Title

The use of focused reflection and articulation to promote the development of clinical reasoning

Date of Completion

January 2001

Abstract

Nursing practice is influenced by changes in the acuity and complexity of hospitalized patients today. Nurses must possess high level thinking skills to deal with the ill-defined problems they will encounter in the acute care setting. This study addressed the problem: How can nurse educators prepare graduate nurses to carry out clinical reasoning essential to provide safe effective care? This study explored the effect of using focused reflection and articulation to promote clinical reasoning with first semester nursing students. Student volunteers were randomly assigned to clinical groups. Two clinical groups received instruction in the use of focused reflection and articulation, while the other two clinical groups did not. The two groups were compared on the dependent variable, clinical reasoning. ^ Analyses indicated that clinical reasoning was made up of two distinct dimensions: a practice dimension and a knowledge dimension. Students in the treatment group scored significantly higher on the practice measure of clinical reasoning accounting for 28% of the variance between groups. This finding indicates that use of focused reflection and articulation enhanced the practice dimension of clinical reasoning, not the knowledge dimension. ^ Once clinical reasoning scores were tabulated, the top six scorers on clinical reasoning and bottom six scorers on clinical reasoning were interviewed to identify qualitative differences between students with different reasoning levels. Themes from the interviews revealed that those with high clinical reasoning reported a high frequency of use of focused reflection and articulation, engaged in abstract learning, and were more self-regulated in their learning than those who scored low on clinical reasoning. ^ This study is of interest to nurse educators because it demonstrates that using instructional methods that focus learners' attention to concrete application of theory in the practicum setting helps to enhance their reasoning skills. Additionally, this study is important for adult educators because results indicate that explicit instruction on ways to enhance learning should be provided to all students. ^