Clinical reasoning in nursing students: A concept analysis

The mediating role of self-directed learning ability in the impact of educational environment, learning motivation, and emotional intelligence on metacognitive awareness in nursing students

PURPOSE

This study aimed to examine the mechanisms influencing metacognitive awareness among nursing students, encompassing educational environment, learning motivation, emotional intelligence, and self-directed learning ability. These findings could be a theoretical reference for formulating metacognitive awareness intervention strategies specifically designed for nursing students.

METHOD

Through stratified sampling, 600 nursing students were recruited from two universities in China. Data collection involved five self-report instruments: the Metacognitive Awareness Inventory, Medical Education Environment Evaluation Scale, Learning Motivation Scale, Emotional Intelligence Scale, and Self-Directed Learning Ability Scale. Confirmatory factor analysis was utilized to test the measurement model, while structural equation modeling utilized multiple indices to assess model fit. Bootstrapping was conducted to analyze total, direct, and indirect effects.

RESULTS

All study variables differed significantly according to age and year level (p < 0.01). Metacognitive awareness positively correlated with the educational environment, learning motivation, emotional intelligence, and self-directed learning ability ( r = 0.493-0.729; all p < 0.01). The test of the measurement model shows good reliability and validity. The model depicting factors influencing metacognitive awareness demonstrated a good fit (χ2/df = 2.42, SRMR = 0.048, RMSEA = 0.049, CFI = 0.947, IFI = 0.935). Path analyses revealed that educational environment (EE), learning motivation (LM), and emotional intelligence (EI) directly impacted self-directed learning ability (SDLA) ( βEE = 0.189, βLM = 0.436; βEI = 0.215; all p < 0.05). Moreover, educational environment and self-directed learning ability directly influenced metacognitive awareness (βEE = 0.224, βSDLA = 0.520; all p < 0.05). Lastly, the educational environment, learning motivation, and emotional intelligence influenced metacognitive awareness by self-directed learning ability.

CONCLUSION

Metacognitive awareness in nursing students rises with age and year level. Females exhibit more potent self-directed learning abilities than males. Educational environment, motivation, and emotional intelligence indirectly influence metacognitive awareness via self-directed learning ability. This finding has enriched the ways and perspectives of metacognitive awareness training for nursing students.

The impact of unfolding case studies combined with think-aloud strategies on the clinical reasoning and self-directed learning abilities of postgraduate students: A mixed methods study

AIM

To conduct unfolding case studies and test their effectiveness in improving clinical reasoning, teamwork and self-directed learning among postgraduate students.

BACKGROUND

Postgraduate students, as advanced nursing professionals in clinical settings, are the driving force behind the rapid development of the nursing profession. Effective clinical reasoning is a fundamental nursing skill that postgraduate students must cultivate, having a direct impact on patient health outcomes. The development and usation of unfolding case studies, which reflect the evolving conditions of patients, combined with think-aloud teaching methods, can enhance postgraduate students' clinical reasoning abilities and foster communication and self-reflection, thereby achieving this goal.

DESIGN

Mixed methods design.

METHODS

The Nurses' Clinical Reasoning Scale and the Nursing Students' Self-Directed Learning Ability Scale were used to evaluate the clinical reasoning and self-directed learning abilities of nursing students. A qualitative exploratory design with a think-aloud interview technique was employed to explore the clinical reasoning process of nursing students in unfolding cases. Twenty-one nursing students completed the questionnaire survey. Data analysis was conducted using Wilcoxon signed-rank tests, Spearman correlations, regressions and inductive content analysis.

RESULTS

After implementing the case study, there was a statistically significant improvement in students' clinical reasoning, self-directed learning and teamwork abilities. Think-aloud analysis revealed that the cognitive strategies most employed by students in clinical reasoning were 'Making choices', 'Forming relationships', 'Searched for information' and 'Drawing conclusions'.

CONCLUSION

Unfolding case studies combined with think-aloud strategies provide a conducive learning environment for postgraduate students, effectively enhancing their clinical reasoning and self-directed learning abilities.

Evaluating the effectiveness of illness script teaching on clinical reasoning skills in post-baccalaureate nursing students

BACKGROUND

Typically, nurse education curricula are separated into the teaching of theoretical knowledge and practical skills. This separation may hinder nursing students' development of clinical reasoning skills, making it difficult for them to prioritize tasks and make decisions about interventions. Illness scripts have been shown to help medical students improve their clinical reasoning skills; however, they are rarely used in nurse education.

OBJECTIVES

To evaluate the influence of illness script teaching method on post-baccalaureate nursing students' clinical reasoning skills.

DESIGN

The study adopted a single-arm quantitative pre-experimental research design and incorporated qualitative focus group discussions.

SETTINGS/PARTICIPANTS

This study was conducted at a university in northern Taiwan. Participants included 35 post-baccalaureate nursing students who were enrolled in an elective course focused on clinical skills.

METHODS

To enhance nursing students' clinical reasoning skills, illness scripts for five clinical scenarios were developed and implemented as part of their curriculum. The Nurses Clinical Reasoning Scale was utilized to assess self-rated clinical reasoning abilities, while dual-teacher scoring was used to evaluate clinical reasoning objectively. The VARK learning preference questionnaire was used to examine how learning preferences affect learning outcomes. After the course, semi-structured focus groups were held to collect student feedback on the effectiveness of the teaching methods and the learning outcomes.

RESULTS

This study's quantitative and qualitative results show that illness script-based teaching improves nursing students' clinical reasoning. Quantitative results showed significant objective reasoning score improvements. However, minimal changes in self-rated scores suggest a learning style-influenced gap between perceived and actual abilities. Qualitative findings showed that students valued linking clinical issues to practical applications but struggled with knowledge gaps and engagement.

CONCLUSIONS

The illness script teaching method improved students' understanding of clinical scenarios and enhanced their clinical reasoning abilities. Incorporating illness scripts into nurse education was beneficial for nursing students.

Clinical reasoning and clinical judgment in nursing research: A bibliometric analysis

AIMS

To characterize the thematic foci, structure, and evolution of nursing research on clinical reasoning and judgment.

DESIGN

Bibliometric analysis.

METHODS

We used a bibliometric method to analyze 1528 articles.

DATA SOURCE

We searched the Scopus bibliographic database on January 7, 2024.

RESULTS

Through a keyword co-occurrence analysis, we found the most frequent keywords to be clinical judgment, clinical reasoning, nursing education, simulation, nursing, clinical decision-making, nursing students, nursing assessment, critical thinking, nursing diagnosis, patient safety, nurses, nursing process, clinical competence, and risk assessment. The focal themes, structure, and evolution of nursing research on clinical reasoning and judgment were revealed by keyword mapping, clustering, and time-tracking.

CONCLUSION

By assessing key nursing research areas, we extend the current discourse on clinical reasoning and clinical judgment for researchers, educators, and practitioners. Critical challenges must still be met by nursing professionals with regard to their use of clinical reasoning and judgment within their clinical practice. Further knowledge and comprehension of the clinical reasoning process and the development of clinical judgment must be successfully translated from research to nursing education and practice.

IMPLICATIONS FOR THE PROFESSION

This study highlights the nursing knowledge gaps with regard to nurses' use of clinical reasoning and judgment and encourages nursing educators and professionals to focus on developing nurses' clinical reasoning and judgment with regard to their patients' safety.

IMPACT

In addressing nurses' use of clinical reasoning and judgment, and with regard to patient safety in particular, this study found that, in certain clinical settings, the use of clinical reasoning and judgment remains a challenge for nursing professionals. This study should thus have an effect on nursing academics' research choices, on nursing educators' teaching practices, and on nurses' clinical practices.

REPORTING METHOD

Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods.

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.

Relationship of high-fidelity simulation experience, clinical reasoning, and clinical competence of new nurses: A cross-sectional study

AIM

This study aimed to determine which high-fidelity simulation (HFS) experiences were associated with clinical reasoning and clinical competence among new nurses.

BACKGROUND

HFS has been actively used in nursing education. It is necessary to verify the effects of HFS transfer to the clinical environment.

DESIGN

A cross-sectional study reported following STROBE criteria.

METHODS

Data were collected on new nurses (n = 224) who experienced HFS in their fourth-year undergraduate courses. The number of HFSs, the inclusion of simulation elements, the importance of elements to learning, clinical reasoning, and clinical competence were measured. Hierarchical regression models examined factors associated with clinical reasoning and clinical competence.

RESULTS

Feedback was the most sufficiently included element of the HFS learning, and participants perceived it as the most important. A significant factor associated with clinical competence was clinical reasoning, and HFS design indirectly affected clinical competence through clinical reasoning.

CONCLUSIONS

HFS learning is one of the best ways to improve clinical reasoning. Improving students' clinical reasoning should be an important goal of HFS learning in undergraduate courses to prepare students to be clinically competent nurses.

IMPLICATIONS FOR NURSING

The ultimate goal of nursing education is to prepare nursing students to be competent nurses. Validating the outcomes of nursing education in the clinical environment setting is an essential task to improve clinical practice.

IMPLICATIONS FOR NURSING POLICY

Nurse educators and leaders can increase nurses' clinical competence by emphasizing education to foster nurses' clinical reasoning in nursing education policies.

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.

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.

Translation, Reliability, and Validity of the Japanese Clinical Reasoning Skills Self-Evaluation Scale: An Instrument Design Study

BACKGROUND

Currently, little evidence supports the notion that improved practical skills through simulation education are reflected in actual clinical practice and ultimately lead to positive outcomes for participants. However, by clarifying the relationship between the simulation foundation and its practicality, insights can be gained to develop educational programs to improve clinical reasoning skills. However, no clear scale is currently available in Japan.

AIMS

To create a valid Japanese version of the clinical reasoning skills self-evaluation scale and evaluate its reliability and validity.

METHODS

This instrument design study included 580 nursing students and nurses surveyed online from February to March 2023. The clinical reasoning skills self-evaluation scale was translated into Japanese using a back-translation method, and semantic equivalence and content validity were assessed. The content validity index was assessed using a pilot test involving 26 clinical nurses, 25 nursing students, and an expert panel. Validity and reliability were tested using a convenience sample of 580 nursing students and nurses. Reliability was assessed using internal consistency and test-retest reliability. Construct validity was assessed using confirmatory factor analysis.

RESULTS

Cronbach's alpha for all dimensions was >0.7, and the questionnaire showed acceptable internal consistency. Test-retest reliability was evaluated using the intraclass correlation coefficient (0.674-0.797, all dimensions); the lowest value at a 95% confidence interval was 0.504 (at least moderate reliability).

CONCLUSION

Our scale has acceptable validity and reliability. It may help in clinical reasoning skill assessment for nurses and nursing students and aid in examining and supporting these skills.

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.

The influence of occupational therapy students' preferred language on academic and clinical performance in a Canadian university program

The Occupational Therapy Program at this Canadian university is a French program however, students must be bilingual to function in English or French clinical fieldwork settings. An understanding of the role of language in successful completion of program requirements was needed to effectively support students' education. The study objectives were to identify the role of linguistic factors in students' academic and clinical performance and to provide recommendations for strategies to address areas of learning difficulty. A multimethod approach used 4 data sources: (1) Multiple Mini Interview (MMI) informal language assessment scores, (2) grade point average (GPA), (3) fieldwork evaluation reports, and (4) an online survey of program graduates. The GPA on admission and MMI scores of 140 students predicted respectively only 20% and 2% of the variation in GPA on program completion. The areas of poorest performance in failed clinical fieldwork reports were in clinical reasoning and communication competencies. Among survey respondents (n = 47), 44.5% reported that a clinical placement in their second language with related charting (51.6%) and client communication (40.9%) were the most significant difficulties encountered in the program. Clients with mental health issues (45.4%) were the most challenging population to work with, attributed to communication barriers in the students' second language. Strategies are proposed to support occupational therapy students' academic and clinical language proficiency, including conversational training courses, problem-based learning activities in students' second language, focussed teaching on the clinical reasoning process and reflective skills, and language coaching to address early signs of difficulty in clinical fieldwork.

Undergraduate nurses' reflections on visual thinking learning to construct inductive reasoning through situated patient pictures: A mixed-method study

BACKGROUND/OBJECTIVE

Deductive logic has often been used to develop critical thinking. However, inductive logical thinking, essential to care decision-making, has yet to be emphasized. This study aimed to explore visual thinking learning among undergraduate nursing students by asking them to draw situated patient pictures in order to integrate theoretical knowledge and promote inductive logical thinking.

METHODS

A mixed-methods research design was used to obtain quantitative and qualitative data from a convenience sample of 100 students. The study was conducted in a Taiwanese university from September 2022 to January 2023. In the quantitative component, learners' views of situated patient pictures were captured based on 15 paired identifiers and two questions: (a) What word should be used in describing the situated patient's picture? (b) How strongly do you feel about the selection? Written feedback was analyzed using qualitative content analysis.

RESULTS

Quantitative analysis identified specific, unpretentious, humorous, harmonious, conservative, realistic, rational, entire, image performance, professional performance, understandable, expressive, static performance, rigorous, and profuse with a reasonable degree of choice. Qualitative analysis identified four stages in participants' development of inductive reasoning through situated patient pictures and visual thinking learning. These were: exploration, intuition, theme, and logic and creation.

CONCLUSIONS

The results suggest that visual thinking learning is a practical pedagogical approach to increasing learners' communication abilities, group cooperation, theoretical knowledge integration, and logical thinking. Neither educators nor learners required any artistic skills. Nonetheless, participants demonstrated creativity and innovation through continuous visual thinking learning.

"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.

Clinical reasoning: What do nurses, physicians, and students reason about

Clinical reasoning is a core ability in the health professions, but the term is conceptualised in multiple ways within and across professions. For interprofessional teamwork it is indispensable to recognise the differences in understanding between professions. Therefore, our aim was to investigate how nurses, physicians, and medical and nursing students define clinical reasoning. We conducted 43 semi-structured interviews with an interprofessional group from six countries and qualitatively analysed their definitions of clinical reasoning based on a coding guide. Our results showed similarities across professions, such as the emphasis on clinical skills as part of clinical reasoning. But we also revealed differences, such as a more patient-centered view and a broader understanding of the clinical reasoning concept in nurses and nursing students. The explicit sharing and discussion of differences in the understanding of clinical reasoning across health professions can provide valuable insights into the perspectives of different team members on clinical practice and education. This understanding may lead to improved interprofessional collaboration, and our study's categories and themes can serve as a basis for such discussions.

Gender prediction based on University students' complex thinking competency: An analysis from machine learning approaches

This article aims to study machine learning models to determine their performance in classifying students by gender based on their perception of complex thinking competency. Data were collected from a convenience sample of 605 students from a private university in Mexico with the eComplexity instrument. In this study, we consider the following data analyses: 1) predict students' gender based on their perception of complex thinking competency and sub-competencies from a 25 items questionnaire, 2) analyze models' performance during training and testing stages, and 3) study the models' prediction bias through a confusion matrix analysis. Our results confirm the hypothesis that the four machine learning models (Random Forest, Support Vector Machines, Multi-layer Perception, and One-Dimensional Convolutional Neural Network) can find sufficient differences in the eComplexity data to classify correctly up to 96.94% and 82.14% of the students' gender in the training and testing stage, respectively. The confusion matrix analysis revealed partiality in gender prediction among all machine learning models, even though we have applied an oversampling method to reduce the imbalance dataset. It showed that the most frequent error was to predict Male students as Female class. This paper provides empirical support for analyzing perception data through machine learning models in survey research. This work proposed a novel educational practice based on developing complex thinking competency and machine learning models to facilitate educational itineraries adapted to the training needs of each group to reduce social gaps existing due to gender.

Development and Psychometric Testing of the Clinical Reasoning Scale Among Nursing Students Enrolled in Three Types of Programs in Taiwan

BACKGROUND

There is no instrument currently available to assess the essential nursing competency of clinical reasoning (CR).

PURPOSE

The purpose of this study was to develop and test the psychometric properties of CR assessment instrument appropriate for use with nursing students across different types of programs.

METHODS

H. M. Huang et al.'s (2018) Framework of Competencies of Clinical Reasoning for Nursing Students was used to guide this study. Two rounds of Delphi study and confirmatory factor analysis (CFA) were conducted to test content and construct validity. Internal consistency was tested for reliability.

RESULTS

The four-domain, 16-item Likert-scale Clinical Reasoning Scale (CRS) was developed. One thousand five hundred four nursing students currently enrolled in three different types of nursing programs completed the CRS. The content validity index was .85-1.0, the CFA indicated goodness of fit, and the Cronbach's α score range was .78-.89.

CONCLUSION

The CRS is a valid and reliable tool for assessing CR in nursing students in different types of nursing program.

Impact of Simulation on Undergraduate Student Outcomes

BACKGROUND

Clinical reasoning is a cognitive and metacognitive process that is essential for positive patient outcomes. Simulation experiences provide situations and reflection where students can build clinical reasoning.

PURPOSE

This study examined the impact of a higher number of simulation experiences on undergraduate student outcomes.

METHODS

A retrospective comparison study examined differences between group grade point average, Assessment Technologies Institute (ATI) predictor, and National Council Licensure Examination (NCLEX) scores ( P < .05). A sample of 395 students was included in data analysis.

RESULTS

No differences were noted in grade point average or NCLEX pass rates. However, students who completed a simulation elective had significantly higher ATI predictor scores. Cohen's d (0.39) approached a medium effect size.

CONCLUSIONS

Incorporating higher levels of in-person simulation through creative delivery models can improve student outcomes. Simulations may enhance students' clinical reasoning skills.

The Essential Elements of the Clinical Reasoning Process

BACKGROUND

Clinical reasoning is an important skill that enables health care professionals to identify and evaluate patients' real or potential problems, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes.

PURPOSE

The goal of this study was to go beyond individual professions and seek consensus across health care professions on the essential elements of the clinical reasoning process.

METHODS

This study used a traditional Delphi methodology to seek consensus from clinical reasoning experts from the fields of nursing, medicine, and physical and occupational health.

RESULTS

The experts reached a consensus on 56 essential elements identified from the clinical reasoning literature. This is the first time health care professions have reached a consensus on the essential elements of the clinical reasoning process using a Delphi study.

CONCLUSIONS

Achieving consensus on the essential elements of the clinical reasoning process is essential to better understanding, improved teaching, and evaluation of clinical reasoning skills.

Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis

Background

The COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students.

Method

A systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed.

Results

The search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective.

Conclusions

Virtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning.

Clinical judgement in nursing - An evolutionary concept analysis

AIMS

The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist.

RESULTS

This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion.

CONCLUSION

The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.