Exploring the observer role and clinical reasoning in simulation: A scoping review

AimThis scoping review aimed to explore nursing students experience as simulation observers and their level of engagement in learning through use of clinical decision-making models and learning scaffolds.BackgroundA gap continues to exist between the published empirical literature, the role and experiences of the simulation observer and teaching scaffolds that enhance learning outcomes, despite the increased understanding of simulation and its role in preparing nursing students for practice. Further, little is known about the nursing student’s experience of clinical reasoning whilst observing simulation and the impact of scaffolding observations using clinical decision-making models.DesignThis scoping review was conducted using the methodological framework of Arksey and O'Malley (2005) and the PRISMA checklist for systematic reviews (Page et al., 2020).MethodsA comprehensive search of the literature published in Medline and CINAHL databases between 1999 and 2020 was undertaken in May 2019. The studies selected for this review (n = 18) were analyzed thematically. The validated Mixed-Methods Appraisal Tool assessed quality of the quantitative, qualitative and mixed methods studies.ResultsThe role of the observer in simulation was explored and included observation to transform practice in self and observation to transform practice in others, namely peers in the nurse role in simulation. Application of the MMAT indicated that of the 18 studies included only 6 (33.3%) had a clear research question. Research aims or objectives were found in another six studies (33.3%). In this review 13 studies (72%) included answers to the research question or aim, three (17%) did not and in two (11%) it was impossible to tell.ConclusionsResults of this review indicate the paucity of research relating to nursing student’s experience of clinical reasoning while observing simulation. Further, it highlights the value of nurse educators optimizing the observer role and maximizing learning by scaffolding observer activities within the simulation experience.     

The impact of a clinical coaching education on faculty's coaching behavior

BackgroundInconsistent clinical educator preparation to guide students’ thinking, engage reflection, and provide immediate feedback impacts student's decision-making. Clinical coaching, a teaching framework, promotes one-to-one teaching, questioning, and feedback between the educator and student. There are limited studies measuring the impact of clinical coaching education on educators.MethodsA quasi experimental design was conducted in 2019 with 36 clinical nursing instructors from two undergraduate programs. Data were collected using the Clinical Coaching Interactions Inventory: Educator Group Version. A match-paired Wilcoxon test was used for analysis of responses.ResultsClinical educators reported a statistical increase in the use of one higher-order question—asking students to synthesize clinical knowledge and reasoning.ConclusionsThe findings suggest that a clinical coaching education program improves clinical nurse educators’ ability to engage students in synthesizing knowledge, which can help in prioritizing care. These findings may promote clinical coaching strategies for clinical faculty to improve clinical reasoning skills in students.     

The impact of combining concept-based learning and concept-mapping pedagogies on nursing students' clinical reasoning abilities

BackgroundIntegrating contemporary teaching strategies into the nursing curriculum is an effective approach to enhance undergraduate clinical-judgment and reasoning abilities.ObjectiveThis study aims to document the impact of blending the teaching strategies of concept-based learning and concept-mapping to enhance nursing students' clinical-reasoning abilities.DesignA quasi experimental design is used to guide data collection from second year students.Setting and participantsA consecutive sample of all students undertaking adult health nursing courses at a private university in Jordan and meeting the eligibility criteria resulted in (N = 40).MethodData was collected via a questionnaire and observation to reveal students' independence in both clinical-reasoning and clinical-judgment. General Clinical-Reasoning Behavior Scale, Independence in Clinical-Reasoning and Clinical-Judgment scales were completed by the students at the beginning and end of the courses.ResultsDespite requesting extensive preparation time, concept-based learning and concept-mapping as student-centered approaches enabled the move away from a content laden approach towards constructing criteria against which various patients' encounters were reflected. This study documented enhancement in students' independence in clinical-reasoning and clinical-judgment as they learned to take command of the elements of their clinical-reasoning. Significant improvement in students' general clinical-reasoning behavior was also documented.ConclusionThe data collection tools utilized in this study can be used as clinical teaching aides, hence maximizing the impact of blended teaching strategies by providing the faculty with specific feedback regarding students' clinical reasoning and judgment abilities. Institutionalizing these processes by initiating relevant policies and guidelines is essential to help students take command of their clinical-reasoning, maturity, and responsibility in a practice area that is constantly changing and evolving.     

Clinical judgment conceptualization scoping review protocol

Clinical judgment within nursing is best understood as the observable outcome of clinical reasoning and critical thinking. However, clinical judgment is poorly conceptualized and lacks a universal definition within nursing. Clinical judgment, clinical reasoning, and critical thinking have been used interchangeably in practice and literature. The objectives of this scoping review are to (1) investigate the extent, range, and nature of the literature pertaining to clinical judgment; (2) provide a synthesis of the current literature as related to clinical judgment within nursing; and (3) inform future research regarding clinical judgment in nursing. Twenty-four English peer-reviewed literature, including primary research studies, systematic reviews, meta-analyses, and guidelines, were included in this study. The identified literature was charted using a summary table of included sources of evidence from the databases. Four main themes were extracted from the review: (1) Varying definitions of clinical judgment; (2) Clinical Judgment, Experience, and Intuition; (3) Clinical Judgment and Evidence-Based Practice; and (4) Clinical Judgment, Clinical Reasoning, and Critical Thinking. The authors conclude that there are evident discrepancies in the definition of clinical judgment. Clinical judgment in nursing is multifaceted and involves both experiential knowledge as well as evidence-based knowledge.     

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

BackgroundThe 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.ObjectivesThe 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.DesignAn exploratory qualitative think-aloud design with protocol analysis was used.SettingsHome healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway.ParticipantsA purposeful sample of eight registered nurses with one year of experience.MethodsEach 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.ResultsRecently 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.ConclusionsOur 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.     

Technological literacy in nursing education: A scoping review

BackgroundNurses are the key professionals in the introduction, implementation, and use of technology in clinical practice. A lack of technical expertise and technological understanding poses a challenge to the quality of health services and possibly to the safety, dignity, and quality of life of patients. Therefore, possessing technological literacy upon completing nursing baccalaureate studies is essential. However, no previous scoping review has mapped the existing studies of technological literacy in nursing education.ObjectivesTo map and assess the published studies on technological literacy in nursing education and to identify how educational institutions operationalize, teach, measure, and maintain students' technological literacy throughout their educational programs.DesignA scoping review was conducted using the methodological framework of Arksey and O'Malley. The reporting was guided by the PRISMA extension for Scoping Reviews.MethodsA comprehensive systematic search of the MEDLINE, EMBASE, PsycINFO, ERIC, and CINAHL was performed for studies published from January 2008 through March 2020. Two authors independently assessed eligibility and extracted data. The reference lists of the included studies were also examined.ResultsThe review included 28 papers from 27 studies. Three thematic groupings with their respective subgroups were identified among the included papers: 1) the acquisition (simulated electronic documentation, diversified learning methods, and evaluation learning focus), 2) the measurement (digital/computer literacy/competence, nursing informatics competence, technology acceptance, and students' interests and preferences in technology), and 3) the maintenance (follow-up evaluation) of technological knowledge and skills.ConclusionsPedagogical models designed to teach an entire process for the acquisition, measurement, and maintenance of technological literacy are lacking. Studies are needed that bring technological competencies to a higher level, including problem-solving and critical thinking. Educators' competencies should be enhanced. Educational institutions need to ensure the readiness of future nurses for a technology-enriched environment by providing the necessary knowledge in technological literacy.“Tweetable abstract”Due to the importance of technological literacy to the nursing profession, educational institutions must ensure that it is taught to nursing students.     

Strategies used for the promotion of critical thinking in nursing undergraduate education: A systematic review

ObjectiveIdentifying the strategies used to promote critical thinking (CT) during undergraduate education in nursing courses.DesignSystematic review.Source of DataFive electronic databases were searched without language, publication time or geographic filters.MethodA systematic review of the literature. Including experimental studies that considered at least one teaching strategy to promote critical thinking of undergraduate students in Nursing courses. The search for studies occurred in three phases: title and summary review, complete text and implementation of a clinical form of selection according to predetermined criteria. All included studies were assessed for quality through a classification tool for experimental studies.ResultsSix studies were selected. The results were grouped into three key themes: an evaluation of the quality of the selected studies, characterization of the studies and the strategies used to promote critical thinking. All selected studies were in English, with significant conceptual similarity of Critical Thinking and dominance in choosing the approached theme during strategies in clinical nursing education with an emphasis on the nursing process.ConclusionsThe most widely used teaching intervention was Problem-Based Learning. Nursing education mediated by strategies that stimulate CT is considered a positive difference in undergraduate curriculums.     

Nurses’ clinical leadership in the intensive care unit: A scoping review

ObjectiveTo explore the existing knowledge in the literature about nurses' clinical leadership in the intensive care unit.MethodsA scoping review was conducted according to Arksey & O'Malley’s methodology. The search process encompassed five main online databases, PubMed (including MEDLINE), CINAHL, PsycINFO, Scopus and Cochrane, for the period January 2007-September 2022. Data abstraction, quality appraisal and narrative synthesis were conducted in line with the Preferred Reporting Items for Systematic reviews and meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.ResultsEleven studies were included. The evidence reveals that idealised influence, motivational inspiration, intellectual stimulation and intrinsic individual consideration are the key clinical nurse leader competencies needed in the intensive care unit. The compatible leadership styles in this setting are situational and transformational. Communication skills and professional experience seem to be determinants to consider in the strategies to promote clinical leadership in intensive care units.ConclusionsThis scoping review provides broad and comprehensive knowledge, which helps to understand, in a single study, the key competencies, leadership styles, determinants and strategies needed to promote intensive care unit nurses' clinical leadership.     

Triage education in rural remote settings: A scoping review

BackgroundTriage is a complex nursing task to prioritise patient care, based on acuity. Triage decisions can affect patient safety and must employ critical thinking. Graduate registered nurses are expected to triage in rural facilities, which is in contrast to current guidelines. The purpose of this review was; to discover how effective education support programs were in developing clinical decision-making skills for graduates at triage; and to determine what is known about triage education support programs for graduate or novice registered nurses undertaking triage in rural and remote settings.MethodA scoping review was undertaken to identify and analyse primary research articles following PRISMA guidelines, sourced from four electronic databases.Results6158 retrieved articles were found, after duplicate removal and screening against inclusion/exclusion criteria; fourteen articles were included. Themes included ‘variability of triage accuracy and assessment’; ‘education qualifications and experience’; and ‘training and supervision’.ConclusionThis review demonstrates significant gaps in the literature reporting on this topic area, particularly in the rural context. Common recommendations include standardised triage education strategies, and strategies that account for differences in resourcing levels. Further research is required to attempt to link education strategies in rural contexts to acceptable triage outcomes like triage accuracy.     

Nursing students' preparedness and practice in critical care settings: A scoping review

BackgroundDue to the demanding nature of critical care settings, students are prone to experience stress and lack of confidence, which hinders their learning and affects patient care. Educators should be knowledgeable about students' roles, stressors, and challenges as well as strategies to enhance students' competence and confidence to efficiently practice in critical care.PurposeTo map and analyze the literature about nursing students' placement, preparedness, and practice in critical care settings and identified areas for future research and practice.MethodsA scoping review using PRISMA guidelines. The literature was searched within eight databases using indexed terms. In total, 32 sources were selected for review. Literature summary tables, thematic synthesis, narrative summaries were used for data extraction and synthesis.FindingsThree themes and 12 sub-themes were generated. The themes included students' experiences and perspectives about critical care placements, strategies to enhance student learning, and the impact of clinical placements and teaching strategies on students.ConclusionsCritical care placements allow students in understanding the care of complex patients, enhancing their observational skills, and improving their interpersonal relationships in critical care teams. To enhance student preparedness for effective practice, high fidelity simulations and course-based teaching have been demonstrated to be effective.     

Seeking autonomy: Grounded theory of clinical reasoning processes during simulation based experiences

AimTo conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment.BackgroundNursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.DesignA constructivist grounded theory methodology was used to explore nursing students’ clinical reasoning during SBEMethodA grounded theory methodology was used to explore nursing students’ clinical reasoning during SBE. A purposive sample was used to recruit participants including 32 third-year nursing students. Data collection using semi-structured interviews conducted over 9 months in 2020–2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the logic of constant comparison supported by memoing, theoretical sampling and conceptual mapping.ResultsSeeking autonomy is the core category that emerged from the participants’ responses that conceptualizes the students' reasoning process during SBEs.ConclusionEvidence from this grounded theory study adds validation to the practice of using SBEs to support students’ clinical reasoning process and prepare them to be competent in clinical practice.     

Educational programs and teaching strategies for health professionals responding to women with complex perinatal mental health and psychosocial concerns: A scoping review

BackgroundMental health and psychosocial concerns such as domestic violence in pregnancy and after birth are significant issues. Maternal health, social and environmental contexts have a direct influence on child development and long-term health. However, midwives, nurses and other health professionals lack confidence and skills in assessing, supporting and referring women with perinatal psychosocial concerns.Aim and objectivesThe aim of the scoping review is to review educational innovations and teaching strategies used to build skills and knowledge in health professionals and students to address psychosocial concerns including perinatal mental health, domestic violence and drug and alcohol misuse.DesignA scoping review was undertaken to help identify the breadth of papers reporting educational innovations and strategies particularly to address psychosocial concerns.MethodFour databases CINAHL, PsychoInfo, PubMed, OvidMedline and the grey literature were searched using a diverse range of terms for papers published in English between January 2009 and December 2020. This yielded 2509 papers and after review, 34 papers were included in the scoping review.ResultsThe 34 papers in this review found a diversity of educational initiatives and strategies delivered either face-to-face, online or in a blended mode addressing the learning needs of health professionals working with women with complex psychosocial concerns. The following characteristics in the papers were examined; focus of education, design and development, length, target audience including interprofessional focus, self-care, sensitive topics, debriefing, involving lived experience consumers and evaluation measures.ParticipantsIn the studies indicated that they benefited from hearing about the individuals’ lived experiences, opportunities for simulated practice and valued interprofessional learning experiences for both content and teamwork. The emergence of virtual modes offered some innovative and engaging ways to create a safe space for psychosocial education. However, the research does not provide guidance as to the best mode of delivery or length of programConclusionThis scoping review provides a broad overview of innovative and diverse educational methods and strategies being used in the nursing, midwifery and health disciplines to engage students and practitioners in learning in the areas of perinatal mental health and psychosocial care. Involvement of lived experience consumers in the design and delivery of education programs can positively impact learners’ knowledge and understandings of sensitive psychosocial topics. These diverse approaches could be used to shape the development and evaluation of future education programs.     

Exploring the clinical decision-making used by experienced cardiorespiratory physiotherapists: A mixed method qualitative design of simulation,video recording and think aloud techniques

BackgroundThe ability of physiotherapists to make clinical decisions is a vital component of being an autonomous practitioner, yet this complex phenomenon has been under-researched in cardiorespiratory physiotherapy. The purpose of this study was to explore clinical decision-making (CDM) by experienced physiotherapists in a scenario of a simulated patient experiencing acute deterioration of their respiratory function.ObjectivesThe main objective of this observational study was to identify the actions, thoughts, and behaviours used by experienced cardiorespiratory physiotherapists in their clinical decision-making processes.DesignA mixed-methods (qualitative) design employing observation and think-aloud, was adopted using a computerised manikin in a simulated environment.SettingThe participants clinically assessed the manikin programmed with the same clinical signs, under standardised conditions in the clinical skills practice suite, which was set up as a ward environment.ParticipantsExperienced cardiorespiratory physiotherapists, recruited from clinical practice within a 50-mile radius of the University(*).MethodsParticipants were video-recorded throughout the assessment and treatment and asked to verbalise their thought processes using the 'think-aloud' method. The recordings were transcribed verbatim and managed using a Framework approach.ResultsEight cardiorespiratory physiotherapists participated (mean 7 years clinical experience, range 3.5–16 years. CDM was similar to the collaborative hypothetico-deductive model, five-rights nursing model, reasoning strategies, inductive reasoning and pattern recognition. However, the CDM demonstrated by the physiotherapists was complex, interactive and iterative. Information processing occurred continuously throughout the whole interaction with the patient, and the specific cognitive skills of recognition, matching, discriminating, relating, inferring, synthesising and prediction were identified as being used sequentially.ConclusionsThe findings from this study were used to develop a new conceptual model of clinical decision-making for cardiorespiratory physiotherapy. This conceptual model can be used to inform future educational strategies to prepare physiotherapists and nurses for working in acute respiratory care.