Developing the Clinical Reasoning Achievement-Based (CRAB) framework

Developing the Clinical Reasoning Achievement-Based (CRAB) framework

Registered nurses use clinical reasoning to engage in safe nursing practice, however research indicates that many do not possess adequate levels of clinical reasoning upon graduation. This has raised concerns on the capability of baccalaureate programs to prepare registered nurses with the skills and abilities needed to meet the challenges of dynamic healthcare environments. This research project aims to develop a framework to assess the clinical reasoning of undergraduate registered nurses using a three-phase research design. The initial scoping phase involved a scoping review in which common themes and concepts for clinical reasoning characteristics and processes were identified with the results then being benchmarked against the NMBA Registered Nurse Standards for Practice (2016). A literature review identifying clinical reasoning measurement methods completed this phase. The information gathered in the scoping phase was used in a framework development phase comprised a Modified Delphi study to determine framework content and construct design, and the confirmation phase - single site testing using a pre and post intervention design. The benchmarked concepts from the scoping phase informed the first iteration of the Modified Delphi with many being incorporated in the framework. The framework developed through the Modified Delphi study is currently being trialled at a single site university educating undergraduate registered nurses. The initial indications from this study are that the Clinical Reasoning Achievement-Based (CRAB) framework is a valid, reliable measure of clinical reasoning in undergraduate registered nurses.

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