Clinical reasoning in nursing, a think-aloud study using virtual patients - a base for an innovative assessment

The effect of case-based teaching method on professional competence and clinical decision-making levels of public health nursing students: A sequential explanatory mixed-methods study

OBJECTIVES

To evaluate the effect of case-based teaching method applied to fourth year nursing students on their professional competence and clinical decision-making levels.

DESIGN

A quasi-experimental design study with a sequential-exploratory mixed-method approach.

SAMPLE

64 nursing students enrolled in the Public Health Nursing course.

METHODS

A case-based teaching program was applied to the students that cover the topics of the Public Health Nursing course. Quantitative phase data were collected with the Clinical Decision Making in Nursing Scale and Nursing Students' Competence Scale. For the qualitative part, focus group interviews were conducted with a Structured Interview Form.

RESULTS

It was determined that the total and subscale posttest scores of the students increased significantly compared to their pretest scores (p < .001). A moderate positive correlation was found between the total scores received from the scale and a significant positive correlation was found between researching information and adopting new information impartially and all sub-dimensions except care (p < .05). Three main themes emerged from the focus group interviews conducted after the case-based teaching method experience: usefulness, limitations, and improvement.

CONCLUSIONS

Case-based teaching method is effective on students' professional competence and clinical decision-making scores. Students' professional competence levels positively affect their clinical decision-making levels.

Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review

BACKGROUND

The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available, however, the affordances and design principles for the facilitation of critical thinking are yet to be explored.

OBJECTIVE

To examine how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education.

DESIGN

Systematic review.

REVIEW METHODS

A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened. The quality of the included studies was evaluated using the Mixed Methods Assessment Tool (MMAT).

RESULTS

A total of 12 studies with 1108 participants were included. The breadth of healthcare disciplines was limited to five disciplines that utilised bespoke scenarios on head-mounted displays. Most scenarios were emergency or critical response, with limited time for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others including indirect reference to diagnoses, interpretation, analysis, or evaluation of healthcare scenarios. Affordances and design principles for the future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified.

CONCLUSIONS

While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines, there remain to be limited valid measures of critical thinking used to quantify effectiveness. Future studies would benefit from considering scenarios beyond emergency and critical responses, including longitudinal studies that reflect the development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and healthcare students.

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.

Decision-making processes in image guided radiotherapy: A think aloud study

INTRODUCTION

3D Image Guided Radiotherapy (IGRT) using Cone Beam Computer Tomography (CBCT) has been implemented for a range of treatment sites across the UK in the last decade. A paucity of evidence exists to understand how radiation therapists (RTTs) make clinical decisions during image interpretation as part of the IGRT process. The aim of this study was to investigate the decision-making processes used by RTTs during image interpretation of IGRT.

METHOD

Case study methodology was adopted utilising a think aloud observational method with follow-up interviews. 12 RTTs were observed and interviewed across three UK radiotherapy centres. Participants were observed reviewing and making clinical decisions in a simulated environment using clinical scenarios developed in partnership with each centres' Clinical Imaging Lead. Protocol analysis was used to analyse the observational data and thematic analysis was used to analyse the interview data.

RESULTS

A range of approaches to decision-making was observed which varied in length from nine phrases to 57 (mean 24) per case. Six themes emerged from the data: Set Sequence, Site Specific Clinical Priorities, Initial Gross Review, Decision to treat, Compromise and experience. In addition, three cognitive decision-making processes were identified: Simple linear, Linear repeating and Intuitive decision-making process. The findings of the study align with general principles of expert performance, whereby experience in a specific scope of practice is more beneficial in developing expertise than overall experience.

CONCLUSION

This study has provided new and original insight in the decision-making processes of RTTs. The study has highlighted three process models to explain how RTTs make decisions during IGRT: Simple linear, Linear repeating and Intuitive decision-making process. Intuitive processes are widely accepted to be error prone and linked to bias. When using this process, some RTTs followed this with a confirmation phase. This second phase of the process should be encouraged when teaching IGRT. The results of the study support the concept of expert performance, where performance and expertise are only improved by exposing individuals to specific types of experiences. RTTs, managers and Higher Education Institutions are encouraged to review these models and implement them into IGRT training. It is clear from the evidence base that understanding how we make decisions, enables us to develop expertise and reduce errors during the decision-making process.

Developing a virtual patient: design, usability, and learning effect in communication skills training

BACKGROUND

Literature shows that Virtual Patients (VPs) find extensive usage in the field of health sciences, especially in the post-pandemic period. VPs are successfully utilized in developing various effective skills like medical interview. However, this technology is quite new in Turkey and has not yet been used in communication skills training in a structured form. This research aimed to develop a virtual patient to improve the communication skills of medical students.

METHODS

Developmental research method was used in the study. The implementation phase involved the one group posttest quasi-experimental design. The study group comprised of experts in various fields and 213 medical students. Needs Analysis Form, Scenario Building Form, System Validation Form, Communication Skills Assessment Form, and Interview Form were used as data collection tools. The research primarily concentrated on ensuring minimal errors within the system and enhancing students' communication skill scores.

RESULTS

The study found that VP was effective in teaching communication skills. Communication skills improved from a mean score of 36.74 in the first interview with 15 students to 74.2 in the final application with 198 students. It was determined that the students who practiced repeatedly (n = 26) made 17% more effective interviews than their first practices (score: 89.2). The script matching of the VP was 83%. Other data obtained from the students generally showed that the VP application was developed in accordance with the purpose, that it was user-friendly, and that the scenarios were adequate.

CONCLUSION

VPs like this have the potential to develop skills such as history taking, clinical reasoning, etc., which are very important in the field of health sciences.

Cognitive and Metacognitive Processes Demonstrated by Pharmacy Students When Making Therapeutic Decisions

Objective. To characterize the types of cognitive and metacognitive processes demonstrated by third-year pharmacy students during a therapeutic reasoning activity.Methods. A qualitative, descriptive study following a think-aloud protocol was used to analyze the cognitive (analytical) and metacognitive processes observed by third-year pharmacy students as they completed a 25-minute therapeutic reasoning activity. Using a deductive codebook developed from literature about reasoning, two independent coders characterized processes from students' audio-recorded, transcribed think-aloud episodes while making therapeutic decisions about simulated clinical cases.Results. A total of 40 think-aloud episodes were transcribed among the cohort. Categorization of the think-aloud transcriptions revealed a series of cognitive analytical and metacognitive processes demonstrated by students during the therapeutic decision-making activity. A total of 1792 codes were categorized as analytical processes, falling into six major themes: 69% gathering information (1232/1792), 13% processing information (227/1792), 7% making assessments (133/1792), 1% synthesizing information (19/1792), 7% articulating evidence (117/1792), and 4% making a recommendation (64/1792). In comparison to gathering information, a much lower frequency of processing and assessment was observed for students, particularly for those that were unable to resolve the case. Students' movement between major analytical processes co-occurred commonly with metacognitive processes. Of the 918 codes categorized as metacognitive processes, two major themes arose: 28% monitoring for knowledge or emotions (257/918) and 72% controlling the planning of next steps or verification of correct information (661/918). Sequencing the codes and co-occurrences of processes allowed us to propose an integrated cognitive/metacognitive model of therapeutic reasoning for students.Conclusion. This study categorizes the cognitive (analytical) and metacognitive processes engaged during pharmacy students' therapeutic reasoning process. The findings can inform current instructional practices and further research into educational activities that can strengthen pharmacy students' therapeutic reasoning skills.

Transformational leadership and predictors of resilience among registered nurses: a cross-sectional survey in an underserved area

BACKGROUND

High resilience increases nurses' ability to cope with job-related stressors and enhances job satisfaction and, consequently, their retention. The study aims to identify resilience predictors and perceptions of transformational leadership in a convenience sample of registered nurses in Lebanon.

METHODS

An anonymous cross-sectional survey of a convenience sample of 240 registered nurses working for more than a year at three private hospitals in an underserved area in South Lebanon was used. The survey instrument included demographic questions, the True Resilience Scale ©, and the Global Transformational Leadership Scale. Multiple linear regression was used to assess the predictors of resilience after a descriptive analysis of the study variables.

RESULTS

The survey response rate was 85%. The nurses' mean resilience score was 119.4 (SD 15.3), and their perception of transformational leadership score was M = 25.0, SD = 6.8. Compared to bedside nurses, nurse managers, nurses with more than five years of experience, and nurses in critical nursing units had statistically significant higher resilience scores (p < 0.05). Resilience scores and perception of global transformational leadership were moderately correlated (r = 0.53, p < 0.05). In the final multiple linear regression model, 30% of the variation in resilience scores was explained by designation (p < 0.05) and perception of Global Transformational Leadership (p < 0.01). Perception of global transformational leadership scores explained 29% of the variance in resilience scores. Designation and perception of global transformational leadership predicted resilience in this sample.

CONCLUSIONS

A national survey of the Lebanese nursing workforce is needed to achieve an improved predictive model and support policy developments to increase resilience among bedside nurses and retain them in the nursing workforce. Nurse administrators can help by strengthening their transformational leadership behaviors. Consistent use of transformational leadership styles will strengthen bedside nurses' resilience, increase nurse retention, and help sustain the Lebanese nursing workforce.

Global Trends and Hot-Spots in Research on Virtual Simulation in Nursing: A Bibliometric Analysis From 1999 to 2021

Background

Virtual simulation has been widely used in nursing education and nursing training. This study aims to characterize the publications in terms of countries, institutions, journals, authors, collaboration relationships, and analyze the trends of virtual simulation in nursing research.

Methods

Publications regarding virtual simulation in nursing were retrieved from Web of Science core collection. Microsoft Excel 2010, VOSviewer were used to characterize the contributions of the authors, journals, institutions, and countries. The trends, hot-spots and knowledge network were analyzed by Citespace and VOSviewer.

Results

We identified 677 papers between 1999 and 2021. The number of publications grew slowly until 2019, after that, it got a sharp increase in 2020 and 2021. The USA, Canada and Australia were three key contributors to this field. Centennial College and University of San Paulo, University of Ottawa and Ryerson University were top major institutions with a larger number of publications. Verkuyl M was the most productive and highest cited author. Clinical Simulation in Nursing, Nurse Education Today, Journal of Nursing Education were the three productive journals. The foundational themes of virtual simulation research in nursing are “virtual learning during COVID-19, clinical nursing care, education in nurse practitioners, education technology”.

Conclusion

Virtual simulation in nursing field has attracted considerable attention during COVID-19 pandemic. The research hotspot is gradually shifting from clinical nursing care to studies of nursing education using different virtual simulation technologies

Nursing students' development of using physical assessment in clinical rotation-a stimulated recall study

Background

The overall aim of this study was to explore third-year bachelor nursing students’ stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students’ use of physical assessment skills while in clinical rotation. There is a need to explore nursing students’ learning processes related to the use of physical assessments.

Methods

Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students’ physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students’ performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews.

Results

Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice.

Conclusions

This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students’ learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students’ learning of physical assessment skills—building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

A conceptual model for clinical psychomotor skill development in an era of simulated and virtual reality

Psychomotor skill development is central to a beginner practitioner's learning pathway. Curriculum constraints around time, access to facilities and resources in health professions education have prompted the growth in alternative approaches to clinical skill development in both simulation and direct patient care. Among these is the increased incorporation of virtual reality (VR) systems with haptic feedback alongside traditional, solid simulations. Given the rapid growth in the adoption of technological affordances to support skill development, it is cogent to pause and examine whether the underpinning concepts regarding psychomotor skill development that have driven much of the approaches to teach clinical skill acquisition in dentistry remain fit-for-purpose. This conceptual paper proposes a new taxonomy for clinical simulation psychomotor skill development in the era of increasing variety of simulation modalities.

Effectiveness of using simulation in the development of clinical reasoning in undergraduate nursing students: A systematic review

AIM/OBJECTIVE

This systematic review examines the effectiveness of undergraduate nursing students' using simulation to acquire clinical reasoning.

BACKGROUND

Use of simulation to positively impact practice outcomes is an established method in nursing education. Clinical reasoning is a graduate capability that contributes to safe practice, so developing clinical reasoning requires explicit scaffolding in undergraduate contexts. While research has primarily evaluated specific clinical reasoning frameworks, variability in clinical reasoning definitions has obscured simulation efficacy for clinical reasoning acquisition.

DESIGN

This review uses the Joanna Briggs Institute Systematic Reviews approach.

METHODS

An electronic database search was conducted to identify studies published from May 2009 to January 2020 using a three-step search strategy. Selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction. Ten studies using quasi-experimental designs involving 1532 students were included.

RESULTS

Evidence regarding the effectiveness of simulation for undergraduate nursing students' acquisition of clinical reasoning was limited but of high quality. Review results showed no statistically significant gains in clinical reasoning with a single simulation exposure. Two emerging concepts, situation awareness and teamwork support the enhancement of clinical reasoning within simulation. In order to draw future conclusions on the efficacy of simulation to develop clinical reasoning, more research is warranted.

CONCLUSIONS

New insights about team-based simulations and situation awareness were identified as integral for development of clinical reasoning in the context of simulation. More consistent use of terminology in the context of simulation research is also recommended.

Exploring the effect of two different teaching strategies on first-year nursing students' understanding of nutritional concepts: A mixed-method approach

AIM

The aim of the study was twofold. First, to explore understanding difficulties in nutritional concepts among nursing students and second, to analyse the effect of two teaching strategies on the level of understanding.

BACKGROUND

Previous studies have pointed out the need to improve the nutritional care education offered to undergraduates in health sciences. As nurses play a crucial role in lifestyle counselling and nutrition assessment, it is essential to identify the learning difficulties that can impair their learning capacity and the more effective teaching strategy in the nutrition area during the nursing degree.

DESIGN

A pretest-posttest study was conducted with a mixed-method conversion design.

METHODS

146 first-year-nursing students were included. Two teaching methods, debate-based learning and lecture-based learning were used for instruction on the effect of macronutrient intake on an individual's state of health. Each group completed two open-ended questions before and after the intervention. Firstly, phenomenographic analysis was performed to identify the learning categories representing variations in students' understanding. Secondly, qualitative data were quantised and statistically analysed to address differences in learning improvement.

RESULTS

More than 40% of students struggled with the idea that proteins are associated with weight gain independently of the teaching strategy applied. In the first evaluation question, the debate-based learning teaching method improved students' learning, achieving higher levels of understanding (p < 0.05). In the second evaluation question, no significant differences were found between the two groups.

CONCLUSIONS

Areas of problematic knowledge in nutrition education have been identified for the first time that will allow nurse educators to design research-based teaching strategies. Further studies are necessary not only on how to address these misconceptions in nursing students, but also to investigate how nurse educators can contribute to deeper levels of student learning.

Virtual clinical simulation in nursing education: a concept analysis

OBJECTIVES

To analyze the concept of virtual clinical simulation in nursing education.

METHODS

The Walker and Avant concept analysis model guided the study process and the data collection followed the integrative literature review method. Databases searched were: CINAHL, PubMed, Education Resources Information Center, and Scopus. Search terms and Boolean operators were: e-simulation OR virtual clinical simulation OR computer-simulation OR computer simulation OR virtual gaming OR virtual reality AND nursing education OR nursing. The sample comprised 45 studies.

RESULTS

Virtual clinical simulation in nursing education was defined as the innovative teaching and learning technological strategy that provides immersive self-regulated training of nursing practice, reproducing real-life experiences and feedback in a virtual environment that is safe, interactive, dynamic and enjoyable.

CONCLUSIONS

Clarification of this concept contributes to the development of a standardized terminology to include in the nursing nomenclature system and its dissemination for the construction of nursing science.

Using virtual simulation and electronic health records to assess student nurses' documentation and critical thinking skills

INTRODUCTION

Electronic health records have become a standard documentation platform to house patient information in most US hospitals. To improve documentation, providers suggest establishing electronic health record user education at the classroom level so students can interact with patient data early. The purpose of this study was to assess student nurses' clinical documentation and critical thinking skills using virtual patients and a simulated electronic health record system.

METHODS

Eighty-four undergraduate nursing students completed assessments on four assigned virtual patients and entered their findings into a simulated electronic health record system. Benner's five stage novice to expert theory was used to evaluate performance of six assessment items.

RESULTS

Significant differences (p = 0.046) were seen in median scores between the first and second assignments, and between the second and fourth assignments (p = 0.021) with minimal improvements from one assignment to the next.

DISCUSSION

Data entered in the electronic health record showed that students started at an advance beginner's level and moved to be proficient in documenting basic patient information using critical thinking skills by the end of the first semester.

CONCLUSION

It is important to expose students to electronic health record systems before entering the workforce or while training in a hospital setting to enhance readiness for clinical practice with electronic documentation and critical thinking skills.

Assessment Practices of Student’s Clinical Competences in Nurse Education

Background:

Clinical competence in nursing practices includes all the theoretical and clinical knowledge used by the student in a clinical setting. It also involves psychomotor as well as problem-solving skills. The assessment focuses on evaluating the student's ability to provide both safe and competent care for the patients. However, it requires the use of several assessment methods that must be varied according to the components of the clinical competence.

Several studies have revealed that the evaluation of this competency is mostly limited to knowledge testing or the acquisition of technical skills verification.

Aims:

This study has two objectives. Firstly, it aims to analyze the assessment practices related to clinical competence and adopted by teachers in higher institutes of nursing and health technology in Morocco. Secondly, it seeks to identify the difficulties faced by them in using a variety of appropriate assessment tools to target all the components of clinical competence.

Methods:

Based on the theoretical model adapted from the Miller’s pyramid by Mehay and Burns in 2009, relating to the assessment of clinical competence, a self-administered questionnaire was shared with 129 nursing teachers.

Results:

The results indicate that 98.06% of participants use a given tool to assess clinical competence; however, using the appropriate tools to evaluate all its components is limited, and the assessment tools are not characterized by variety.

Conclusion:

Reflecting on the evaluation of clinical competences, a clinical assessment model could be proposed to be in accordance with the theoretical model and to measure its impact on nursing students' learning.

Data on healthcare perceptions about system risk factors associated with patient safety from the Ministry of Health hospitals in Hail Region of Saudi Arabia

Patient protection has become one of the key elements of the quality of health care systems in Saudi Arabia. Medical errors that threaten patient safety are mediated by several factors including system risk factors. Hence, we used a self-structured questionnaire to assess and rank the system factors according to the perceptions of nurses working in the hospitals of the ministry of health in Hail, KSA. Eight out of twelve factors tested were perceived as threatening factors of the patient safety that are; 'Shortage of medical staff', 'Poor design of the hospital structure', 'Long working hours', 'Overcrowding of patients','Poor coordination between hospital departments, 'Punitive and blaming environment, 'Lack of clinical practice standards' and, 'Poor financial incentives'. Thus, considering the negative impact of the identified threatening system factors in this study on patient safety, urgent planning and managing appropriate corrective actions should be designed to improve patient safety issues.

What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis

Background

Virtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students’ virtual patient interviews using WHO International Classification of Functioning Disability and Health (ICF).

Methods

Eighteen speech pathology students in their final year of training participated. Students interviewed virtual patients with dysphagia (swallowing difficulties) as part of their curriculum. Student questions and patient responses were coded using established ICF coding. Codes were tallied and compared under categories of body structures, body functions, activities/participation and environmental factors. Flesch Reading Ease was calculated as a measure of health literacy.

Results

Conversational turns primarily focused on the ICF component—activity and participation in both student questions and virtual patient responses: 0.03% body structures, 30% body functions—swallowing, 7% body functions—associated, 43% activities/participation and 19% environmental factors. Personal factors such as gender, ethnicity, age or socio-economic situation were not mentioned by student or patient. Patients commented on social impact on self and/or family, sometimes in the absence of targeted student questions. Student and virtual patient Flesch Reading Ease scores were congruent.

Conclusion

Speech pathology students naturally matched their virtual patient’s health-literacy level and asked a range of medical and daily living questions. Virtual patients readily offered social impact information to student questions. Computer science: healthcare teams should consider creating virtual patients who challenge students to practise asking sensitive questions and in doing so develop holistic thinkers with competent communication skills.

Clinical reasoning and hypothesis generation in expert clinical swallowing examinations

BACKGROUND

A clinical swallow examination (CSE) provides integral information that informs the diagnostic decision-making process within dysphagia management. However, multiple studies have highlighted a high degree of reported variability within the CSE process. It has been hypothesized that such variability may be the result of the clinical reasoning process rather than poor practices.

AIMS

To elucidate the nature of expert, speech-language therapists' (SLTs) clinical reasoning during an initial bedside assessment of patients referred for suspected dysphagia in the acute care environment.

METHODS & PROCEDURES

An exploratory 'observation of practice' qualitative methodology was used to achieve the aim. Four expert SLTs, from two clinical services, completed CSEs with 10 new referrals for suspected dysphagia. All assessments were video-recorded, and within 30 min of completing the CSE, a video-stimulated 'think aloud' semi-structured interview was conducted in which the SLT was prompted to articulate their clinical reasoning at each stage of the CSE. Three types of concept maps were generated based on this video and interview content: a descriptive concept map, a reasoning map and a hypothesis map. Patterns that consistently characterized the assessment process were identified, including the overall structure; types of reasoning (inductive versus deductive), facts (i.e., clinical information) drawn upon; and outcomes of the process (diagnosis and recommendations). Interview content was examined to identify types of expert reasoning strategies using during the CSE.

OUTCOMES & RESULTS

SLTs' approach to clinical assessment followed a consistent structure, with data gathered pre-bedside, during the patient interview and direct assessment before a management recommendation was made. Within this structure, SLTs engaged in an iterative approach with inductive hypothesis-generating and deductive hypothesis-testing, with each decision-making pathway individually tailored and informed by patient-specific facts collected during the assessment. Clinical assessment was primarily geared towards management of an initial acute presentation with less focus on formulating a diagnostic statement.

CONCLUSIONS & IMPLICATIONS

Variability in reported dysphagia practice is likely the result of a patient-centred assessment process characterized by iterative cycles of fact-gathering in order to generate and test clinical hypotheses. This has implications for the development of novel assessment tools, as well as professional development and education of novice SLTs. What this paper adds What is already known on the subject CSE practices are reportedly variable, which has led to calls for more stringent, standardized assessment tools. Emerging evidence suggests that this variation is non-random, but may arise from clinical reasoning processes. What this paper adds to existing knowledge We directly observed expert SLTs conducting CSEs and identified patterns in practice that were consistent across all CSEs evaluated. These patterns were consistent in structure, whereas the content of the assessment items varied and was tailored to individual patient presentation. Overall, expert SLTs engaged in balanced cycles of inductive hypothesis generation and deductive hypothesis-testing, a hallmark of good clinical assessment and practice. What are the potential or actual clinical implications of this work? Ensuring quality CSE requires a more nuanced approach that considers the role of clinical reasoning in SLTs' decision-making and the potential unintended negative consequences of standardized assessment tools.

Examining response process validity of script concordance testing: a think-aloud approach

OBJECTIVES

This study investigated whether medical student responses to Script Concordance Testing (SCT) items represent valid clinical reasoning. Using a think-aloud approach students provided written explanations of the reasoning that underpinned their responses, and these were reviewed for concordance with an expert reference panel.

METHODS

A set of 12, 11 and 15 SCT items were administered online to Year 3 (2018), Year 4 (2018) and Year 3 (2019) medical students respectively. Students' free-text descriptions of the reasoning supporting each item response were analysed, and compared with those of the expert panel. Response process validity was quantified as the rate of true positives (percentage of full and partial credit responses derived through correct clinical reasoning); and true negatives (percentage of responses with no credit derived through faulty clinical reasoning).

RESULTS

Two hundred and nine students completed the online tests (response rate = 68.3%). The majority of students who had chosen the response which attracted full or partial credit also provided justifications which were concordant with the experts (true positive rate of 99.6% for full credit; 99.4% for partial credit responses). Most responses that attracted no credit were based on faulty clinical reasoning (true negative of 99.0%).

CONCLUSIONS

The findings provide support for the response process validity of SCT scores in the setting of undergraduate medicine. The additional written think-aloud component, to assess clinical reasoning, provided useful information to inform student learning. However, SCT scores should be validated on each testing occasion, and in other contexts.

Increasing competence in wound care: A cross-sectional study to evaluate use of a virtual patient by undergraduate student nurses

Concerns have arisen internationally over the competency of student nurses to perform wound care. A global shortage of nursing faculty and clinical practice opportunities is regarded as a contributing factor. Virtual simulation offers a possible solution. The aim of this study was to describe the development and educational evaluation of a virtual patient to supplement undergraduate learning of wound care. The National League for Nursing Jeffries model informed the design of the media. Evaluation of the virtual patient by penultimate year nursing students (n = 148) was conducted using a survey design. Findings are presented from statistical and directed content analyses. Most students rated the educational value of the virtual patient and its support of learning highly. They reported a perceived increase in confidence and ability to meet wound care competency outcomes. The virtual patient also provided students with opportunities to develop their clinical reasoning skills. This study provides evidence that virtual patient simulation is an effective pedagogy to increase clinical competence in wound care. It allows nursing students the opportunity to practice skills and utilise theory repetitively in a safe environment, unhampered by a lack of resources such as clinical placement availability and a declining faculty.

A Systems Approach to Design and Implementation of Patient Assessment Tools in the Inpatient Setting

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information. This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

Theoretical foundations of educational strategies used in e-learning environments for developing clinical reasoning in nursing students: A scoping review

E-learning environments expand opportunities for the use of educational strategies that may contribute to the development of clinical reasoning in nursing students. The purposes of this scoping review were the following: 1) to map the principles of cognitive companionship and the theoretical foundations underlying the design and implementation of educational strategies used in e-learning environments for developing clinical reasoning in nursing students; and 2) to identify the types of educational strategies used in e-learning environments for developing or assessing clinical reasoning in nursing students. A scoping review was conducted and was based on the Joanna Briggs Institute Framework. Bibliographical databases were searched for studies published between January 2010 to July 2017. Out of 1202 screened articles, 18 met eligibility criteria and were included in this review. Principles of cognitive companionship in e-learning environments provide key clues from a learning support perspective, such as integrated feedback, interactive group discussion, gaming, and questioning. However, theoretical foundations underlying educational strategies in e-learning environments are poorly documented and insufficiently associated with cognitive learning models. E-learning environments must have solid theoretical foundations to provide support for the development of CR in nursing students.

Current Trends and Opportunities for Competency Assessment in Pharmacy Education-A Literature Review

An increasing emphasis on health professional competency in recent times has been matched by an increased prevalence of competency-based education models. Assessments can generate information on competence, and authentic, practice-based assessment methods are critical. Assessment reform has emerged as an academic response to the demands of the pharmacy profession and the need to equip graduates with the necessary knowledge, skills and attributes to face the challenges of the modern workforce. The objective of this review was to identify and appraise the range of assessment methods used in entry-level pharmacy education and examine current trends in health professional assessment. The initial search located 2854 articles. After screening, 36 sources were included in the review, 13 primary research studies, 12 non-experimental pharmacy research papers, and 11 standards and guidelines from the grey literature. Primary research studies were critically appraised using the Medical Education Research Study Quality Instrument (MERSQI). This review identified three areas in pharmacy practice assessment which provide opportunities for expansion and improvement of assessment approaches: (1) integrated approaches to performance assessment; (2) simulation-based assessment approaches, and; (3) collection of validity evidence to support assessment decisions. Competency-based assessment shows great potential for expanded use in pharmacy, but there is a need for further research and development to ensure its appropriate and effective use.

Contributions of the nurse's clinical practice to Primary Care

OBJECTIVE

To understand the repercussions of the nurse's clinical practice on Primary Health Care.

METHOD

Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis' Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups.

RESULTS

nurses' clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional's clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice.

FINAL CONSIDERATIONS

Nurses' clinical practice has positive repercussions on the health of Primary Health Care users.

Clinical Reasoning in Physical Therapy: A Concept Analysis

BACKGROUND

Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research.

OBJECTIVE

The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research.

DESIGN/METHODS

The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified.

RESULTS

Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management.

LIMITATIONS

Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded.

CONCLUSIONS

A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.

Using Think Aloud in Health Assessment: A Mixed-Methods Study

BACKGROUND

Health assessment courses are foundational to prepare students in nursing baccalaureate programs for clinical practice. Nurse educators are interested in testing strategies to improve students' ability to perform physical assessment techniques.

METHOD

A mixed-methods design was used to examine nursing students' experiences with the Think Aloud (TA) approach and its affect on their ability and perceived self-efficacy when performing physical assessment skills.

RESULTS

The participants in the TA intervention group made significant pre-post self-efficacy score gains and had higher focused physical examination marks. There was no significant difference in pre-post self-efficacy scores with the control group. A focus group yielded the following themes: benefits of TA, student challenges, and transferring physical assessment skills to practice.

CONCLUSION

The TA approach encourages students to focus on the critical steps in physical assessment skills aiding memory, knowledge gains and preparation for practical testing, and transition to clinical practice. [J Nurs Educ. 2018;57(11):684-686.].

Exploring undergraduate nursing student interactions with virtual patients to develop 'non-technical skills' through case study methodology

Background

Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in undergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based resource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of non-technical skills in undergraduate health professionals. However, there is limited literature exploring how the interaction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills in undergraduate nursing students.

Methods

An intrinsic case study method, using focus groups and individual interviews, enabled exploration of the experience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills. Purposive sampling identified participants to address the research question. Framework analysis supported by a codebook enabled deductive and inductive data analysis.

Results

Forty-five first-year and 31 third-year students consented to participate. Findings indicated that the different years interacted differently with the virtual patients. Four themes were recognised in the data: how the virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter, changing the way students perceive practice and potential limitations to learning.

Conclusions

Interactions with virtual patients influence learning knowledge, attitudes and practice of non-technical skills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the professional role, vicarious learning and learning by making mistakes. Potential limitations to learning from virtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to learning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key. This study demonstrates learning non-technical skills via interactions with virtual patients can change the way students perceive practice, with learning transferable to the clinical setting to support safe and competent patient care.

Clinical Reasoning in the Primary Care Setting: Two Scenario-Based Simulations for Residents and Attendings

Introduction

We describe the development and implementation of tools medical educators or researchers can use for developing or analyzing residents' through attending physicians' clinical reasoning in an outpatient clinic setting. The resource includes two scenario-based simulations (i.e., diabetes, angina), implementation support materials, an open-ended postencounter form, and a think-aloud reflection protocol.

Method

We designed two scenarios with potential case ambiguity and contextual factors to add complexity for studying clinical reasoning. The scenarios are designed to be used prior to an open-ended written exercise and a think-aloud reflection to elicit reasoning and reflection. We report on their implementation in a research context but developed them to be used in both educational and research settings.

Results

Twelve physicians (five interns, three residents, and four attendings) considered between three and six differential diagnoses (M = 4.0) for the diabetes scenario and between three and nine differentials (M = 4.3) for angina. In think-aloud reflections, participants reconsidered their thinking between zero and 14 times (M = 3.5) for diabetes and zero and 11 times (M = 3.3) for angina. Cognitive load scores ranged from 4 to 8 (out of 10; M = 6.2) for diabetes and 5 to 8 (M = 6.6) for angina. Participants rated scenario authenticity between 4 and 5 (out of 5).

Discussion

The potential case content ambiguity, along with the contextual factors (e.g., patient suggesting alternative diagnoses), provides a complex environment in which to explore or teach clinical reasoning.

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

BACKGROUND

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.

OBJECTIVES

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.

SETTING AND PARTICIPANTS

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Cognitive processing differences of experts and novices when correlating anatomy and cross-sectional imaging

The ability to correlate anatomical knowledge and medical imaging is crucial to radiology and as such, should be a critical component of medical education. However, we are hindered in our ability to teach this skill because we know very little about what expert practice looks like, and even less about novices' understanding. Using a unique simulation tool, this research conducted cognitive clinical interviews with experts and novices to explore differences in how they engage in this correlation and the underlying cognitive processes involved in doing so. This research supported what has been known in the literature, that experts are significantly faster at making decisions on medical imaging than novices. It also offers insight into the spatial ability and reasoning that is involved in the correlation of anatomy to medical imaging. There are differences in the cognitive processing of experts and novices with respect to meaningful patterns, organized content knowledge, and the flexibility of retrieval. Presented are some novice-expert similarities and differences in image processing. This study investigated extremes, opening an opportunity to investigate the sequential knowledge acquisition from student to resident to expert, and where educators can help intervene in this learning process.

Advancing clinical reasoning in virtual patients - development and application of a conceptual framework

Background: Clinical reasoning is a complex skill students have to acquire during their education. For educators it is difficult to explain their reasoning to students, because it is partly an automatic and unconscious process. Virtual Patients (VPs) are used to support the acquisition of clinical reasoning skills in healthcare education. However, until now it remains unclear which features or settings of VPs optimally foster clinical reasoning. Therefore, our aims were to identify key concepts of the clinical reasoning process in a qualitative approach and draw conclusions on how each concept can be enhanced to advance the learning of clinical reasoning with virtual patients. Methods: We chose a grounded theory approach to identify key categories and concepts of learning clinical reasoning and develop a framework. Throughout this process, the emerging codes were discussed with a panel of interdisciplinary experts. In a second step we applied the framework to virtual patients. Results: Based on the data we identified the core category as the "multifactorial nature of learning clinical reasoning". This category is reflected in the following five main categories: Psychological Theories, Patient-centeredness, Context, Learner-centeredness, and Teaching/Assessment. Each category encompasses between four and six related concepts. Conclusions: With our approach we were able to elaborate how key categories and concepts of clinical reasoning can be applied to virtual patients. This includes aspects such as allowing learners to access a large number of VPs with adaptable levels of complexity and feedback or emphasizing dual processing, errors, and uncertainty.

Thinking in Pharmacy Practice: A Study of Community Pharmacists' Clinical Reasoning in Medication Supply Using the Think-Aloud Method

Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists’ clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply.

Guided university debate: Effect of a new teaching-learning strategy for undergraduate nursing students

BACKGROUND

A number of studies have shown that the traditional lecture suffers from limitations in the development of many important competencies such as reasoning ability for nursing professionals.

OBJECTIVES

In view of this issue, the authors present a promising alternative to the traditional lecture: the Guided University Debate (GUD). With regard to this aim a teaching-learning sequence of schizophrenia is described based on the GUD. Next, the improvement in the argumentative and declarative knowledge of the students who have participated in the said methodology is demonstrated.

METHODS

Quasi-experimental study with pre-test and post-test design to measure differences in the improvement of declarative and argumentative knowledge. To determine if there is a statistically significant difference in the score obtained in the pre-test and in the post-test score a parametric t-tests was carried. 64 students participated in the study. Implementation of the study took place during the 2015-2016 academic year in the third year of the Nursing undergraduate degree course in the University of the Basque Country (UPV/EHU) as part of the Mental Health class.

RESULTS

The results showed a statistically-significant improvement in the students' scores for all learning outcomes analysed: Identifies symptoms of schizophrenia (p≤0.001), identifies the nursing interventions (p≤0.001), provides a rationale for nursing interventions (p≤0.001) and provides evidence of nursing interventions (p≤0.001). That is, the declarative and argumentative capacity of the group improved significantly with the Guided University Debate methodology.

CONCLUSIONS

Although the teaching design feasibility and outcomes may vary in different contexts, based on this studies' positive outcome, the authors call today's educators to be able to use GUD as a teaching method.

Clinical reasoning in nursing: teaching strategies and assessment tools

ABSTRACT Objective: To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice. Method: This is a theoretical reflection based on scientific studies. Results: Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning. Conclusion: The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making.

Effect of a PBL teaching method on learning about nursing care for patients with depression

BACKGROUND

Depression is a worldwide public health problem that requires the attention of qualified health professionals. The training of skilled nurses is a challenge for nursing instructors due to the complexity of this pathology.

OBJECTIVES

The aim was to analyse the declarative and argumentative knowledge acquired about depression by students receiving traditional expository instruction versus students receiving problem-based learning instruction.

METHODS

Quasi-experimental study with pre-test and post-test design in experimental and control group to measure differences in the improvement of declarative and argumentative knowledge. Non parametric tests were used to compare the scores between the experimental group and the control group, and between the pre-test and post-test in each group. 114 students participated in the study. Implementation of the study took place during the 2014-2015 academic year in the third year of the Nursing undergraduate degree courses in the University of the Basque Country (UPV/EHU) as part of the Mental Health Nursing subject.

RESULTS

The data indicated that there were no statistically significant differences between the two methodologies in regard to declarative knowledge in the care of patients with depression. Nevertheless, the argumentative capacity of the experimental group improved significantly with the problem-based learning methodology (p=0.000).

CONCLUSIONS

The results of the implementation indicated that problem-based learning was a satisfactory tool for the acquisition of argumentative capacity in depression nursing care. Still, working examples of teaching sequences that bridge the gap between general clinical practice and classroom practice remain an important goal for continuing research in nursing education.

Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study

BACKGROUND

As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses.

OBJECTIVE

This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting.

DESIGN

A qualitative exploratory design was used with a think-aloud method.

METHODS

A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis.

RESULTS

Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase.

CONCLUSIONS

It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion.

Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis

BACKGROUND

The home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required.

OBJECTIVES

The aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice.

DESIGN

An exploratory qualitative think-aloud design with protocol analysis was used.

SETTINGS

Home healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway.

PARTICIPANTS

A purposeful sample of eight registered nurses with one year of experience.

METHODS

Each nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis.

RESULTS

Recently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies.

CONCLUSIONS

Our results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes.

Virtual patient simulation in psychiatric care - A pilot study of digital support for collaborate learning

Psychiatric and mental health nursing is built on a trusted nurse and patient relationship. Therefore communication and clinical reasoning are two important issues. Our experiences as teachers in psychiatric educational programmes are that the students feel anxiety and fear before they start their clinical practices in psychiatry. Therefore there is a need for bridging over the fear. Technology enhanced learning might support such activities so we used Virtual patients (VPs), an interactive computer simulations of real-life clinical scenarios. The aim of this study was to investigate 4th term nursing students' opinions on the use of Virtual Patients for assessment in a Mental Health and Ill-health course module. We asked 24 volunteering students to practise with five different VP cases during almost 10 weeks before the exam. The participants were gathered together for participating in a written and an oral evaluation. The students were positive to the use of VPs in psychiatry and were very positive to use VPs in their continued nursing education. It seems that Virtual Patients can be an activity producing pedagogic model promoting students' independent knowledge development, critical thinking, reflection and problem solving ability for nurse students in psychiatric care.

Evaluation of a novel scoring and grading model for VP-based exams in postgraduate nurse education

For Virtual Patient-based exams, several scoring and grading methods have been proposed, but none have yet been validated. The aim of this study was to evaluate a new scoring and grading model for VP-based exams in postgraduate paediatric nurse education. The same student group of 19 students performed a VP-based exam in three consecutive courses. When using the scoring and grading assessment model, which contains a deduction system for unnecessary or unwanted actions, a progression was found in the three courses: 53% of the students passed the first exam, 63% the second and 84% passed the final exam. The most common reason for deduction of points was due to students asking too many interview questions or ordering too many laboratory tests. The results showed that the new scoring model made it possible to judge the students' clinical reasoning process as well as their progress.