With the increasing demand for high-risk obstetrics-gynecology (Ob/Gyn) nursing, nurses’ clinical reasoning ability must derive optimal health outcomes for patients [1, 2]. Considering this need, the Korean Accreditation Board of Nursing Education defined clinical reasoning ability as a core competency for nursing graduates as academic outcomes to emphasize quality management, improve nursing education programs based on its performance-oriented education system, and produce students with competencies required in clinical practice [3].
Clinical reasoning refers to a decision-making process to interpret or draw conclusions regarding patients’ needs, interests, and health problems and determine alternative actions by collecting and analyzing related information— a complex cognitive and metacognitive process [4–6]. Specifically, it is a cognitive process and strategy used by nurses to identify critical patient data, diagnose their actual and potential problems, and make clinical decisions to solve problems resulting in positive outcomes [7–13].
Generally, clinical reasoning and clinical judgment are used interchangeably as well as for problem-solving, decision-making, and critical thinking [14]. While clinical judgment focuses on the results of a nurse’s interpretation or judgment of a patient’s condition, clinical reasoning is primarily concerned with the process leading to that judgment. Clinical reasoning includes a characteristic pattern of the reflection process to gauge understanding of a given clinical situation, identify problems and needs, prepare alternative courses of action, and choose the appropriate alternative considering the evidence [4]. Therefore, this study approached nursing students’ clinical reasoning ability with an emphasis on strengthening their clinical reasoning. This differs from previous studies, wherein clinical reasoning ability was treated as an outcome variable [14].
Tanner [4] noted that clinical reasoning ability is a core competency essential for all nurses, proving they are professional nurses. However, despite the need to equip themselves with professional nursing competencies during their undergraduate years, nursing students have limited opportunities to obtain direct nursing experiences in high-risk Ob/Gyn cases using their clinical reasoning ability [15–18]. Nursing educators must guide nursing students to acquire and strengthen their clinical reasoning ability by providing experiential learning to train clinical reasoning based on diverse and unique clinical nursing situations to equip them with nurse competencies [4, 10, 12, 13, 15–18].
In this context, this study was conducted to apply the Simulation with Problem-Based Learning (S-PBL) program based on the Clinical Judgment Model proposed by Tanner [4] to strengthen nursing students’ clinical reasoning ability as a conceptual framework for teaching and evaluate this as regular undergraduate nursing curriculum. This program, S-PBL, is a learning method combining simulation training and PBL, wherein a team of students experiences the learner-centered process of jointly solving a multidisciplinary problem [19–23]. As an alternative to nursing education, S-PBL is a highly effective intervention for improving nursing competencies, such as clinical reasoning, by integrating theoretical learning into clinical practice through repetitive experiential learning, immediate feedback, evaluation, and reflection based on extensive real-life nursing scenarios [24–28]. Specifically, it efficiently improves their clinical reasoning ability, allowing them to reflect on the problem-solving process or integrate clinical judgment into debriefing [4, 28]. Therefore, S-PBL’s educational effect on strengthening nursing students’ clinical reasoning ability was examined by providing them with S-PBL sessions using high-risk Ob/Gyn nursing scenarios during nursing education and repeatedly measuring their clinical reasoning ability.
This study aimed to examine the effects of S-PBL on nursing students’ clinical reasoning ability by comparing and analyzing how it is strengthened based on repeatedly measured data and to identify their learning satisfaction. The following hypotheses were examined:
H 1–1. Nursing students’ clinical reasoning ability will be higher after participation in S-PBL than before.
H 1–2. Nursing students’ clinical reasoning ability will gradually increase with repeated participation in S-PBL.
H 2. Nursing students’ learning satisfaction will be high after participation in S-PBL.