Daniel J. Pesut

Promoting Clinical Reasoning in Undergraduate Nursing Students: Application and Evaluation of the Outcome Present State Test (OPT) Model of Clinical Reasoning

Promoting clinical reasoning in undergraduate nursing students through application of the Outcome Present State Test (OPT) Model of Clinical Reasoning, is a challenge that can be successfully managed through effective teaching-learning strategies. Empirical evidence to support teaching strategies that foster both cognitive and metacognitive skill acquisition is limited. The purpose of this research was to evaluate the development of clinical reasoning skills among nursing students through the application and evaluation of teaching-learning strategies associated with self-regulated learning and the OPT model (Pesut & Herman, 1998; 1999; Pesut, 2004). The model and self-regulated learning prompts were used to structure learning with junior level baccalaureate nursing students during a ten-week, medical-surgical clinical experience in acute care telemetry units. Data analysis revealed students effectively made gains in learning associated with the OPT model. Qualitative analysis of self-regulated learning prompt journal data revealed students made significant gains in self-observation, self-judgment, knowledge work and use of health care personnel resources during clinical experiences. Results indicated the intentional use of guided reflection coupled with structure and learning tools of the OPT model significantly enhanced clinical reasoning skill acquisition, and provided evidence for the effectiveness of structured teaching learning strategies.

Applications of complex systems theory in nursing education, research, and practice

The clinical and administrative processes in todays healthcare environment are becoming increasingly complex. Multiple providers, new technology, competition, and the growing ubiquity of information all contribute to the notion of health care as a complex system. A complex system (CS) is characterized by a highly connected network of entities (e.g., physical objects, people or groups of people) from which higher order behavior emerges. Research in the transdisciplinary field of CS has focused on the use of computational modeling and simulation as a methodology for analyzing CS behavior. The creation of virtual worlds through computer simulation allows researchers to analyze multiple variables simultaneously and begin to understand behaviors that are common regardless of the discipline. The application of CS principles, mediated through computer simulation, informs nursing practice of the benefits and drawbacks of new procedures, protocols and practices before having to actually implement them. The inclusion of new computational tools and their applications in nursing education is also gaining attention. For example, education in CSs and applied computational applications has been endorsed by The Institute of Medicine, the American Organization of Nurse Executives and the American Association of Colleges of Nursing as essential training of nurse leaders. The purpose of this article is to review current research literature regarding CS science within the context of expert practice and implications for the education of nurse leadership roles. The article focuses on 3 broad areas: CS defined, literature review and exemplars from CS research and applications of CS theory in nursing leadership education. The article also highlights the key role nursing informaticists play in integrating emerging computational tools in the analysis of complex nursing systems.

OPT: Transformation of Nursing Process for Contemporary Practice.

Over time, clinical, educational, and social forces have influenced the development of three generations of traditional nursing process. The first generation was concerned with problems and process. Analysis of second-generation models revealed interest in understanding the nature of diagnosis and diagnostic reasoning. We have proposed a third generation model that underscores the importance of critical, metacognitive, and thinking skills that support outcome specification and testing in clinical reasoning. Clinicians, educators, managers, and administrators are invited to consider the OPT model as an alternative to traditional nursing process. The OPT model may be one of many transitional reasoning models needed for contemporary nursing practice.

Promoting the Self-Regulation of Clinical Reasoning Skills in Nursing Students

Aim: The purpose of this paper is to describe the research surrounding the theories and models the authors united to describe the essential components of clinical reasoning in nursing practice education. The research was conducted with nursing students in health care settings through the application of teaching and learning strategies with the Self-Regulated Learning Model (SRL) and the Outcome-Present-State-Test (OPT) Model of Reflective Clinical Reasoning. Standardized nursing languages provided the content and clinical vocabulary for the clinical reasoning task. Materials and Methods: This descriptive study described the application of the OPT model of clinical reasoning, use of nursing language content, and reflective journals based on the SRL model with 66 undergraduate nursing students over an 8 month period of time. The study tested the idea that self-regulation of clinical reasoning skills can be developed using self-regulation theory and the OPT model. Results: This research supports a framework for effective teaching and learning methods to promote and document learner progress in mastering clinical reasoning skills. Self-regulated Learning strategies coupled with the OPT model suggest benefits of self-observation and self-monitoring during clinical reasoning activities, and pinpoints where guidance is needed for the development of cognitive and metacognitive awareness. Recommendations and Conclusions: Thinking and reasoning about the complexities of patient care needs requires attention to the content, processes and outcomes that make a nursing care difference. These principles and concepts are valuable to clinical decision making for nurses globally as they deal with local, regional, national and international health care issues.

Barriers and benefits associated with nurses information seeking related to patient education needs on clinical nursing units.

The purpose of this study was to answer the following two questions: What are clinical nurses’ rationales for their approaches to finding patient educational materials on the web? What are perceived barriers and benefits associated with the use of web-based information resources for patient education in the context of nursing clinical practice? Over 179 individual data units were analyzed to understand clinical nurses’ rationales for their approaches to find patient educational materials on the web. Rationales were defined as those underlying catalysts or activators leading to an information need. Analyses found that the primary reasons why clinical nurses conducted web-based information searches included direct patient requests ( 9 requests), colleague requests (6 requests), building patient materials collections (4), patients’ family requests (3), routine teaching (1), personal development (1), or staff development (1). From these data, four broad themes emerged: professional reasons, personal reasons, technology reasons, and organization reasons for selecting information resources. Content analysis identified 306 individual data units representing either ‘benefits’ (178 units) or ‘barriers’ (128) to the nurses’ use of web resources for on-unit patient care. Inter-rater reliability was assessed and found to be excellent (r = 0.943 to 0.961). The primary themes that emerged as barriers to the used of web-based resources included: 1) time requirements to perform a search, 2) nurses’ experience and knowledge about the resources or required technology, 3) specific characteristics of individuals electronic information resources, and 4) organizational procedures and policies. Three primary themes that represented the benefits of using web-based resources were also identified: 1) past experiences and knowledge of a specific resource or the required technologies, 2) availability and accessibility on the unit, and 3) specific characteristics of individual information tool. In many cases, nurses commented on specific characteristics or features of favorite information resources. Favorite sites included a variety or reputable health care organizations that displayed context in text, audio, and/or video. In addition such sites were described as easy-to read and provided content related to patient-focused information or specific content such as toll free telephone contact numbers. Information searching is the interaction between and among information users and computer-based information systems. Information seeking is becoming an important part of the knowledge work of nurses. Information seeking and searching intersects with the field of human computer interaction (HCI), which focuses on all aspects of human, and computer interactions. Users of an information system are understood as “actors” in situations, with a set of skills and shared practices based on work experiences with others. Designing better tools and developing information searching strategies that support, extend, and transform practices, begins by asking: Who are the users? What are the tasks? What is the interplay between the technology and the organization of the task? This study contributes fundamental data and information about the rationales nurses use in information seeking tasks. In addition it provides empirical evidences regarding barriers and benefits of information seeking in the context of patient education needs in inpatient clinical settings.

The nature of clinical supervision in psychiatric nursing: A survey of clinical specialists

There is a growing body of theory and research on clinical supervision within other mental health disciplines; however, there has been little study of clinical supervision within psychiatric mental health nursing. This article reports the results of a survey of 61 psychiatric mental health specialists to determine their attitudes toward selected supervisory issues. Two-thirds of the respondents had received further supervision beyond the masters degree, one-half reported a personal psychotherapy experience, and one-half were certified in psychiatric mental health nursing. There were significant differences of opinion between clinical nurse specialists who were certified and those who were not and between those who reported a personal therapy experience and those who did not. The authors suggest that more attention be paid to the development of curriculum content regarding clinical supervision in graduate nursing programs. In addition, they recommend further research on the topic of clinical supervision in psychiatric mental health nursing.

Toward an Integration of Competencies for Advanced Practice Mental Health Nursing

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of bound aries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic pro grams. The purposes of this article are to discuss the need for a blended clinical spe cialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners. (J Am Psychiatr Nurses Assoc [1998]. 4, 48-56)

Learning Skills Profiles of Master's Students in Nursing Administration: Assessing the Impact of Problem-Based Learning

Attempts to compare graduate student performances before and after introducing new curricula are rare; yet faculties need outcome measures to justify program costs and demonstrate effectiveness. Boyatzis and Kolbs Learning Skills Profile is used to assess the outcomes of a problem-based learning MSN program. Increases were demonstrated among all 12 learning skills; statistically significant increases were found in eight of the personal learning skills and six of the job skill demands. Comparisons are made between scores of students in the MSN program and scores of masters students in business administration.

A Database for Nurse Practitioner Clinical Education

This article presents the utility and lessons learned regarding subscription to a database service for tracking nurse practitioner clinical education at the Indiana University School of Nursing. Initiatives and activities, such as the one described in this article, support the implementation of the Technology Informatics Guiding Educational Reform strategic agenda related to the transformation of nursing education through evidence and informatics. Descriptive reports of clinical database management are useful to conceptualize the evaluation of teaching and learning experiences as well as document the significance to students, faculty, future employers, and administration. The use of a database system for documentation of clinical experiences allows the student to practice and master informatics capabilities. Through data analysis, faculty can coordinate and assess students in the clinical environment and tailor learning experiences based on aggregated sets of patient encounters. Examination of the nature of patient encounters and clinical activities experienced permits an evidenced informed approach to student progress, curriculum development, and formative and summative evaluations.

Perceived Patient Safety Culture in a Critical Care Transport Program

BACKGROUND The purpose of this study was to examine the association among selected safety culture dimensions and safety outcomes in the context of a critical care transport (CCT) program. METHODS A descriptive cross-sectional correlational design used the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture to validate perceived safety culture among personnel (n = 76) in a large Midwestern CCT program. RESULTS Findings revealed significant associations between 1) teamwork and frequency of error reporting (r = .428, P < .001), overall perception of safety (r = .745, P < .001), and perceived patient safety grade (r = -.681, P < .001); 2) between perception of manager actions promoting safety and frequency of error reporting (r = .521, P < .001), overall perception of safety (r = .779, P < .001), and perceived patient safety grade (r = -.756, P < .001); and 3) between communication openness and frequency of error reporting (r = .575, P < .001), overall perception of safety (r = .588, P < .001), and perceived patient safety grade (r = -.627, P < .001). CONCLUSION The study supports other literature showing significant associations among safety culture dimensions and safety outcomes and provides a framework for future research on safety culture in CCT programs.