Clinical reasoning is the “ability to interpret a patient’s needs, concerns or health problems and the decision to take action, use or modify standard approaches or improvise new ones as deemed appropriate by the patient’s response.” (Tanner, 2006, p. 204) Clinical reasoning is considered a requisite skill for nurses to provide safe and effective patient-centered care and is among the core competencies of a baccalaureate nursing education. Further, the National Council of State Boards of Nursing seeks to assess the clinical reasoning abilities of their candidates on the Next Generation of NCLEX. Yet, nursing research shows clinical reasoning is a skill baccalaureate nursing students struggle to develop.
Purpose: The purpose of this presentation is to describe an innovation evidence-based teaching strategy which enhanced clinical reasoning abilities among first semester nursing students.
Methods: In 2018, 93 first semester baccalaureate nursing students were given a pre-assessment of their clinical reasoning abilities. The pre-assessment tool was created from Tanner’s Model of Clinical Judgement. The pre assessment tool measured a student's ability to recognize pertinent patient background, notice when patient status changed, interpret the assessment data collected related to the change correctly and respond with the appropriate nursing actions.
Pre-assessment results showed most of the students who began the semester were able to recognize the pertinent background of the patient situation, but did not notice when the patient's assessment data changed. They further were unable to interpret the assessment data and unable to respond with appropriate nursing actions.
Results: This presentation will describe a clinical peer mentoring intervention which addressed the development of clinical reasoning abilities in first semester nursing students. The author will give specific details of the program and share innovative strategies used in this intervention which enhanced the learners' clinical reasoning abilities. The author will also share post-assessment data which will demonstrate how the groups who received the clinical peer mentoring intervention developed foundational clinical reasoning abilities and were better able than the non-intervention groups to notice changes in patient status, interpret assessment data correctly and respond with the appropriate nursing actions.
Conclusions: The strategies used in this research are appropriate for baccalaureate education, which often has a programmatic outcome of improving clinical reasoning abilities in students. However, the strategies could easily be adapted to be used in any healthcare facility in which a novice and expert nurse are paired. The strategies the author will discuss are robust and advance the science of nursing education.