Barriers to the Development of Clinical Reasoning Skills among Coronary Care Nurses: A Qualitative Study

Touba Hosseinzadeh, Kian Norouzi Tabrizi, Masoud Fallahi‑Khoshknab, Hamidreza Khankeh, Forozan Shokooh

Abstract


Background: Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses.

Materials and Methods: Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi‑structured interviews and were analyzed using conventional content analysis.

Results: The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self‑efficacy.

Conclusion: There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses’ CR skills.



Keywords


Clinical reasoning, Coronary care units, Nurses

Full Text:

PDF PDF

References


Gracia‑Lewis M. Developing Clinical Reasoning in Critical Care Practice. Stanislaus: California State University; 2013.

Simmons B. Clinical reasoning: Concept analysis. J Adv Nurs 2010;66:1151‑8.

Benner P. Educating nurses: A call for radical transformation‑how far have we come? J Nurs Educ 2012;51:183‑4.

Levett‑Jones Tea. Learning to Think Like a Nurse. HNE Handover: For Nurses and Midwives, [S.l.], v. 3, n. 1, may 2013. Available from: http://journals.sfu.ca/hneh/index.php/hneh/article/ view/6.

Fox R, Yelland A, Draycott T. Analysis of legal claims‑‑informing litigation systems and quality improvement. BJOG 2014;121:6‑10.

Lapkin S, Levett‑Jones T, Bellchambers H, Fernandez R. Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: A systematic review. Clin Simul Nurs 2010;6:e207‑22.

American Association of Colleges of Nursing. The Essentials of Baccalaureates Education for Professional Nursing Practice. U.S. Government Printing Office, Washington, DC, 2008.

Abbasi S, Masoudi R, Rabiei L, Shahbazi K. The effect of assertiveness program on clinical competence of intensive care units nurses; a randomized clinical trial. Avicenna Journal of Nursing and Midwifery Care 2019;27:293‑305.

Kalantary S, Kord F, Kazemi S, Rahimian SH, Araghianmojarad F, Jalali T. Determination of nurses’ clinical competence in critical care ward in Golestan hospital. Nurs Dev Health 2016;7:49‑56.

Mahdavisaeb F, Roohani M, Hanifi N, Kamali K. Comparison of critical care nurses’ clinical competency using self‑assessment method and assessment by head nurses, Zanjan. Prev Care Nurs Midwifery J 2016;6:72‑82.

Herron EK, Sudia T, Kimble LP, Davis AH. Prelicensure baccalaureate nursing students’ perceptions of their development of clinical reasoning. J Nurs Educ 2016;55:329‑35.

Menegon F, Guedes dos Santos J, Gonçalves N, Kahl C, Barreto M, Gelbcke F. Development of the clinical reasoning of nurses of an emergency hospital service. Rev Rene 2019;20:e40249.

Oostra KA, Barbara Meyerhoff, Heather. Clinical Reasoning on an Assignment: Baccalaureate Nursing Students’ Perceptions/ Raisonnement clinique à partir d’un travail écrit: La perception d’ étudiantes au baccalauréat en sciences infirmières. Quality Advancement in Nursing Education‑Avancées en formation infirmière. 2019;5.

Brown Tyo M, McCurry MK. An integrative review of clinical reasoning teaching strategies and outcome evaluation in nursing education. Nurs Educ Perspect 2019;40:11‑7.

Deschênes M, Goudreau J. Addressing the development of both knowledge and clinical reasoning in nursing through the perspective of script concordance: An integrative literature review. J Nurs Educ Pract 2017;7:28‑38.

Delany C, Golding C. Teaching clinical reasoning by making thinking visible: An action research project with allied health clinical educators. BMC Med Educ 2014;14:20.

Baloyi O, Mtshali NG. A middle‑range theory for developing clinical reasoning skills in undergraduate midwifery students. Int J Afr Nurs Sci 2018;9:92‑104.

Baloyi O, Mtshali NG. Developing clinical reasoning skills in an undergraduate midwifery program: A grounded theory inquiry. Int J Afr Nurs Sci 2018;8:98‑106.

Audetat MC, Laurin S, Sanche G, Beique C, Fon NC, Blais JG, et al. Clinical reasoning difficulties: A taxonomy for clinical teachers. Med Teach 2013;35:e984‑9.

van Wyngaarden A, Leech R, Coetzee I. Challenges nurse educators experience with development of student nurses’ clinical reasoning skills. Nurse Educ Pract 2019;40:102623. doi: 10.1016/j.nepr.2019.102623.

Andersson N, Klang B, Petersson G. Differences in clinical reasoning among nurses working in highly specialised paediatric care. J Clin Nurs 2012;21:870‑9.

Jessee MA. Pursuing improvement in clinical reasoning: The integrated clinical education theory. J Nurs Educ 2018;57:7‑13.

Lee J, Lee YJ, Bae J, Seo M. Registered nurses’ clinical reasoning skills and reasoning process: A think‑aloud study. Nurse Educ Today 2016;46:75‑80.

Wong SHV, Kowitlawakul Y. Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study. Nurse Educ Today 2020;95:104600. doi: 10.1016/j.nedt.2020.104600.

Yauri I, Nash R, Ramsbotham J. Improving student nurses’ clinical‑reasoning skills: Implementation of a contextualised, guided learning experience. Padjadjaran Nurs J 2019;7:152‑63.

Seidi J, Alhani F, Salsali M, Kazemnejad A. Challenges of nurses’ clinical judgment education: A qualitative study. Iran J Nurs Res 2016;11:48‑57.

T T. Promotion the quality of nursing care in cardiac care unit: Participatory Action Research Tarbiat Modares University; 2012.

Hunter S, Arthur C. Clinical reasoning of nursing students on clinical placement: Clinical educators’ perceptions. Nurse Educ Pract 2016;18:73‑9.

Roshangar F. The Process of Competence Attainment in New Nurse`s Clinical Judgement: A Grounded Theory Study. Tabriz University of Medical Sciences; 2015.

Hasanpour M, Hasanzadeh A, Ghaedi Heidari F, Bagheri M. Critical thinking skills of nursing students. Iran J Nurs 2015;28:22‑31.

Barratt J. Developing clinical reasoning and effective communication skills in advanced practice. Nurs Stand 2018. doi: 10.7748/ns.2018.e11109.

Bahrami M, Alavi A, Zargham‑Boroujeni A. Clarify of caring self‑efficacy perception of pediatric nurse’s perspectives: A qualitative study. Iran J Pediatr Nurs 2019;5:26‑36.


Refbacks

  • There are currently no refbacks.