Improving Clinical Reasoning in Nurse Residents: Evaluation of a Resident Facilitator Model in a Nurse Residency Program

Clinical reasoning, a key component of knowledge development for new nurses, is a practice-based, situated form of reasoning that requires general case knowledge, basic scientific and evidence-based knowledge of patient care. Within Benner’s Novice to Expert framework, a quasi-experimental study with a matched pairs, pre-and post-test design, was conducted using a commercially available web-based instrument validated for measuring clinical reasoning in health care providers (Insight Assessment’s Health Science Reasoning Test-Numeracy). The study evaluated the nurse resident’s clinical reasoning skills in an established academic medical center’s nurse residency program. This followed the pilot of a four-session resident facilitation model using Socratic questioning, case studies, peer-discussion and self-reflection compared with the standard lecture model. No statistical significance between the intervention and control cohort was found on the overall clinical reasoning score (t=-.661 df (43), p=0.512> 0.05). However a statistically significant difference was noted on the sublevel category of explanation for the control group which could not be explained by this project (t=-2.043, df (43), p=0.047<0.05). This suggests the need for further studies to better understand the expected levels of clinical reasoning and impact of education delivery models within a nurse residency program curriculum.