Effect of a guide for clinical reasoning on Nursing students' diagnostic accuracy: A clinical trial. / Efeito de guia para raciocínio clínico na acurácia diagnóstica de estudantes de enfermagem: ensaio clínico.

OBJECTIVE: to evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate Nursing students. METHOD: a randomized, parallel and double-blind (researchers and outcome evaluators) clinical trial, carried out with undergraduate Nursing students. Validated case studies were applied in two phases to identify the patient's Nursing diagnosis/problem, etiology and clues, using the Guide with the intervention group in the second phase. The outcomes - diagnostic and etiological accuracy and number of clues - were evaluated using validated rubrics. Descriptive statistics were used to analyze demographic data; Fisher's exact test for similarities in prior education and confidence; Mann-Whitney's test for age; and non-parametric ANOVA test in the evaluation of the hypothesis of differences in performance. RESULTS: final sample composed of 24 students in the control group and 27 in the intervention group; no difference as to gender, age and schooling. There was a difference in diagnostic (p=0.041) and etiological (p=0.0351) accuracy in the intervention group, showing a negative effect of using the Guide. CONCLUSION: the one-time self-instruction was not effective in impacting the diagnostic accuracy of students solving case studies. Repeated application of the Guide as a teaching tool can be effective in improving such outcome. REBEC: RBR-4bhr78.

Cross-cultural adaptation for Brazil and validity of a guide to assist nursing students' clinical reasoning.

PURPOSE: To assess the validity of a Written Clinical Reasoning Prompt (WCRP) to help nursing students' clinical reasoning (CR). METHOD: This is a methodological study of translation and cross-cultural adaptation into Brazilian Portuguese of instruments that aim to promote CR improvement, composed of (1) WCRP; (2) two case studies; (3) a questionnaire about students' perceptions during decision-making in case studies; (4) a scoring rubric for correcting case studies. For translation and cross-cultural adaptation, stages 1-8 of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Consortium Network were adopted. Agreement values among experts >80% and content validity coefficient (CVC) > 0.8 were considered satisfactory. For the pretest, a randomized clinical trial was carried out with 24 nursing students (intervention group, n = 14, using the WCRP to solve case studies; control group, n = 10, without using the WCRP). FINDINGS: The WCRP was translated and adapted into Brazilian Portuguese, requiring minimal adjustments to obtain agreement among the judges above 80% and CVC above 0.80. Regarding face validation, an adequate agreement was obtained in the assessment by students. There was no difference in the accuracy of nursing diagnoses between the intervention and control groups in the pretest. CONCLUSION: The WCRP was translated and adapted into Brazilian Portuguese and had adequate face and content validity estimates; however, there was no association with improving nursing students' diagnostic accuracy. IMPLICATIONS FOR NURSING PRACTICE: The translated and adapted versions of all instruments into Brazilian Portuguese had adequate evidence of content and face validity. The use of WCRP was not associated with a significant improvement in nursing students' diagnostic accuracy. New studies with larger samples, a sample power of at least 80%, and a level of significance of 5% are needed.

Efeito de guia para raciocínio clínico na acurácia diagnóstica de estudantes de enfermagem: ensaio clínico / Effect of a guide for clinical reasoning on Nursing students' diagnostic accuracy: A clinical trial / Efecto de una guía de razonamiento clínico sobre la precisión diagnóstica de estudiantes de enfermería: ensayo clínico

Resumo Objetivo avaliar o efeito do Guia Autoinstrucional para Raciocínio Clínico na acurácia diagnóstica de estudantes de Bacharelado em Enfermagem. Método ensaio clínico randomizado, paralelo, duplo cego (pesquisadores e avaliadores dos desfechos), realizado com graduandos de Enfermagem. Aplicaram-se, em duas fases, estudos de caso validados para a identificação de diagnóstico de enfermagem/problema do paciente, etiologia e pistas, sendo utilizado o Guia com o grupo intervenção na segunda fase. Os desfechos - acurácia diagnóstica, etiológica e número de pistas - foram avaliados por meio de rubricas validadas. Para análise, utilizou-se estatística descritiva para dados demográficos; teste exato de Fisher para similaridades na educação prévia e confiança; teste de Mann-Whitney para idade; teste ANOVA não paramétrico na avaliação da hipótese de diferenças no desempenho. Resultados amostra final composta por 24 estudantes no grupo controle e 27 no intervenção; sem diferença quanto ao sexo, idade e educação. Houve diferença para acurácia diagnóstica (p=0,041) e etiológica (p=0,0351) no grupo intervenção, mostrando efeito negativo da utilização do Guia. Conclusão a autoinstrução implementada uma única vez não foi efetiva em impactar a acurácia diagnóstica de estudantes solucionando estudos de caso. A aplicação repetida do Guia como ferramenta didática pode ser efetiva para melhorar tal desfecho. REBEC: RBR-4bhr78.

Abstract Objective to evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate Nursing students. Method a randomized, parallel and double-blind (researchers and outcome evaluators) clinical trial, carried out with undergraduate Nursing students. Validated case studies were applied in two phases to identify the patient's Nursing diagnosis/problem, etiology and clues, using the Guide with the intervention group in the second phase. The outcomes - diagnostic and etiological accuracy and number of clues - were evaluated using validated rubrics. Descriptive statistics were used to analyze demographic data; Fisher's exact test for similarities in prior education and confidence; Mann-Whitney's test for age; and non-parametric ANOVA test in the evaluation of the hypothesis of differences in performance. Results final sample composed of 24 students in the control group and 27 in the intervention group; no difference as to gender, age and schooling. There was a difference in diagnostic (p=0.041) and etiological (p=0.0351) accuracy in the intervention group, showing a negative effect of using the Guide. Conclusion the one-time self-instruction was not effective in impacting the diagnostic accuracy of students solving case studies. Repeated application of the Guide as a teaching tool can be effective in improving such outcome. REBEC: RBR-4bhr78.

Resumen Objetivo evaluar el efecto de la Guía Autoinstruccional de Razonamiento Clínico en la precisión diagnóstica de estudiantes de Licenciatura en Enfermería. Método ensayo clínico aleatorizado, paralelo, doble ciego (investigadores y evaluadores de resultados), realizado con estudiantes de la carrera de enfermería. Se aplicaron estudios de casos validados en dos fases para identificar el diagnóstico de enfermería/problema del paciente, etiología y pistas, utilizando la Guía con el grupo experimental en la segunda fase. Los resultados (precisión diagnóstica, etiológica y número de pistas) se evaluaron utilizando rúbricas validadas. Para el análisis se utilizó estadística descriptiva para datos demográficos; prueba exacta de Fisher para similitudes en educación previa y confianza; prueba de Mann-Whitney para la edad; prueba ANOVA no paramétrica en la evaluación de la hipótesis de diferencias en el desempeño. Resultados muestra final compuesta por 24 estudiantes en el grupo control y 27 en el grupo experimental; no había diferencias en cuanto al sexo, la edad y educación. Hubo diferencia en la precisión diagnóstica (p=0,041) y etiológica (p=0,0351) en el grupo experimental, que mostraron un efecto negativo del uso de la Guía. Conclusión la autoinstrucción implementada por única vez no fue efectiva para generar un impacto en la precisión diagnóstica de los estudiantes que resolvieron los estudios de casos. La aplicación repetida de la Guía como herramienta de enseñanza puede ser eficaz para mejorar dicho resultado. REBEC: RBR-4bhr78.

Effects of Clinical Reasoning Prompts on Nursing Students' Clinical Judgment for a Patient Experiencing Respiratory Distress.

PURPOSE: To test the effects of clinical reasoning prompts on students' clinical judgment of a written case study. METHODS: An experimental pre- and posttest study with second semester nursing students (N = 163). FINDINGS: The intervention was insufficient to significantly improve clinical judgment. Students identified that the prompts would help them "narrow… down the problem" and "slow… the decision-making process" to improve analysis. The most accurate patient problem was identified by 28% of students in pretest and 35% in posttest. CONCLUSIONS: This study provides evidence of variations in nursing students' clinical judgment and students' desire to use decision-making algorithms. NURSING IMPLICATIONS: Nurse educators should provide students with additional education and practice to identify and solve these types of problems.

Translation and cultural adaptation for Brazil of the Developing Nurses' Thinking model / Tradução e adaptação cultural para o Brasil do modelo Developing Nurses' Thinking / Traducción y adaptación cultural para Brasil del modelo Developing Nurses' Thinking

OBJECTIVES: to translate and culturally adapt to Brazilian Portuguese the Developing Nurses' Thinking model, used as a strategy for teaching clinical reasoning. METHOD: the translation and cultural adaptation were undertaken through initial translation, synthesis of the translations, back-translation, evaluation by a committee of specialists and a pre-test with 33 undergraduate nursing students. RESULTS: the stages of initial translation, synthesis of the translations and back-translation were undertaken satisfactorily, small adjustments being needed. In the evaluation of the translated version by the committee of specialists, all the items obtained agreement over 80% in the first round of evaluation and in the pre-test with the students, so the model was shown to be fit for purpose. CONCLUSION: the use of the model as a complementary strategy in the teaching of diagnostic reasoning is recommended, with a view to the training of nurses who are more aware regarding the diagnostic task and the importance of patient safety. .

OBJETIVOS: traduzir e adaptar culturalmente para a língua portuguesa do Brasil o modelo Developing Nurses' Thinking, utilizado como estratégia ao ensino do raciocínio clínico. MÉTODO: a tradução e adaptação cultural foi realizada por meio de tradução inicial, síntese das traduções, retrotradução, avaliação por comitê de especialistas e pré-teste com 33 estudantes de graduação em enfermagem. RESULTADOS: as etapas de tradução inicial, síntese das traduções e retrotradução foram realizadas a contento, havendo a necessidade de pequenos ajustes. Na avaliação pelo comitê de especialistas da versão traduzida, todos os itens obtiveram concordância superior a 80% na primeira rodada de avaliação e no pré-teste com os estudantes. O modelo mostrou-se adequado à sua finalidade. CONCLUSÃO: recomenda-se o uso do modelo como uma estratégia complementar ao ensino do raciocínio diagnóstico, visando a formação de enfermeiros mais conscientes sobre a tarefa diagnóstica e a importância da segurança do paciente. .

OBJETIVOS: traducir y adaptar culturalmente para el idioma portugués de Brasil el modelo Developing Nurses' Thinking, utilizado como estrategia la enseñanza del raciocinio clínico. MÉTODO: la traducción y adaptación cultural fue realizada por medio de traducción inicial, síntesis de las traducciones, retrotraducción, evaluación por comité de especialistas y preprueba con 33 estudiantes de graduación en enfermería. RESULTADOS: las etapas de traducción inicial, síntesis de las traducciones y retrotraducción fueron realizadas satisfactoriamente, habiendo la necesidad de realizar pequeños ajustes. En la evaluación por el comité de especialistas de la versión traducida, todos los ítems obtuvieron concordancia superior a 80% en la primera rodada de evaluación y en el preprueba con los estudiantes, el modelo se mostró adecuado para su finalidad. CONCLUSIÓN: se recomienda el uso del modelo como una estrategia complementaria a la enseñanza del raciocinio diagnóstico, objetivando la formación de enfermeros más conscientes sobre la tarea diagnóstica y la importancia de la seguridad del paciente. .

Translation and cultural adaptation for Brazil of the Developing Nurses' Thinking model.

OBJECTIVES: to translate and culturally adapt to Brazilian Portuguese the Developing Nurses' Thinking model, used as a strategy for teaching clinical reasoning. METHOD: the translation and cultural adaptation were undertaken through initial translation, synthesis of the translations, back-translation, evaluation by a committee of specialists and a pre-test with 33 undergraduate nursing students. RESULTS: the stages of initial translation, synthesis of the translations and back-translation were undertaken satisfactorily, small adjustments being needed. In the evaluation of the translated version by the committee of specialists, all the items obtained agreement over 80% in the first round of evaluation and in the pre-test with the students, so the model was shown to be fit for purpose. CONCLUSION: the use of the model as a complementary strategy in the teaching of diagnostic reasoning is recommended, with a view to the training of nurses who are more aware regarding the diagnostic task and the importance of patient safety.

Effects of using the developing nurses' thinking model on nursing students' diagnostic accuracy.

This quasi-experimental study tested the effectiveness of an educational model, Developing Nurses' Thinking (DNT), on nursing students' clinical reasoning to achieve patient safety. Teaching nursing students to develop effective thinking habits that promote positive patient outcomes and patient safety is a challenging endeavor. Positive patient outcomes and safety are achieved when nurses accurately interpret data and subsequently implement appropriate plans of care. This study's pretest-posttest design determined whether use of the DNT model during 2 weeks of clinical postconferences improved nursing students' (N = 83) diagnostic accuracy. The DNT model helps students to integrate four constructs-patient safety, domain knowledge, critical thinking processes, and repeated practice-to guide their thinking when interpreting patient data and developing effective plans of care. The posttest scores of students from the intervention group showed statistically significant improvement in accuracy.