Abstract
Nurses with effective clinical reasoning skills have a positive impact on patient outcomes. For this reason it is imperative that students understand and are able to demonstrate application of the clinical reasoning process. While clinical reasoning is often taught and assessed in preparation for clinical placements, a post-practicum assessment can help to identify if and to what extent students’ clinical experiences influence their learning. The aim of this chapter is to provide a detailed overview of the development of a post-practicum clinical reasoning exam, guidelines for educators interested in adopting this novel approach, and results from the initial evaluation of the exam.
The post-practicum clinical reasoning exam for nursing students was conducted in the following manner: Students were provided with a verbal clinical handover and the healthcare records of four patients. In the individual face-to-face oral exam that followed, students were required to describe how they would prioritise, plan and manage the care of the four patients using the clinical reasoning cycle as their organising framework. The exam was marked by a trained staff member, and immediate summative feedback was provided. On completion of the oral exam students were invited to complete a short evaluation survey with closed and open-ended questions. Quantitative data was statistically analysed and qualitative data was thematically analysed. There were 471 students enrolled in the clinical course; of these, 181 participated giving a response rate of 38%. The mean satisfaction score was 3.03 out of a maximum of 5 indicating a moderate level of satisfaction with the oral exam. Three themes emerged from qualitative analysis: ‘Better than written assessment items’, ‘Authenticity of the approach’ and ‘The need for better preparation’.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617–1620.
Bucknall, T. (2000). Critical care nurses decision-making activities in the natural clinical setting. Journal of Clinical Nursing, 9(1), 25–36.
Cioffi, J., Salter, C., Wilkes, L., Vonu-boriceanu, O., & Scott, J. (2006). Clinicians responses to abnormal vital signs in an emergency department. Australian Critical Care, 19(2), 66–72.
del Bueno, D. (2005). A crisis in critical thinking. Nursing Education Perspectives, 26(5), 278–283.
Ericsson, K., Krampe, R., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100, 363–406.
Fonteyn, M. E., & Ritter, B. J. (2008). Clinical reasoning in nursing. In D. J. Higgs, M. A. Jones, S. Loftus, & N. Christensen (Eds.), Clinical reasoning in the health professions (3rd ed., pp. 235–244). Oxford, UK: Butterworth-Heinemann.
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2014). Clinical reasoning in nursing, a think-aloud study using virtual patients - a base for an innovative assessment. Nurse Education Today, 34(4), 538–542.
Hoffman, K., Dempsey, J., Levett-Jones, T., Noble, D., Hickey, N., Jeong, S., et al. (2010). The design and implementation of an interactive computerised decision support framework (ICDSF) as a strategy to improve nursing students’ clinical reasoning skills. Nurse Education Today, 31(6), 587–594.
IBM Corp. (Released 2013). IBM SPSS Statistics for Windows, version 22.0. Armonk, NY: IBM Corp.
Kirkpatrick, D. L. (2009). Implementing the four levels: A practical guide for effective evaluation of training programs: Easyread super large 24pt edition. ReadHowYouWant.com. ReadHowYouWant.com.
Lapkin, S., Levett-Jones, T., Bellchambers, H., & Fernandez, R. (2010). The effectiveness of using human patient simulation manikins in the teaching of clinical reasoning skills to undergraduate nursing students: A systematic review. Clinical Simulation in Nursing, 6(6), e207–e222.
Levett-Jones, T. (2018). Clinical reasoning – What it is and why it matters. In T. Levett-Jones (Ed.), Clinical reasoning: Learning how to think like a nurse (2nd ed.). Frenchs Forrest, Australia: Pearson.
Levett-Jones, T., Hoffman, K., Dempsey, Y., Jeong, S., Noble, D., Norton, C., et al. (2010). The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today, 30(6), 515–520.
Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Dempsey, J., et al. (2011). The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Education Today, 31(7), 705–710.
Pike, G. (1991). The effects of background, coursework, and involvement on students’ grades and satisfaction. Research in Higher Education, 32, 15–31.
Sandelowski, M., & Barroso, J. (2007). Handbook for synthesizing qualitative research. New York: Springer.
Scheffer, B., & Rubenfeld, M. (2000). A consensus statement on critical thinking in nursing. Journal of Nursing Education, 39, 352–359.
Sinclair, P., Levett-Jones, T., Morris, A., Carter, B., Bennett, P., & Kable, A. (online 2017). High engagement, high quality: A guiding framework for developing empirically informed asynchronous e-learning programs for health professional educators. Nursing & Health Sciences, 19(1), 1–137.
Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgement in nursing. Journal of Nursing Education, 45(6), 204–211.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Levett-Jones, T., Courtney-Pratt, H., Govind, N. (2019). Implementation and Evaluation of the Post-Practicum Oral Clinical Reasoning Exam. In: Billett, S., Newton, J., Rogers, G., Noble, C. (eds) Augmenting Health and Social Care Students’ Clinical Learning Experiences. Professional and Practice-based Learning, vol 25. Springer, Cham. https://doi.org/10.1007/978-3-030-05560-8_3
Download citation
DOI: https://doi.org/10.1007/978-3-030-05560-8_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-05559-2
Online ISBN: 978-3-030-05560-8
eBook Packages: EducationEducation (R0)