A Case Study Of How Nursing Students Learn Clinical Decision-Making In Practice Placements

decision-making is a crucial component of being a health care
professional and is essential for a registered nurse. Therefore it is a key
competence for nursing students to achieve during their pre-registration
programme. There is a dearth of research about how nursing students learn
clinical decision-making in practice, and most of the previous studies sought
students’ opinions about their practice learning.
The aim of the research was to explore how nursing students learn to make
clinical decisions in practice placements and the influences that affect
learning clinical decision-making in practice placements. Using Yin’s (2009)
case study approach, the thesis explored the influences on first and third year
nursing students learning of clinical decision-making on a female medical
ward in a hospital. Ethical approval was obtained. A complex consent process
included students, mentors, ward staff and patients, prior to data collection.
Six students’ learning in practice was observed on two occasions each (n=12)
and they were interviewed at the time of the observations about their learning
of clinical decision-making (n=12). Mentors supporting the students’ learning
were also interviewed (n=4) and students’ practice assessment documents
analysed (n=4). The data was analysed using Richie and Spencer’s (1994)
framework approach.
The findings showed that the ward’s community approach to supporting
students’ learning enhanced their experience and supported the learning of
clinical decision-making. Ensuring patient safety and delivery of dignified
compassionate care was paramount through role modelled behaviour and
safe supervision. A structured approach to learning clinical decision-making
was evident by mentors and students, who were highly motivated and
demonstrated a heutagogical approach (Hase and Kenyon 2000) to their
learning.
First and third year students were supported differently by mentors with third
year students having close supervision to enable them to make clinical decisions about higher risk patients. First year students were sometimes in
decision-making situations that caused them anxiety. Students needed to be
self-regulating in their decision-making, seeking support from other staff when
decisions might compromise patient safety.
Synthesis of the findings with established tools informed the generation of a
proposed framework to support students’ learning clinical decision-making
and to facilitate their mentors supporting their learning in the future. The study
has brought new understanding to the subject of learning clinical decisionmaking
through real life evidence from observation of students and mentors in
practice placements.