Forsberg Elenita, Ziegert Kristina, Hult Håkan, Fors Uno
School of Social and Health Sciences, Halmstad University, Halmstad, Sweden; Dept. of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
Nurse Educ Today. 2014 Apr;34(4):538-42. doi: 10.1016/j.nedt.2013.07.010. Epub 2013 Jul 25.
In health-care education, it is important to assess the competencies that are essential for the professional role. To develop clinical reasoning skills is crucial for nursing practice and therefore an important learning outcome in nursing education programmes. Virtual patients (VPs) are interactive computer simulations of real-life clinical scenarios and have been suggested for use not only for learning, but also for assessment of clinical reasoning. The aim of this study was to investigate how experienced paediatric nurses reason regarding complex VP cases and how they make clinical decisions. The study was also aimed to give information about possible issues that should be assessed in clinical reasoning exams for post-graduate students in diploma specialist paediatric nursing education. The information from this study is believed to be of high value when developing scoring and grading models for a VP-based examination for the specialist diploma in paediatric nursing education. Using the think-aloud method, data were collected from 30 RNs working in Swedish paediatric departments, and child or school health-care centres. Content analysis was used to analyse the data. The results indicate that experienced nurses try to consolidate their hypotheses by seeing a pattern and judging the value of signs, symptoms, physical examinations, laboratory tests and radiology. They show high specific competence but earlier experience of similar cases was also of importance for the decision making. The nurses thought it was an innovative assessment focusing on clinical reasoning and clinical decision making. They thought it was an enjoyable way to be assessed and that all three main issues could be assessed using VPs. In conclusion, VPs seem to be a possible model for assessing the clinical reasoning process and clinical decision making, but how to score and grade such exams needs further research.
在医疗保健教育中，评估专业角色所必需的能力非常重要。培养临床推理能力对护理实践至关重要，因此是护理教育项目的一项重要学习成果。虚拟患者（VPs）是现实临床场景的交互式计算机模拟，不仅被建议用于学习，还用于临床推理评估。本研究的目的是调查经验丰富的儿科护士如何对复杂的虚拟患者病例进行推理以及他们如何做出临床决策。该研究还旨在提供有关在专科儿科护理教育研究生临床推理考试中应评估的可能问题的信息。当为儿科护理教育专科文凭开发基于虚拟患者的考试的评分和分级模型时，本研究的信息被认为具有很高的价值。采用出声思维法，从瑞典儿科部门、儿童或学校保健中心工作的30名注册护士中收集数据。采用内容分析法对数据进行分析。结果表明，经验丰富的护士试图通过识别模式并判断体征、症状、体格检查、实验室检查和放射学检查结果的价值来巩固他们的假设。他们表现出很高的专业能力，但类似病例的早期经验对决策也很重要。护士们认为这是一种侧重于临床推理和临床决策的创新性评估。他们认为这是一种令人愉快的评估方式，并且所有三个主要问题都可以使用虚拟患者进行评估。总之，虚拟患者似乎是评估临床推理过程和临床决策的一种可能模式，但如何对这类考试进行评分和分级还需要进一步研究。
