School of Nursing Curriculum Framework and Guiding Document

Clinical Reasoning and Critical Inquiry

Professional nurses are expected to deliver patient-centered, safe, quality care while working as members of collaborative interprofessional teams. In addition, they act as transformative change agents for patients and health care at microsystem and societal levels (AACN, 2008; Institute of Medicine of the National Academies [IOM], 2010, 2011). To do this requires nurses to “integrate reliable evidence from multiple ways of knowing to inform practice and make clinical judgments” (AACN, 2008, p. 16). “Nurses need multiple ways of thinking, such as clinical reasoning and clinical imagination as well as critical, creative, scientific, and formal criterial reasoning” (Benner, Sutphen, Leonard, & Day, 2010, p. 85) in order to fulfill their professional roles and potential. This curriculum incorporates many ways of knowing in student learning experiences but emphasizes clinical reasoning and critical inquiry as cornerstones of evidence-based nursing practice.

Clinical reasoning is “the practitioner’s ability to assess patient problems or needs and analyze data to accurately identify and frame problems within the context of the individual patient’s environment” (Murphy, 2004, p. 227). Inherent in clinical reasoning is practical reasoning, enhancing nurses’ basic analytic processes with evidenced, reflective clinical judgment, which also takes into account the unpredictable, ever-changing nature of patient care situations and contexts (Benner et al., 2010; Sullivan & Rosin, 2008).

Critical inquiry is a process involving examining existing assumptions, knowledge, and questions, gaining (and creating) new information, and acquiring new perspectives. It then requires using critical analysis to reflect, take action, examine responses, and share learning with others (Jennings & Smith, 2002). Critical inquiry skills allow a person to identify a problem, propose solutions, find evidence for and against proposed solutions, and evaluate the solutions based on this evidence (Suthers, 1997). Critical inquiry assists students to examine and challenge the status quo and the power relations that produce inequalities, in ways that can lead to advocacy and community action (Wright, 2004).

Learning to think and act like professional nurses involves using clinical reasoning and critical inquiry with elements of reflective judgment resulting in a reasoned, analytic cyclical process which incorporates scientific evidence, objective thought, contextual elements, values, and ever-changing conditions. Teaching students to reason and “think like a nurse” (Benner et al., 2010, p. 85) involves elements of focused reflection, written and/or verbal articulation of thoughts, assignments that connect new experiences to existing knowledge, critical inquiry, creative thinking, and nursing judgment.

Communication

Communication is the process of exchanging information, ideas, feelings, and beliefs with the aim of understanding (Nordby, 2007). Skillful communication occurs when a person clearly, concisely, and accurately conveys messages to another person(s). It involves active listening and careful evaluation including nonverbal, extrasensory, written, spoken, and written in technological formats. Nursing communication has a professional, therapeutic, collaborative and client-centered focus. The main intent of communication in a health setting is to influence well-being (Fleischer, Berg, Zimmermann, Wuste, & Behrens (2009).

Experiential Learning

Experiential Learning is an educational process of engaging learners through a variety of learning methodologies to increase knowledge, develop skills, and clarify and foster values essential to nursing. Experiential Learning is engagement, the process whereby students and faculty are actively connected and involved in their learning about nursing and their work with people, the interprofessional healthcare team, and the community. This active engagement has intellectual, social, and emotional components (Kahu, 2011; Schreiner, 2010 a, b, c) and requires “meaningful processing, focused attention and active participation” (Schreiner, 2010b, p. 4).

Experiential Learning may include, but is not limited to:

1. Student-focused learning using reality-based situations and problems
2. Faculty and student interactions to construct meaningful interpretation of events and ideas
3. Teaching-learning techniques, such as active learning, cooperative learning, collaborative learning, self-directed and student-focused learning and clinical simulations
4. Authentic field experiences and partnerships (acute, immediate, long-term, public health and community agencies)
5. Civic engagement and service-learning experiences
6. Advocacy and policy development experiences
7. Cultural immersion through global nursing and health experiences
8. Mentoring in research, evidence-based practice, and scholarly projects

Global Worldview

Global Worldview is the process of integrating an intercultural and international dimension into the teaching, research, and service functions of nursing education. A global outlook is universal in scope, not limited by what is known and familiar. It demonstrates an awareness of the interconnected world community and the importance of social justice. “Worldview” is defined as “the overall perspective from which one sees and interprets the world” (The American Heritage® Dictionary, 2006). A global worldview is integral to achieving cultural competence in areas such as ability, age, ethnicity, generation, gender, race, religion, sexual orientation and socioeconomic status.

This approach may include, but is not limited to:

1. Diverse communities
2. Intercultural issues
3. Student and faculty foreign exchange opportunities
4. Intercultural and international program development
5. Faculty/institutional support services
6. Service-learning programs

Professionalism and Leadership

Professionalism requires a body of knowledge, on-going generation of knowledge, evidence- based practice, socially sanctioned or mandated service, autonomy, self-governance, code of ethics and participation in professional societies and organizations (Porter-O’Grady & Malloch, 2012).

Professionalism is exhibited in the behaviors and attitudes of each individual nurse. The integration of core disciplinary values, knowledge, and personal reflection is the foundation of professionalism in nursing. Core disciplinary values include the values of integrity, respect for human dignity, caring and advocacy. All nurses must have knowledge of legal, ethical and practice standards. Personal reflection includes the integration of personal evaluation and self-care practices with lifelong career and personal goals. Nursing professionalism is expressed through leadership skills such as creativity, collaboration, assertiveness, adaptability to change, vision, innovation, life-long commitment to learning and professional accountability, role behaviors and appearance (Porter-O’Grady & Malloch, 2010; Porter- O’Grady & Malloch, 2012) that influence, motivate and affect others to contribute to the improvement of client health care and to the success of the organization. Professionalism is the foundation of the nurse’s roles of information resource, clinician, mentor, care coordinator, advocate and change agent. It also underpins the management skills of administration, organization, delegation, supervision, change leadership and resource management (Huber, 2011). Nursing professionalism is the foundation for the efficient, effective use and stewardship of human, physical, financial, intellectual and technical resources to meet client needs and support organizational outcomes.

The curriculum of the School of Nursing was developed to be congruent with the strategic vision of the College and University. The School of Nursing recognizes clinical reasoning and critical inquiry, communication, experiential learning, global worldview, and professionalism and leadership are necessary to deliver nursing care to clients in a variety of environments to optimize health.