FACTORS THAT AFFECT THE CLINICAL REASONING COMPETENCIES AMONG UNDERGRADUATE NURSING STUDENTS : A CROSS-SECTIONAL STUDY

Main Article Content

Atif Khan
Fazal Haq
Saeedullah
Nouman Khan

Keywords

clinical reasoning, students, clinical, Nursing education

Abstract

Background: Clinical reasoning (CR) is vital for clinical practice and patient safety and can be very important in the health professions. Health profession educators generally believe that CR has to be taught clearly and longitudinally in health profession education. The aim of the study was to determine the factors that affect the clinical reasoning competencies of undergraduate nursing students.


Methodology: A cross-sectional descriptive study was conducted from September to December 2023 in the nursing institutes of Khyber Pukhtankhwa, Pakistan. Data was collected from 323 participants using a convenient sampling technique. The study instrument was a validated and reliable questionnaire of the Clinical Reasoning Competency Scale with a Cronbach alpha of 0.90. Independent sample t-tests, ANNOVA and multiple linear regression were used for data analysis through SPSS 22. The study was approved by the institutional review committee, and informed consent was obtained from each participant.


Results: In this study, the maximum number of students were male (221; 85%), and the majority of the students academic performance was average 156 (60%). The overall mean score of clinical reasoning competencies was 60.0 ± 8.9, while there were significant differences within the groups of gender (0.021), age (0.000), clinical experience (0.000) and academic performance (0.007), while there were no significant differences within the groups of semester (0.140), living area (0.925), or college status (0.277) in clinical reasoning competencies.


Conclusion: The study concluded that undergraduate students, especially the final-year BSN students, had high clinical reasoning competencies due to their exposure to clinical practice was high. The academic performance of the students affects their clinical reasoning competencies, so to achieve more confidence in clinical reasoning, students require excellent academic performance.

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References

1. Sultan A, Khanum S, Naz N, Khan S, Ali S. The caring competencies of nursing students: Comparing the four and two-year Bachelor of Nursing Programme. Journal of Pakistan Medical Association. 2024 Jan 31;74(1):123-.
2. Sultan A, Ali S, Jamal H, Ahmed F. Correlation of Perceived Stress on the Academic Achievement of Undergraduate Nursing Students of KPK. Esculapio Journal of SIMS. 2022 Dec 30;18(4):473-7.
3. Kononowicz AA, Hege I, Edelbring S, Sobocan M, Huwendiek S, Durning SJ. The need for longitudinal clinical reasoning teaching and assessment: results of an international survey. Medical teacher. 2020 Apr 2;42(4):457-62.
4. Higgs, J., Jensen, G., Loftus, S., & Christensen, N. Clinical reasoning in the health professions (4th ed.) (2019). Elsevier.
5. American Nurses Association. Nursing: scope and standards of practice. 3rd ed. Silver Spring: American Nurses Association; 2015.
6. Victor-Chmil J. Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis. Nurse Educ. 2013;38:34–6. https://doi.org/10.1097/NNE.0b013e318276dfbe
7. Juma S, Goldszmidt M. What physicians reason about during admission case review. Adv Health Sci Educ Theory Pract. 2017;22:691–711. https://doi.org/10.1007/s10459-016-9701-x.
8. Soh M, Konopasky A, Durning SJ, Ramani D, McBee E, Ratcliffe T, et al. Sequence matters: patterns in task-based clinical reasoning. Diagnosis (Berl). 2020;7:281–9. https://doi.org/10.1515/dx-2019-0095.
9. Levett-Jones T, Hoffman K, Dempsey J, Jeong SY, Noble D, Norton CA, et al. The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Educ Today. 2010;30:515–20. https://doi.org/10.1016/j.nedt.2009.10.020.
10. Wong SH, Kowitlawakul Y. Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study. Nurse Education Today. 2020 Dec 1;95:104600.
11. American Association of Colleges of Nursing. A vision of baccalaureate and graduate nursing education: The next decade. Journal of Professional Nursing. 1999 Jan 1;15(1):59-65.
12. Alfaro-Lefevre, R. Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach, 6th ed.; Elsevier Health Sciences: Philadelphia, PA, USA, 2016.
13. Lee, J.; Lee, Y.J.; Bae, J.; Seo, M. Registered nurses’ clinical reasoning skills and reasoning process: A think-aloud study. Nurse Educ. Today 2016, 46, 75–80. [CrossRef]
14. Tanner, C.A. Thinking like a nurse: A research-based model of clinical judgment in nursing. J. Nurs. Educ. 2006, 45, 204–211. [CrossRef]
15. Gonzalez, L. Teaching clinical reasoning piece by piece: A clinical reasoning concept-based learning method. J. Nurs. Educ. 2018, 57, 727–735. [CrossRef]
16. Kuiper, R.A.; O’Donnell, S.; Pesut, D.; Turrise, S. The Essentials of Clinical Reasoning for Nurses; Sigma Theta Tau International: Indianapolis, IN, USA, 2017.
17. Liou SR, Liu HC, Tsai HM, Tsai YH, Lin YC, Chang CH, Cheng CY. The development and psychometric testing of a theory‐based instrument to evaluate nurses’ perception of clinical reasoning competence. Journal of advanced nursing. 2016 Mar;72(3):707-17.
18. Hong S, Lee J, Jang Y, Lee Y. A cross-sectional study: What contributes to nursing students’ clinical reasoning competence?. International journal of environmental research and public health. 2021 Jun 25;18(13):6833.
19. Chan A. The association between nursing students’ perceptions of their clinical reasoning ability and their background of clinical experience: A cross-sectional correlation study. Journal of Nursing Education and Practice [Internet]. Sciedu Press; 2023 Oct 18;14(2):5. Available from: http://dx.doi.org/10.5430/jnep.v14n2p5
20. Gunay U, Kilinc G. The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: A qualitative study. Nurse Educ Today. 2018; 65: 81–86. PMid:29547811 https://doi.org/10.1016/j.nedt.2018.02.031
21. Saifan A, et al. Managing the theory-practice gap in nursing education and practice: Hearing the voices of nursing students in the United Arab Emirates. J Nurs Manag. 2021; 29(6): 1869–1879. PMid:34217148 https://doi.org/10.1111/jonm.13407
22. Liu Y, Li Y, Cui X, et al. Clinical study on flipped classroom and mind map in newly recruited nurses’ pre-job training. BMC Nurs. 2022; 21(1): 72–72. PMid:35351110 https://doi.org/10.118 6/s12912-022-00843-z
23. Kuiper, R.; Pesut, D.; Kautz, D. Promoting the self-regulation of clinical reasoning skills in nursing students. Open Nurs. J. 2009, 3,76–85.
24. Alamouti HD, Mofrad MN, Farahani ZB, Amini AR. Clinical Reasoning in Nursing Students. Advances in Nursing & Midwifery. 2020 Dec 1;29(4).
25. Noone T, Seery A. Critical thinking dispositions in undergraduate nursing students: A case study approach. Nurse Educ Today. 2018;68:203-7.
26. Kaur G. Assessment of Clinical Reasoning Skills among BSc Nursing Students: Script Concordance Test. Nursing Journal of India. 2021 Jul 1;112(4):153-6.
27. Postma TC, White JG. Socio‐demographic and academic correlates of clinical reasoning in a dental school in South Africa. European Journal of Dental Education. 2017 Feb;21(1):58-65.