看護学生の臨床判断における気づきと解釈の共通性

Purpose: To identify common themes related to noticing and interpreting in the clinical judgment of nursing students and obtain insights about the training needs for developing basic clinical judgment skills. Methods: Observational and semi-structured interview data were obtained from eight final-year undergraduate nursing students participating in a simulation. Data were analyzed qualitatively and descriptively. Results: Three common themes for noticing and five common themes for interpreting were identified in the thinking process involved in the clinical judgment of nursing students. The noticing themes were “focusing on an aspect of the history of the present illness,” “medical history as a basis for identifying aspects of nursing skills that require extra care,” and “noticing an abnormal condition by the difference between the patient’s actual and expected condition.” The interpreting themes were “no relationship between the order of information gathering and students’ initial grasp of the situation,” “gathering further data to confirm not only students’ initial grasp but also their expectations,” “interpreting the information consistent with initial grasp,” “treating assumptions as facts during interpreting,” and “trying to use past experience and knowledge.” Conclusion: The common noticing themes indicate that nursing students must learn to integrate disease-related knowledge. The common interpreting themes indicate that they must learn to mainly reflect on their interpreting, and to verbalize their thinking process.