Psychometric properties of the persian version of the nursing clinical reasoning scale.

AIM: The aim of this study was to translate the Nursing Clinical Reasoning Scale (NCRS) into Persian and evaluate its psychometric properties. DESIGN: This study was a methodological and cross-sectional study. METHODS: This methodological study was conducted in 2020 in a teaching hospital. After obtaining necessary permission from its developers, NCRS was translated into Persian through the method proposed by the World Health Organization. Then, its face, content, and construct validity and reliability were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 300 nurses (two 150-nurse samples), who had randomly been selected, completed the instrument. Reliability also assessed through the internal consistency and the stability methods. Data were analysed using the SPSS (v. 20.0) and the AMOS (v. 5.0) software. RESULTS: The content validity indices of NCRS and its items were 0.97 and more than 0.79, respectively. Exploratory factor analysis revealed an assessment and confirmation factor and an implementation and reflection factor for the scale which together explained 57.30% of the total variance. Confirmatory factor analysis also confirmed this two-factor structure (χ2 /df = 2.11, NNFI = 0.952, RMSEA = 0.053, CFI = 0.91, GFI = 0.94, IFI = 0.95, and NFI = 0.96). The Cronbach's alpha and the intraclass correlation coefficient values of the scale were 0.96 and 0.94, respectively. PUBLIC CONTRIBUTION: The Persian NCRS can help nursing policy makers and mentors identify the need for developing nurses' and nursing students' CR skills and implement need-based educational courses to improve these skills. Moreover, it helps determine whether the educational programmes are effective in improving nurses' CR skills and clinical competence.

Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study.

INTRODUCTION: Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills. AIM: The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU. DESIGN: A qualitative design was used. METHODS: This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring. RESULTS: The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively. CONCLUSION: This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.

Barriers to the Development of Clinical Reasoning Skills among Coronary Care Nurses: A Qualitative Study.

Background: Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses. Materials and Methods: Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self-efficacy. Conclusion: There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses' CR skills.

Clinical reasoning in nursing students: A concept analysis.

AIM: The aim of this analysis is to clarify the concept of clinical reasoning in nursing students. BACKGROUND: Sound clinical reasoning is the most important skill required in professional nursing and understanding of this concept is emphasized as a basis for clinical reasoning development in nursing education curricula. DESIGN: Rodgers' concept analysis method was used to achieve a clear and understandable definition. DATA SOURCE: Resources published from 2000 to 2020 were identified via electronic databases. REVIEW METHODS: A review of the literature was completed, and the data were analyzed to identify the Surrogate and related terms, attributes, antecedents and consequences of the concept. RESULTS: This concept is a holistic and recursive cognitive process that has a dynamic and flexible nature to perceive the patient's condition, select the best practice to respond to the situation, and learn from the situation. Clinical reasoning in nursing students emerges despite professional standards; discipline-specific knowledge, cognitive perception, critical thinking, learning experiences, and intuitive ability, and the requirements of the professional system affect its establishment in the nursing discipline. Clinical reasoning is the cognitive process underlying clinical judgment, appropriate decision making, improvement of nursing quality, metacognitive awareness, and professional competence in nursing, whose achievement, generally, paves the way for nursing professionalization and development that are important steps toward independence in the nursing profession. CONCLUSIONS: The present concept analysis clarifies the concept of clinical reasoning as a complex thinking process that should be considered as a fundamental thinking skill in nursing program.