Use of Think-Aloud Strategies to Capture Clinical Reasoning during High Fidelity Patient Simulation

Think Aloud (TA), a strategy in which subjects are instructed to verbalize thoughts as they occur while completing an assigned task, was integrated into a study of clinical reasoning during high fidelity patient simulation by baccalaureate nursing students.  TA methods in nursing education research with patient simulation have not previously been reported.  Both concurrent TA data (verbalization of thoughts in short term memory) and retrospective TA data (reflective thoughts verbalized during an immediate post-simulation interview) were collected and analyzed using qualitative techniques.  Analysis of concurrent TA data yielded significant understanding into the clinical reasoning processes used during the care of a complex, rapidly evolving patient care situation.  Themes identified from concurrent TA data included public and private thoughts, narration of care, and the use of the pause to facilitate clinical reasoning.  Retrospective TA data provided rich descriptions of reflection-on-action.  TA provides a rich source of data regarding clinical reasoning as experienced by the baccalaureate nursing student during high fidelity patient simulation.