Clinical reasoning: What do nurses, physicians, and students reason about.

Clinical reasoning is a core ability in the health professions, but the term is conceptualised in multiple ways within and across professions. For interprofessional teamwork it is indispensable to recognise the differences in understanding between professions. Therefore, our aim was to investigate how nurses, physicians, and medical and nursing students define clinical reasoning. We conducted 43 semi-structured interviews with an interprofessional group from six countries and qualitatively analysed their definitions of clinical reasoning based on a coding guide. Our results showed similarities across professions, such as the emphasis on clinical skills as part of clinical reasoning. But we also revealed differences, such as a more patient-centered view and a broader understanding of the clinical reasoning concept in nurses and nursing students. The explicit sharing and discussion of differences in the understanding of clinical reasoning across health professions can provide valuable insights into the perspectives of different team members on clinical practice and education. This understanding may lead to improved interprofessional collaboration, and our study's categories and themes can serve as a basis for such discussions.

Developing a European longitudinal and interprofessional curriculum for clinical reasoning.

Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

The extraordinary makes the ordinary visible - nursing students' experiences of their learning in clinical practice during COVID-19: a qualitative study.

BACKGROUND: The COVID-19 crisis had a significant impact on health care and nursing education as a large part of it is carried out in clinical practice. However, it is not known how the learning situations during the pandemic affected students' learning. To deepen the understanding of students' learning, learning theories within a constructive paradigm is used as a framework for this study. The purpose of the study was to explore nursing students´ perceptions of their learning in clinical practice during COVID-19. METHODS: In this interpretative qualitative study, seven focus group discussions were conducted with 21 nursing students at different stages of the nursing programme, all of whom performed clinical practice during the outbreak of COVID-19. The analysis of the discussions was performed with interpretative content analysis related to theoretical assumptions about learning. RESULTS: The learning situation was characterised by chaos and confusion affecting both the students' opportunities to learn and what they learned. Despite the uncertainty the students appreciated having experienced this unique situation, which contributed to valuable learning. Things otherwise taken for granted or not encountered before became visible. The learning processes were characterised by complexity and challenges that hindered or stimulated learning. It depended on the student's approach and the management of the clinical education. Concerns about one´s own and relatives' health, and not being able to finish studies, also affected learning. The students learned about important measures during a pandemic regarding hygiene, care organisation, communication, and the multifaceted role of the nurse. CONCLUSION: Unpredictable situations such as a pandemic can lead to unique learning since "the extraordinary makes the ordinary visible". The students learned things additional to the formal learning outcomes, and the experiences strengthened their will to become nurses. Challenges due to a crisis can become important driving forces for learning, if not experienced as overwhelming. Some students felt they received space for own initiatives and responsibility while others felt lost and abandoned. Preparing for a crisis means preparing for an unknown future. Students therefore need to experience dilemmas and uncertain situations and reflect in a safe environment.

Psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric.

A number of studies attest to the effectiveness of virtual patients in fostering and assessing students' development of clinical reasoning. An objective assessment of students' clinical reasoning is, however, challenging. This study focused on determining the psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric, a rubric that is aimed at assessing nursing students' clinical reasoning processes when encountering virtual patients. A nonexperimental design was used in which data from 125 students' reflections on solving two different virtual patient scenarios were included in the analysis. First, a deductive content analysis was conducted using the categories of the rubric as a lens. After that, each student's performance was quantified according to the different levels of the rubric. Exploratory factor analysis and test of normality and reliability, including the Kaiser-Meyer-Olkin test, Bartlett's test, the Shapiro-Wilk test, and Cronbach's alpha were used in the analysis. The result suggested three factors: "Understanding the patient", "Care planning" and "Reflecting" that explained 81.8% of the variance. Cronbach's alpha was 0.931. The result showed the rubric to be a valid assessment instrument for assessing nursing students' clinical reasoning when encountering virtual patients.

A Rubric to Assess Students' Clinical Reasoning When Encountering Virtual Patients.

BACKGROUND: Training with virtual patients has been proposed as a suitable learning activity to improve clinical reasoning skills for nursing students. However, published instruments with the capacity to assess students' reasoning process in the encounter with virtual patients are lacking. METHOD: Deductive and abductive analyses were used to adapt the Lasater Clinical Judgment Rubric (LCJR) to assess nursing students' clinical reasoning skills in the encounter with virtual patients. The new rubric's ability to capture nursing students' clinical reasoning processes was tested using deductive analysis and statistical analysis. RESULTS: A grading rubric for virtual patients, the vpLCJR, was developed. Cronbach's alpha showed .892, indicating good internal consistency. CONCLUSION: The rubric vpLCJR, which deconstructs aspects of clinical reasoning for both students and faculty members, can be used to clarify expectations, assess students' clinical reasoning process, and provide feedback for learning when nursing students encounter virtual patients. [J Nurs Educ. 2018;57(7):408-415.].

Web-based virtual patients in nursing education: development and validation of theory-anchored design and activity models.

BACKGROUND: Research has shown that nursing students find it difficult to translate and apply their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as a learning activity that can support nursing students in their learning of scientific knowledge and help them integrate theory and practice. Although VPs are increasingly used in health care education, they still lack a systematic consistency that would allow their reuse outside of their original context. There is therefore a need to develop a model for the development and implementation of VPs in nursing education. OBJECTIVE: The aim of this study was to develop and evaluate a virtual patient model optimized to the learning and assessment needs in nursing education. METHODS: The process of modeling started by reviewing theoretical frameworks reported in the literature and used by practitioners when designing learning and assessment activities. The Outcome-Present State Test (OPT) model was chosen as the theoretical framework. The model was then, in an iterative manner, developed and optimized to the affordances of virtual patients. Content validation was performed with faculty both in terms of the relevance of the chosen theories but also its applicability in nursing education. The virtual patient nursing model was then instantiated in two VPs. The students' perceived usefulness of the VPs was investigated using a questionnaire. The result was analyzed using descriptive statistics. RESULTS: A virtual patient Nursing Design Model (vpNDM) composed of three layers was developed. Layer 1 contains the patient story and ways of interacting with the data, Layer 2 includes aspects of the iterative process of clinical reasoning, and finally Layer 3 includes measurable outcomes. A virtual patient Nursing Activity Model (vpNAM) was also developed as a guide when creating VP-centric learning activities. The students perceived the global linear VPs as a relevant learning activity for the integration of theory and practice. CONCLUSIONS: Virtual patients that are adapted to the nursing paradigm can support nursing students' development of clinical reasoning skills. The proposed virtual patient nursing design and activity models will allow the systematic development of different types of virtual patients from a common model and thereby create opportunities for sharing pedagogical designs across technical solutions.

Virtual patients for assessment of clinical reasoning in nursing -- a pilot study.

In different nursing programmes, one important learning outcome is clinical reasoning (CR) skills. However, to date, there is limited number of methods available for assessment of CR skills; especially for distance-based courses. This study investigates students' opinions about the feasibility of using Virtual Patients (VPs) for assessing CR in nursing education. VPs were introduced as an assessment tool in three different nursing courses at two universities, comprising 77 students in total. Students' overall acceptance of this assessment tool, including its applicability to the practise of nursing and the potential of VP-based assessment as a learning experience, were investigated using questionnaires. Course directors used the Web-SP system to assess students' interactions with VPs and their answers regarding diagnoses, caring procedures and their justifications. Students' found the VP cases to be realistic and engaging, and indicate a high level of acceptance for this assessment method. In addition, the students' indicated that VPs were good for practising their clinical skills, although some would prefer that the VP system be less "medical" and asked for more focus on nursing. Although most students supplied correct diagnoses and made adequate clinical decisions, there was a wide range in their ability to explain their clinical reasoning processes.