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

AIMS: To characterize the thematic foci, structure, and evolution of nursing research on clinical reasoning and judgment. DESIGN: Bibliometric analysis. METHODS: We used a bibliometric method to analyze 1528 articles. DATA SOURCE: We searched the Scopus bibliographic database on January 7, 2024. RESULTS: Through a keyword co-occurrence analysis, we found the most frequent keywords to be clinical judgment, clinical reasoning, nursing education, simulation, nursing, clinical decision-making, nursing students, nursing assessment, critical thinking, nursing diagnosis, patient safety, nurses, nursing process, clinical competence, and risk assessment. The focal themes, structure, and evolution of nursing research on clinical reasoning and judgment were revealed by keyword mapping, clustering, and time-tracking. CONCLUSION: By assessing key nursing research areas, we extend the current discourse on clinical reasoning and clinical judgment for researchers, educators, and practitioners. Critical challenges must still be met by nursing professionals with regard to their use of clinical reasoning and judgment within their clinical practice. Further knowledge and comprehension of the clinical reasoning process and the development of clinical judgment must be successfully translated from research to nursing education and practice. IMPLICATIONS FOR THE PROFESSION: This study highlights the nursing knowledge gaps with regard to nurses' use of clinical reasoning and judgment and encourages nursing educators and professionals to focus on developing nurses' clinical reasoning and judgment with regard to their patients' safety. IMPACT: In addressing nurses' use of clinical reasoning and judgment, and with regard to patient safety in particular, this study found that, in certain clinical settings, the use of clinical reasoning and judgment remains a challenge for nursing professionals. This study should thus have an effect on nursing academics' research choices, on nursing educators' teaching practices, and on nurses' clinical practices. REPORTING METHOD: Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods.

Surveillance and patient safety in nursing research: A bibliometric analysis from 1993 to 2023.

AIMS: To identify and characterize the thematic foci, structure and evolution of nursing research on surveillance and patient safety. DESIGN: Bibliometric analysis. METHODS: Bibliometric methods were employed to analyse 1145 articles, using Bibliometrix and VOSviewer software. DATA SOURCE: The Scopus bibliographic database was searched on April 7, 2023. RESULTS: A keyword co-occurrence analysis found the most frequently occurring keywords to be: patient safety, nursing, nurses, adverse events, monitoring, critical care, quality improvement, vital signs, safety, alarm fatigue, education, nursing care, surveillance, clinical alarms, failure to rescue, evidence-based practice, acute care, clinical deterioration, communication, intensive care. Network mapping, clustering and time-tracking of the keywords revealed the focal themes, structure and evolution of the research field. CONCLUSION: By assessing critical areas of the nursing research field, this study extends and enriches the current discourse on surveillance and patient safety for nursing researchers and practitioners. Critical challenges still have to be met by nurses, however, including the failure to rescue deteriorating patients. Further knowledge and understanding of surveillance and patient safety must be successfully translated from research to practice. IMPLICATIONS FOR THE PROFESSION: This study highlights the gaps in nursing knowledge with regard to surveillance and patient safety and encourages nursing professionals to turn to evidence-based surveillance practices. IMPACT: In addressing the problem of surveillance and its effect on patient safety, this study found that, in most clinical care settings, preventing failures to rescue and adverse patient outcomes still remains a challenge for the nursing profession. This study should have an impact on nursing academics' future research themes and on nursing professionals' future clinical practices. REPORTING METHOD: Relevant EQUATOR guidelines have been adhered to by employing recognized bibliometric reporting methods.

Nurse practitioners' involvement and experience with AI-based health technologies: A systematic review.

BACKGROUND: Artificial intelligence (AI) is emerging in healthcare in various forms, including AI-based clinical decision support systems, machine learning, computer vision, natural language processing, big data analytics and AI-enhanced robotics. Given their potential impact on clinical processes and decision-making, AI-based health technologies (AIHT) are now seen to have a transformative effect on the nursing and medical professions, and on advanced nursing practice in particular. AIMS: While nurse practitioners (NPs) are increasingly called upon to play a crucial role in improving the healthcare provided to the population, little is known about the nature, extent and outcomes of their involvement and experience with AIHT. This study's research objectives are twofold. First, it aims to characterize NPs' involvement and experience with AIHT in terms of the functional and clinical attributes of the AIHT-based systems and applications that have emerged in advanced nursing care settings, and of the clinical tasks of NPs targeted for support by these systems and applications. Second, it aims to characterize this involvement and experience with AIHT in terms of its expected impacts on the clinical activities and performance of NPs, and of its potential outcomes for NPs' patients and for the general population. METHOD: We thus contribute to advanced practice nursing research by carrying out an initial evaluation of the role played by NPs in the emergence of these technologies, by means of a systematic review of the literature. FINDINGS: This review demonstrates that NPs, acting alone or in collaboration with physicians and other healthcare professionals, participate in the development and evaluation of various AI-based decision-making and predictive tools in primary, hospital and emergency care settings. This participation involves NPs as diagnostic and therapeutic experts whose clinical activities, decision-making and performance can be significantly impacted by their adoption and assimilation of AIHT.

[Nursing Science Education at Bachelor’s level: the process for developing a shared vision]. / L'enseignement de la science infirmière en formation initiale Bachelor : processus de développement d'une vision partagée.

The development and the implementation for a project in nursing science education at a Bachelor?s level is related to the recommendations published in the new curriculum framework (PEC 2012) of the University of Applied Sciences Western Switzerland. Considering the issues raised by the professors concerning the fundamentals in nursing science to be taught at a bachelor?s level, in line with a Master and Doctorate in nursing science, the management of the institution HEDS has given a mandate to two master students in nursing science to brainstorm with professors to develop and improve a plan of action for nursing science education. By relying on a rigorous methodology based on a systemic approach, interviews with national and international nursing experts, nursing faculty deans and professors concerned by those recommendations highlight two priorities for action : incorporate a conception of nursing discipline within the faculty of nursing and set up the curriculum according to the conceptual model chosen. This original project has allowed an important change for the renewal of a shared vision of nursing science education at three levels : the teachers? educational practices, the curriculum and the institution.

Effectiveness of a pedometer-based program using a socio-cognitive intervention on physical activity and quality of life in a setting of cardiac rehabilitation.

BACKGROUND: Physical activity contributes to improve health and quality of life. However, the prevalence of sedentary lifestyle is elevated after an acute coronary syndrome. METHODS: A randomized controlled trial was performed to evaluate the impact of a pedometer-based program associated with a socio-cognitive intervention on physical activity behaviour, cardiovascular risk factors, and quality of life during the year after an acute coronary syndrome event. During hospitalization, we randomized 32 patients to an experimental group and 33 patients to a usual care group. The experimental intervention included 6 consultations with a clinical nurse specialist during 12 months. RESULTS: Groups characteristics were comparable. At baseline, the percentage of participants considered in the active range category was similar between groups (31% vs 41%; P = 0.915). However, the proportion of participants who were still active was greater in the experimental group than in the usual care group at 6, 9, and 12 months follow-up (75% vs 41%; 68% vs 36%, and 83% vs 55%, respectively; P < 0.05). After 12 months, changes in overall quality of life and in health and the functioning scores were different between groups (interaction effects [groups by time] P = 0.048 and P = 0.036, respectively). CONCLUSIONS: The use of a pedometer concomitantly with a socio-cognitive intervention improves adherence to physical activity and quality of life during the year after an acute coronary syndrome event. This finding is relevant because physical activity and quality of life are a great concern in preventive cardiology. These results support applying this innovative approach in cardiac rehabilitation programs.

Innovative program to increase physical activity following an acute coronary syndrome: randomized controlled trial.

OBJECTIVE: To evaluate the impact of a socio-cognitive intervention associated with a pedometer-based program on physical activity, cardiovascular risk factors and self-efficacy expectation during one year following an acute coronary syndrome. METHODS: Sixty-five subjects were randomized during hospitalization in an experimental or a usual care group. Average steps/day was measured every 3 months until one year following discharge. Other dependent variables were measured at baseline, 6 and 12 months follow-up. RESULTS: There were 32 patients in the experimental group and 33 patients in the usual care group. Group characteristics were comparable. At baseline, averages steps/day were similar between groups (5845±3246 vs. 6097±3055 steps/day; p=0.812). At 3-month follow-up, both groups increased their averages steps/day (p<0.05). This increase was higher in the experimental group (3388±844 vs. 1934±889 steps/day; p<0.001). At 12-month, interaction effects (group×time) in physical activity and waist circumference were different between groups (p<0.05), whereas self-efficacy expectation increased in both groups similarly (p<0.05). CONCLUSION: The intervention is useful to improve average steps/day and waist circumference during the first year following an acute coronary syndrome. PRACTICE IMPLICATIONS: This study supports development of the home-based cardiac rehabilitation program using socio-cognitive intervention associated with a pedometer after an acute coronary syndrome.

Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial.

BACKGROUND: Although multidisciplinary congestive heart failure clinics in the United States appear to be effective in reducing the number of hospital readmissions, it is unclear whether the same benefit is seen in countries such as Canada, where access to both general and specialized medical care is free and unrestricted. We sought to determine the impact of care at a multidisciplinary specialized outpatient congestive heart failure clinic compared with standard care. METHODS: We randomly assigned 230 eligible patients who had experienced an acute episode of congestive heart failure to standard care (n = 115) or follow-up at a multidisciplinary specialized heart failure outpatient clinic (n = 115). The intervention consisted of a structured outpatient clinic environment with complete access to cardiologists and allied health professionals. The primary outcomes were all-cause hospital admission rates and total number of days in hospital at 6 months. The secondary outcomes were total number of emergency department visits, quality of life and total mortality. RESULTS: At 6 months, fewer patients in the intervention group had required readmission to hospital than patients in the control group (45 [39%] v. 66 [57%], crude hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.38-0.92. Patients in the intervention group stayed in hospital for 514 days compared with 815 days required by patients in the control group (adjusted HR 0.56, 95% CI 0.35-0.89). The number of patients seen in the emergency department and the total number of emergency department visits were similar in the intervention and control groups. At 6 months, quality of life, which was self-assessed using the Minnesota Living with Heart Failure questionnaire, was unchanged in the control group but improved in the intervention group (p < 0.001). No difference in mortality was observed, with 19 deaths in the control group and 12 in the intervention group (HR 0.61, 95% CI 0.24-1.54). INTERPRETATION: Compared with usual care, care at a multidisciplinary specialized congestive heart failure outpatient clinic reduced the number of hospital readmissions and hospital days and improved quality of life. When our results are integrated with those from other, similar trials, multidisciplinary disease management strategies for congestive heart failure are associated with clinically worthwhile improvements in survival.