Do Measures of Self-Regulatory Dispositions Relate to Nursing Students' Clinical Reasoning Competencies in a Simulated Clinical Setting?

Wednesday, 15 July 2009: 3:45 PM

Robert H. Cantwell, PhD
School of Education, University of Newcastle, Callaghan, Australia
Krystyna M. Cholowski, PhD, RN
School of Nursing & Midwifery, University of Newcastle, Callaghan, Australia

Learning Objective 1: The learner will be able to identify underlying self-regulatory factors characteristic of novice nurses’ approaches to clinical reasoning

Learning Objective 2: The learner will be able to identify instructional strategies aimed at facilitating higher-level competency in clinical reasoning

Purpose: In this study, we examine the influence of existing metacognitive beliefs on the planning and strategy choices of pre-service nurses when faced with a simulated clinical task. Metacognitive belief – as a form of prior knowledge – acts as an internal reference point whenever self-regulating activity is required. It is reasonable to predict, then, that how pre-service nurses choose to engage with a complex and open-ended clinical task will reflect pre-existing conceptions of how to approach clinical tasks (analogous to an approach to learning (Biggs, 1993)) and how to actively self-regulate strategy choices in the completion of that task (Cantwell & Moore, 1996)

Methods: 87 final year undergraduate nursing students completed a simulated clinical task relating to the conduct of a pre-operative clinical interview and assessment. Two self-report questionnaires relating to aspects of metacognitive beliefs were completed: Biggs’ (1987) “Study Process Questionnaire”, a measure of dispositional motivational and strategy choices in learning (surface, deep and achieving approaches), and Cantwell and Moore’s (1996) “Strategic Flexibility Questionnaire”, a measure of disposition towards active or passive self-regulation (adaptive, inflexible or irresolute regulation). The clinical interview was completed in three phases: a “Planning” phase in which students gave written responses to five aspects of the pre-interview planning; a “Note-taking” phase in which students generated case notes whilst viewing a simulated interview; and a “Clinical Reasoning” component in which students generated a “Mental Status Assessment” and four Nursing Diagnoses. Data from each phase were analysed against expert templates.

Results: Analyses indicated that a disposition towards active and coherent self-regulation, combined with a disposition towards meaning construction (deep processing) as opposed to symptom reproduction (surface processing), was associated with higher quality performance across all phases of the clinical task.

Conclusion: The results of the study are discussed in relation to both attributes of developing expertise and instructional implications.