Investigating clinical decision-making in bleeding complications among nursing students: A longitudinal mixed-methods study.

Autor: Lavoie P; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada. Electronic address: patrick.lavoie.1@umontreal.ca., Lapierre A; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada., Deschênes MF; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), 6363 Hudson Road, Lindsay Pavilion, Montreal, Quebec H3S 1M9, Canada., Royère K; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada., Lalière H; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada., Khetir I; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada., Bussard ME; School of Nursing, Bowling Green State University, 337 Central Hall, Bowling Green, OH 43403, USA., Mailhot T; Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec H1T 1C8, Canada.
Jazyk: angličtina
Zdroj: Nurse education in practice [Nurse Educ Pract] 2024 Oct; Vol. 80, pp. 104140. Date of Electronic Publication: 2024 Sep 15.
DOI: 10.1016/j.nepr.2024.104140
Abstrakt: Aim: To describe undergraduate nursing students' clinical decision-making in post-procedural bleeding scenarios and explore the changes from the first to the final year of their program.
Background: Bleeding is a common complication following invasive procedures and its effective management requires nurses to develop strong clinical decision-making competencies. Although nursing education programs typically address bleeding complications, there is a gap in understanding how nursing students make clinical decisions regarding these scenarios. Additionally, little is known about how their approach to bleeding management evolves over the course of their education.
Design: Longitudinal mixed-methods study based on the Recognition-Primed Decision Model.
Methods: A total of 59 undergraduate students recorded their responses to two clinical decision-making vignettes depicting patients with signs of bleeding post-hip surgery (first year) and cardiac catheterization (final year). Their responses were analyzed using content analysis. The resulting categories capture the cues students noticed, the goals they aimed to achieve, the actions they proposed and their expectations for how the bleeding situations might unfold. Code frequencies showing the most variation between the first and final years were analyzed to explore changes in students' clinical decision-making.
Results: Nearly all students focused on two primary categories: 'Bleeding' and 'Instability and Shock.' Fewer students addressed six secondary categories: 'Stress and Concern,' 'Pain,' 'Lifestyle and Social History,' 'Wound Infection,' 'Arrhythmia,' and 'Generalities in Surgery.' Students often concentrated on actions to manage bleeding without further assessing its causes. Changes from the first to the final year included a more focused assessment of instability and shifts in preferred actions.
Conclusions: This study reveals that nursing students often prioritize immediate actions to stop bleeding while sometimes overlooking the assessment of underlying causes or broader care goals. It suggests that concept-based learning and reflection on long-term outcomes could improve clinical decision-making in post-procedural care.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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