Script concordance testing to understand the hypothesis processes of undergraduate nursing students : multiple case study

Background: Albeit essential to clinical reasoning (CR), strategies for generating student nursing clinical hypotheses at the time of transition to professional practice are underdeveloped. While script concordance testing (SCT) has been shown to be a valid and reliable assessment tool for CR in nursing education, the thought processes including the hypothesis processes involved in choosing an answer is not examined. Methods: A multiple case study was used to understand the complex phenomenon of students’ hypothesis activation and confrontation with the combined use of SCT questions and the think-aloud method. Structured individual interviews were conducted. Results: A total of 18 students, nine first-year and nine third-year students participated in the study. The results show that the students demonstrate certain CR cognitive processes, including early representation of a clinical situation, semantic transformation of data, and hypothesis comparison. Conclusions: Results suggest promoting knowledge articulation aloud and the frequent use of micro-judgments to compare and differentiate hypotheses involving the uncertainty of clinical practice, which underpin learning in successive layers

Addressing the development of both knowledge and clinical reasoning in nursing through the perspective of script concordance : an integrative literature review

Background: In clinical practice settings, where situations of uncertainty exist, clinical reasoning is situated or contextualized. It calls upon honed knowledge, wherein nurses rely on highly developed and organized knowledge networks known as “mental scripts”. Methods: The aim of this integrative literature review was to address ways to develop knowledge and clinical reasoning in nursing through the use of mental scripts, and to tackle these pedagogical considerations. The literature search was performed using the following data sources: CINHAL, MEDLINE Google Scholar, PubMed, ProQuest, PsycINFO, Scopus and Web of Science. Results: Script concordance, which optimizes situated clinical reasoning, ties in with the sociocognitive perspective of cognitive companionship, using role models to guide the development of knowledge and clinical reasoning in nursing. Moreover, this perspective proposes implementing new teaching strategies, which focus on situational awareness, reflective acuity, and cognitive dialogue. Conclusions: The perspective of script concordance allows a foreseeable innovative formulation of practices favourable to the development of clinical reasoning in nursing

Clinical Nursing Reasoning in Nursing Practice: A Cognitive Learning Model based on a Think Aloud Methodology

Background. The current context of increasingly complex nursing care requires a high level of clinical reasoning in nursing practice. Still, teaching clinical reasoning in nursing remains a challenge for educators in the field. Although several studies have been conducted to try to understand clinical reasoning in nursing, neither its developmental stages nor the corresponding critical milestones have been uncovered. Therefore, nursing educators cannot rely on a cognitive learning model (a description of how people learn and develop a specific competency) to facilitate the learning of this crucial competency. Objectives. This study was conducted to develop a cognitive learning model of clinical reasoning in nursing, from the beginning of education to the development of expertise, highlighting the critical milestones corresponding to each stage. Design. A descriptive design based on the think aloud method was used. Settings and participants. The study was held in one university and two associated hospitals. Individual interviews were conducted with 45 undergraduate nursing students and 21 registered nurses (RN). Participants were asked to think aloud, using five clinical scenarios that were validated in a previous study. Analysis. Interviews were transcribed verbatim and subsequently analyzed using the protocol analysis method recommended for think aloud studies. Results. Five developmental stages and their related critical milestones were identified and used in the elaboration of a cognitive learning model for clinical reasoning in nursing: (1) internalization of the idea that nursing is a scientific profession; (2) learning to read and use scientific literature in care planning and nursing interventions; (3) learning to move from data collection to hypothesis generation to nursing interventions; (4) integrating wards’ routines and protocols; (5a) towards professional expertise or (5b) towards task-oriented practice. Conclusion. Recommendations for teaching and learning clinical reasoning in nursing during initial and continuing education in nursing are suggested. _________________ Contexte. Le contexte actuel de soins infirmiers de plus en plus complexes exige un niveau élevé de raisonnement clinique. L’enseignement et l’apprentissage du raisonnement clinique représentent un défi pour la formation infirmière. L’utilisation d’une approche par compétences (APC) de deuxième génération pour la formation en sciences infirmières (initiale et continue) demande un modèle cognitif d’apprentissage (MCA) conçu avec rigueur pour chacune des compétences. Le raisonnement clinique en sciences infirmières constitue une compétence essentielle de la pratique infirmière; il est donc urgent d’élaborer un MCA pour cette compétence. Même si plusieurs études ont été menées pour comprendre le raisonnement clinique infirmier, aucune n’a porté sur ses étapes de développement ni sur les apprentissages critiques de ces étapes. Objectifs. Une étude a été menée pour élaborer un MCA du raisonnement clinique infirmier, du début de l’apprentissage à l’expertise, tout en faisant ressortir les apprentissages critiques qui correspondent à chaque étape de développement. Conception. Un devis descriptif fondé sur la méthode de réflexion à voix haute a été utilisé. Méthodologie. L’étude a été réalisée dans une université et deux centres hospitaliers affiliés. Des étudiantes (n=41) et des infirmières soignantes (n=25) ont été invitées à réfléchir à voix haute pendant des entrevues individuelles, sur 5 vignettes cliniques validées dans une étude antérieure. Résultats. La méthode d’analyse de protocole a été utilisée afin de définir les apprentissages critiques et les étapes de développement correspondantes. D’abord, les étudiantes doivent s’approprier l’idée que les sciences infirmières sont une profession scientifique et apprendre à lire des écrits scientifiques. Ensuite, les étudiantes et les infirmières doivent procéder à un processus itératif entre la collecte de données et l’élaboration d’hypothèses, au lieu de se reposer sur les routines et les protocoles des services. Conclusion. Des recommandations ont été formulées pour l’enseignement et l’apprentissage du raisonnement clinique infirmier pendant la formation initiale et continue des infirmières

Humanistic caring, a nursing competency : modelling a metamorphosis from students to accomplished nurses

Background Most nursing regulatory bodies expect nurses to learn to be humanistic and caring. However, the learning process and the developmental stages of this competency remain poorly documented in the nursing literature. Methods The study used interpretive phenomenology, and 26 participants (students and nurses) were individually interviewed. Benner's (1994) method was adapted and concretised into a five-phase phenomenological analysis to assist with intergroup comparisons. Results Critical milestones and developmental indicators were identified for each of the five stages of the ‘humanistic caring’ competency. Satisfaction and meaning at work seemed closely connected to the development of ‘humanistic caring’. Links emerged between the development of ‘humanistic caring’ and three other competencies. Conclusions Nurse educators might insist on the fact that ‘humanistic caring’ goes beyond nurse–patient communication and that it is integrated in nursing care. The findings highlight that nurses' working conditions should be improved in order to uphold humanistic caring after graduation

How do new graduated nurses from a competency-based program demonstrate their competencies? A focused ethnography of acute care settings

Background : Following major organizations' recommendations, healthcare professionals' education has been reformed in the last decade into competency-based education (CBE) to better prepare them with core competencies. This change was intended to prepare new graduates for the reality of health systems and future challenges. Few studies have focused on how new graduate nurses (NGNs) from these reformed programs use the competencies they have developed. Objective : To describe the competencies of NGNs from a Canadian competency-based baccalaureate program, as perceived by various actors in acute-care settings. Methods : A focused ethnography was conducted on three acute-care wards of an academic hospital. Participants (n = 19) from four subgroups (NGNs, preceptors, clinical nurse specialists, and nurse managers) participated in individual semi-structured interviews or focus groups. Data were also collected through observation and fieldnotes; an ethnographic analysis framework was used. Results :Three themes were identified to describe the deployment of NGNs' competencies: NGNs' appropriation of their new role, fragmentation of practice into tasks, and development of practice; NGNs' collaboration within the interprofessional team, management of the dyad with licensed practical nurses, and ability to integrate patients and families into the team; and NGNs' scientific practice, increased scientific curiosity, and use of credible sources. Analysis of these themes' elements in light of the competency framework of the program showed that NGNs deploy seven of the eight competencies developed during their training. Conclusion :This study's results can be applied by nursing educators and hospital decision makers to ensure NGNs are able to use their competencies and to smoothen the transition period between the academic and clinical settings

Learning strategies used by undergraduate nursing students in the context of a digitial educational strategy based on script concordance : a descriptive study

Background: the digital educational strategy based on script concordance is an educational method that has been attracting increasing attention in healthcare education programs to fostering the development of clinical reasoning. It includes a digitized Script Concordance Test with incorporated expert feedback. However, the learning strategies required of students in the context of its use remain unknown. Objective: This study aimed to identify the learning strategies that undergraduate nursing students need to use in the context of the digital educational strategy based on script concordance. Method: A qualitative descriptive design was used to identify student learning strategies. Data was collected using an online questionnaire and semi-directed focus group interviews. Bégin’s taxonomy provided the framework for linking the data collected to learning strategies required of students. Results: Forty-four students participated in the study. Results show that when using a digital educational strategy based on script concordance, students are called to rely on their nascent scripts in order to select the data in short ill-defined clinical vignettes, evaluate new information repeatedly, anticipate microjudgments, and thus, gradually increase their knowledge and refine their scripts. Viewing the experts’ feedback and consulting the referencing tools helped students self-monitor their knowledge, a key metacognitive strategy to learning clinical reasoning. Completed individually or with peers, the digital educational strategy could be used to learn a particular concept or as an integrative activity before an evaluation. Conclusion: This original study has allowed us to link nursing clinical reasoning teaching conditions to the learning strategies used to develop this competency. Study results inform instructors about digital educational strategy based on script concordance to make it complementary with other educational strategies to better support complex learning of nursing clinical reasoning

Script concordance approach in nursing education

Background The script concordance approach aims at triggering judgments in simulated contexts of uncertainty. Problem Nursing students need to be prepared to manage the uncertainty of clinical practice. Approach The purpose of this article is to describe the theoretical foundation and the pedagogical use of the script concordance approach, as well as to present the current state of nursing evidence on the subject. The script concordance approach includes (1) script concordance testing, which is a quantitative examination that evaluates clinical reasoning; (2) a face-to-face script concordance activity; and (3) a digital educational strategy based on script concordance delivered via an online teaching/learning platform that aims to support clinical reasoning development. Conclusions Relying on questioning and experts' modeling, the script concordance offers an innovative pedagogical approach that approximates the uncertainty of clinical practice

Comparative Study of Knowledge Acquisition, Satisfaction, Self-confidence and Perceived Support in Nursing Students Experiencing Simulation Versus Clinical Placement in Perinatal Care

The aim of this study was to compare nursing students experiencing simulations (SIM group) (n=25) versus clinical placement (CPG) (n=55) in perinatal care. Questionnaires on satisfaction, self-confidence and perceived support were completed by both groups. Knowledge acquisition was assessed using standardized course evaluation. The Student’s t-test showed that differences between groups were not statistically significant for knowledge acquisition and satisfaction, while they were statistically significant for self-confidence and perceived support with higher scores in the CPG group. This study contributes to knowledge development since few have compared simulations as a learning method to replace totally clinical placement. Findings support the simulations as an appropriate method for students’ knowledge acquisition and satisfaction in a perinatal care course, but more studies are needed for generalization. Résumé L’objectif de cette étude était de comparer les expériences d’étudiantes en sciences infirmières ayant terminé des activités de simulation (groupe SIM) (n=25) avec celles d’étudiantes ayant effectué un stage en milieu clinique (groupe CPG) (n = 55). Les expériences des deux groupes étaient en soins périnataux. Des questionnaires sur la satisfaction, la confiance en soi et le soutien perçu ont été remplis par les deux groupes. L’acquisition des connaissances a été mesurée à l’aide des modes standardisés d’évaluation dans le cadre du cours. Le test-t de Student a montré que les différences entre les groupes n’étaient pas statistiquement significatives pour l’acquisition de connaissances ni la satisfaction, alors qu’elles l’étaient pour la confiance en soi et le soutien perçu avec des scores plus élevés dans le groupe CPG. Cette étude contribue au corps de connaissances puisque peu ont comparé les activités de simulation comme méthode d’apprentissage pour entièrement remplacer le stage en milieu clinique. Les résultats appuient les activités de simulation comme une méthode appropriée pour l’acquisition de connaissances et la satisfaction des étudiantes dans un cours de soins périnataux, mais d’autres études sont nécessaires avant la généralisation