Chapter 15: Can Clinical Reasoning Be Taught?

1. Chapter 15: Can Clinical Reasoning Be Taught?

2. Radical Transformation Needed • Currently not preparing graduates for real-life situations due to: • Content overload and saturation • Fragmented student learning • Education–practice gap • Emphasis of critical thinking over clinical reasoning

3. What Is Clinical Reasoning? • Describes the way a nurse reflectively thinks about their thinking • Uses nursing knowledge to quickly review and analyze clinical data • Evaluates the relevance of this clinical data • Formulates a judgment that leads to action

4. Priority Setting • One of the most difficult skills for students to master • Students have difficulty seeing the big picture and identifying what is clinically significant. • Students must be able to understand and state the rationale of everything that is done in the clinical setting. • Grasp the essence of the current clinical situation • Identify and trend relevant clinical data

5. Question Are students adequately prepared to face today’s challenges in the clinical setting?

6. Answer No, they are not currently adequately prepared due to • Content overload and saturation • Fragmented student learning • Education–practice gap • Emphasis of critical thinking over clinical reasoning

7. Benefits of Clinical Reasoning • Improved student learning • Improved patient outcomes

8. Why Is Clinical Reasoning Important? • To make a correct clinical judgment • Used to select from all alternatives • Understand the rationale for each alternative • Collect and recognize the significance of clinical data • Process this information to understand the current problem • Identify the current care priority and plan of care

9. Strategies to Develop Clinical Reasoning Series of questions that represent the sequential thinking that is required before a patient is seen by the nurse • Relevant data collection • Care planning priorities/interventions • Nurse vigilance by identifying the worst possible or most likely complication and what to do if it is realized

10. Strategies to Develop Clinical Reasoning (cont.) • Questions after the patient has been seen by the nurse • Relevance of VS, assessment data personally collected • Nursing priority . . . has it changed? • Priority educational needs • Rationale of primary care provider’s plan of care

11. Research Study Fuels the Controversy • SAFETY: An Integrated Clinical Reasoning and Reflection Framework for Undergraduate Nursing Students • SAFETY template • Findings

12. Question Why is developing clinical reasoning so important for nursing?

13. Answer To make a correct clinical judgment, clinical reasoning is used to select from all alternatives, understand the rationale for each alternative, collect and recognize the significance of clinical data, process this information to understand the current problem, and identify the current care priority and plan of care.

14. Tools to Teach Clinical Reasoning • Case studies that include • Contextualize content • Integrate classroom and clinical learning • Emphasize clinical reasoning • Practice thinking like a nurse • Emphasize knowledge usage and application of content

15. Tools to Teach Clinical Reasoning (cont.) • Rehearse for most common changes of patient status • Active learning strategy • NCLEX principles reinforced • Open-ended versus multiple choice

16. Barrier to Integrating Clinical Reasoning • Change • Time • Student buy-in

17. Question What are the barriers to incorporating clinical reasoning?

18. Answer Change, time, and student buy-in

19. End of Presentation