Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool.

Hunter S ，Arthur C 《-》

Establishing the competences of clinical reasoning for nursing students in Taiwan: From the nurse educators' perspectives.

Clinical reasoning is an essential core competence for nurses. Maintaining quality of care and safety of patients results from cultivation of student's clinical reasoning competency. However, the concept of clinical reasoning in nursing students is complex and its meaning and process needs further clarification. The objectives were to explore the meaning of clinical reasoning competency in Taiwanese nursing students and to operationalize the concept in order to structure a framework illustrating the process of clinical reasoning. Thirteen seasoned nursing experts who had more than ten years of experience in nursing education or clinical practice participated in the interviews. The interviews were conducted in settings that the participants perceived as convenient, quiet and free of disturbance. Semi-structured interviews were conducted. The interviews were audio-recorded and field notes were taken. The data were analyzed using Waltz et al.'s (2010) method of content analysis. The data revealed four domains and 11 competency indicators. The four domains include: awareness of clinical cues, confirmation of clinical problems, determination and implementation of actions, and evaluation and self-reflection. Each domain comprises of 2-4 indicators of clinical reasoning competency. In addition, this study established a framework for cultivation of clinical reasoning competency in nursing students. The indicators of clinical reasoning competency in nursing students are interwoven, interactive and interdependent to form a dynamic process. The findings of this study may facilitate evaluation of nursing students' clinical reasoning competency and development of instruments to assess clinical reasoning in nursing students.

Huang HM ，Huang CY ，Lee-Hsieh J ，Cheng SF ... -  《-》

Prelicensure Baccalaureate Nursing Students' Perceptions of Their Development of Clinical Reasoning.

Establishing a strong foundation for the development of clinical reasoning in nursing students is essential to ensure safe and effective patient care. This study explored prelicensure baccalaureate nursing students' perceptions of their development of clinical reasoning, as well as their perceptions of how it is taught. In this phenomenological study, individual semistructured interviews were conducted to gather data related to participants' perceptions of their development of clinical reasoning. Data were analyzed using procedural steps delineated by Giorgi. Data analysis revealed three main themes: Instructor Characteristics, Importance of Clinical Reasoning, and Best Place to Learn Clinical Reasoning. Students recognized how clinical reasoning enhances safe and effective clinical practice and indicated the clinical arena was the most beneficial environment in which to learn clinical reasoning. Understanding students' perceptions of learning benefits nurse educators in planning nursing program curricula to enhance and facilitate the development of clinical reasoning. [J Nurs Educ. 2016;55(6):329-335.].

Herron EK ，Sudia T ，Kimble LP ，Davis AH ... -  《-》

Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol.

MacKinnon K ，Marcellus L ，Rivers J ，Gordon C ，Ryan M ，Butcher D ... -  《-》

Challenges nurse educators experience with development of student nurses' clinical reasoning skills.

Traditional teacher-centred teaching strategies do not always facilitate the development of desired clinical reasoning skills required for nursing practice. A multiphase study was conducted to facilitate a process of change towards improving educational practices in order to promote the development of undergraduate student nurses' clinical reasoning skills. The study was conducted at a military nursing education institution. This paper reflects on Phase 1, where a descriptive, qualitative study was conducted to explore the challenges nurse educators experienced in utilizing teaching and learning strategies that could promote the development of clinical reasoning skills in undergraduate student nurses. Unstructured interviews were conducted with 16 nurse educators who were selected purposively. Interviews were recorded, transcribed and data were analysed for content. The findings indicate that the clinical learning environment, the military environment, and various role players in the environment are instrumental in nurse educators not utilizing educational practices that promote the development of clinical reasoning skills in undergraduate student nurses. Addressing nurse educator challenges and empowering them with the means, opportunity and skills to utilize student-centred teaching and learning strategies may contribute to the development of undergraduate student nurses' clinical reasoning skills. Raising awareness of challenges nurse educators experience in implementing student-centred facilitation of learning can assist in developing strategies to ensure nurse educators become more student-centred in their teaching.

van Wyngaarden A ，Leech R ，Coetzee I 《-》