Providing evidence-based information at the point of care for time-poor nurses may lead to better clinical care and patient outcomes. Smartphone applications (apps) have the advantage of providing immediate access to information potentially increasing time spent with patients. This small-scale pre-post survey study explored the impact a smartphone app had on the distance nurses walked and their perceived clinical decision-making ability. A total of 20 nurses working in a rural hospital medical/surgical unit participated. The findings suggest that the use of the smartphone app did not decrease nurses' walking distance. Nor did using the app enhances nurses' perception of their clinical decision-making ability. However, there was a statistically significant increase in confidence in the app over time (F(1,16) = 5.416, p = 0.033, partial η = 0.253), suggesting that providing training opportunities including time to learn how to use smartphone applications has the potential to enhance nurses work.

Introduction: Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. Methods: This study used a non-traditional approach for data collection. Fifteen rural acute care nurses with varying years of experience working in southern Alberta, Canada, were observed while they provided care to patients of varying acuity within a simulated rural setting. Following the simulation, semi-structured interviews were conducted using a substantive approach to critical thinking. Results: Findings revealed that the ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. Furthermore, the number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning. Novice nurses, however, did rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. In situations where the patient's condition was deteriorating quickly, regardless of years of experience, all of the participants depended on their colleagues when making decisions and reasoning throughout the simulation. Conclusions: Deep clinical reasoning and decision making is a function of reflection and self-correction that requires a critical selfawareness and is more about how nurses think than what they think. The degree of sophistication in reasoning of experts and novices © MG Sedgwick, L Grigg, S Dersch, 2014. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 is at times equivalent in that the reasoning of experts and novices can be somewhat limited and focused primarily on human physicality and less on conceptual knowledge. To become proficient in clinical reasoning, practice is necessary. The study supports the accumulating evidence that using clinical simulation and reflective interviewing that emphasize how clinical decisions are made enhances reasoning skills and confidence.

Healthcare environments require practitioners to competently and independently collect pertinent data, select appropriate key resources, prioritize information, solve problems, and make sound clinical decisions. The steady increase of health-related information implies a need for useful, practical Information and Communication Technology (ICT) tools that easily provide nurses' access to accurate evidence-based information. The purpose of this study was to explore the impact of using mobile technologies at the point of care on new graduates' perceived clinical decision making ability and associated level of self-efficacy over time. A longitudinal quasi-experimental pre-test/post-test design was used. A trend in the findings of this small study suggests that over time, using mobile technologies at the point of care did not enhance the participants' perceived clinical decision making ability or self-efficacy in clinical decision making. Notwithstanding, the use of mobile technologies in the practice setting is wide spread. It, however, may be that the transition from student to graduate nurse is a significant enough event that seriously limits the useful influence of mobile devices and their associated applications on clinical decision making ability and self-efficacy.

The purpose of this study was to explore how a smartphone app influences undergraduate nursing students' perceptions of their critical thinking and clinical decision making ability at the point of care. Using a pretest-posttest approach, the findings suggest that there were no statistically significant differences in the participants' perception of their critical thinking and clinical decision making ability over time. Statistically significant findings on four questionnaire items pertaining to participants' perception in their ability to engage in evidence based practice over time suggests that experience with the app, led the participants to believe the app provided them with the information they needed in order to engage in evidence based practice. Consequently, they were less likely to seek information from other sources. Although having learning resources available in clinical practice environments might enhance critical thinking ability, perhaps counterintuitively, the findings in this study suggest that having access to a clinical mobile app did not positively influence the participants' perceived critical thinking ability. Nurse educators therefore, must teach students how to be active learners as well as role model the proper use of critical thinking skills. Students need to be reminded to use institutional policies and procedure manuals as well as other appropriate sources of information. Last, students need to see registered nurses use critical thinking and clinical decision making dispositions by asking comprehensive questions, exploring assumptions and inferences, and incorporating varying resources into their decisions.

While the use of simulation is gaining popularity as an educational and training method, little is known about its utility in supporting field research activities. To address this gap, the physical, psychological, and conceptual dimensions of a full-scale simulated multi-bed rural nursing unit that became the 'field' for a rural nursing practice study is presented. The advantages of using simulation in this manner are that it: 1) allows processes to unfold in a controlled but natural fashion; 2) supports the exploration of complex phenomena; 3) and provides comparable data sets for analysis. Items to consider prior to using a simulation environment are also discussed.