Simulators Use in Clinical Reasoning In Nursing Education
What is Meant By Clinical Reasoning
Clinical reasoning is the cognitive and meta-cognitive process used for analyzing knowledge edge as it relates to individual patients and distinct clinical situations (Banning, 2008). Clinical reasoning is a process of making professional judgments, evaluating evidence to solve problems, and making diagnostic and patient management decisions (Higgs, Burn, & Jones, 2001). It is a deliberate process of weighing alternatives against evidence and choosing the most appropriate intervention for the patient (Tanner, 2006).
The terms critical thinking, decision making, and Chinese judgment are often used interchangeably with clinical reasoning (Simmons, 2010). The terms are interrelated concepts; however, they are not the same and their differences, although subtle, are important to recognize (Victor Chmil, 2013).
Implementation of Simulation In Clinical Reasoning In Nursing Education
Developing clinical reasoning skills is essential to the development of competent, high-functioning clinical nurses. Developing clinical reasoning is a challenge that nursing educators have struggled with for decades. Traditional teaching methods may be insufficient to develop clinical reasoning skills when an adult learner is involved.
Recently the suggestion of using human patient simulation (HPS), also known as high fidelity patient simulation (HFPS) training has been considered as a learning strategy to assist in the development of clinical reasoning and teamwork skills for nurses as well as others clinical disciplines (Baldwin, 2007; Bremner, Aduddel, Bennett, & Van Geest, 2006; Gierach & Everson, 2010; Lasater, 2007) Typically, HPS actively engages the learner, incorporating the use of both clinical reasoning and teamwork skills (Fanning & Gaba, 2007).
The simulation culminates in a debrief that affords the learner the opportunity to reflect on the simulation encounter and learn experiential (Fanning & Gaba, 2007) Experiential learning is a tenet of adult learning strategy described by Kolb (1984). According to Benner, Stannard, and Hooper (1996), the purpose of the thinking in action approach is to allow students to simulate clinical reasoning through patient circumstances as they occur.
The thinking in action approach encourages educators to recreate scenarios using HPS as a connection between didactic education and experiential learning where students can use problem solving and clinical skills to provide patient care in a safe environment (Vyas, Ottis & Caligiuri, 2011) Simulation effectiveness has been positively associated with improvement of critical thinking and clinical reasoning in complex patient care situations and assists in improving student confidence (Lewis, Strachan, & Smith, 2012)
Simulation in Clinical Reasoning and Patient Safety Aspects
The demands of patient safety standards, the implementation of the Affordable Care Act, and the increased use of HPS technology has provoked nurse educators to reevaluate educational methods. The paucity of clinical educational sites has made HPS a viable nursing educational option. Integrating HPS into nursing curricula may provide nurses with improved learning and development of clinical judgment (Lasater, 2007). The use of simulation-based learning includes an adult learner who is actively engaged, both cognitively and emotionally (Fanning & Gaba 2007).
Fanning describes the simulation encounter and the subsequent nonjudgmental debrief process as being tailored to the objectives and needs of the participant and team. When used correctly, the results of a well-developed and executed simulation can influence not only the acquisition of skills but positively affect clinical judgment and decision making (Fanning & Gaba, 2007), Clinical simulation is being used as a tool in the development of clinical reasoning in nursing education with promising results.
Clinical simulation therefore fulfills Tanner's (2006) description of a clinical reasoning skill set as the ability to sort information, prioritize, reflect, and create conclusions.The review on clinical reasoning is concentrated on the nursing student. It can be hypothesized that nursing students are novices at clinical reasoning and therefore the most suitable subjects. Simulation has been found to provide a safe environment to practice decision making and prioritization when used as part of a nursing curriculum (Gierach & Evenson, 2010). Gierach used a mass casualty simulation to test the clinical knowledge of nursing students and their ability to hone their clinical reasoning skills.
Results indicated that the debriefing process assists the nursing student with incorporation of nursing principles and concepts, and with reflecting on their strengths and areas for improvement (Gierach & Evenson, 2010).Baldwin (2007) used emergency department clinical scenarios developed for nursing students to enhance clinical reasoning skills. The author concluded that the simulation experience provided a safe venue for students to practice their clinical reasoning skills both individually and as a group (Baldwin, 2007).Another reported finding was that the reflective debriefing sessions were instrumental in solidifying clinical reasoning concepts while allowing the students to evaluate their own progress (Baldwin, 2007).
Responsibilities of Nursing Educators for Simulation Use In Clinical Learning
Nurse educators have a substantial responsibility of educating future nurses; There fore, the integration of innovative teaching modalities is crucial for the development of sound clinical reasoning. One of the modalities that has emerged in recent years is HPS. Clinical reasoning is the process of applying nursing knowledge to a clinical situation in order to initiate an appropriate patient intervention. The literature over the past decade substantiates the investment in innovative teaching methods such as HPS to develop and improve clinical reasoning skills in nurses.
HPS requires scenario specific objectives and meticulous planning to achieve the desired effects. The simulated scenarios are therefore able to be replicated on demand until the desired outcome is reached. This can be seen as an effective educational strategy, not only for improving clinical reasoning but because HPS may be used to address the growing ethical dilemma of practicing on human patients (Bremner et al. 2006) This eliminates the need for finding a human patient with the desired disease state in order to practice a particular skill or to develop clinical reasoning.
Further nursing research is needed to study the effect of simulation and structured debriefing on clinical reasoning, including replicating studies, which have demonstrated students' improved critical reasoning in complex patient care simulations. HPS is being integrated into nursing school curricula therefore, a longitudinal study on the clinical reasoning skills of nursing students who have used HPS would be valuable. Additionally, future research would benefit from larger sample sizes and studying clinical reasoning in diverse nursing populations for improved generalization. Baldwin, KB (2007) Friday night in the pediatric emergency department: A simulated exercise to promote clinical reasoning in the classroom.
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