Clinical judgment and diagnostic reasoning of nursing students in clinical simulation

Nunes, Janaina Gomes Perbone; Amendoeira, José Joaquim Penedos; Cruz, Diná de Almeida Lopes Monteiro da; Lasater, Kathie; Morais, Sheila Coelho Ramalho Vasconcelos; Carvalho, Emilia Campos de

doi:10.1590/0034-7167-2018-0878

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2018-0878 linkcopy

Clinical judgment and diagnostic reasoning of nursing students in clinical simulation

Juicio clínico y razonamiento diagnóstico de estudiantes de enfermería en simulación clínica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to determine the degree of association between clinical judgment and diagnostic reasoning of nursing students in clinical simulation.

Methods: this is a correlational research design using a quantitative approach. The sample consisted of 41 nursing students who assisted a patient with vaso-occlusive crisis in a high-fidelity clinical simulation setting. The instruments used included the Lasater Clinical Judgment Rubric - Brazilian Version and the Diagnostic Thinking Inventory.

Results: clinical judgment was associated with diagnostic reasoning (r=0.313; p=0.046), as well as the “noticing” aspect of clinical judgment with diagnostic reasoning (r=0.312; p=0.047).

Conclusions: the results show that skills to interpret patient data are associated with diagnostic reasoning skills. Teaching clinical judgment skills is necessary to develop the diagnostic reasoning of nursing students.

Descriptors: Clinical Judgment; Clinical Reasoning; Patient Simulation; Clinical Simulation; Education, Nursing

Aspects	n	Mean	SD	Median	Interval	Value p
Noticing
Junior	23	6.7	1.8	7	3-10	0.149^* * Mann-Whitney U test;
Senior	18	7.6	1.5	7.5	5-10
Interpreting
Junior	23	5.0	1.1	5	3-6	0.021^* * Mann-Whitney U test;
Senior	18	5.8	0.9	6	4-8
Responding
Junior	23	10.0	2.2	10	7-14	0.183^* * Mann-Whitney U test;
Senior	18	11.0	2.2	12	8-14
Reflecting
Junior	23	5.6	0.8	6	3-6	0.159^* * Mann-Whitney U test;
Senior	18	5.8	0.9	6	4-7
Total score
Junior	23	28.8	4.9	30	21-36	0.110^ Student's t test.
Senior	18	31.2	4.1	30	25-39

Variables	n	Mean	Median	Interval	SD	Value p
Flexible thinking
Junior	23	86.6	87	61-106	12.7	0.125^* * Student's t test;
Senior	18	92.5	92.5	71-121	11.1
Organization of knowledge within memory
Junior	23	82.0	83	68-92	6.3	0.762^ Mann-Whitney U test.
Senior	18	81.6	83	50-98	11.6
Total score
Junior	23	168.6	170	132-195	16.9	0.334^* * Student's t test;
Senior	18	174.1	176	143-216	19.3

Clinical Judgment	Diagnostic Reasoning
Clinical Judgment		Flexible thinking	Organization of knowledge within memory	Total score
Noticing	r	0.288	0.227	0.312
	p value	0.067	0.154	0.047
Interpreting	r	0.216	0.164	0.233
	p value	0.174	0.305	0.142
Responding	r	0.196	0.267	0.233
	p value	0.220	0.092	0.143
Reflecting	r	0.029	-0.099	-0.041
	p value	0.856	0.538	0.800
Total score	r	0.278	0.289	0.313
	p value	0.078	0.067	0.046

Clinical Judgment		Diagnostic Reasoning
Clinical Judgment		Flexible thinking	Organization of knowledge within memory	Total score
Noticing	r	0.394	0.310	0.436
	p value	0.060	0.151	0.037
Interpreting	r	0.152	-0.015	0.091
	p value	0.488	0.947	0.678
Responding	r	0.070	0.106	0.064
	p value	0.751	0.629	0.771
Reflecting	r	-0.047	-0.115	-0.131
	p value	0.832	0.600	0.551
Total score	r	0.196	0.145	0.186
	p value	0.370	0.509	0.396

Clinical Judgment		Diagnostic Reasoning
Clinical Judgment		Flexible thinking	Organization of knowledge within memory	Total score
Noticing	r	0.002	0.151	0.084
	p value	0.995	0.551	0.740
Interpreting	r	0.194	0.378	0.309
	p value	0.441	0.122	0.213
Responding	r	0.304	0.439	0.382
	p value	0.220	0.069	0.118
Reflecting	r	0.046	- 0.072	0.002
	p value	0.857	0.777	0.994
Total score	r	0.455	0.433	0.502
	p value	0.058	0.073	0.034

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[TFN1] Note: SD - Standard Deviation;

[TFN2] ^*
Mann-Whitney U test;

[TFN3] ^**
Student's t test.