Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinica...Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinical reasoning skills to deliver safe and effective patient cam. It is therefore of paramount importance to enhance nursing students＇ clinical reasoning ability. High-fidelity simulation （HFS） is proved to be an effective teaching and learning method, which may also have some advantages over other teaching methods. Methods： The authors retrospectively reviewed the related literature, illustrated the application of high-fidelity simulation teaching method in nursing education, putting the focus on the use of it in teaching with clinical reasoning. Results： The application of high-fidelity simulation to nursing education can simulate the clinical situation, thus to create a safe, continuous and efficient learning environment for students, and it can effectively improve students＇ clinical reasoning ability. Conclusions： high-fidelity simulation is effective for clinical reasoning teaching in nursing education. The extension of its application in China should be of great value. The relevant further study is suggested focusing on how to overcome its own limitations and have it better applied in nursing education in China.展开更多
Background: Clinical reasoning is an essential skill for nursing students since it is required to solve difficulties that arise in complex clinical settings. However, teaching and learning clinical reasoning skills is...Background: Clinical reasoning is an essential skill for nursing students since it is required to solve difficulties that arise in complex clinical settings. However, teaching and learning clinical reasoning skills is difficult because of its complexity. This study, therefore aimed at exploring the challenges experienced by nurse educators in promoting acquisition of clinical reasoning skills by undergraduate nursing students. Methods: A qualitative exploratory research design was used in this study. The participants were purposively sampled and recruited into the study. Data were collected using semi-structured interview guides. Thematic analysis method was used to analyze the collected data The principles of beneficence, respect of human dignity and justice were observed. Results: The findings have shown that clinical learning environment, lacked material and human resources. The students had no interest to learn the skill. There was also knowledge gap between nurse educators and clinical nurses. Lack of role model was also an issue and limited time exposure. Conclusion: The study revealed that nurse educators encounter various challenges in promoting the acquisition of clinical reasoning skills among undergraduate nursing students. Training institutions and hospitals should periodically revise the curriculum and provide sufficient resources to facilitate effective teaching and learning of clinical reasoning. Nurse educators must also update their knowledge and skills through continuous professional development if they are to transfer the skill effectively.展开更多
Background: Clinical reasoning is a critical cognitive skill that enables undergraduate nursing students to make clinically sound decisions. A lapse in clinical reasoning can result in unintended harm to patients. The...Background: Clinical reasoning is a critical cognitive skill that enables undergraduate nursing students to make clinically sound decisions. A lapse in clinical reasoning can result in unintended harm to patients. The aim of the study was to assess and compare the levels of clinical reasoning skills between third year and fourth year undergraduate nursing students. Methods: The study utilized a descriptive comparative research design, based on the positivism paradigm. 410 undergraduate nursing students were systematically sampled and recruited into the study. The researchers used the Self-Assessment of Clinical Reflection and Reasoning questionnaire to collect data on clinical reasoning skills from third- and fourth-year nursing students while adhering to ethical principles of human dignity. Descriptive statistics were done to analyse the level of clinical reasoning and an independent sample t-test was performed to compare the clinical reasoning skills of the student. A p value of 0.05 was accepted. Results: The results of the study revealed that the mean clinical reasoning scores of the undergraduate nursing students were knowledge/theory application (M = 3.84;SD = 1.04);decision-making based on experience and evidence (M = 4.09;SD = 1.01);dealing with uncertainty (M = 3.93;SD = 0.87);reflection and reasoning (M = 3.77;SD = 3.88). The mean difference in clinical reasoning skills between third- and fourth-year undergraduate nursing students was not significantly different from an independent sample t-test scores (t = −1.08;p = 0.28);(t = −0.29;p = 0.73);(t = 1.19;p = 0.24);(t = −0.57;p = 0.57). Since the p-value is >0.05, the null hypothesis (H0) “there is no significantno significant difference in clinical reasoning between third year and fourth year undergraduate nursing students”, was accepted. Conclusion: This study has shown that the level of clinical reasoning skills of the undergraduate nursing students was moderate to low. This meant that the teaching methods have not been effective to improve the students clinical reasoning skills. Therefore, the training institutions should revise their curriculum by incorporating new teaching methods like simulation to enhance students’ clinical reasoning skills. In conclusion, evaluating clinical reasoning skills is crucial for addressing healthcare issues, validating teaching methods, and fostering continuous improvement in nursing education.展开更多
A 49-year-old male was admitted with a 9-month history of intermittent abdominal pain and a 2-day cessation of exhaust and defecation.He had no history of metabolic disorders,malignancy,or relevant family history.At d...A 49-year-old male was admitted with a 9-month history of intermittent abdominal pain and a 2-day cessation of exhaust and defecation.He had no history of metabolic disorders,malignancy,or relevant family history.At disease onset,he experienced sudden,severe upper abdominal pain radiating to the back.展开更多
Background: The COVID-19 pandemic greatly impacted the clinical practicum programs of student midwives. It is very important for clinical educators to educate novice midwives in clinical settings. The purpose of this ...Background: The COVID-19 pandemic greatly impacted the clinical practicum programs of student midwives. It is very important for clinical educators to educate novice midwives in clinical settings. The purpose of this study was to develop an educational program for clinical educators to promote clinical judgment of novice midwives during delivery and to evaluate the feasibility of its practicality, acceptability and implementation. Methods: This feasibility study used an exploratory descriptive design with data generated from a questionnaire. The inclusion criteria were midwives assigned to the delivery ward who were newly scheduled to educate novice midwives in 2019 or had become a clinical educator within a year or two. The program consisted of e-learning (30 minutes) and lecture, simulation and discussion (about 2.5 hours). Descriptive statistics were performed for participant characteristics and evaluation of feasibility. Responses to the open-ended question were sorted into categories. Results: There were nine participants from two facilities. Practicality and acceptability received mostly positive evaluations. However, for a few the simulation scenarios were difficult to understand. Implementation of all the e-learning content was successful, and seminar attendance was 100% from start to finish. Conclusion: We found this e-learning program feasible in terms of practicality, acceptability and implementation. Most of the comments were positive opinions regarding future utilization of novice midwives’ education and clinical utilization of the program, suggesting that the clinical significance of this program was extremely high.展开更多
In Chinese medicine, practitioners assess patients’ complaints, analyze their underlying problems, identify causes and come to a diagnosis, which then directs treatment. What is not obvious and not recorded in a cons...In Chinese medicine, practitioners assess patients’ complaints, analyze their underlying problems, identify causes and come to a diagnosis, which then directs treatment. What is not obvious and not recorded in a consultation is the clinical reasoning process that practitioners use. The research filmed three practitioners in the UK while they conducted a consultation and treatment on new patients. The practitioners and researchers viewed the films and used them as aide-memoirs while the reasoning process throughout was discussed. In order to determine the pattern, practitioners used the four examinations to gather information from the patient in an iterative process;their aesthetic reasoning was highly developed. Through triangulation they checked the information they received against a detailed understanding of the qi-dynamic. They used highly analytical strategies of forward(inductive) and backward(deductive) reasoning against the prototypes of the signs and symptoms that indicate a specific Zheng. This was achieved through an abductive process that linked description with explanation and causal factors with pathological mechanisms. The feedback loop with the patient continued through the consultation and into the treatment. A process of translation and interpretation was needed to turn the patient’s story into the practitioner’s story of qi-dynamics that then directed the treatment. Awareness of our clinical reasoning process will mitigate against biases, improve our diagnoses and treatment choices and support the training of students.展开更多
Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper...Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.展开更多
Dermatovenereology,as a cornerstone discipline in clinical medical education,is characterized by its extensive morphological diversity,complex pathophysiology,and high clinical specificity.However,traditional lecture-...Dermatovenereology,as a cornerstone discipline in clinical medical education,is characterized by its extensive morphological diversity,complex pathophysiology,and high clinical specificity.However,traditional lecture-based pedagogical approaches are often insufficient to address the discipline’s dynamically evolving knowledge base,heterogeneous disease presentations,and the demand for multidimensional clinical reasoning.In response to these challenges,Case-Based Learning(CBL)has emerged as a pivotal educational reform strategy.By leveraging authentic clinical case narratives,CBL effectively activates learners’intrinsic motivation,fosters higher-order clinical reasoning,and enhances collaborative problem-solving capabilities.This review synthesizes current evidence regarding the theoretical foundations,practical implementation strategies,and educational outcomes associated with CBL within dermatovenereology curricula.Grounded in modern educational theories,including Bloom’s taxonomy and situated cognition,CBL employs carefully designed clinical scenarios with structured problem-chain frameworks to integrate three core competency domains:case deconstruction,differential diagnosis,and therapeutic decision-making.Essential instructional components encompass structured controversial case discussions,multidisciplinary team(MDT)-based simulations,and clinical-translational reasoning mechanisms.Accumulated evidence indicates that CBL significantly improves learners’proficiencies in lesion interpretation,diagnostic efficiency,evidence-based decision-making,teamwork,and enhancing professional identity formation.Nevertheless,sustainable integration of CBL faces challenges related to pedagogical systematization,faculty development,learner adaptation,and technological support.Future efforts should focus on building a resilient dermatology talent cultivation system through optimized instructional design,intelligent tutoring systems,and competency-oriented assessments.展开更多
文摘Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinical reasoning skills to deliver safe and effective patient cam. It is therefore of paramount importance to enhance nursing students＇ clinical reasoning ability. High-fidelity simulation （HFS） is proved to be an effective teaching and learning method, which may also have some advantages over other teaching methods. Methods： The authors retrospectively reviewed the related literature, illustrated the application of high-fidelity simulation teaching method in nursing education, putting the focus on the use of it in teaching with clinical reasoning. Results： The application of high-fidelity simulation to nursing education can simulate the clinical situation, thus to create a safe, continuous and efficient learning environment for students, and it can effectively improve students＇ clinical reasoning ability. Conclusions： high-fidelity simulation is effective for clinical reasoning teaching in nursing education. The extension of its application in China should be of great value. The relevant further study is suggested focusing on how to overcome its own limitations and have it better applied in nursing education in China.
文摘Background: Clinical reasoning is an essential skill for nursing students since it is required to solve difficulties that arise in complex clinical settings. However, teaching and learning clinical reasoning skills is difficult because of its complexity. This study, therefore aimed at exploring the challenges experienced by nurse educators in promoting acquisition of clinical reasoning skills by undergraduate nursing students. Methods: A qualitative exploratory research design was used in this study. The participants were purposively sampled and recruited into the study. Data were collected using semi-structured interview guides. Thematic analysis method was used to analyze the collected data The principles of beneficence, respect of human dignity and justice were observed. Results: The findings have shown that clinical learning environment, lacked material and human resources. The students had no interest to learn the skill. There was also knowledge gap between nurse educators and clinical nurses. Lack of role model was also an issue and limited time exposure. Conclusion: The study revealed that nurse educators encounter various challenges in promoting the acquisition of clinical reasoning skills among undergraduate nursing students. Training institutions and hospitals should periodically revise the curriculum and provide sufficient resources to facilitate effective teaching and learning of clinical reasoning. Nurse educators must also update their knowledge and skills through continuous professional development if they are to transfer the skill effectively.
文摘Background: Clinical reasoning is a critical cognitive skill that enables undergraduate nursing students to make clinically sound decisions. A lapse in clinical reasoning can result in unintended harm to patients. The aim of the study was to assess and compare the levels of clinical reasoning skills between third year and fourth year undergraduate nursing students. Methods: The study utilized a descriptive comparative research design, based on the positivism paradigm. 410 undergraduate nursing students were systematically sampled and recruited into the study. The researchers used the Self-Assessment of Clinical Reflection and Reasoning questionnaire to collect data on clinical reasoning skills from third- and fourth-year nursing students while adhering to ethical principles of human dignity. Descriptive statistics were done to analyse the level of clinical reasoning and an independent sample t-test was performed to compare the clinical reasoning skills of the student. A p value of 0.05 was accepted. Results: The results of the study revealed that the mean clinical reasoning scores of the undergraduate nursing students were knowledge/theory application (M = 3.84;SD = 1.04);decision-making based on experience and evidence (M = 4.09;SD = 1.01);dealing with uncertainty (M = 3.93;SD = 0.87);reflection and reasoning (M = 3.77;SD = 3.88). The mean difference in clinical reasoning skills between third- and fourth-year undergraduate nursing students was not significantly different from an independent sample t-test scores (t = −1.08;p = 0.28);(t = −0.29;p = 0.73);(t = 1.19;p = 0.24);(t = −0.57;p = 0.57). Since the p-value is >0.05, the null hypothesis (H0) “there is no significantno significant difference in clinical reasoning between third year and fourth year undergraduate nursing students”, was accepted. Conclusion: This study has shown that the level of clinical reasoning skills of the undergraduate nursing students was moderate to low. This meant that the teaching methods have not been effective to improve the students clinical reasoning skills. Therefore, the training institutions should revise their curriculum by incorporating new teaching methods like simulation to enhance students’ clinical reasoning skills. In conclusion, evaluating clinical reasoning skills is crucial for addressing healthcare issues, validating teaching methods, and fostering continuous improvement in nursing education.
文摘A 49-year-old male was admitted with a 9-month history of intermittent abdominal pain and a 2-day cessation of exhaust and defecation.He had no history of metabolic disorders,malignancy,or relevant family history.At disease onset,he experienced sudden,severe upper abdominal pain radiating to the back.
文摘Background: The COVID-19 pandemic greatly impacted the clinical practicum programs of student midwives. It is very important for clinical educators to educate novice midwives in clinical settings. The purpose of this study was to develop an educational program for clinical educators to promote clinical judgment of novice midwives during delivery and to evaluate the feasibility of its practicality, acceptability and implementation. Methods: This feasibility study used an exploratory descriptive design with data generated from a questionnaire. The inclusion criteria were midwives assigned to the delivery ward who were newly scheduled to educate novice midwives in 2019 or had become a clinical educator within a year or two. The program consisted of e-learning (30 minutes) and lecture, simulation and discussion (about 2.5 hours). Descriptive statistics were performed for participant characteristics and evaluation of feasibility. Responses to the open-ended question were sorted into categories. Results: There were nine participants from two facilities. Practicality and acceptability received mostly positive evaluations. However, for a few the simulation scenarios were difficult to understand. Implementation of all the e-learning content was successful, and seminar attendance was 100% from start to finish. Conclusion: We found this e-learning program feasible in terms of practicality, acceptability and implementation. Most of the comments were positive opinions regarding future utilization of novice midwives’ education and clinical utilization of the program, suggesting that the clinical significance of this program was extremely high.
基金This research was self-funded as part of an Education Doctorate at the Institute of Education,University College London.
文摘In Chinese medicine, practitioners assess patients’ complaints, analyze their underlying problems, identify causes and come to a diagnosis, which then directs treatment. What is not obvious and not recorded in a consultation is the clinical reasoning process that practitioners use. The research filmed three practitioners in the UK while they conducted a consultation and treatment on new patients. The practitioners and researchers viewed the films and used them as aide-memoirs while the reasoning process throughout was discussed. In order to determine the pattern, practitioners used the four examinations to gather information from the patient in an iterative process;their aesthetic reasoning was highly developed. Through triangulation they checked the information they received against a detailed understanding of the qi-dynamic. They used highly analytical strategies of forward(inductive) and backward(deductive) reasoning against the prototypes of the signs and symptoms that indicate a specific Zheng. This was achieved through an abductive process that linked description with explanation and causal factors with pathological mechanisms. The feedback loop with the patient continued through the consultation and into the treatment. A process of translation and interpretation was needed to turn the patient’s story into the practitioner’s story of qi-dynamics that then directed the treatment. Awareness of our clinical reasoning process will mitigate against biases, improve our diagnoses and treatment choices and support the training of students.
文摘Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.
文摘Dermatovenereology,as a cornerstone discipline in clinical medical education,is characterized by its extensive morphological diversity,complex pathophysiology,and high clinical specificity.However,traditional lecture-based pedagogical approaches are often insufficient to address the discipline’s dynamically evolving knowledge base,heterogeneous disease presentations,and the demand for multidimensional clinical reasoning.In response to these challenges,Case-Based Learning(CBL)has emerged as a pivotal educational reform strategy.By leveraging authentic clinical case narratives,CBL effectively activates learners’intrinsic motivation,fosters higher-order clinical reasoning,and enhances collaborative problem-solving capabilities.This review synthesizes current evidence regarding the theoretical foundations,practical implementation strategies,and educational outcomes associated with CBL within dermatovenereology curricula.Grounded in modern educational theories,including Bloom’s taxonomy and situated cognition,CBL employs carefully designed clinical scenarios with structured problem-chain frameworks to integrate three core competency domains:case deconstruction,differential diagnosis,and therapeutic decision-making.Essential instructional components encompass structured controversial case discussions,multidisciplinary team(MDT)-based simulations,and clinical-translational reasoning mechanisms.Accumulated evidence indicates that CBL significantly improves learners’proficiencies in lesion interpretation,diagnostic efficiency,evidence-based decision-making,teamwork,and enhancing professional identity formation.Nevertheless,sustainable integration of CBL faces challenges related to pedagogical systematization,faculty development,learner adaptation,and technological support.Future efforts should focus on building a resilient dermatology talent cultivation system through optimized instructional design,intelligent tutoring systems,and competency-oriented assessments.
