Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice

Abstract

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.

Student Nurses’ Perceptions of the Role of High-Fidelity Simulation in Developing Decision-Making Skills for Clinical Practice: A Qualitative Research Study

“… Dreifuerst (2012) reported that a structured debriefing and reflection on the simulation experience were critical factors to enhance nursing students’ learning, confidence, and clinical reasoning. Sedgwick et al (2014) also found that simulation and reflective debriefing enhanced the quality of novice and experts’ clinical decision-making skills.…”

The Effect of Clinical Decision Support Systems on Patients, Nurses, and Work Environment in ICUs

“…More studies (41%) were carried out in the United States compared with other countries. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Five studies were conducted in the United Kingdom, [25][26][27][28][29] four studies in Australia, [30][31][32][33] three studies in Iran, [34][35][36] two studies in Canada, 37,38 two studies in Italy, 39,40 and one study in each of the following countries: Austria, 41 Bosnia and Herzegovina, 42 Turkey, 43 South Africa, 44 Korea, 45 Norway, 46 and China. 47 The studies were conducted during the period between the years 2007 and 2022.…”

“…13,26,30,32,34,41,43,46 Two studies found that using CDSS in clinical simulations, education, and reflective interviewing augmented the critical-thinking skills of intensive care nurses and improved the level of correct decisionmaking. 37,42 Moreover, it was determined that ICU nurses mostly act intuitively in decision-making processes related to critical patient care, and the need for standardized and evidence-based protocols, algorithms, and guidelines and the use of CDSS were mentioned. 19,26,31,35,36,44,46…”

A scoping review of therapeutic reasoning process research

“…A small number of articles (n = 8) tested original hypotheses (Chang et al, 2016;Chaturvedi, 1994;Horsky et al, 2017;Kavanagh, 1997;McBee et al, 2017;Price et al, 2017;Sedgwick et al, 2014;Tona, 2004). These articles validated a self-generated hypothesis, and neither tested pre-existing theories nor generated hypotheses.…”