Learning of systematic health assessment and clinical reasoning skills in nursing education supported by a digital evaluation and feedback system

A PhD-project by Ösp Egilsdottir.


Following implementation of the “coordination reform” in Norway in 2008-2009, patients are discharged earlier from hospitals to primary health care service for continued treatment and follow up. As a result, there is increasing likelihood of demanding treatment, comorbidity and higher incidence of chronic diseases, that requires nurses to take on more tasks and new responsibilities that changes their role and assignment. These changes makes the case for focusing on how to prepare nursing students readiness for practice. Concepts like clinical reasoning and clinical decision-making are important to incorporate in the nursing education. These concepts build on cognitive processes like critical thinking, reflection and metacognition. 

Clinical reasoning is a skill that nursing students need to learn systematically throughout their study, by using different learning resources with the aim to stimulate reflection and critical thinking, and with support of facilitators (teachers and preceptors) learn how to process the complex information in different contexts. In nursing education, the learning strategies and resources also need to facilitate for personal motivation. Thus, the nursing students need be motivated and self-directed to engage the learning processes toward to learn how to reason in authentic patient situation, when in clinical rotation. That is an important aspect in the transition from being a nursing student to a novice nurse entering the clinical practice, and continuing the journey as lifelong learner.

The overall aim of the project is to continue the development of the learning model related to systematic clinical assessment, which is underpinned by natural science topics like, anatomy, physiology, pathology, pathophysiology and pharmacology, along with other forms of knowledge important for nursing. The digital evaluation and feedback system is supposed to highlight personal motivation, learning challenges and stimulates self-direct learning that influences cognitive processes, related to clinical reasoning and clinical decision-making.

The methodological framework for the project is educational design research which is a participatory action research approach developed for education, and encompasses collaboration with key stakeholders like students, patients, teachers, preceptors and external collaborative partners influenced by the context.  Educational design research has two main goals: to develop knowledge and to develop solutions which fits well the aim of the project. The project has a mixed method design drawing up on participatory action research, quantitative and qualitative methods.