What strategies are effective for clinical nurse instructors to use in developing critical thinking in student nurses? Many clinical strategies have been discussed in, literature, but only a few have been verified through research as to their usefulness.This study used the qualitative research methodology of multiple case studies. Participants were six clinical nurse instructors. Nursing experience ranged from 17-27 years, teaching experience involved 2-24 years. Four instructors had doctorates, one nurse had a masters degree, and the sixth nurse lacked two courses before completing a masters degree. The six instructors were from five areas of nursing: medical/surgical (beginning and intermediate level), maternity, mental health, community health and management.Each instructor was interviewed three times during the same semester, approximately two weeks apart. Interviews were audio recorded and transcribed. Spradley's (1979) domain and taxonomic analyses were used to analyze the data.Data analysis showed that some strategies were used by all instructors, with adaptations made for the specialty. The strategies used by all instructors were questioning, nursing care plans and clinical conferences. More than one instructor used student journals, teaching projects, research articles, milieu assessments, and case studies/scenarios.This research strongly supported the use of questioning to help the student progress in critical thinking. Contrary to some research, the present research found that questioning by the instructors was not detached but was situated in the client setting which helped the student synthesize facts into a whole. The research identified many questions used by the clinical nurse instructors.Instructors identified their role in assisting students toward critical thinking as helper, facilitator, coach and guide. Instructors also identified the following characteristics as necessary to help students: caring attitude, creativity, perseverance, knowledgeable, listener, encourager and learning attitude. The instructors motivated students as they progressed in critical thinking through verbal and nonverbal rewards. Students gained self-confidence as they experienced success in their journey towards critical thinking. Implications for nursing practice are provided. The importance of this research lies in the rich depth of discovering how these strategies, roles, characteristics, and motivators assist nursing students in developing critical thinking skills in different clinical settings.2 / Department of Educational Leadership

A comparative analysis was undertaken using descriptive survey and cross-sectional design to explore the effects of two curricular approaches ( Problem-based learning and traditional) used in Comprehensive basic nursing programme on the development of, clinical reasoning abilities of nursing students was undertaken, Triple Jump Exercise as the data collection instrument was used to evaluate students' abilities, in clinical reasoning, Using quota sampling technique, a convenience sample of 87 subjects was selected from two nursing institutions using these two approaches, These were student nurses in their 1st, 2nd and 4th year levels of study, Using individual interviews, subjects were required to think aloud and verbalize their clinical reasoning after being presented with a clinical scenario, Subjects' verbalizations were quantified, based on the criteria specified in the evaluation form of the data collecting instrument, and total scores were obtained, Analysis using computer software package (SAS) was done to provide for descriptive and statistical summarisation, Though descriptive analysis through mean scores of clinical reasoning showed slight differences resulting from the curricular approaches used. this was not confirmed statistically as the two factor ANOVA and Tukey's method revealed no significant differences by approaches nor their interaction with level of study, Only levels of study had significant differences at p=O,OOO I, with senior levels outperforming their juniors, These findings therefore conclude that PBL and the traditional approach perfonn on a similar level in clinical reasoning. Nurse educators are therefore challenged to identify effective strategies to enhance and nurture clinical reasoning, One strategy, which this study recommends, is the use of case-based approaches in CBNP. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Clinical reasoning (CR) is an essential skill for nursing and is necessary for safe and effective nursing practice. This skill is critical in how well nurses make clinical decisions and take action to assist their patients. However, this skill is significantly lacking in new nurses, and an academic-practice gap is thought to be the reason. This study investigated the impact of a new concept-based inquiry teaching approach on nursing students’ CR and its relationship with demographics, retention, critical thinking (CT), and metacognition. A quasi-experimental pretest and posttest study design using a non-equivalent comparison group was conducted with undergraduate students enrolled in a baccalaureate pre-licensure program using a concept-based curriculum. The concept-based inquiry (CBI) approach was introduced to students in the intervention group, while the control group participated in a flipped classroom teaching approach. Both groups engaged in content related to the concept of gas exchange. Clinical reasoning was measured using an NCLEX Next Generation (NGN) style exam created by the author, the clinical reasoning exam (CRE). Test analysis on the exam revealed challenges in writing and using these types of exams to assess CR and were discussed. The relationships of CBI to demographics, critical thinking, and metacognition were also evaluated. A demographic survey assessed age, gender, race/ethnicity, learning disabilities, work experience, military experience, and education level. The Health Sciences Reasoning Test assessed CT, and the Metacognitive Awareness Inventory assessed metacognition. The results of the study revealed no significant difference in CR between the CBI intervention group and the Flipped Classroom comparison group after the gas exchange class. No significant relationships to demographics or knowledge retention were noted. However, the study revealed that the CBI significantly affected CT and metacognition, critical elements of the CR process. This study demonstrates that the CBI approach may be a promising new teaching method that should be investigated further to determine if using it for a more extended time period would have a greater impact on CR.