Clinical Reasoning Competence Research Articles

문제중심학습 교육이 간호대학생의 문제해결능력, 자기주도 학습능력, 임상추론역량에 미치는 효과

Objectives The purpose of this study was to determine the effect of problem-based learning education on problem-solving ability, self-directed learning ability, and clinical reasoning competency of nursing students. Methods The research design is a quasi-experimental study with a single-group before/after design. A preliminary survey was conducted on April 3 and 4, 2024, targeting 55 fourth-year nursing students, and a follow-up survey was conducted on April 24 and 25. Data analysis included descriptive statistics, paired t-test, and Pearson correlation analysis using the SPSS Statistics 22.0 program. Results After problem-based learning education, nursing students' problem-solving ability(t=-5.91, p<.001), self-directed learning ability(t=-6.02, p<.001), and clinical reasoning ability(t=-7.39, p<.001) was statistically significantly improved. Conclusions Through this study, it was confirmed that problem-based learning is an effective teaching and learning method in improving nursing students' problem-solving ability, self-directed learning ability, and clinical reasoning competency. Therefore, efforts should be made to strengthen the capabilities of nursing students by expanding subjects that apply problem-based learning in nursing education.

Psychometrics assessment of clinical reasoning competency scale in nurses of critical care units

BackgroundNurses play a crucial role in identifying patients’ needs and assessing their clinical conditions to provide adequate and timely interventions. However, evaluating the clinical reasoning competence of nurses requires valid, specific, and comprehensive tools. The present study aimed to translate and psychometrically assess the Persian version of the Clinical Reasoning Competence Scale (CRCS) for nurses in special care units in Iran.MethodsThis cross-sectional, multi-axis methodological study involved 630 nurses from critical care departments in 11 Iranian hospitals. The original version of the Clinical Reasoning Competency Scale for Nurses (CRCSN) was translated into Persian using the forward and backward translation method. The psychometric properties of this scale were assessed using COSMIN criteria.ResultsEach item’s content validity ratio (CVR) ranges from 0.69 to 1, the Item content validity index (I-CVI) ranges from 0.82 to 1, while the S-w was 0.95. Exploratory factor analysis revealed that the items load on three distinct dimensions—“plan setting,” “intervention strategy regulation,” and “self-instruction”—with loadings ranging from 0.621 to 0.912. These dimensions collectively explain 74.32% of the variance. Confirmatory validity was affirmed without necessitating the removal or reordering of items during the exploratory phase. The scale’s reliability was established with a Cronbach’s alpha coefficient of 0.91 and a test-retest reliability coefficient of 0.92. Factor analysis was also conducted.ConclusionThe Persian version of CRCSN has been found to be valid and reliable in critical care units. Therefore, nursing managers can confidently use this tool to evaluate the clinical reasoning competence of nurses. They can also implement appropriate strategies, such as educational interventions, to improve their clinical reasoning skills.

Factors influencing clinical reasoning competence in nursing students

This study is a descriptive survey research aimed at identifying the factors influencing clinical reasoning competence among nursing students. The participants were 553 third-year students from nursing programs at three universities located in the K region of South Korea. The collected data were analyzed using the SPSS 23.0 program, employing Pearson’s correlation coefficient and multiple regression analysis. According to the research results, the factors affecting the participants' clinical reasoning competence were found to be communication skills (β = 0.23, p = 0.000), problem-solving processes (β = 0.50, p = 0.000), and self-efficacy (β = 0.10, p = 0.008). Therefore, it is necessary to assess the effectiveness of various educational programs and teaching methods for improving clinical reasoning competence. The study suggests developing and researching programs focused on enhancing communication skills, self-efficacy, and problem-solving processes to improve clinical reasoning competence among nursing students.

Effectiveness of simulation-based augmented reality in enhancing pediatric nursing and clinical reasoning competency among students: A quasi-experimental study

BackgroundThis study developed simulation-based augmented reality (AR) to enhance pediatric nursing and clinical reasoning competency among students in Taiwan. MethodsA quasi-experimental repeated measures study was conducted with 45 participants. The pediatric nursing knowledge test and clinical reasoning scale (CRS) were evaluated three times: pre-test, post-test, and follow-up. ResultsRepeated measures ANOVA showed that pediatric nursing knowledge and CRS both had significant differences in the three time points. The highest-scoring CRS domain was 'awareness of clinical cues' and the lowest was 'conformation of clinical problems'. ConclusionsSimulation-based AR is effective in improving students’ knowledge and clinical reasoning competency.

Collaborative framework to assess achievement of American Association of Colleges of Nursing and National Organization of Nurse Practitioner Faculties patient-centered competencies using evolving case studies

BackgroundThe American Association of Colleges of Nursing (AACN) and National Organization of Nurse Practitioner Faculties (NONPF) emphasize the role of clinical reasoning in nurse practitioner (NP) competencies. Evidence-based clinical reasoning is vital to patient safety. Collaborative technology tools can aid in assessing progress towards achieving clinical reasoning competency. Purpose/aimsThe purpose of this article is to describe an electronic, collaborative learning framework to teach and assess second year NP students in systematically selecting and eliminating diagnoses and forming treatment plans. Design/methodsPost gap analysis, the collaborative learning framework was created. This visual, collaborative resource was scaffolded across two sequential advanced NP second year clinical synthesis courses and embedded with evolving case studies. Students identified pertinent positives and negatives from the history, physical, and diagnostic findings. Each student developed a unique differential diagnosis and plan of care and critiqued their peers. Result/findingsThe tool exceeded expectations. Faculty were able to visualize data, provide clarification on interpretation of data and pharmacology, and grade in small groups. ConclusionThe collaborative learning framework provided real-time visualization of students' work in clinical reasoning. It was easy to use and integrate into second year NP courses to meet learning objectives and assess clinical reasoning competency.

The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses.

To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses. Cross-sectional descriptive design. Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis. Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence. The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence. The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical-focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses. We have adhered to STROBE checklist. Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.

Interprofessional clinical reasoning education.

Clinical reasoning is considered one of the most important competencies but is not included in most healthcare curricula. The number and diversity of patient encounters arethe decisive factors in the development of clinical reasoning competence. Physical real patient encounters are considered optimal, but virtual patient cases also promote clinical reasoning. A high-volume, low-fidelity virtual patient library thus can support clinical reasoning training in a safe environment and can be tailored to the needs of learners from different health care professions. It may also stimulate interprofessional understanding and team shared decisions. Implementation will be challenged by tradition, the lack of educator competence and prior experience as well as the high-density curricula at medical and veterinary schools and will need explicit address from curriculum managers and education leads.

Factors Influencing Nursing Performance of Intensive Care Unit Nurses: Role of Clinical Reasoning Competence, Positive Psychological Capital, and Nursing Work Environment

Factors Influencing Nursing Performance of Intensive Care Unit Nurses: Role of Clinical Reasoning Competence, Positive Psychological Capital, and Nursing Work Environment

Teaching Clinical Reasoning to Veterinary Medical Learners with a Case Example

Clinical reasoning is an essential competence of veterinary graduands. It is a complex competence with cognitive, metacognitive, social, and situational activities. The literature on clinical reasoning in veterinary medical education is relatively scarce or focused on theoretical rather than practical applications. In this review, we address the practicality of teaching clinical reasoning to veterinary learners utilizing a practical example of a cow with allergic rhinitis. Learners should be guided through all the domains of clinical reasoning, including concepts, data collection and analysis, take action, and reflection on an encounter. Each of these domains needs to be clearly but concisely explained and practiced repeatedly by learners throughout the veterinary curricula. The teaching of clinical reasoning should start as early in the curriculum as possible, preferably in the pre-clinical years, with a gradual scaffolding and building of complexity before work-based learning begins, with an increase in demanding for advanced clinical reasoning competence. The teaching of clinical reasoning is best performed in specialized sessions and continued as a horizontally and vertically integrated activity.

Comparing the effects of patient safety education using design thinking and case based learning on nursing students’ competence and professional socialization: A quasi-experimental design

BackgroundPatient safety issues should be constantly monitored and sensitively recognized. In nursing education, it is necessary to find effective teaching methods to increase students' competencies in patient safety. ObjectivesThis study aimed to compare the effectiveness of a new method, design thinking (DT), and a traditional method, case-based learning (CBL), in patient safety education. DesignThis study used a quasi-experimental, pre-post control group design. SettingsA 30-h training tutorial was developed for intervention groups, DT and CBL, while the control group received no treatment. ParticipantsIn this study were junior nursing students receiving baccalaureate nursing education with experiences of at least 480-h clinical practice. A total of 53 students (21 in the DT group, 19 in the CBL group, and 13 in the control group) were recruited. MethodsClinical reasoning competency, patient safety competency, and professional socialization were measured immediately after the end of the educational program using DT and CBL, 4 weeks later, and 8 weeks later. Effects of DT and CBL were analyzed using a generalized estimating equation. ResultsBoth DT and CBL were effective in clinical reasoning competency (χ2 = 15.432, p = 0.017) and knowledge domain of patient safety competency (χ2 = 42.824, p < 0.001), showing no significant difference between the two. CBL was more effective in professional socialization than DT. ConclusionsDT was as effective as CBL in clinical reasoning competency and knowledge domain of patient safety competency. In the healthcare field, where improving the patient experience is becoming increasingly important, DT is worth applying as an educational method to train nursing students who can take a creative and human-centered problem-solving approach. It is expected that educational curricula utilizing DT will be developed not only in the field of patient safety but also in various patient care areas.

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

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. 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. 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. 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. 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.

Using Group History-Taking and Individual Reasoning to Identify Shortcomings in Clinical Reasoning for Medical Students.

It is crucial that teaching faculties determine and remain informed of medical school learners' clinical reasoning competence. We created an innovative assessment method for fourth-year medical students to identify deficiencies in various components of their clinical reasoning ability. This was a cross-sectional observational study of fourth-year medical students' reasoning assessments from 2019 to 2022. Teams of four-five trainees questioned standardized patients in clinical scenarios, including fever, abdominal pain, and weight loss. They then individually documented key information to reflect comprehension of patient problems. Trainees were tasked with differentiating diagnoses and associated statuses and reaching the most likely diagnosis along with two tentative diagnoses. The correlations observed between 2020 and 2022 for abdominal pain were analyzed using student t-tests. A total of 177 students participated in this study. Across the scenarios, there was no significant difference in key information representation scores (56%-58%). Reasoning ability scores were 49% for fever, 57% for abdominal pain, and 61% for weight loss. A comparison between 2020 and 2022 revealed a significant improvement in the objective structured clinical examination scores and differential diagnoses (P < .01). Shortcomings included brief chief complaint duration, lack of detailed presentation, and insufficient description of negative information. Differential diagnosis and diagnostic justification were inadequate for acute and chronic conditions, and disease location clarity within the organ system was lacking. On average, students presented two correct diagnoses. Fourth-year medical students exhibited inadequate reasoning abilities, particularly in fever and abdominal pain scenarios, with deficiencies in hypothesis generation and differential diagnosis. Group history-taking with individual reasoning assessment identified students' shortcomings and provided faculty feedback to improve their teaching strategies.

간호대학생의 비판적 사고성향과 공감능력이 임상추론역량에 미치는 영향

Objectives This study is to assess the level of clinical reasoning skills of nursing students who are in the initial stages of learning clinical reasoning abilities, and to analyze the impact on these skills using quantitative and qual-itative research methods.&#x0D; Methods A mixed methods research approach was utilized. Quantitative data were collected using self-administered questionnaires from 163 nursing college students in Kimhae City. Qualitative data were collected through focus group interviews with 12 participants. The data were analyzed using a convergent design model.&#x0D; Results The quantitative analysis revealed that grades (β=.215, p=.003), major satisfaction (β=.163, p=.021), and critical thinking disposition (β=.593, p=&lt;.001) significantly influenced clinical reasoning competency, explaining 47.0% of the variance (F=18.826, p=&lt;.001, Adj R2=.470). The qualitative analysis indicated that students faced dif-ficulties due to lack of nursing knowledge and inadequate understanding of patient situations.&#x0D; Conclusions Educational programs aimed at enhancing clinical reasoning competency should include various methods such as presenting scenarios related to patient situations and teaching students how to search for rele-vant information, to facilitate students' understanding.

Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit

AimThe purpose of this study was to evaluate the effectiveness of ECMO care board games facilitated teaching approach (ECMO care board games) in enhancing ECMO care knowledge, clinical reasoning and learning engagement among intensive care unit (ICU) nurses. BackgroundECMO is a highly complex, relatively low-incidence, high-risk clinical life support device system used in the intensive care unit (ICU). Its usage has increased nearly tenfold over the past 30 years. Traditionally, ECMO education has been delivered through classroom teaching, which has demonstrated limited effectiveness in promoting nurses’ learning engagement, clinical reasoning competency and confidence. The literature suggests that well-designed board games can enhance learning engagement, stimulate higher-level thinking and improve the effectiveness and confidence of nurses' learning. DesignA quasi-experimental study two-group repeated measure design. MethodsA purposive sample of 73 ICU nurses from two campuses of one medical center was recruited (37 in the experimental group and 36 in the control group). The experimental group received ECMO care training through ECMO care board games facilitated teaching approach, whereas the control group completed the training through a traditional teaching approach. Instruments used for data collection include a demographic information sheet, ECMO Care Knowledge Scale, Clinical Reasoning Scale (Huang et al., 2023) and Learning Engagement Scale (Ciou , 2020). Both groups completed a pre-test before the training, a post-test one week after the training and a second post-test three weeks after the training. ResultsPrior to the intervention, there were no significant differences between the two groups in ECMO care knowledge and learning engagement. However, there was a significant difference in clinical reasoning. One week after the intervention, the experimental group demonstrated significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement than the control group (p <0.01). Three weeks after the intervention, the experimental group showed significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement (p <0.001). ConclusionsThe content for ECMO care is complex and difficult. Board games can enhance ECMO care knowledge, clinical reasoning and learning engagement. This teaching strategy may be applied to learning challenging subjects in the future to improve learning effectiveness. The clinical reasoning framework is conducive to guiding nurses' learning. In future continuing education, board games designed based on the clinical reasoning framework and tailored to the focus of in-service education can effectively enhance nurses' learning effectiveness.

Formative key feature examinations as innovative teaching approach in dental education: A project report.

Clinical reasoning ability is one of the core competencies of physicians. It should already be trained during undergraduate medical education. At University Medical Center Göttingen (UMG), medical students can participate in formative key feature examinations in which they work on virtual patient cases in order to apply and deepen the procedural knowledge acquired in lectures and seminars. While this teaching format is already established in the medical curriculum at the UMG, it has not yet been implemented in the dental curriculum at the same institution. Therefore, the current project aimed to evaluate the feasibility of formative key feature examinations in dental education. In 2022, new key feature cases focusing on dental-surgical teaching content were created. For pilot testing, the new cases were worked on by two cohorts of dental students via an online learning platform in February 2023. The students were also asked to complete an anonymous online questionnaire in order to evaluate the new teaching format. Overall, the formative key feature examinations were evaluated positively by the dental students, and they demanded for further dental key feature cases. However, descriptive analyses of item characteristics as well as students' comments in the questionnaire revealed some potential for improvements, so that a few cases were partly revised afterwards. This project shows that formative key feature examinations are feasible in dental education and that dental students can benefit from working on virtual case scenarios. Whether dental students' clinical reasoning competence can be improved by completing formative key feature examinations is being investigated in an ongoing study at the UMG.

시뮬레이션 기반 결핵환자 간호교육이 간호대학생의 지식, 임상추론역량, 임상수행능력, 교육만족도에 미치는 효과

시뮬레이션 기반 결핵환자 간호교육이 간호대학생의 지식, 임상추론역량, 임상수행능력, 교육만족도에 미치는 효과

임상사례기반 SBAR를 적용한 급성악화환자간호 시뮬레이션 교육이 의사소통명확성, 의사소통자신감, 임상추론역량에 미치는 효과

Objectives The purposes of this study was to identify the effect of nursing simulation education for acute deteriorating patients using clinical case-based SBAR on communication clarity, communication confidence, and clinical reasoning competency.&#x0D; Methods This quasi-experimental study used a one group pre-post design. The participants were 41 nursing students. A survey to collect data was conducted twice, before and after education. Data were analyzed using the SPSS 23.0 program with descriptive statistics and paired t-test.&#x0D; Results Communication clarity (t=7.906, p&lt;.001), communication confidence (t=24.623, p&lt;.001) and clinical reasoning competency (t=6.427, p&lt;.001) were significantly improved after education compared to before.&#x0D; Conclusions This study is the first study to evaluate the effectiveness of nursing simulation education for acute deteriorating patients conducted in Korea. The results of this study can be used as basic data to develop a nursing education curriculum for patients with deterioration in Korea in the future. In addition, based on the results of this study, if nursing students' competency in nursing patients with acute deterioration is improved by expanding nursing simulation education by applying various contents and teaching methods, it will ultimately contribute to improving the prognosis of patients with acute deterioration.

"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.

The association between nursing students’ perceptions of their clinical reasoning ability and their background of clinical experience: A cross-sectional correlation study

Background and objective: Nursing students tend to show poor clinical reasoning skills and incompetence in clinical performance. This study aimed to explore nursing students’ perceptions of their clinical reasoning ability in relation to their different background of academic program and clinical experience.Methods: A cross-sectional correlation study was conducted in a private tertiary professional training institute. Nursing students (n = 508) were surveyed with demographic details and a self-reported Nurse Clinical Reasoning Scale (NCRS) questionnaire about their perceptions of clinical reasoning in relation with their clinical experience.Results: Descriptive statistic, parametric analyses of variance, and Pearson’s correlation coefficients were used to determine the relationships between variables. The mean NCRS score was lower for paid student nurse externs (49.22 ± 9.2) than for participants who were not paid student nurse externs. The mean NCRS scores differed significantly between the different clinical placements that nursing students last experienced (F = 5.41, p ≤ .001), as well as between students of various academic programs (F = 11.88, p ≤ .001), with students of the sub-baccalaureate level nursing program showing the highest score (53.04 ± 10.48), followed by those of the accelerated baccalaureate level nursing program (52.93 ± 7.67) and those of the baccalaureate level nursing program (48.82 ± 10.11). The mean NCRS score showed a weakly positive, but significant, correlation with the attendance of pre-clinical training, r(506) = .12, p = .009. The free-text surveys provided rich information concerning nursing students’ preferences for future pre-clinical training.Conclusions: Different academic backgrounds and clinical experiences influence nursing students’ clinical reasoning competence. Strategies are needed to motivate earlier clinical preparedness and caring attitudes which are essential attributes of a nursing student before their exposure to real patients.

대학의 시뮬레이션 실습교육이 신규간호사의 임상수행능력에 미치는 영향

Objectives New nurses have experienced clinical practice restrictions due to COVID-19 in the nursing department undergraduate course. Therefore, this study aimed to identify the difference in their clinical performance competency based on the characteristics of the simulation practice education they experienced, determine the effect of simulation practice on their clinical performance competency, and identify the influencing factors. Methods Data were collected from a self-reported questionnaire survey conducted on 197 new nurses from January 10 to February 25, 2023, at 12 general hospitals located in the metropolitan area and Gyeongsang-do. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and hierarchical regression based on the SPSS/WIN 22.0 statistical program. Results Clinical performance competency showed a statistically significant positive correlation with simulation design characteristics (r=.54, p&lt;.001); likewise clinical reasoning competency (r=.69, p&lt;.001) also showed a positive correlation to simulation design characteristics. A statistically significant positive correlation was seen between clinical performance competency and clinical reasoning competency (r=.50, p&lt;.001). Multiple regression analysis revealed that factors significantly affecting clinical performance competency were clinical reasoning competency (β=.57, p&lt;.001) and simulation design characteristics (β=.25, p&lt;.001). The explanatory power was 53.8%. Conclusions To improve new nurses' clinical performance competency, various educational programs that can enhance simulation design characteristics and clinical reasoning competency need to be developed. In the simulation practice class, efforts to enhance the clinical realism of nursing students are required, such as scenario development of cases and methods.