Educational practices for promoting student nurses' clinical reasoning skills

Abstract

English: 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.

Sepedi: Tshedimošo ya mathomong: Kakanyo ya tša kalafi ke bokgoni bja go akanya ge seemo sa tša kalafi se fetoga gomme ke karolo ye bohlokwa ya bokgoni tirong ya booki. Le ge go le bjalo, maano a mangwe a a tlwaelegilego a go ruta le go ithuta ga se ka mehla ao a thušago baithuti ba ithutelago tiro ya booki go ba le bokgoni bjo bo hlokagalago bja go akanya ka tša kalafi. Tlhalošo ya bothata: Barutiši ba baoki kholetšheng ya booki ya sešole ka Gauteng ba šomiša kudu maano a tlwaelegilego a go ruta le go ithuta ao a nepeišitšwego go barutiši. Bothata ke gore ge baithuti ba rutwa kudu ka maano ao a tlwaelegilego ao a lebanego le barutiši se se ka no se be le seabe go tlhabollo ya mabokgoni a go bea mabaka a tša kalafi ao a lhokagalgo tirong ya booki. Go kaonafatša mekgwa ya thuto go tšwetša pele tlhabollo ya mabokgoni a baoki ba baithuti a go bea mabaka ka kalafii, monyakišiši o dirile thuto ya dinyakišišo tša tiro. Maikemišetšo: Maikemišetšo a nyakišišo ye e be e le go nolofatša tshepedišo ya phetogo go ya go kaonafatša mekgwa ya thuto ka nepo ya go tšwetša pele tlhabollo ya mabokgoni a go bea mabaka a kliniki a baoki ba baithuti ba pele ga dithuto tša pele. Mokgwa: Nyakišišo ya tiro e šomišitšwe go dira nyakišišo ka go šomiša magato a mararo. Nakong ya Kgato ya 1: kgato ya Motheo, datha e kgobokeditšwe ka dipoledišano tše di sa rulaganywago le barutiši ba baoki le hlogo ya mafapha go hlahloba le go hlaloša ditlhohlo tšeo barutiši ba baoki ba itemogetšego tšona ge ba šomiša mekgwa ye mengwe ya thuto. Nakong ya Kgato ya 2: kgato ya Tshepetšo ya Nyakišišo ya Tiro, sehlopha sa nyakišišo ya tiro se hlomilwe go aga mmogo leanotiro la go rarolla ditlhohlo tše di lemogilwego. Medikologo ye me tša nyakišišo ya tiro ye nngwe le ye nngwe e akaretša magato a mane, e lego peakanyo, dira, go lebelela le go naganišiša e phethagaditšwe. Kgato ya 3, e lego kgato ya Tekolo ya Tshepetšo ya Nyakišišo ya Tiro, e lekotše dipoelo tša tshepedišo ya nyakišišo ya tiro ka mokgwa wa kgoboketšo ya datha ya World Cafe. Datha ya boleng go tšwa go Kgato ya 2 e ile ya sekasekwa ka go šomiša magato ao a hlalošitšwego go Saldana (2013). Go ile gwa ngwalwa ditiro tšeo di bego di dirwa nakong diseminara tša sehlopha sa nyakišišo ya tiro di ile tša rekotwa gomme gwa bolokwa metsotso. Datha go tšwa go World Cafe e ile ya sekasekwa ka go šomiša mokgwa wa tshekatsheko ya tlhathollo ya datha ka boitlhamelo bjalo ka ge go šišinywa ke Boomer le McCormack (2010). Diphihlelelo: Ditlhohlo tšeo barutiši ba baoki ba kopanego le tšona di ile tša hlohlomišwa gomme gwa tšwelela ditlhohlo tše nne tše kgolo tše di latelago: mekgwa ya thuto; tikologo ya go ithuta ya tša kalafi; tikologo ya go ithuta ya sešole; le bakgathatema tikologong ya go ruta le go ithuta. Ditlhohlo di ile tša bewa pele ke sehlopha sa nyakišišo ya tiro ka maano a mane: maano a go ruta, go ithuta le a kelo; tikologo ya go ithuta ya kliniki; tlhabollo ya profešene ye e tšwelago pele; le thekgo le kgetho ya baithuti le barutiši ba baoki. Leanotiro le agilwe mmogo nakong ya Kgato ya 2 ke batšwasehlabelo ba sehlopha sa nyakišišo ya tiro. Protšeke ye e ile ya hlahlobja ke sehlopha sa nyakišišo ya tiro bjalo ka yeo e atlegilego. Tshepedišo ya dinyakišišo tša tiro e bile le seabe go tlhabollo ya profešene ya barutiši ba baoki gomme ya feleletša ka tšhomišo ya maano a go ruta, go ithuta le go hlahloba ao a lebanego kudu le baithuti. Diphetho: Leanotiro le hlamilwe go kaonafatša mekgwa ya thuto Kholetšheng ya Baoki ya Tirelo ya Maphelo ya Sešole ya Afrika Borwa. Monyakišiši o hlamile gape tlhako ya dikgopolo go tšwetša pele mabokgoni a go fa mabaka ka ga tša kalafo. Go rarolla ditlhohlo tša morutiši wa baoki ka tirišano le go ba matlafatša ka mekgwa, sebaka le bokgoni bja go šomiša maano a go ruta le go ithuta ao a lebanego le baithuti go ka tsenya letsogo go tlhabollo ya mabokgoni a go bea mabaka a kliniki a baoki ba baithuti ba pele ga dithuto tša pele.

Afrikaans: Agtergrond: Kliniese redenasie is die vermoë om te redeneer namate ’n kliniese situasie verander, en is ’n noodsaaklike komponent van bevoegdheid in verpleegpraktyk. Sommige tradisionele onderrig- ​​en leerstrategieë help egter nie altyd om by verpleegstudente die verlangde vaardighede in kliniese redenasie te ontwikkel nie. Probleemstelling: Verpleegopvoeders by ’n militêre verpleegkollege in Gauteng maak hoofsaaklik van tradisionele onderwysergesentreerde onderrig- ​​en leerstrategieë gebruik. Die kommer is dat indien studente hoofsaaklik by wyse van tradisionele onderwysergesentreerde strategieë onderrig word, dit moontlik nie bydra tot die ontwikkeling van die verlangde klinieseredeneervaardighede wat vir verpleegpraktyk vereis word nie. Om opvoedkundige praktyke te verbeter om die ontwikkeling van studentverpleegkundiges se klinieseredeneervaardighede te bevorder, het die navorser ’n aksienavorsingstudie uitgevoer. Doel: Die doel van die studie was om ’n proses van verandering te fasiliteer om opvoedkundige praktyke te verbeter en sodoende die ontwikkeling van voorgraadse studentverpleegkundiges se klinieseredeneervaardighede te bevorder. Metodologie: Aksienavorsing is gebruik om die navorsingstudie in drie fases uit te voer. Gedurende Fase 1, die basislynfase, is data deur middel van ongestruktureerde onderhoude met verpleegopvoeders en departementshoofde ingesamel om te ondersoek en te beskryf watter uitdagings verpleegopvoeders met die gebruik van alternatiewe onderwyspraktyke ervaar. Gedurende Fase 2, die aksienavorsingsprosesfase, is 'n aksienavorsingsgroep gestig om saam ’n aksieplan op te stel om die geïdentifiseerde uitdagings te bespreek. Vier aksienavorsingsiklusse is geïmplementeer; elkeen met vier stappe, naamlik beplan, optree, waarneem en bespreek. Fase 3, die evaluering van die aksienavorsingsprosesfase, het die uitkomste van die aksienavorsingsproses geëvalueer met gebruikmaking van die World Café-data-insamelingsmetode. Kwalitatiewe data van Fase 2 is ontleed volgens die stappe wat in Saldana (2013) uiteengesit word. Die aktiwiteite wat tydens die aksienavorsingsgroepwerkswinkels uitgevoer is, is aangeteken en notules is gehou. Data van die World Café is ontleed volgens die kreatiewe hermeneutiese dataontledingsmetode wat deur Boomer en McCormack (2010) voorgestel is. Bevindinge: Die uitdagings wat verpleegopvoeders ervaar, is ondersoek, en die volgende vier hooftemas het na vore gekom: opvoedkundige praktyke; kliniese leeromgewing; militêre leeromgewing; en rolspelers in die onderrig- ​​en leeromgewing. Die aksienavorsingsgroep het vier strategieë vir die uitdagings geprioritiseer: onderrig-, leer- en assesseringsstrategieë; die kliniese leeromgewing; deurlopende professionele ontwikkeling; en ondersteuning en seleksie van studente en verpleegopvoeders. ’n Aksieplan is in Fase 2 gesamentlik deur die deelnemers aan die aksienavorsingsgroep opgestel. Die projek is deur die aksienavorsingsgroep as suksesvol geëvalueer. Die aksienavorsingsproses het tot die verpleegopvoeders se professionele ontwikkeling bygedra, en meegebring dat meer studentgesentreerde onderrig-, leer- en assesseringstrategieë gebruik word. Gevolgtrekkings: ’n Aksieplan is ontwikkel om opvoedkundige praktyke by die Suid-Afrikaanse Militêre Gesondheidsdiensverpleegkollege te verbeter. Die navorser het ook ’n konseptuele raamwerk ontwikkel om klinieseredeneervaardighede te bevorder. Deur verpleegopvoeders se uitdagings in samewerkende verband te bespreek en hulle te bemagtig met die middele, geleentheid en vaardighede om studentgesentreerde onderrig- ​​en leerstrategieë te gebruik, kan bygedra word tot die ontwikkeling van voorgraadse studentverpleegkundiges se klinieseredeneervaardighede.

IsiZulu: Ngemuva: Ukucabanga kwezokwelapha kuyikhono lokucabanga njengoba isimo sezokwelapha sishintsha futhi kuyingxenye ebalulekile yekhono ekusebenziseni ubuhlengikazi. Kodwa-ke, amanye amasu endabuko okufundisa nokufunda awasizi ngaso sonke isikhathi ukuthuthukiswa kwamakhono okucabanga okwelapha afiswayo kubafundela ubuhlengikazi. Isitatimende senkinga: Othisha babahlengikazi ekolishi labahlengikazi lasemasosheni eGauteng basebenzisa kakhulu amasu okufundisa kanye nokufunda agxile kothisha. Ukukhathazeka ukuthi uma abafundi befundiswa ngokuyinhloko ngamasu endabuko agxile kothisha lokhu kungenzeka kungabi nomthelela ekwakhiweni kwamakhono okucabanga okwelapha afunwayo adingekayo ekusebenziseni ubuhlengikazi. Ukwenza ngcono indlela yokufundisa ukuze kuthuthukiswe amakhono abahlengikazi okucabanga ngokuphathelene nezempilo, umcwaningi wenza ucwaningo lophenyo lwesenzo. Inhloso: Inhloso yocwaningo kwakuwulungiselela inqubo yoshintsho ngokuphathelene nokwenza ngcono izindlela zokufundisa ukuze kukhuthazelwe ukuthuthukiswa kwamokhono okwazi ukucabanga ngokuphathelene nezempilo kwabafundela ubuhlengikazi. Indlela yokwenza: Ucwaningo lwesenzo lwasetshenziselwa ukwenza ucwaningo lophenyo ngokusebenzisa izigaba ezintathu. Phakathi neSigaba 1: isigaba esiyisisekelo, idatha yaqoqwa ngokusebenzisa izingxoxo ezingahlelekile nothisha babahlengikazi kanye nezinhloko zeminyango ukuze bahlole futhi bachaze izinselele abahlengikazi abahlangabezana nazo ekusebenziseni ezinye izindlela zemfundo. Phakathi neSigaba 2: Isigaba se-Action Research Process, kwasungulwa iqembu locwaningo lokubambisana ukwakha uhlelo lokubhekana nezinselelo ezihlonziwe. Kwaqaliswa imijikelezo emine yocwaningo ngayinye enezinyathelo ezine, okungukuthi ukuhlela, ukuthatha isinyathelo, ukubuka kanye nokubonisa. Isigaba 3, Ukuhlolwa Kwesigaba Senqubo Yokucwaninga Ngezenzo, kuhlolwe imiphumela yenqubo yocwaningo ngezindlela zokuqoqa idatha ye-World Cafe. Idatha yokuthola ukuthi kwenzeke kanjani futhi ngobani evela Esigabeni 2 yahlaziywa kusetshenziswa izinyathelo ezichazwe ku-Saldana (2013). Kwenziwa imisebenzi phakathi nemihlangano yokucobelelana ngolwazi yamaqembu ocwaningo lwezenzo yaqoshwa futhi kwagcinwa amaminithi. Idatha evela ku-World Cafe yahlaziywa kusetshenziswa indlela yokuhlaziya idatha yobuciko njengoba kuphakanyiswe ngu-Boomer and McCormack (2010). Okutholakele: Izinselelo abahlengikazi abafundisa abahlangabezana nazo zahlolwa futhi kwavela lezi zihloko ezine eziyinhloko: imikhuba yemfundo; indawo yokufunda yezokwelapha; indawo yokufunda yezamasosha; kanye nabadlali abayindima emkhakheni wokufundisa nokufunda. Izinselelo zazibekwa phambili yiqembu locwaningo lwezenzo ngamasu amane: amasu okufundisa, ukufunda nokuhlola; indawo yokufunda yezokwelapha; ukuthuthukiswa kobuchwepheshe okuqhubekayo; kanye nokusekelwa nokukhethwa kwabafundi kanye nabafundisa abahlengikazi. Uhlelo lwezenzo lwakhiwa ngokubambisana phakathi neSigaba 2 ngababambiqhaza beqembu locwaningo lwezenzo. Iphrojekthi ihlolwe yiqembu locwaningo lwezenzo njengephumelele. Inqubo yocwaningo lwezenzo yaba negalelo ekuthuthukisweni kobungcweti kothisha abahlengikazi futhi kwaphumela ekusetshenzisweni kwamasu amaningi okufundisa, ukufunda nokuhlola agxile kubafundi. Isiphetho: Kusungulwe uhlelo lokwenza okuthile ukuze kuthuthukiswe izinqubo zemfundo e-South African Military Health Service Nursing College. Umcwaningi uphinde wasungula uhlaka lomqondo lokukhuthaza amakhono okucabanga kwezokwelapha. Ukubhekana nezinselelo zothisha abahlengikazi ngokubambisana nokubanika amandla ngezindlela, ithuba nekhono lokusebenzisa amasu okufundisa nokufunda agxile kubafundi kungase kube nomthelela ekwakhiweni kwamakhono okucabanga kwabahlengikazi bezokwelapha abasafunda.