Zadeh Touba Hossein, Tabrizi Kian Norouzi, Fallahi-Khoshknab Masoud, Khankeh HamidReza, Shokooh Forozan
School of Nursing and Midwifery, Guilan University of Medical Science (GUMS), Shahid Beheshti HWY., Daneshjoo Blvd., Rasht, 4146939814, Iran.
Social Determinants of Health Research Center, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Koodakyar St., Daneshjoo Ave., Evin, Tehran, 1985713834, Iran.
BMC Nurs. 2025 May 3;24(1):490. doi: 10.1186/s12912-025-03106-9.
Clinical reasoning (CR) skills are among the most important nursing competencies for providing safe and effective care in critical care units. Development of CR skills in nursing needs a well-designed interactive process for change to effectively support clinical competence promotion. The aim of this study was to develop CR skills among coronary care nurses through an action plan.
This participatory action research study was conducted in 2021 based on the framework of Hart and Bond (1995). Study setting was the coronary care unit of a leading heart center in Rasht, Iran. An action plan was designed and implemented with three main components, namely efficiency of nursing education, effective nursing management, and personal professional development. The results of the plan were provided to participants and strategies for improving the plan were determined. Quantitative outcome assessment was performed using the Nurses' Clinical Reasoning Skills Checklist and the Nurses' Clinical Reasoning Scale and data were analyzed through the Wilcoxon's test. Qualitative outcome assessment was performed through focus group discussions and data were analyzed through conventional content analysis.
The mean scores of CR skills significantly increased after the action plan and participants were satisfied with the plan. The four main categories of the outcomes of the plan were improvement of the thinking process, improvement of professional commitment, improvement of professional competence, and improvement of interprofessional communications. The challenges of the plan were limited efficiency of educational courses on the nursing process, incoherence in nursing documentation, mentors' inadequate supervision and instructions, and mentors' role pressure.
The CR skills action plan can improve coronary care nurses' CR skills and their competency in making sound clinical decisions and providing safe and quality care services.
临床推理（CR）技能是在重症监护病房提供安全有效护理的最重要的护理能力之一。护理中CR技能的发展需要一个精心设计的互动变革过程，以有效地支持临床能力的提升。本研究的目的是通过一项行动计划来培养冠心病护理护士的CR技能。
本参与性行动研究于2021年基于哈特和邦德（1995年）的框架进行。研究地点是伊朗拉什特一家领先心脏中心的冠心病监护病房。设计并实施了一项行动计划，该计划有三个主要组成部分，即护理教育的效率、有效的护理管理和个人职业发展。将计划的结果提供给参与者，并确定改进计划的策略。使用护士临床推理技能清单和护士临床推理量表进行定量结果评估，并通过威尔科克森检验分析数据。通过焦点小组讨论进行定性结果评估，并通过传统内容分析法分析数据。
行动计划实施后，CR技能的平均得分显著提高，参与者对该计划感到满意。该计划结果的四个主要类别是思维过程的改善、职业承诺的提高、专业能力的提高和跨专业沟通的改善。该计划面临的挑战包括护理过程教育课程效率有限、护理记录不连贯、导师监督和指导不足以及导师角色压力。
CR技能行动计划可以提高冠心病护理护士的CR技能，以及他们做出合理临床决策和提供安全优质护理服务的能力。
