Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

Background: An important concern of nursing practice and education is the difficulty new graduates experience while making the transition from graduate nurse to practicing nurse. Method: Using a comparative descriptive design, self-regulated learning strategies were used to enhance metacognitive critical thinking abilities as 32 new graduate nurses reflected during 8-week preceptorship programs. Results: Verbal protocol analysis revealed the majority of noun referents as metacognitive with thinking nouns increasing in rank from Week 1 to Week 8, present tense verbs were used most fre-The quest to improve metacognitive critical thinking abilities has gained increasing momentum during the past 30 years throughout the world. The President's Council of Economic Advisers has mandated that critical thinking is the one characteristic a worker needs for high productivity and to be competitive in the business world by making well thoughtout decisions (Paul, 1993). Professional disciplines acknowledge the importance of improving domain specific thinking abilities, but are unable to guarantee it as an educational outcome. Metacognition is self-communication about task demands and cognitive strategies a person engages in before, during, and after performing a task (Beitz, 1996). Once learned, metacognition supports lifelong reflective thinking in divergent situations, enables one to handle ambiguity, assists with problem solving, promotes responsibility for actions, and fosters devel-78 quently with lower-level thinking phrases. Common themes in the narrative were knowledge observation, thinking strategies, judgments of self-improvement, judgments of competence, judgments of resources, self-reactions, and selfcorrection strategies. Conclusions: New graduate nurses have unique circumstances to overcome in making a transition to the workplace, and having self-regulatory skills would enable this process. The data suggest nursing education and practice consider self-regulated learning prompts with new graduates to promote thinking strategies. opment of self-confidence for rapid decision making. Metacognitive critical thinking abilities in nursing practice are crucial as health care becomes more complex, the knowledge base expands, and nurses practice more autonomously (Brigham, 1993). Novice practitioners lack experience in prioritizing and accurately applying domain specific data. Therefore, they have difficulty making efficient and accurate judgments concerning patient care. This situation translates into tremendous economic losses for health care institutions caused by the attrition of new graduate nurses (Anderson, 1989). Thus, underdeveloped metacognitive critical thinking skills impact health care with poor clinical judgments and professional dissatisfaction. Specifically, the significant problem is helping new graduates problem-solve in clinical situations as they transition from graduate nurses to practicing nurses by using metacognitive critical thinking processes. Selfregulation uses critical thinking skills and refers...

Abstract:PURPOSE. To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS. A scoring instrument was developed and 100 worksheets were retrospectively analyzed. FINDINGS. NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. CONCLUSIONS. NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. IMPLICATIONS FOR PRACTICE. If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use.

2005). Promoting clinical reasoning in undergraduate students: Application and evaluation of the Outcome Present State Test (OPT) model of clinical reasoning.

Aim:The purpose of this paper is to describe the research surrounding the theories and models the authors united to describe the essential components of clinical reasoning in nursing practice education. The research was conducted with nursing students in health care settings through the application of teaching and learning strategies with the Self-Regulated Learning Model (SRL) and the Outcome-Present-State-Test (OPT) Model of Reflective Clinical Reasoning. Standardized nursing languages provided the content and clinical vocabulary for the clinical reasoning task. Materials and Methods:This descriptive study described the application of the OPT model of clinical reasoning, use of nursing language content, and reflective journals based on the SRL model with 66 undergraduate nursing students over an 8 month period of time. The study tested the idea that self-regulation of clinical reasoning skills can be developed using self-regulation theory and the OPT model.Results:This research supports a framework for effective teaching and learning methods to promote and document learner progress in mastering clinical reasoning skills. Self-regulated Learning strategies coupled with the OPT model suggest benefits of self-observation and self-monitoring during clinical reasoning activities, and pinpoints where guidance is needed for the development of cognitive and metacognitive awareness.Recommendations and Conclusions:Thinking and reasoning about the complexities of patient care needs requires attention to the content, processes and outcomes that make a nursing care difference. These principles and concepts are valuable to clinical decision making for nurses globally as they deal with local, regional, national and international health care issues.