Promoting Clinical Reasoning in Undergraduate Nursing Students: Application and Evaluation of the Outcome Present State Test (OPT) Model of Clinical Reasoning

Kautz, Donald D.; Kuiper, RuthAnne; Pesut, Daniel J.; Knight-Brown, Phyllis; Daneker, Darlene

doi:10.2202/1548-923x.1052

Cited by 51 publications

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“…3 Metacognition, which is the act of connecting knowledge and cognition, is a much more elusive facet of reasoning. The development and assessment of clinical reasoning skills have become focuses of education programs in several disciplines, including medicine, 4,7,8 nursing, 9,10 occupational therapy, 6,11,12 and physical therapy. 13 However, few researchers have investigated clinical reasoning during the athletic training clinical education process.…”

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A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

Heinerichs

Vela

Drouin

2013

Journal of Athletic Training

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Context: Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for selfdirected study (SNAPPS) is used in medicine to express clinical reasoning.Objective: To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students.Design: Randomized controlled clinical trial. Setting: Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education.Patients or Other Participants: We randomly assigned 38 athletic training students (17 men, 21 women; age ¼ 21.53 6 1.18 years, grade point average ¼ 3.25 6 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme.Intervention(s): The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period.Main Outcome Measures: Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning.Results: Case presentations were longer (t 18.806 ¼ À5.862, P , .001) but were more concise (t 32 ¼ 11.297, P , .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale (t 32 ¼ 2.857, P ¼ .007) and the clinical reasoning subscale (t 25.773 ¼À14.162, P , .001) than the other group. We found a time effect for Diagnostic Thinking Inventory scores (F 1,34 ¼ 6.230, P ¼ .02) but observed no group effects (F 1,34 ¼ 0.698, P ¼ .41) or time-by-group interaction (F 1,34 ¼ 1.050, P ¼ .31). The Reflection in Learning Scale scores analysis revealed no group-by-time interaction (F 1,34 ¼ 1.470, P ¼ .23) and no group (F 1,34 ¼ 3.751, P ¼ .06) or time (F 1,34 ¼ 0.835, P ¼ .37) effects.Conclusions: The SNAPPS is an effective and feasible clinical education technique for case presentations. This learnercentered technique provides the opportunity for the expression of clinical reasoning skills.Key Words: learning styles, metacognition, clinical education Key PointsThe expression of clinical reasoning and uncertainties is possible in the athletic training environment with the learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan ...

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“…Several clinical reasoning techniques, including case studies, 6 journaling, 9 problem-based learning, 12 peer coaching, 13 and role play, 8 have been used to evaluate the expression of clinical reasoning in allied health and medical students. However, each technique has limitations.…”

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A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

Heinerichs

Vela

Drouin

2013

Journal of Athletic Training

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“…In this sense, nurses are able to note the nursing diagnosis with the most arrows in the web supporting that this diagnosis has an impact on the other related diagnoses in the patient's situation 32 . Explaining relationships among nursing diagnosis supports the development of clinical reasoning skills 33 .…”

Section: Discussionmentioning

confidence: 98%

“…NANDA-I, Inc. keystone issue was chosen for the patient was based on an analysis and synthesis of functional relationships among competing nursing diagnosis 32 . Thus, focus on the diagnosis Imbalanced nutrition: less than body requirements (00002) may resolve the related nursing diagnosis.…”

Section: Fig1 Application Of a Clinical Reasoning Web In One Patientmentioning

confidence: 99%

Application of the Outcome Present State Test Model in a Patient with Liver Cirrhosis: A Case Study

2015

American Research Journal of Nursing

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This paper presents the case study of a 74 year old man with liver cirrhosis and consumptive syndrome. Data was collected in a Brazilian university hospital. The case study approach used was outcomepresent state test (OPT) model. The assessment was made by using the Conceptual Model of Wanda Horta. Also, the NANDA-I, Inc., Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC) linkages were used to capture accurate nursing care plan. The keystone nursing diagnosis was: Imbalanced nutrition: less than body requirements. The NOC outcomes chosen were Nutritional Status: Food and Fluid Intake; and Weight: Body Mass Control. The NIC interventions chosen for the patient were: Enteral Tube Feeding and Fluid Monitoring. The findings support that the use of a clinical reasoning web helps nurses to identify the priority focus of care in patients with complex health problem, and to prevent future complications associated with the evolution of disease. Future researches are needed to determine the NANDA-I, NOC, and NIC linkages based on a clinical reasoning model to capture accurate nursing care plan for all patients with chronic condition, in order to provide competent and safe care, thus improving patient outcomes.

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“…In educational environments, problem-solving models have been shown to support the development of clinical reasoning skills as well as process skills such as working as a team to define problems, explain solutions, and evaluate solution outcomes. [14][15][16] To date, little research has been reported on the implementation of the PPCP in pharmacy education. In a search of literature through the EBSCOHost Multi-search database aggregator using the term "pharmacists' patient care process", 12 articles were identified, of which only 1 reported on the use of the PPCP as an instructional tool.…”

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Evaluation of Video-enhanced Case-based Activities Guided by the Pharmacists’ Patient Care Process

Rebitch

Fleming

MEd

et al. 2019

American Journal of Pharmaceutical Education

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Objective. To design and develop a series of technology-enhanced case-based learning activities framed by the Pharmacists' Patient Care Process (PPCP), and to evaluate the impact of these activities on student perceptions and performance. Methods.A mixed methods approach was utilized to generate both quantitative and qualitative data.Survey and focus group interviews were used to analyze student perceptions. Performance on a pre/post case was assessed to measure the impact of the PPCP case-based learning activities.Results. Students demonstrated positive attitudes overall towards the case-based learning activities.Themes emerged during focus group interviews regarding awareness of the PPCP, engagement in learning, and a desire for realistic experiences. Statistically significant changes were observed for the pre/post assessment within the Plan and Follow-up parameters, as well as the total score within each disease state. Conclusion.The use of technology-enhanced case-based modules framed around a standardized patient care process resulted in positive student perceptions and improved scores on a pre/post patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge.

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Promoting Clinical Reasoning in Undergraduate Nursing Students: Application and Evaluation of the Outcome Present State Test (OPT) Model of Clinical Reasoning

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

Cited by 51 publications

References 13 publications

A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

Application of the Outcome Present State Test Model in a Patient with Liver Cirrhosis: A Case Study

Evaluation of Video-enhanced Case-based Activities Guided by the Pharmacists’ Patient Care Process

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