Teaching and Learning Clinical Reasoning in Nursing Education: A Student Training Course.

Clinical reasoning is an essential component of nursing. It has emerged as a concept that integrates the core competencies of quality and safety education for nurses. In cooperation with five European partners, Instituto Politécnico de Setúbal (IPS) realized the "Clinical Reasoning in Nursing and Midwifery Education and Practice" project as part of the Erasmus+ project. As a partner, our team designed a multiplier event-the student training course. The aim of this report is to describe the construction and development of this clinical reasoning training course for nursing students. We outline the pedagogical approach of an undergraduate training course on clinical reasoning in 2023, which we separated into four stages: (i) welcoming, (ii) knowledge exploration, (iii) pedagogical learning, and (iv) sharing experience. This paper presents the learning outcomes of the collaborative reflection on and integration of the clinical reasoning concept among nursing students. This educational experience fostered reflection and discussion within the teaching team of the nursing department regarding the concept, models, and teaching/learning methods for clinical reasoning, with the explicit inclusion of clinical reasoning content in the nursing curriculum. We highlight the importance of implementing long-term pedagogical strategies in nursing education.

How to choose a preceptor: aspects to consider based on a grounded theory study.

BACKGROUND: Nurses in clinical practice settings share responsibility with academy teachers in the education of nursing students in clinical teaching. This dynamic is essential for the students' learning and their skill development. During preceptorship, the nurse has to mobilize the available resources to act competently and effectively. The purpose of this article is to identify the aspects that should be considered when selecting a nurse preceptor. METHODS: A qualitative study was carried out based on Grounded Theory using Strauss and Corbin's version. The study took place in a medicine ward and a surgery ward of a hospital in the Lisbon metropolitan area. The authors conducted fourteen semi-structured interviews with nurses who were at different stages of Benner's Professional Development Model and with different outlooks on nursing preceptorship. The initial script was reorganized after the pilot test. It was also adjusted after the first exploratory interviews and after the in-depth interviews in order to reflect the interviewees' work experience and outlooks on preceptorship. The interviews had an average duration of 45 min and were audio recorded. Theoretical sampling was conducted considering the needs identified in data coding until we reached theoretical saturation. Data analysis began after the first interview, first by open coding, followed by axial and selective coding, always in a logic of constant comparison with theory. Ethical principles, scientific integrity and methodological rigour were ensured throughout the study. RESULTS: Two categories emerged that were supported by all nurses: skills and individual characteristics. The former includes communication skills, relational skills, reflective skills, technical-scientific skills, and emotional skills, while the latter includes perceptiveness, responsibility, motivation, and professional initiative. CONCLUSION: Nurses value both the individual characteristics they possess and the skills they have developed throughout their career. The recognition of the aspects found in this study for the selection of nurse preceptors allows for an informed and reasoned decision making, with a view to the success of the preceptorship and to the improvement of the quality of nursing education.

A avaliação e registo da dor no serviço de urgência: um estudo transversal

Resumo: Introdução: A dor constitui-se como o principal motivo de procura de cuidados de saúde no serviço de urgência. Os enfermeiros têm um papel essencial na promoção e intervenção no controlo da dor dado serem profissionais com uma relação privilegiada com as pessoas. Objetivo: Descrever como foi avaliada e registada a dor na área de ambulatório de um serviço de urgência geral pela equipa de enfermagem. Metodologia: Estudo quantitativo, descritivo e transversal. Foram analisados os registos de avaliação da dor de 105 pessoas. Procedeu-se à análise dos dados utilizando estatística descritiva. Resultados: A dor foi avaliada em 53 episódios (50,48 %). A Escala de Avaliação Numérica foi o instrumento mais utilizado (43,81 %). As características da dor foram descritas em 39,05 % dos episódios. Em 1,90 % dos episódios houve registo de reavaliação da dor após implementação de medidas farmacológicas. Conclusão: A avaliação da dor foi subnotificada nas diferentes dimensões descritas no estudo. Neste sentido, torna-se essencial a definição de estratégias para a formação e treino dos enfermeiros sobre avaliação da dor.

Resumen: Introducción: El dolor es el principal motivo de búsqueda de atención sanitaria en un servicio de urgencias. Las enfermeras tienen un papel crucial en la promoción e intervención en el control del dolor, ya que son profesionales con una relación privilegiada con las personas. Objetivo: Describir cómo el equipo de enfermería valoró y registró el dolor en el área de menores de un servicio de Urgencias. Metodología: Estudio cuantitativo, descriptivo y transversal. Se analizaron los registros de valoración del dolor de 105 personas. El análisis de los datos se realizó mediante estadística descriptiva. Resultados: El dolor fue evaluado en 53 episodios (50,48 %). La Escala Numérica fue el instrumento más utilizado (43,81 %). Las características del dolor se describieron en el 39,05 % de los episodios. En el 1,90 % de las crisis se registró una reevaluación del dolor tras la aplicación de medidas farmacológicas. Conclusiones: La evaluación del dolor fue subestimada en las dimensiones presentadas en el estudio. Por ello, es imprescindible definir estrategias para la educación y formación de las enfermeras en la valoración del dolor.

Abstract: Introduction: Pain is the main reason for seeking healthcare in an emergency service. Nurses have a crucial role in promoting and intervening in pain control as they are professionals with a privileged relationship with people. Objective: Describe how the nursing team assessed and recorded pain in the minor's area of an Accident and Emergency service. Methodology: Quantitative, descriptive, and cross-sectional study. The pain assessment records of 105 people were analyzed. Data analysis was conducted using descriptive statistics. Results: Pain was assessed in 53 episodes (50.48 %). The Numerical Rating Scale was the most used instrument (43.81 %). The characteristics of pain were described in 39.05 % of the episodes. In 1.90 % of the attacks, there was a record of pain reassessment after implementing pharmacological measures. Conclusion: Pain assessment was underreported in the different dimensions described in the study. Thus, it is essential to define strategies for the education and training of nurses on pain assessment.

Recursos mobilizados na preceptoria de enfermagem: um estudo em Grounded Theory / Resources mobilized in nursing preceptorship: a study in Grounded Theory

O desenvolvimento de competências implica a mobilização de recursos considerando a aprendizagem pessoal, a formação educacional e a experiência profissional. A qualidade das competências depende da combinação de recursos pessoais e do meio ambiente. O objetivo deste estudo foi identificar os recursos que são mobilizados no desenvolvimento de competências do enfermeiro preceptor. Foi realizado um estudo qualitativo com base na Grounded Theory. O estudo decorreu em dois serviços de um hospital da área metropolitana de Lisboa, de novembro de 2018 a dezembro de 2019. As entrevistas foram realizadas a enfermeiros em diferentes estádios do Modelo de Desenvolvimento Sócio-Profissional de Patrícia Benner e com diferentes experiências na orientação de estudantes de Enfermagem. A amostragem teórica foi conduzida de acordo com as necessidades identificadas na codificação dos dados. A análise e tratamento dos dados foi realizada de acordo com a metodologia da Grounded Theory. Os recursos mobilizados no desenvolvimento de competências do enfermeiro preceptor foram caracterizados como endógenos e exógenos. Os endógenos referem-se às características individuais, habilidades e experiências vividas. Os exógenos são a equipe de Enfermagem e o professor. Os enfermeiros, suportados pela equipa de Enfermagem, mobilizam caraterísticas individuais e habilidades no seu desenvolvimento de competências enquanto preceptores. A identificação destes recursos poderá definir indicadores para o perfil de preceptor e contribuir para a capacitação de enfermeiros preceptores.

The development of skills implies the mobilization of resources considering personal learning, educational training, and professional experience. The quality of skills depends on the combination of personal resources and the environment. The objective of this study was to identify the resources that are mobilized in the development of competencies of nursing preceptors. A qualitative study was carried out based on Grounded Theory. The study took place in two services of a hospital in the metropolitan area of Lisbon, from November 2018 to December 2019. The interviews were carried out with nurses at different stages of Patrícia Benner's Socio-Professional Development Model and with different experiences in guiding nursing students. Theoretical sampling was conducted according to the needs identified in the data coding. Data analysis and treatment was performed according to the Grounded Theory methodology. The resources mobilized in the development of preceptor nurses' competencies were characterized as endogenous and exogenous. Endogenous refers to individual characteristics, skills, and experiences. The exogenous characteristics are the Nursing team and the teacher. Nurses, supported by the Nursing team, mobilize individual characteristics and skills in their skill development as preceptors. The identification of these resources can define indicators for a preceptor profile and contribute to the training of preceptor nurses.

Desenvolvimento de competências dos enfermeiros orientadores: uma visão de peritos / Developing preceptors' skills: experts' view / Desarrollo de las competencias de los enfermeros orientadores: una visión de expertos

Resumo Enquadramento: O quadro legal do Curso de Licenciatura em Enfermagem em Portugal e o Regulamento para o Exercício Profissional dos enfermeiros apontam para a contribuição do enfermeiro na formação dos estudantes de enfermagem. Objetivo: Caracterizar o processo de desenvolvimento de competências dos enfermeiros orientadores de ensino clínico. Metodologia: Estudo qualitativo, utilizando a metodologia da Grounded Theory. Foram realizadas entrevistas semiestruturadas a 7 enfermeiros peritos. A amostragem teórica foi conduzida de acordo com as necessidades identificadas no processo de codificação. A análise e tratamento dos dados seguiu a metodologia em uso. Resultados: Os aspetos caracterizadores do desenvolvimento de competências dos orientadores são a nível educacional, a socialização primária e secundária, e a nível profissional, a experiência, o conhecimento, a capacidade de análise e a iniciativa profissional. Conclusão: Os peritos evidenciam no seu desenvolvimento de competências as vivências de natureza educacional e escolar que promovem a reflexão critica e uma postura proativa e aspetos de natureza profissional como a perícia, a capacidade de análise e a motivação.

Abstract Background: In Portugal, the legal framework of the Undergraduate Degree in Nursing and the Regulation of Nursing Practice point to the nurse's contribution to nursing students' education. Objective: To characterize the process of developing clinical preceptors' skills. Methodology: Qualitative study, using the Grounded Theory methodology. Semi-structured interviews were conducted with 7 expert nurses. Theoretical sampling was used based on the needs identified in the coding process. Data analysis and treatment followed the methodology adopted. Results: The following aspects characterize the development of clinical preceptors' skills: primary and secondary socialization at the educational level, and experience, knowledge, analytical skills, and professional initiative at the professional level. Conclusion: Throughout the development of their skills, the experts highlighted the educational and academic experiences that promote critical reflection and a proactive attitude, and professional aspects such as expertise, analytical skills, and motivation.

Resumen Marco contextual: El marco legal de la licenciatura de Enfermería en Portugal y el Reglamento para el Ejercicio Profesional de los enfermeros señalan la contribución del enfermero en la formación de los estudiantes de enfermería. Objetivo: Caracterizar el proceso de desarrollo de competencias de los enfermeros orientadores de enseñanza clínica. Metodología: Estudio cualitativo, para el cual se utilizó la metodología de la teoría fundamentada (grounded theory). Se realizaron entrevistas semiestructuradas a 7 enfermeros expertos. El muestreo teórico se realizó en función de las necesidades identificadas en el proceso de codificación. Para el análisis y el tratamiento de los datos se siguió la metodología utilizada. Resultados: Los aspectos que caracterizan el desarrollo de las competencias de los orientadores son, a nivel educativo, la socialización primaria y secundaria, y a nivel profesional, la experiencia, el conocimiento, la capacidad de análisis y la iniciativa profesional. Conclusión: Los expertos destacan en el desarrollo de sus competencias las experiencias educativas y escolares que promueven la reflexión crítica y una postura proactiva, y aspectos de carácter profesional como la destreza, la capacidad de análisis y la motivación.

Factores que interfieren en el sueño del paciente en ambiente hospitalario / Factors that interfere with patient's sleep in the hospital

Las alteraciones del sueño son bastante comunes en los pacientes hospitalizados, pero también son subvaloradas por los profesionales de la salud. La identificación de los factores que interfieren en el sueño ha sido objeto de incontables estudios. OBJETIVO. Identificar los factores que interfieren en el sueño del enfermo en ambiente hospitalario. METODOLOGÍA. Se ha efectuado una investigación en EBSCO (CINAHL with Full Text; MEDLINE with Full Text; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Database of Abstracts of Reviews of Effects; Medlatina), LILACS (texto integral disponible) y SCIELO (Brasil, España y Portugal), y buscado artículos en texto integral, publicados desde el 1 de enero de 2007 al 31 de diciembre de 2012. Se utilizó el método de PI[C]O y se seleccionaron 6 artículos de un total de 36. RESULTADOS. Identificamos 20 factores que interfieren en el sueño de los pacientes en el contexto hospitalario y describimos aspectos particulares y relevantes de cada uno de esos factores. CONCLUSIÓN. Los factores que interfieren con el sueño en ambiente hospitalario fueron agrupados en Externos (Ambientales y Asociados a la prestación de asistencia) e Internos (Fisiológicos y Psicológicos). Los resultados permiten percibir que estos factores están identificados, pero siguen persistiendo en los servicios, interfiriendo en el sueño de los pacientes. La concienciación de los profesionales de la salud es el primer paso para la adopción de medidas sugeridas en este artículo, a fin de reducir el impacto de esos factores en el sueño de los pacientes en ambiente hospitalario (AU)

The sleep disorders are quite common in hospitalized patients, but are also undervalued by health professionals. The identification of factors that interfere with sleep patients has been the subject of numerous studies. OBJECTIVE. To identify factors that interfere with the patient's sleep in the hospital. METHODOLOGY. We performed a research on EBSCO (CINAHL with Full Text; MEDLINE with Full Text; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Database of Abstracts of Reviews of Effects; Medlatina), LILACS (full text available) and SCIELO (Brazil, Spain and Portugal), and search full-text articles, published from 1 January 2007 to 31 December 2012. The PI[C]O method was used, and selected six articles from a total of thirty-six. RESULTS. We identify 20 factors that interfere with the patient's sleep in the hospital and describe particular aspects relevant to each of these factors. CONCLUSION. The factors that interfere with the patient's sleep in the hospital were grouped into External (Environmental and Associated to care) and Internal (Physiological and Psychological). The results allow us to realize that these factors are identified, but they still persist in services, interfering with the patient's sleep. Awareness of health professionals is the first step to adopt the measures suggested in this article, in order to reduce the impact of these factors on the patient's sleep in the hospital (AU)

[FACTORS THAT INTERFERE WITH PATIENT'S SLEEP IN THE HOSPITAL]. / Factores que interfieren en el sueño del paciente en ambiente hospitalario.

UNLABELLED: The sleep disorders are quite common in hospitalized patients, but are also undervalued by health professionals. The identification of factors that interfere with sleep patients has been the subject of numerous studies. OBJECTIVE: To identify factors that interfere with the patient's sleep in the hospital. METHODOLOGY: We performed a research on EBSCO (CINAHL with Full Text; MEDLINE with Full Text; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Database of Abstracts of Reviews of Effects; Medlatina), LILACS (full text available) andSCIELO (Brazil, Spain andPortugal), andsearch full-text articles, publishedfrom 1 January 2007 to 31 December2012. The PI[C]O method was used, and selected six articles from a total of thirty-six. RESULTS: We identify 20 factors that interfere with the patient's sleep in the hospital and describe particular aspects relevant to each of these factors. CONCLUSION: The factors that interfere with the patient's sleep in the hospital were grouped into External (Environmental and Associated to care) and Internal (Physiological and Psychological). The results allow us to realize that these factors are identified, but they still persist in services, interfering with the patient's sleep. Awareness of health professionals is the first step to adopt the measures suggested in this article, in order to reduce the impact of these factors on the patient's sleep in the hospital.