtained, evidenced by statistically significant results, with a p-value<0.001. Conclusion: the articulation of the adopted strategies can enhance knowledge development in Nursing regarding Basic Life Support in adult patients, due to the emphasis on the development of critical thinking, the encouragement of clinical judgment, reflective discussion and active participation of individuals in their learning process, factors that positively impact on the acquisition of the individuals' cognitive ability/knowledge.

Nursing fundamentals - supporting clinical competency online during the COVID-19 pandemic

During the Spring of 2020, due to the COVID-19 pandemic, many schools of nursing were challenged to change their educational delivery methods from a face-to-face to an online format. This article discusses educational strategies utilized to support clinical competency using an online format for a fundamentals of nursing clinical course. Discussions of regulatory considerations, faculty planning, and teaching pedagogy utilized during this transition are presented. The authors also discuss future implications and suggestions for attaining learning objectives for a clinical course using an online format.