Mwale Omero Gonekani, Mukwato Patricia Katowa, Kabinga-Makukula Marjorie
The University of Zambia, Lusaka, Zambia.
Community and Mental Health Department, Faculty of Nursing and Midwifery, The Catholic University of Malawi, Limbe, Malawi.
BMC Nurs. 2025 Apr 14;24(1):416. doi: 10.1186/s12912-025-03064-2.
Acquiring clinical reasoning skills is essential for patient safety in nursing, and a lack of clinical reasoning skills can harm patients. However, teaching and learning clinical reasoning skills is not easy due to its complexity. Without a model, clinical reasoning is taught intuitively. Therefore, this study aimed to investigate how undergraduate nursing students acquire clinical reasoning skills towards the development of a middle-range theory.
This study employed the grounded theory of systematic design underpinned by a social constructivism paradigm. Forty-eight (48) undergraduate nursing students were purposive, and 12 nurse educators were theoretically sampled. Nurse educators were full-time lecturers with two or more years of teaching experience who were willing to share their knowledge to promote clinical reasoning skills. Students in their third and fourth years were selected because of their completion of the three- to four-year educational process and their acquisition of essential knowledge and competencies. Twelve individual in-depth interviews and six focus group discussions were conducted with nurse educators and undergraduate nursing students, respectively. Two qualitative data analysis frameworks were employed to analyse the data: thematic analysis and grounded theory analysis. Ethical principles of respect for human dignity, beneficence and justice were observed.
Undergraduate nursing students reported that their clinical reasoning skills were acquired through automation while they utilized the nursing process. Through the themes, a new theory called 'a middle-range theory for the acquisition of clinical reasoning skills' was generated in the present study. The associated concepts were the environmental setting, type of curriculum, anchors and expected outcomes, which included individual and health care system indicators.
Teaching undergraduate nursing students how to reason clinically will help nurses adjust and solve problems in changing patients' situations. On the basis of the findings of this study, it is recommended that nursing students be equipped with adequate clinical reasoning skills before they graduate. Therefore, implementing the new model called 'a middle range theory for the acquisition of clinical reasoning skills' could foster the development of clinical reasoning skills from the start of the nursing training program.
培养临床推理能力对于护理工作中的患者安全至关重要，缺乏临床推理能力可能会伤害患者。然而，由于临床推理能力的复杂性，教授和学习这些技能并不容易。在没有模型的情况下，临床推理是凭直觉教授的。因此，本研究旨在探讨本科护理学生如何获得临床推理能力，以发展一个中程理论。
本研究采用以社会建构主义范式为基础的系统设计扎根理论。48名本科护理学生是有目的地选取的，12名护士教育工作者是理论抽样。护士教育工作者是具有两年或以上教学经验的全职讲师，他们愿意分享知识以促进临床推理能力。选择大三和大四的学生是因为他们完成了三到四年的教育过程，并获得了必要的知识和能力。分别与护士教育工作者和本科护理学生进行了12次个人深度访谈和6次焦点小组讨论。采用两个定性数据分析框架对数据进行分析：主题分析和扎根理论分析。遵守了尊重人类尊严、行善和公正的伦理原则。
本科护理学生报告说，他们在运用护理程序时通过自动化获得了临床推理能力。通过这些主题，本研究产生了一个名为“临床推理能力获得的中程理论”的新理论。相关概念包括环境设置、课程类型、锚点和预期结果，其中包括个人和医疗保健系统指标。
教授本科护理学生如何进行临床推理将有助于护士在不断变化的患者情况中进行调整和解决问题。基于本研究的结果，建议护理学生在毕业前具备足够的临床推理能力。因此，实施名为“临床推理能力获得的中程理论”的新模型可以从护理培训项目开始就促进临床推理能力的发展。
