Abstract:

The actual context of increasingly complex care requires a high level of clinical nursing reasoning. Although teaching and learning clinical reasoning remains a challenge for nurse educators (Benner et al, 2010). When using a second generation competency based approach (CBA) to nursing education (basic-continuing) (Goudreau et al, 2009), it is essential to rely on a rigorously conceptualized cognitive learning model (CLM) for every competency (NRC, 2001). A crucial competency for nursing practice that must be closely linked with caring, clinical nursing reasoning (CNR) is one CLM that is urgent to develop. Indeed, although several studies have been conducted to understand CNR (Simmons, 2010), neither its developmental stages nor the required milestones of each stage have been uncovered. A study was conducted to develop the CLM of the CNR, from the beginning of education through to expertise, highlighting the critical milestones corresponding to each competency stage. A qualitative methodology using the “think aloud” technique was done. Fifty students and practising nurses were invited to think aloud during individual interviews using five scenarios validated in a previous study. Participants were: 1) 10 students who have successfully completed two semesters of a six-semester baccalaureate program; 2) 10 students who have successfully completed four semesters; 3) 10 students at the end of the program; 4) 10 nurses with 12 to 18 months of clinical experience (“critical” stage of integration into the profession); and 5) 10 nurses recognized by their peers as displaying solid clinical reasoning (at least five years experience with clients) were interviewed. Analysis was done using the protocol analysis method to identify the critical milestones and the related stages. Besides identifying obstacles like task oriented role modeling that is actually very present in the clinical environment, results showed that in order to start developing CNR the students must internalize the idea of the nurse as a scientific practitioner and learn to read the scientific literature; after, they have to learn to do iterations from data collected to hypothesis to data in order to make the best decisions for the patient’s care. Recommendations for teaching and learning clinical reasoning during basic and continuing education of nurses will be discussed with the audience.

References:
Benner, P, Surphen, M, Leonard, V, & Day, L 2010, Educating Nurses. A Call for Radical Transformation, Jossey-Bass, San Francisco.
Goudreau, J, Pépin, J, Dubois, S, Boyer, L, Larue C & Legault A 2009, “A second generation of the competency-based approach to nursing education”, International Journal of Nursing Education Scholarship , vol 6, article 15 .
National Research Council 2001, Knowing what students know. The science and design of educational assessment, National Academy Press, Washington DC.
Simmons, B, 2010, “Clinical reasoning: Concept analysis”, Journal of Advanced Nursing, vol. 66, no.5, pp. 1151-1158.

Keywords:

Clinical nursing reasoning, cognitive learning model.