The contextual nature of Saudi Arabian nursing interns' clinical reasoning while undertaking medical/surgical clinical internship

The contextual nature of Saudi Arabian nursing interns' clinical reasoning while undertaking medical/surgical clinical internship

Today’s dynamic and complex health care systems require contemporary nurses to be effective thinkers and decision makers. To develop this clinical reasoning and decision making ability, students of nursing require time and development to achieve the required skills, competency and reasoning ability. Nursing students in Saudi Arabia undertake a period of nursing internship which represents a transitional period from their nursing college studies to the commencement of professional practice. Little is known however about how these internship programs assist in the development of the nursing interns’ clinical reasoning skills or their ability to make effective clinical judgements when involved in actual patient care situations.

The aim of this study is to determine the contextual nature and influences of a medical/surgical clinical internship program on the development of clinical reasoning in a cohort of female Saudi Arabian nursing interns.

A sequential explanatory mixed method research design was used to gather and analyse the data obtained. The complex nature of clinical reasoning required the researcher to apply triangulation in the form of multiple triangulations using a mixed methodology of three data sources. This methodology enabled the researcher to apply a credible approach to the study of the development of clinical reasoning in the cohort. Data were collected in two phases with phase one consisting of quantitative data collection via questionnaires introduced to 28 Interns twice at the beginning and end of Medical/Surgical rotations; and phase two comprising semi structured interviews with both the nursing interns, their clinical resource nurses and their clinical preceptors. The quantitative and qualitative data from both phases were then compared, contrasted and melded to present an overall picture of the contextual nature of the female Saudi Arabian nursing interns’ development of clinical reasoning while undertaking their clinical internship medical/surgical rotations.

The data revealed that the interns experienced a reasoning leap following action impelled reasoning which enabled them to build the personal mental parameters needed to undertake both routine and non-routine clinical judgements. They identified that reflection on their practice and their questioning, which they self-monitored, were important. Of interest to the researcher was the possible effect of cultural influences on the female interns and how this might possibly impact on their clinical reasoning development. The data, however, revealed a deliberate behavior of the female Saudi Arabian interns that facilitated their clinical reasoning development and enhanced the attainment of professional abilities.

The study found that the role of the nursing unit environment and the support of both the clinical resource nurses and the clinical preceptors were important in assisting the nursing interns to develop their clinical reasoning skills. The role of the college and the acquisition of prior knowledge were also identified as important to the nursing interns when undertaking their clinical rotations. The link between the academic body and the experiential clinical learning context was noted to be inseparable and an important factor to consider when preparing cohorts of nurses to enter the profession of nursing.