Educational practices for promoting student nurses' clinical reasoning skills

Abstract

Background: Clinical reasoning is the ability to reason as a clinical situation changes and is an essential component of competence in nursing practice. However, some traditional teaching and learning strategies do not always facilitate the development of the desired clinical reasoning skills in nursing students. Problem statement: Nurse educators at a military nursing college in Gauteng are predominantly utilising traditional teacher-centred teaching and learning strategies. The concern is that if students are predominantly taught by means of traditional teacher-centred strategies this may not contribute to the development of the desired clinical reasoning skills required for nursing practice. To improve educational practices to promote the development of student nurses' clinical reasoning skills, the researcher conducted an action research study. Aim: The aim of the study was to facilitate a process of change towards improving educational practices in order to promote the development of undergraduate student nurses' clinical reasoning skills. Methodology: Action research was used to conduct the research study by means of three phases. During Phase 1: the Baseline phase, data was collected by means of unstructured interviews with nurse educators and head of departments to explore and describe the challenges experienced by nurse educators in utilising alternative educational practices. During Phase 2: the Action Research Process phase, an action research group was established to co-construct an action plan to address the identified challenges. Four action research cycles each comprising four steps, namely plan, act, observe and reflect was implemented. Phase 3, the Evaluation of the Action Research Process phase, evaluated the outcomes of the action research process by means of the World Café data collection method. Qualitative data from Phase 2 was analysed using the steps outlined in Saldaña (2013). The activities conducted during the action research group workshops were recorded and minutes were kept. Data from the World Café was analysed using the creative hermeneutic data analysis method as suggested by Boomer and McCormack (2010). Findings: The challenges encountered by nurse educators were explored and the following four main themes emerged: educational practices; clinical learning environment; military learning environment; and role players in the teaching and learning environment. The challenges were prioritised by the action research group into four strategies: teaching, learning and assessment strategies; the clinical learning environment; continuous professional development; and support and selection of students and nurse educators. An action plan was co-constructed during Phase 2 by the action research group participants. The project was evaluated by the action research group as successful. The action research process contributed to the professional development of the nurse educators and resulted in the utilisation of more student-centred teaching, learning and assessment strategies. Conclusions: An action plan was developed to improve educational practices at the South African Military Health Service Nursing College. The researcher also developed a conceptual framework to promote clinical reasoning skills. Addressing nurse educator challenges in collaboration and empowering them with the means, opportunity and skill to utilise studentcentred teaching and learning strategies may contribute to the development of undergraduate student nurses' clinical reasoning skills.