Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada.
Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada.
Nurse Educ Pract. 2024 Oct;80:104140. doi: 10.1016/j.nepr.2024.104140. Epub 2024 Sep 15.
To describe undergraduate nursing students' clinical decision-making in post-procedural bleeding scenarios and explore the changes from the first to the final year of their program.
Bleeding is a common complication following invasive procedures and its effective management requires nurses to develop strong clinical decision-making competencies. Although nursing education programs typically address bleeding complications, there is a gap in understanding how nursing students make clinical decisions regarding these scenarios. Additionally, little is known about how their approach to bleeding management evolves over the course of their education.
Longitudinal mixed-methods study based on the Recognition-Primed Decision Model.
A total of 59 undergraduate students recorded their responses to two clinical decision-making vignettes depicting patients with signs of bleeding post-hip surgery (first year) and cardiac catheterization (final year). Their responses were analyzed using content analysis. The resulting categories capture the cues students noticed, the goals they aimed to achieve, the actions they proposed and their expectations for how the bleeding situations might unfold. Code frequencies showing the most variation between the first and final years were analyzed to explore changes in students' clinical decision-making.
Nearly all students focused on two primary categories: 'Bleeding' and 'Instability and Shock.' Fewer students addressed six secondary categories: 'Stress and Concern,' 'Pain,' 'Lifestyle and Social History,' 'Wound Infection,' 'Arrhythmia,' and 'Generalities in Surgery.' Students often concentrated on actions to manage bleeding without further assessing its causes. Changes from the first to the final year included a more focused assessment of instability and shifts in preferred actions.
This study reveals that nursing students often prioritize immediate actions to stop bleeding while sometimes overlooking the assessment of underlying causes or broader care goals. It suggests that concept-based learning and reflection on long-term outcomes could improve clinical decision-making in post-procedural care.
描述本科护理学生在术后出血场景下的临床决策，并探讨其在整个学习过程中从第一年到最后一年的变化。
出血是侵入性操作后的常见并发症，其有效管理需要护士发展出强大的临床决策能力。尽管护理教育计划通常涉及出血并发症，但对于护理学生如何针对这些情况做出临床决策，仍存在理解上的差距。此外，对于他们在教育过程中对出血管理方法的演变方式，我们知之甚少。
基于识别-启发式决策模型的纵向混合方法研究。
共有 59 名本科护生记录了他们对两个临床决策情景的反应，这些情景描绘了髋关节手术后（第一年）和心脏导管插入术后（最后一年）有出血迹象的患者。使用内容分析法对他们的反应进行了分析。得出的类别捕捉了学生注意到的线索、他们旨在实现的目标、他们提出的行动以及他们对出血情况可能如何发展的期望。分析了第一年和最后一年之间变化最大的代码频率，以探讨学生临床决策的变化。
几乎所有的学生都集中在两个主要类别上：“出血”和“不稳定和休克”。较少的学生涉及六个次要类别：“压力和担忧”、“疼痛”、“生活方式和社会史”、“伤口感染”、“心律失常”和“手术一般情况”。学生们经常专注于采取行动来止血，而没有进一步评估其原因。从第一年到最后一年的变化包括对不稳定情况的更集中评估以及对首选行动的转变。
本研究表明，护理学生通常优先考虑立即采取行动止血，而有时忽略了评估潜在原因或更广泛的护理目标。这表明基于概念的学习和对长期结果的反思可以改善术后护理的临床决策。
