Department of Cardiology and Cardiac Surgery, Cardio Centro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Nursing Direction of Settore Anziani Città di Bellinzona, Bellinzona, Switzerland.
Nurse Educ Pract. 2023 Feb;67:103548. doi: 10.1016/j.nepr.2023.103548. Epub 2023 Jan 17.
AIM/OBJECTIVE: To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing. BACKGROUND: Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice. DESIGN: A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established. METHODS: The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text. RESULTS: 1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions. CONCLUSIONS: Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.
目的：报告并综合文献中描述的高级临床实践中临床推理教学的主要策略，并促进新的研究领域的发展，以改进高级实践护理中临床推理的教学方法。
背景：临床推理和临床思维是高级护理临床实践决策过程中的重要组成部分。护理质量的提高与这些技能的发展有关。因此，优化能够增强临床推理在高级临床实践中作用的教学策略至关重要。
设计：使用 Arksey 和 O'Malley 开发的框架作为研究策略进行了范围综述。根据范围综述的性质，制定了研究方案。
方法：本范围综述中包含和分析的研究涵盖了 2016 年 1 月至 2022 年 6 月期间的内容。选择了包括定性研究在内的生物医学数据库中的原始研究和二次修订研究。使用的电子数据库包括：CINAHL、PubMed、Cochrane 图书馆、Scopus 和 OVID。三位作者独立评估了文章的标题、摘要和全文。
结果：共检查了 1433 篇文章，应用合格性和排除标准，评估了 73 篇研究的合格性，其中 27 篇被纳入范围综述。从综述中得出的结果进行了解释并分为三个宏观策略（基于模拟的教育、艺术和视觉思维以及其他学习方法）和十九项教育干预措施。
结论：在所使用的不同策略中，模拟是最常用的。尽管如此，我们的范围综述表明，有必要使用不同的教学策略来激发批判性思维、提高诊断推理能力、完善临床判断和加强决策能力。然而，目前尚无法证明哪种方法在获得获得足够的判断和批判性思维所需的学习成果方面更为有效。因此，有必要将教学方法与所培养的技能联系起来。
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